Institute Of Tropical Medicine Research Articles

A closer look at Cuba’s public health model that prioritizes population health

As the largest Caribbean island, Cuba is known for its picturesque Havana boardwalk, musical rhythms, and tropical climate. A closer look at the national public health model that integrates care for Cuban citizens, however, is fundamental to learn and adapt lessons learned and best practices to bridge knowledge-practice gaps within global health systems. In this visual essay, the author explores connections between photography and community health, illustrating an invaluable story about a primary care workforce, supported by the health system infrastructure, dedicated to achieve high-quality community health for citizens. She shares photographs coupled with narrative elements to showcase the population health model of Cuba, one Latin America and Caribbean country that has received international recognition for achieving universal health care to residents. She weaves words and images to portray her experiences of completing clinical rotations in tuberculosis prevention and control at the ‘Pedro Kourí’ Tropical Medicine Institute and surrounding public health institutions in the capital city of Havana.

Polymorphisms of CCR5, IL-6, IFN-γ and IL-10 genes in Cuban HIV/AIDS patients

IntroductionGenetic studies have shown associations of several single nucleotide polymorphisms (SNP) with different rates of progression and variation in susceptibility to HIV infection. This study aimed to estimate the frequency of ccr5Δ32, IL-6-174G/C, IFN-γ+874T/A and IL-10-1082A/G polymorphisms in Cuban HIV-infected patients and a group of sero-discordant couples to assess their influence on risk and disease progression. MethodsA cross-sectional study was carried out on 120 subjects registered at the Institute of Tropical Medicine «Pedro Kour» (IPK) and the Ameijeiras Hospital from June 2018 until December 2019. The amplification of fragments of the ccr5, IL-6, IFN-γ and IL-10 genes was performed by polymerase chain reaction followed by identification of polymorphisms using the restriction fragment length polymorphism analysis for IL-6 with the restriction enzymes Nla III. Amplification Refractory Mutation System was used for IFN-γ and IL-10 genes. ResultsThe allelic and genotypic distributions of the genes ccr5, IL-6, IFN-γ and IL-10 did not differ significantly between the two groups. Cell counts and plasma viral load values did not differ significantly between genotypes of the ccr5, IL-6, IFN-γ and IL-10 genes. Only the IL-6 GC genotype was associated with higher viral load values. The combination of alleles of the four considered SNPs showed a highly significant increase in the risk of HIV infection for one of them, but with a very low frequency (<1%). ConclusionThis study contributes to evaluating the frequency of these polymorphisms and their influence on biomarkers of the progression of HIV infection in the Cuban HIV-population.

Efficacy and Safety of Makabuhay (Tinospora rumphii) 25% Cream Versus Hydrocortisone 1% Cream in the Management of Mosquito Bite Reactions: Randomized Double-Blind Controlled Trial.

Most insect bite reactions resolve spontaneously, but the inflammation and pruritus induced have been shown to decrease the quality of life. Previous studies have shown the potential anti-inflammatory properties of Tinospora rumphii. The aim of the study is to assess the efficacy and safety of T rumphii 25% cream versus hydrocortisone 1% cream in the management of local cutaneous reactions caused by mosquito bites. This study was a parallel-group, double-blind, randomized, placebo-controlled trial with a 1-week duration in a span of 3 months (June 2019 to August 2019). Participants were exposed to sterile noninfectious mosquitoes (Aedes aegypti) for 5-10 minutes to elicit cutaneous lesions. Tinospora 25% cream or hydrocortisone 1% cream was applied twice daily throughout the 7-day study period. Of the 70 participants screened for this study, which was approved by an institutional review board (IRB 2019-07) at the Dermatology Outpatient Department of the Research Institute for Tropical Medicine, Alabang, Muntinlupa, Philippines, 58 participants in total met the inclusion criteria and were randomized to treatment (Tinospora: n=29) and active control (hydrocortisone: n=29) groups. In total, 58 participants were randomized to receive Tinospora cream (n=29) or hydrocortisone cream (n=29). All participants completed the follow-up. There was a significant decrease in lesion size in both groups from the first 15 minutes to day 7 (P<.001). Comparing the lesion size in both groups, there was a statistically significant decrease in lesion size in the first hour (P=.003) and after 24 hours (P=.03). On day 1, 10% (n=29) of participants in the hydrocortisone group and 7% (n=29) in the Tinospora group experienced complete resolution. On day 3, all participants experienced complete resolution. No adverse effects were documented. Tinospora 25% cream is safe, effective, and comparable to hydrocortisone 1% cream as an anti-inflammatory agent for mosquito bite reactions based on the decrease in lesion size, the proportion of participants with complete resolution of wheals, and improvement in pruritus intensity score using a visual analog scale. Long-term safety studies are recommended. Philippine Health Research Registry PHRR230716-005932; https://www.herdin.ph/index.php/registry?view=research&layout=details&cid=5932.

Efficacy and safety of ivermectin for the treatment of Plasmodium falciparum infections in asymptomatic male and female Gabonese adults – a pilot randomized, double-blind, placebo-controlled single-centre phase Ib/IIa clinical trial

Ivermectin's mosquitocidal effect and invitro activity against Plasmodium falciparum asexual stages are known. Its invivo blood-schizonticidal efficacy is unknown. Ivermectin's tolerability and efficacy against P.falciparum infections in Gabonese adults were assessed. The study consisted of a multiple dose stage and a randomized, double-blind, placebo-controlled stage. Adults with asymptomatic P.falciparum parasitaemia (200-5000 parasites/μl) were enrolled. First, three groups of five participants received 200μg/kg ivermectin once daily for one, two, and three days, respectively, and then 34 participants were randomized to 300μg/kg ivermectin or placebo once daily for 3 days. Primary efficacy outcome was time to 90% parasite reduction. Primary safety outcomes were drug-related serious and severe adverse events (Trial registration: PACTR201908520097051). Between June 2019 and October 2020, 49 participants were enrolled. Out of the 34 randomized participants, 29 (85%) completed the trial as per protocol. No severe or serious adverse events were observed. The median time to 90% parasite reduction was 24.1 vs. 32.0h in the ivermectin and placebo groups, respectively (HR 1.38 [95% CI 0.64 to 2.97]). Ivermectin was well tolerated in doses up to 300μg/kg once daily for three days and asymptomatic P.falciparum asexual parasitaemia was reduced similarly with this dose of ivermectin compared to placebo. Further studies are needed to evaluate plasmodicidal effect of ivermectin at higher doses and in larger samples. This study was funded by the Centre de Recherches Médicales de Lambaréné and the Centre for Tropical Medicine of the Bernhard Nocht Institute for Tropical Medicine.

Longitudinal data resource from the Wellbeing of Older People cohort of people aged >50 years in Uganda and South Africa from 2009 to 2019.

The population of people aged ≥60 years continues to increase globally, and has been projected by the United Nations Population Division to increase to 21% of the total population by 2050. In addition, the number of older people living with HIV has continued to increase owing to the introduction of antiretroviral therapy as a treatment for HIV-infected people. Most of the older people living with HIV are in sub-Saharan Africa, an area that faces the biggest burden of HIV globally. Despite the high burden, there are limited reliable data on how HIV directly and indirectly affects the health and wellbeing of older people within this region. To showcase the availability of data on how HIV directly and indirectly affects the health and wellbeing of older people in Uganda and South Africa (SA). The World Health Organization Study on global AGEing and adult health (SAGE), in collaboration with Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit and the Africa Health Research Institute (AHRI) in SA, started the SAGE Wellbeing of Older People Study (WOPS) in Uganda and SA in 2009. Since initiation, respondents have been surveyed every 2 years, with four waves of surveys conducted in Uganda and three waves in South Africa. The available datasets consist of two cohorts of people, aged >50 years, who were surveyed every 2 years between 2009 and 2018. The prevalence of HIV positivity over this period increased from 39% to 54% in Uganda and 48% to 62% in SA. The datasets provide comparisons of variables at a household level and at an individual level. At the individual level, the following measures can be compared longitudinally for a 10-year period for the following variables: sociodemographic characteristics; work history and benefits; health states and descriptions; anthropometrics performance tests and biomarkers; risk factors and preventive health behaviours; chronic conditions and health services coverage; healthcare utilisation; social cohesion; subjective wellbeing and quality of life; and impact of caregiving. This article describes the WOPS in Uganda and SA, the population coverage of this study, and the survey frequency of WOPS, survey measures, data resources available, the data resource access and the strengths and weaknesses of the study. The article invites interested researchers to further analyse the data and answer research questions of interest to enhance the impact of these data.

Lower magnitude and faster waning of antibody responses to SARS-CoV-2 vaccination in anti-TNF-α-treated IBD patients are linked to lack of activation and expansion of cTfh1 cells and impaired B memory cell formation

Patients with inflammatory bowel disease (IBD) and healthy controls received primary SARS-CoV-2-mRNA vaccination and a booster after six months. Anti-TNF-α-treated patients showed significantly lower antibody (Ab) levels and faster waning than α4β7-integrin-antagonist recipients and controls. This prospective cohort study aimed to elucidate the underlying mechanisms on the basis of circulating T-follicular helper cells (cTfh) and B memory cells. We measured SARS-CoV-2- Wuhan and Omicron specific Abs, B- and T-cell subsets at baseline and kinetics of Spike (S)-specific B memory cells along with distributions of activated cTfh subsets before and after primary and booster vaccination. Lower and faster waning of Ab levels in anti-TNF-α treated IBD patients was associated with low numbers of total and naïve B cells vs. expanded plasmablasts prior to vaccination. Along with their low Ab levels against Wuhan and Omicron VOCs, reduced S-specific B memory cells were identified after the 2nd dose which declined to non-detectable after 6 months. In contrast, IBD patients with α4β7-integrin-antagonists and controls mounted and retained high Ab levels after the 2nd dose, which was associated with a pronounced increase in S-specific B memory cells that were maintained or expanded up to 6 months. Booster vaccination led to a strong increase of Abs with neutralizing capacity and S-specific B memory cells in these groups, which was not the case in anti-TNF-α treated IBD patients. Of note, Ab levels and S-specific B memory cells in particular post-booster correlated with the activation of cTfh1 cells after primary vaccination. The reduced magnitude, persistence and neutralization capacity of SARS-CoV-2 specific Abs after vaccination in anti-TNF-α-treated IBD patients were associated with impaired formation and maintenance of S-specific B memory cells, likely due to absent cTfh1 activation leading to extra-follicular immune responses and diminished B memory cell diversification. These observations have implications for patient-tailored vaccination schedules/vaccines in anti-TNF-α-treated patients, irrespective of their underlying disease. The study was funded by third party funding of the Institute of Specific Prophylaxis and Tropical Medicine at the Medical University Vienna. The funders had no role in study design, data collection, data analyses, interpretation, or writing of report.

Impact on medical care at the Institute of Tropical Medicine during 4 months of the Chikungunya epidemic

Introducción: La fiebre chikungunya (FCHIK) es una enfermedad emergente transmitida por mosquitos y causada por un alfavirus, el virus chikungunya (CHIKV). Aunque la mayoría de las personas se recuperan completamente en pocos días o semanas, algunos pacientes requieren hospitalización, pudiendo incluso desarrollar manifestaciones graves e incluso observarse un desenlace fatal. El objetivo del presente trabajo de investigación es describir las características de los pacientes atendidos en el Instituto de Medicina Tropical (IMT), en el marco de la actual Epidemia de Arbovirosis por Chikungunya. Materiales y Métodos: observacional, descriptivo, transversal con componente analítico, de pacientes de ambos sexos, atendidos en el IMT en sala de urgencia y en el área de hospitalización, con diagnóstico Confirmado o Sospechoso de FCHIK. Los datos fueron obtenidos de los sistemas informáticos del hospital (HIS). Resultados: Durante el periodo I (junio a octubre, 2022) fueron atendidos 19.645 pacientes (promedio de 3929 consultas mensuales) y durante el periodo II (noviembre 2022 a marzo 2023) 27.673 pacientes (promedio de 5.534,6 consultas mensuales); reflejando un incremento del 41% de consultas. El número de pacientes que requirieron hidratación y analgesia endovenosa fue incrementándose, con énfasis en los meses de enero, febrero y marzo (590, 781 y 608 casos, respectivamente). requiriendo consecuentemente el incremento de camas de hospitalización de 5 a 15 y de sillones de hidratación, de 10 a 15 sillones. Por otro lado, el número de pacientes que requirieron hospitalización se incrementó de 2 pacientes en el mes de noviembre a 54 pacientes en el mes de marzo. La letalidad fue significativamente superior en los &gt;15 años, comparados con los ≤15 años: 12,5% (7/56) vs 2.9% (2/69), respectivamente (p&lt;0.03. OR=4,8. (IC95%. 1 - 24.0). Conclusión: La epidemia de Chikungunya tuvo un importante impacto en la atención médica en el Instituto de Medicina Tropical, con un aumento significativo en la asistencia de pacientes febriles, traducida en alta tasa de pacientes atendidos en áreas de urgencias, y una pequeña proporción en área de internación. Este estudio subraya la importancia de una preparación adecuada y una respuesta rápida en el contexto de una epidemia para minimizar la repercusión en los servicios de atención médica hospitalaria.

Psychological state of patients with Acquired Immunodeficiency Syndrome, admitted to the Institute of Tropical Medicine in 2022

Introducción: La mayoría de los pacientes con enfermedades graves y progresivas como el VIH/SIDA se enfrentan a una variedad de desafíos psicológicos, es por eso que en esta investigación nos preguntamos cual es el estado psicológico de pacientes con la enfermedad del síndrome de inmunodeficiencia adquirida, internados en el Instituto de Medicina Tropical en el año 2022. Objetivo: Evaluar el estado psicológico de pacientes con la enfermedad del síndrome de inmunodeficiencia adquirida, internados en el Instituto de Medicina Tropical en el año 2022. Metodología: Estudio descriptivo, prospectivo de enfoque mixto con diseño no experimental en el que se incluyeron a 100 pacientes con diagnóstico de VIH/SIDA internados en el IMT en el periodo de enero a julio de 2022, encontrando los siguientes resultados: 30 a 44 años en el 66% del total, procedentes de Asunción (31%), y del área Central (53%). Con respecto al estado cognitivo el 61% estaba lúcido, ubicado en tiempo y espacio, la memoria y atención se ven afectadas en el 51% de los pacientes; estado afectivo: el miedo o temor fueron los estadíos principales, seguido de la preocupación e impotencia. Analizando el estado somático se vio que el descanso fue malo, al igual que la alimentación. En relación al estado interpersonal el 87% contaba con apoyo familiar, el estado conductual mostró incoherencias en cuanto al afrontamiento de los síntomas y la adherencia. Conclusión: Los factores sociodemográficos y psicosociales la percepción de apoyo social, las creencias relacionadas con la enfermedad, los rasgos de personalidad, las habilidades sociales, los estilos de afrontamiento, entre otras, pueden permitir a los pacientes con VIH/ SIDA afrontar la enfermedad para lograr la adaptación y el bienestar de su salud general.

Evaluation of the effect of reduced-dose pneumococcal conjugate vaccine schedules on vaccine serotype carriage in children and their caretakers in a naïve population in Vietnam: Protocol for a cluster randomized non-inferiority trial.

Introduction: The WHO currently recommends giving pneumococcal conjugate vaccines (PCVs) as three doses - either three doses in infancy with Pentavalent vaccine (3p+0), or two doses in infancy followed by a booster around 12 months (2p+1). However, their high price is a barrier to introduction and sustainability in low and middle-income countries. We hypothesize that a schedule with a single priming and a booster dose (1p+1) may maintain similar levels of protection for the community by sustaining herd immunity, once circulation of vaccine types has been controlled. Methods and analysis: We will conduct a cluster randomized trial with four intervention arms (1p+1, 0p+1, 2p+1, 3p+0) and three unvaccinated clusters in the 27 communes of Nha Trang, central Vietnam. A PCV catch-up vaccination campaign to all children under three years of age will be performed at the start of the trial. The primary endpoint is non-inferiority of the1p+1 schedule if compared to the WHO standard 2p+1 and 3p+0 schedules in reducing vaccine serotype carriage prevalence in infants. We will also explore impact of 0p+1 schedule. A baseline and annual pneumococcal carriage surveys of 6480 participants per survey covering infants, toddlers and their mothers will be conducted. Ethics and dissemination: Ethical approvals were obtained from the ethical review committees of Institute of Tropical Medicine, Nagasaki University (151203149-2) and the Ministry of Health, Vietnam (1915/QD-BYT). The results, interpretation and conclusions will be presented at national and international conferences, and published in peer-reviewed open access journals. Trial registration number: NCT02961231.

Capacity building of district health management teams in the era of provincial health administration reform in the Democratic Republic of Congo: a realist evaluation protocol

IntroductionIn 2006, the Congolese Ministry of Health developed a health system strengthening strategy focusing on health district development. This strategy called for reforming the provincial health administration in order to...

TBE in Belgium

In 2018, the two first human tick-borne encephalitis (TBE) cases with possible/probable autochthonous infection were diagnosed at the National Reference Centre (NRC) of Arbovirus (The Institute of Tropical Medicine, Antwerp, Belgium). Every year, some imported cases of TBE are also detected, infected in other European countries such as Germany, Scandinavia, Austria, Kyrgyzstan or Slovenia and Russia.

The East African Community mobile laboratory network prepares for monkeypox outbreaks.

In response to the largest recorded monkeypox virus outbreak outside of endemic Central and Western Africa, the East African Community (EAC), in cooperation with the Bernhard-Nocht- Institute for Tropical Medicine, coordinated an emergency monkeypox diagnostic training for the East African Region. As of June 2022, the Democratic Republic of Congo reported a steady increase of suspected monkeypox cases, increasing the risk of spill-over into the remaining six EAC Partner States. Within the existing EAC Mobile Laboratories project, laboratory experts of the National Public Health Laboratories of the remaining six EAC Partner States (Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan) participated in the workshop and were trained in the reception of suspect samples, DNA extraction and diagnosis using real-time polymerase chain reaction (RT-PCR). The EAC region is now equipped with the tools to prepare and rapidly respond to any emerging monkeypox outbreak.

Head-to-head comparison of diagnostic accuracy of four Ebola virus disease rapid diagnostic tests versus GeneXpert® in eastern Democratic Republic of the Congo outbreaks: a prospective observational study

Ebola virus disease (EVD) outbreaks have emerged in Central and West Africa. EVD diagnosis relies principally on RT-PCR testing with GeneXpert®, which has logistical and cost restrictions at the peripheral level of the health system. Rapid diagnostic tests (RDTs) would offer a valuable alternative at the point-of-care to reduce the turn-around time, if they show good performance characteristics. We evaluated the performance of four EVD RDTs against the reference standard GeneXpert® on stored EVD positive and negative blood samples collected between 2018 and 2021 from outbreaks in eastern Democratic Republic of the Congo (DRC). We conducted a prospective and observational study in the laboratory on QuickNavi-Ebola™, OraQuick® Ebola Rapid Antigen, Coris® EBOLA Ag K-SeT, and Standard® Q Ebola Zaïre Ag RDTs using left-over archived frozen EDTA whole blood samples. We randomly selected 450 positive and 450 negative samples from the EVD biorepositories in DRC, across a range of GeneXpert® cycle threshold values (Ct-values). RDT results were read by three persons and we considered an RDT result as "positive", when it was flagged as positive by at least two out of the three readers. We estimated the sensitivity and specificity through two independent generalized (logistic) linear mixed models (GLMM). 476 (53%) of 900 samples had a positive GeneXpert Ebola result when retested. The QuickNavi-Ebola™ showed a sensitivity of 56.8% (95% CI 53.6-60.0) and a specificity of 97.5% (95% CI 96.2-98.4), the OraQuick® Ebola Rapid Antigen test displayed 61.6% (95% CI 57.0-65.9) sensitivity and 98.1% (95% CI 96.2-99.1) specificity, the Coris® EBOLA Ag K-SeT showed 25.0% (95% CI 22.3-27.9) sensitivity and 95.9% (95% CI 94.2-97.1) specificity, and the Standard® Q Ebola Zaïre Ag displayed 21.6% (95% CI 18.1-25.7) sensitivity and 99.1% (95% CI 97.4-99.7) specificity. None of the RDTs evaluated approached the "desired or acceptable levels" for sensitivity set out in the WHO target product profile, while all of the tests met the "desired level" for specificity. Nevertheless, the QuickNavi-Ebola™ and OraQuick® Ebola Rapid Antigen Test demonstrated the most favorable profiles, and may be used as frontline tests for triage of suspected-cases while waiting for RT-qPCR confirmatory testing. Institute of Tropical Medicine Antwerp/EDCTP PEAU-EBOV-RDC project.

Malaria in Austria : Aretrospective analysis of malaria cases diagnosed at areference center in 2010-2020.

Although malaria is not endemic to Austria, each year infections are imported by travellers, migrants and refugees. This study aims to provide an overview of malaria cases diagnosed at an Austrian institute for tropical medicine between 2010 and 2020. Aretrospective, descriptive study was conducted based on the data of malaria cases confirmed at the Institute of Specific Prophylaxis and Tropical Medicine of the Medical University of Vienna. Laboratory diagnostics included microscopy, polymerase chain reaction (PCR) and real-time quantitative PCR. Overall, 122cases were identified. Annual case numbers were consistently higher from 2016 to 2020 than during the first half of the decade. Most malaria cases were diagnosed during summer and early autumn. This seasonal trend was not observed during the year 2020. With 55.1% (65/118) Plasmodium falciparum was the most common species, followed by Plasmodium vivax (19.5%, 23/118). The majority of patients were male (71.1%, 86/121) and the median age was 34.5 years (interquartile range, IQR 22.5-47.0 years). With amedian age of 20.0 years (IQR 14.0-32.0 years), patients with P.vivax infections were younger than those infected with other Plasmodium species. Moreover, they were mostly male (82.6%, 19/23). From 2010 to 2020, the number of malaria cases diagnosed at the center increased. Growing international mobility and changing travel behavior could at least partly be responsible for this trend and there are indications that particularly P.vivax infections were imported by migrants and refugees.

Treponema pallidum infection rate in patients attending the general hospital of Benguela, Angola

The objectives of this study were to estimate the rate of infection by Treponema pallidum and co-infection with Human Immunodeficiency Virus (HIV) in individuals attending the General Hospital of Benguela (GHB), Angola, to verify the Rapid Plasma Reagin (RPR) test performance for its diagnosis when compared with other RPR tests, and to compare a rapid treponemal test with the Treponema pallidum hemagglutination assay (TPHA). This is a cross-sectional study carried out between August 2016 and January 2017, at the GHB, 546 individuals attending the emergency room, the outpatient service or hospitalized at the GHB were included. All the samples were tested at the GHB with the routine hospital RPR test and a rapid treponemal test. The samples were then transported to the Institute of Hygiene and Tropical Medicine (IHMT) where RPR testing and TPHA testing were performed. The rate of T. pallidum active infection, demonstrated by a reactive RPR and TPHA result, was 2.9%, of which 81.2% corresponded to indeterminate latent syphilis and 18.8% to secondary syphilis. HIV co-infection was detected in 62.5% of individuals diagnosed with syphilis. Past infection, defined as a non-reactive RPR and reactive TPHA test, was diagnosed in 4.1% of individuals. The high rate of syphilis/HIV co-infection emphasizes the urgent requirement for adequate sexually transmitted infections (STIs) screening, prevention and treatment programs. In addition, implementation of quality control measures within RPR testing protocols at GHB are needed, including training for laboratory personnel, adequate equipment and introduction of other rapid testing.

Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project): a study protocol

IntroductionIntegrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY)...

Risk Factors for Death and Severe Neurological Sequelae in Childhood Bacterial Meningitis.

Acute bacterial meningitis (ABM) continues to be a challenge from a diagnostic and therapeutic point of view. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcome. Data from a retrospective study for ABM in children admitted to the Institute of Tropical Medicine in Paraguay was analyzed. ABM was defined as positive cerebrospinal fluid culture, positive latex agglutination, or identification of microorganism by real time-polymerase chain reaction. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed. A point-based scoring system that included variables, which were clearly different among those who passed away, was constructed. One hundred fourteen children hospitalized with ABM were eligible for the study. The mean age was 46 ± 57 months (range, 1-192 months). The observed mortality was 33% (38/114 patients). When a point-based scoring system was used, for score of 0 (n = 29) and 1 (n = 12), no death was observed. Among patients with a score of 2 (n = 14), 3 (n = 10 patients), 4 (n = 12 patients), and 5 (n = 13 patients), the mortality rate was 14.3%, 40%, 50%, and 53.8%, respectively. When the score was 6 or higher, the mortality rate was at least 63.6%. The present score accurately discriminated the probability of death in children hospitalized with ABM, and it could be a useful tool to select candidates for admission to the intensive care unit and for adjunctive therapy in clinical trials.

Sequencing of S and N genes of SARS-CoV-2 strains circulating in Cuba during March- September 2020

ABSTRACT&#x0D; Objectives: The first confirmed cases of COVID-19 in Cuba were reported on March 11, 2020, followed by multiple introductions of infected travelers from Europe, America, and Asia. This work aimed to characterize the SARS-CoV-2 strains circulating in Cuba from March to September 2020 by partial nucleotide sequencing of the S and N genes. &#x0D; Methods: Between March and September 2020, 38 nasopharyngeal exudates from 38 SARS-CoV-2 patients were received at the National Reference Laboratory for Influenza and Respiratory Viruses at the Institute of Tropical Medicine “Pedro Kourí” (IPK). The Sanger sequencing method was used to amplify and sequence a 2539 bp fragment of the spike gene (from position 22020 to 24550) and a 370 bp of the nucleoprotein gene (from position 28340 to 28710). The GISAID database was used to identify the mutation profile of both fragments, and phylogenetic analysis was used to confirm the clades. In addition, clinical and epidemiological data from patients were gathered.&#x0D; Results: There were 34 and 25 sequences from S and N genes, respectively. In 21 of them, both genes (S and N) were available, whereas, in the remaining 13 and 4, only S or N sequences could be obtained. Based on the presence of the D614G mutation, 32 samples (84.2%) were classified as clade G of SARS CoV-2, and two were classified as Wuhan. No classification was possible in the remaining four (where only the N sequence was available). In one sample each, five different mutations were detected in clade G samples: L517F, L517X, N603T, A846V, and E281V. The 26 N sequences obtained were 100.0% identical to those circulated in most countries. &#x0D; The G30R mutation was detected in an infected patient in Cuba. Fourteen of the 38 patients studied were imported cases. The first three cases detected with COVID-19 in Cuba were clade G and originated in Italy. Ten individuals were asymptomatic, four presented severe forms of the disease (two fatal), and the remaining presented mild symptoms. No relationship was observed among the clades or the mutational profile with the clinical features, country of origin, and Cuban provinces. &#x0D; Conclusion: The early establishment of SARS-CoV-2 genetic surveillance in Cuba was helpful for tracking the epidemic. It demonstrated that the SARS-CoV-2 clade G was introduced initially and was the variant that circulated in the country during 2020, although the Wuhan strain was also detected. J Microbiol Infect Dis 2022; 12(3):77-88.

Protocol for a controlled before-after quasi-experimental study to evaluate the effectiveness of a multi-component intervention to reduce gaps in hypertension care and control in low-income communes of Medellin, Colombia

IntroductionResearch on public health interventions to improve hypertension care and control in low-income and middle-income countries remains scarce. This study aims to evaluate the effectiveness and assess the process and...

MEMO: Monitoring of exotic mosquitoes in Belgium.

Monitoring of Exotic MOsquitoes in Belgium' is a sampling event dataset published by the Institute of Tropical Medicine (ITM) in Antwerp, Belgium. It forms part of the early detection of exotic mosquito species (EMS) along high-risk introduction routes in Belgium, where data are collected at defined points of entry (PoEs) using a standardised protocol. The MEMO dataset contains mosquito sampling counts performed between 2017 and 2020. MEMO+2020, an extension of the MEMO dataset, contains only Aedes albopictus mosquito trap counts performed in 2020. Here, we present these data published as a standardised Darwin Core archive, which includes, for each sampling event, an eventID, date, location and sampling protocol (in the event core); and an occurrenceID for each occurrence (tube), the number of collected individuals per tube, species status (present/absent), information on the identification and scientific name (in the occurrence extension).