Tardigrades Research Articles

IT-based health event surveillance in mass gathering - Kumbh Mela 2021, Haridwar, Uttarakhand

The Kumbh Mela is a large religious mass gathering event organised in India. During April 01 to April 30, 2021, Kumbh Mela was organized in Haridwar, Uttarakhand, India in the amid of COVID-19 pandemic. To detect and respond to unusual health events, a special surveillance model was established during Kumbh Mela-2021, Haridwar. The Kumbh module of Integrated Health Information Platform (IHIP) is utilized for real time data capturing. An Emergency Operations Centre (EOC) established to monitor COVID-19 and other disease situations through IHIP. Capacity building of Rapid Response Teams (RRT) was conducted. The special surveillance monitored 24 diseases/ syndromes. Kumbh mela area was divided into 4 zones with total 75 health facilities. A total of 31021 cases were reported on IHIP, including 86% communicable diseases (CDs), 8% non-communicable diseases (NCDs) and 6% unusual syndrome. Among total CDs, 27% acute febrile illness (AFI), 25.3% acute respiratory illness (ARI), 19% water borne diseases (WBDs), 15% COVID-19 and 14% others encountered. Out of total NCDs, 67% trauma, 25% dog bite, 8% others. A total of 36 early warning signals generated and responded, of which 22% WBDs, 22% ARI, 17% COVID-19, 14% AFI, 11% unusual syndrome and 14% others. The special disease surveillance helped monitoring health event alerts and health condition alerts. EOC monitored early warning signals and facilitated early detection and quick response to public health threats. Acute febrile illnesses emerged as a leading cause of morbidity. Future Mass Gathering events like Kumbh Mela should include disease surveillance as part of planning and augment capacity to diagnose and management of acute febrile illness.

Water beads: Expanding toy and 'new' problem for paediatric surgeons and community.

Water beads made from superabsorbent polymers can lead to bowel obstruction, which can sometimes be fatal. This article aims to highlight the dangers of such toys and to propose an innovative, safe and effective approach to diagnostic and therapeutic management. We report two cases of children with intestinal obstruction following the ingestion of products based on superabsorbent polymers. They were diagnosed and treated in two different centres using varying techniques. We compare our experiences with the few cases reported in the literature. Since water beads are radiolucent, ultrasound or CT scans are crucial for diagnosis. As in one of our cases, radiography of the upper gastrointestinal tract with contrast can be very helpful. Laparotomy with enterotomy is the main surgical approach reported in literature to extract the water spheres. We report two cases managed using a minimally invasive approach, and one of them is the second one described in the literature, treated endoscopically. Water beads pose a potential danger to children, making it necessary to limit the sale of this type of toy. We offer a management flowchart based on our experience and evidence from the literature.

“The Itsy-Bitsy Water Bead Went Down the Baby's Mouth. Will Drinking Gastrografin Help to Flush It Out?”

IntroductionForeign body ingestion is a common occurrence in the pediatric population. Superabsorbent polymers (i.e., water beads [WB]), such as Orbeez, are brightly colored spheres, can expand up to 100x their original size and are marketed as toys for kids. Ingested WB may lead to a bowel obstruction and typically require surgical removal. MethodsFully expanded WBs (N = 15) were placed into 1 of the 3 solutions: water (N = 5), gastrografin (N = 5), or 1:1 mixture of gg and water (N = 5), with serial diameter measurements obtained at 1, 4, 8, and 24 h. Additionally, fully expanded WBs were placed into succus containing post mortem porcine small bowel and mixed with gastrografin (N = 10) or nothing (N = 10), with diameters measured prior to placement and at 4 h. ResultsAt all time points, the mean WB diameter of the gastrografin arm was significantly smaller than the other two arms (P < 0.01). WBs submerged in gastrografin saw a 58% reduction in diameter at 4 h compared to 45% reduction in the 1:1 mixture and a 2% growth in water (P < 0.01). When placed into small bowel containing gastrografin, the mean WB diameter decreased by 47% at 4 h versus 37% in the control arm (P < 0.01). ConclusionsGastrografin significantly reduced the size of WB in both the in-vitro and ex-vivo post mortem animal study; and it may offer a nonsurgical option for the management of water bead ingestion. Studies assessing the clinical efficacy of a gastrografin nonoperative management strategy are needed.

Outcomes of ingested superabsorbent polymers (“water beads”): A poison center study

Outcomes of ingested superabsorbent polymers (“water beads”): A poison center study

Unleashing the relationship between climate change and infectious diseases

Climate change is rapidly emerging as a powerful driver of human health, understanding the relation between infectious disease dynamics and climate change is crucial for public health, particularly in developing nations. This article review delves into the intricate relationship between climate change and infectious diseases, with a particular focus on how climate factors are influencing the spread of vector borne diseases and water borne diseases such as prevalent diseases like malaria, cholera, and dengue in India. The objective is to assess the relationship between climate change and the burden of infectious diseases, with a focus on understanding how climate factors influence the prevalence and spread of infectious diseases. A literature search using PubMed, Science Direct, and government and international health reports focused on the terms 'climate change', 'infectious diseases' and 'health impact’. The review highlights that climate change accelerates vector lifecycles and creates favourable conditions for pathogens, leading to more frequent and severe outbreaks. Extreme weather events are worsening these risks, leading to more frequent and severe outbreaks. This poses a growing threat to global health, particularly in vulnerable regions like India. Despite government efforts, significant challenges remain. Strengthening healthcare infrastructure, improving disease surveillance, and adopting climate-resilient practices are essential to safeguard vulnerable populations and mitigate the impact of climate change on public health.

From Wet to Protective: Film Formation in Waterborne Coatings.

The importance of anticorrosive coatings cannot be overstated, as they play a vital role in safeguarding assets and infrastructure across various industries. Within this context, the emergence of waterborne (WB) coatings stands out for their paramount significance, offering a sustainable alternative to traditional solvent-based (SB) coatings and addressing pressing environmental concerns. Despite their eco-friendliness, the complexity of their film formation mechanism and the lack of understanding present challenges in enhancing the performance of waterborne coatings for corrosion protection. These coatings are created by dispersing polymers in water, which then form a protective film on a substrate. The process involves stages like water evaporation, particle packing, and polymer interdiffusion, often leading to films with defects and inferior protection against extremely corrosive environments compared to SB coatings. This Review scrutinizes the interplay of factors affecting film formation in application, including coalescing agents, environmental factors, and application conditions. A comparative analysis between SB and WB coatings is also featured to shed light on the performance gap under harsh conditions. This Review discusses analytical techniques for studying film formation, aiming to guide future research toward improving WB coatings' durability and effectiveness. In compiling this collective wisdom, this Review emphasizes the translation of theoretical understanding into practical knowledge, equipping formulators with actionable insights to optimize WB coatings for real-world application and performance.

Post-Earthquake Survey of Bagmati River Seepage Through Physicochemical Analysis of Water

Bagmati river has a great cultural, economic and mythological significance. It has also been related to the civilization of Kathmandu valley. Due to the rapid and unmanaged urbanization and industrialization the river has been heavily polluted leading to the water borne hazards and water shortage problem in the capital. Amidst this problem there was a major earthquake in Kathmandu in 2015 which disturbs the land masses in the valley. This research was conducted to assess the physico-chemical parameters of Bagmati river water and ground water from its corridor at about 50 m and 100 m distance for comparison to detect the post-earthquake seepage status of river water from October 2019 to March 2020. In total 10 sites (A-J) were selected from Gokarna to Chovar. From each site 1 river and 2 ground water samples at approximately about 50 m and 100 m radial distance from river were taken. The range of temperature, turbidity, conductivity, TDS, pH, chloride, total hardness, total acidity, total alkalinity, total iron content, total ammonia content, dissolved oxygen content and biochemical oxygen demand (BOD) were recorded to be 13-22 ºC, 150.5-395.5 NTU, 121.1-825 μs/cm, 77.56-528 ppm, 6.5-7.84, 4.97-114.3 mg/l, 34-180 mg/l, 10-224 mg/l, 70-382 mg/l, 0.55-4.156 mg/l, 5-150 mg/l, 0-4.5 mg/l and 5.35-320 mg/l respectively for river water samples and 16-21 ºC, 3.8-52.1 NTU, 25.2-745 μs/cm, 16-476.8 ppm, 6.08-7.61, 5.68-134.9 mg/l, 6-328 mg/l, 10-140 mg/l, 30-340 mg/l, 0.02-5.101 mg/l, 0.026-0.9 mg/l, 2.63-8.1 mg/l and 1.62-16.3 mg/l respectively for ground water samples at 50 m distance from river and 16-20 ºC, 3.1-60 NTU, 25.6-697 μs/cm, 12.8-446.08 ppm, 5.49-8.78, 5.68-44.02 mg/l, 10-300 mg/l, 10-160 mg/l, 14-294 mg/l, 0.015-4.37 mg/l, 0.028-0.54 mg/l, 3.1-8.7 mg/l and 0.63-14.2 mg/l respectively for ground water samples at 100 m distance from the river. As there were significant differences in turbidity, chloride, total acidity, iron, ammonia and BOD among Bagmati and ground water samples, direct mixing of polluted Bagmati river water with nearby ground waters through seepage was not detected. Thus, irrespective of earlier condition, the land masses near the Bagmati territory has not been affected so as to allow deeper seepage of river water by the earthquake of 2015.

Nanoarchitectonics of molybdenum rich crown shaped polyoxometalates based ionic liquids reinforced on magnetic nanoparticles for the removal of microplastics and heavy metals from water

The removal of heavy metal ions and microplastics from water remains a significant challenge. This study addresses this issue by introducing mesoporous composites consisting of polyoxometalate-based ionic liquids reinforced on magnetic silica-coated nanoparticles. The composites, Q8 [Mo54] @ SiO2 @ Fe3O4, Q10 [Mo54] @ SiO2 @ Fe3O4, Q8 [Mo46] @ SiO2 @ Fe3O4, and Q10 [Mo46] @ SiO2 @ Fe3O4, are derived from the combination of molybdenum clusters ([Mo46]21- and [Mo54]26-) with tetraoctylammonium and tetradecylammonium counter cations, resulting in ionic liquids Q8 [Mo54], Q10 [Mo54], Q8 [Mo46], and Q10 [Mo46], that are subsequently coated onto SiO2 @ Fe3O4. A comprehensive set of characterization techniques was employed to evaluate the properties of these materials. Fourier transform infrared spectroscopy, UV–vis spectroscopy, thermogravimetric analysis, differential scanning calorimetry, cyclic voltammetry, rheology, elemental analysis, inductively coupled plasma atomic emission spectroscopy, powder X-ray diffraction, scanning electron microscopy, energy-dispersive X-ray spectroscopy, dynamic light scattering, high resolution transmission electron microscopy, and N2 adsorption-desorption isotherms and gas chromatography-mass spectrometry were utilized. These analyses confirm the composites amorphous surface morphology and large specific surface areas and efficient adsorption properties. Inductively coupled plasma atomic emission spectroscopy results demonstrated remarkable heavy metal ions removal efficiencies, ranging from 79.5 % to 99.3 % in laboratory water and from 92 % to 99 % in industrial wastewater. Additionally, dynamic light scattering analysis showed a 100 % removal efficiency for polyvinyl chloride beads in laboratory water and 95–98 % in industrial wastewater. All composites displays excellent reusability and stability over five cycles.

Water quality index of selected borehole locations in Jos North LGA of Plateau State, Nigeria

Prevalence of water borne diseases is a public health concern. The study assessed the quality of selected borehole waters in Jos North for their potability. The physicochemical parameters were assessed in addition to chlorides, phosphates, nitrates, and sulphates, total solids, total dissolved solids, total suspended solids, total hardness, using standard methods. Atomic absorption spectrophotometry used for elemental analysis of samples for manganese, lead, cadmium, copper and zinc. microbial analysis was carried out to test for presence of anaerobic bacteria, coliforms, Escherichia coli, Salmonella typhi, yeast and mould, Staphylococcus aureus using the plate count method. Water Quality Index by Weighted Arithmetic Index Method. Results ranged from 22.19-56.22 mg/L (chlorides), 0.00-0.07 mg/L (phosphates), 0.11-0.19 mS/cm (conductivity), 141.40-169.40 mg/L (alkalinity) and 86.70-160 mg/L (TSS). Kyan Primary school had Mn 0.632 mg/L against 0.500mg/L recommended by WHO. Microbial analysis revealed that Kyan primary school had 1 cfu per 100 mL water for E. coli, Salmonella typhi, yeast and mould. This indicated faecal contamination. The WQI revealed Village hostel, Kyan Village, Gadabiu had values of 6.54, 19.41, 10.97 are potable, Government College, Angwan Jarawa, Kyan Primary school had 28.90, 61.50, 93.60 are potable, poor, very poor, not potable.

Application of FBG Sensing Technology for Real-Time Monitoring in High-Stress Tunnel Environments

In the process of tunnel construction, problems such as high-stress rockburst, large deformation of soft rock, water inrush and mud gushing, secondary cracking of linings, blasting interference, man-made damage, and mechanical damage are often encountered. These pose a great challenge to the installation of monitoring equipment and line protection. In order to solve these problems, the 2# inclined shaft of Muzhailing Tunnel in the Gansu Province of China, which exists under high stress, water bearing, and bias conditions, was taken as the research object in this paper. By assembling a string, drilling grouting and sealing, and introducing multiple modes of protection, new fiber grating sensor group installation and line protection methods were proposed. The automatic continuous monitoring of the deep deformation of surrounding rock and the automatic continuous monitoring of steel arch stress were realized. The field monitoring results showed that: (1) the fiber grating displacement sensor group could be used to verify the authenticity of the surface displacement results monitored by the total station; (2) the NPR anchor cable coupling support effectively limited the large deformation of soft rock and the expansion of surrounding rock in a loose circle, and the range of the loose circle was stable at about 1 m; and (3) the main influence range of blasting was at a depth of 0~5 m in surrounding rock, and about 25 m away from the working face. In addition, to secure weak links in the steel arch due to the hardening phenomenon, a locking tube was set at the arch foot. In the support design, the fatigue life of the steel was found to be useful as the selection index for the steel arch frame to ensure the stability of the surrounding rock and the long-term safety of the tunnel. The present research adopted a robust method and integrates a variety of sensor technologies to provide a multifaceted view of the stresses and deformations encountered during the tunneling process, and the effective application of the above results could have certain research and reference value for the design and monitoring of high stress, water-bearing, and surrounding rock supports in tunnels.

Application of Immobilized Microorganism Gel Beads in Black-Odor Water with High Nitrogen and Phosphorus Removal Performance

Black-odor water, which is caused by the excessive accumulation of nitrogen and phosphorus in water, is a significant problem. Immobilized microorganisms are considered to be an effective technical solution, but there are still many key parameters to be determined, such as organic matter dissolution, insufficient stability, and insufficient phosphorus removal capacity, among other problems. In this study, the optimum raw material ratios of immobilized microorganism gel beads were determined by means of a response surface experiment. The optimal ratio of raw materials was 5% polyvinyl alcohol (PVA), 1% sodium alginate (SA), and 6% bacterial powder. In addition, the nitrogen and phosphorus removal performance of the materials was improved by loading inorganic compounds, such as 0.5 wt.% zeolite, 0.5 wt.% iron powder, and 0.2 wt.% activated carbon. Tolerance analysis determined that these gel beads could maintain a good performance in a series of harsh environments, such as during intense agitation, at high temperatures, and at low pH values, etc. The total nitrogen (TN), ammonia nitrogen (NH3-N), and phosphorus (TP) removal efficiencies were 88.9%, 90%, and 95%.

Socio-Economic Perspectives of Household Water Treatment for Safe Drinking in Nigeria

Access to safe drinking water remains a huge challenge to households in developing countries of which Nigeria is one. This is evident from the numerous cases of water related diseases ravaging the country. The United Nations Children Emergency Fund reports that over 150,000 Nigerians and about 117, 000 under five children, die of water borne diseases annually. Since safe water is gotten from water treatment, the challenges associated with ensuring that water is adequately treated for the households are enormous. Considering that the household is generally the primary source of drinking water for the populace, the socio-economic characteristics of a household plays a key role in determining their access to quality water for drinking. It is based on this that this study seeks to evaluate how household socio-economic characteristics influences a household’s decision to treat its drinking water. The study uses the Binary Logistic regression model to test for the correlates of household water treatment decisions. The data employed in this study is sourced from the Multiple Indicator Cluster survey conducted by UNICEF. A total of 26359 households were selected for the study. The study shows that about 23,495 of the selected households do not treat their water for safe drinking in Nigeria. The result also shows that source of drinking water is a key determining factor in the water treatment decisions of households, as different sources of water were found to have varying degrees of effects on water treatment decisions by households. Some ethnic groups were also observed to have a poor water treatment culture. Also, education of household head and high wealth status increases water treatment.

The Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Prevention of Water Borne Disease among School Children in Selected School of Guntur, A. P.

The Effectiveness of Video Assisted Teaching Programme on Knowledge Regarding Prevention of Water Borne Disease among School Children in Selected School of Guntur, A. P.

A Study to Assess the Knowledge Regarding Selected Water Borne Diseases among the People Residing in Selected Areas of Bangalore

A Study to Assess the Knowledge Regarding Selected Water Borne Diseases among the People Residing in Selected Areas of Bangalore

Prediction of Drinking Water Quality for Effective Public Health Management to Avoid Water Borne Diseases

The issue of water quality failure is a persistent global concern that leads to sickness, toxicity, the spread of diseases, and loss of life in metropolitan areas. Various physical, functional, and ecological factors may affect drinking water quality. These concerns include the incursion of pollutants into water pipes, leakage, the formation of disinfectant waste products, the penetration of chemicals or microbes, and pollution. Water-borne Diseases (WD) have emerged as a significant global public health issue. It is imperative to forecast the quality of drinkable water by utilizing an automated model that provides a preventive strategy that may be created to enhance public health management (PHM). This study forecasted the Drinking Water Quality (DWQ) to promote Public Health Management (PHM) strategies to prevent WD. Convolutional Neural Network (CNN) with Inverse Distance Loaded (IDL) interpolation has been used to forecast DWQ. One hundred five water specimens from the research region underwent thorough examination via physiochemical and microbiological analyses. The tested characteristics were pH, turbidity, temperature, fluoride concentration levels, and bacterial counts (Faecal Coliforms) to prevent WD. The test findings indicated that the CNN-IDL projected 35% of water specimens from the domestic pipeline network had bacteria levels below what the WHO considers acceptable. Also, about 57% of the samples from the home pipeline network met the fluoride reference values set by the WHO. The sanitary assessment rating clearly showed that the lack of appropriate measures to protect against multiple barriers resulted in declining water quality for users. The findings of this research will be valuable to administrators in implementing essential strategies to avoid WD before it significantly impacts public health.

Enhancing corrosion resistance and self-healing of water-borne epoxy coatings using Ti3C2Tx-supported tannic acid on UIO-66-NH2

In this study, we developed a composite material comprising UIO-66-NH2 encapsulated tannic acid (TA) loaded on Ti3C2Tx to improve the corrosion resistance of water borne epoxy (WEP) coatings. The successful synthesis of the material was determined by FT-IR, XRD, XPS, EDS, TGA, SEM and TEM characterization. Furthermore, ultraviolet (UV)tests were conducted to evaluate the release rate of TA at varying pH levels, revealing a release rate of approximately 95 % at pH 2. Electrochemical impedance spectroscopy (EIS) results over 60 d indicated that the Rc value of TU-T/WEP remained unchanged at 3.934 × 108, demonstrating a two-order magnitude increase compared to those of pure epoxy coatings, attributed to the synergistic active and passive protection of TU-T materials. The self-healing ability of the TU-T/WEP coating was validated through manual scratch experiments. Additionally, the EIS test showed that the Rc value of TU-T/WEP coating increased to 3.5 × 105 after 72 h, representing a two-order magnitude increase over that of the WEP coating alone. This study introduces a novel approach using green tannic acid as a corrosion inhibitor and amino-functionalized Ti3C2Tx with UIO-66-NH2 to enhance corrosion resistance and self-healing aproperties of coatings.

The surface tension of Martini 3 water mixtures.

The Martini model, a coarse-grained forcefield for biomolecular simulations, has experienced a vast increase in popularity in the past decade. Its building-block approach balances computational efficiency with high chemical specificity, enabling the simulation of organic and inorganic molecules. The modeling of coarse-grained beads as Lennard-Jones particles poses challenges for the accurate reproduction of liquid-vapor interfacial properties, which are crucial in various applications, especially in the case of water. The latest version of the forcefield introduces refined interaction parameters for water beads, tackling the well-known artifact of Martini water freezing at room temperature. In addition, multiple sizes of water beads are available for simulating the solvation of small cavities, including the smallest pockets of proteins. This work focuses on studying the interfacial properties of Martini water, including surface tension and surface thickness. Employing the test-area method, we systematically compute the liquid-vapor surface tension across various combinations of water bead sizes and for temperatures from 300 to 350K. These findings are of interest to the Martini community as they allow users to account for the low interfacial tension of Martini water by properly adjusting observables computed via coarse-grained simulations to allow for accurate matching against all-atom or experimental results. Surface tension data are also interpreted in terms of local enrichment of the various mixture components at the liquid-vapor interface by means of Gibbs' adsorption formalism. Finally, the critical scaling of the Martini surface tension with temperature is reported to be consistent with the critical exponent of the 3D Ising universality class.

Delineation and validation of GIS-based groundwater potential zones under arid to semi-arid environment using multi-influence-factors approach

ABSTRACT Groundwater is an indispensable source for domestic-use, agriculture, industry and sustainable development. Groundwater scarcity is Pakistan’s emerging issue, especially in the arid and semi-arid regions of southern Khyber Pakhtunkhwa. This study intends to demarcate the groundwater potential zones (GWPZ) in these regions using Multi-Influence-Factors (MIF), validated with Vertical Electrical Sounding (VES) and well data. The study region was classified into four GWPZ: very high (340 km2), high (4997.11 km2), moderate (17615.14 km2) and poor (16355.46 km2). These interpretations were supported by the VES survey, and water bearing layers have been recognized at 32 m, 137 m, 87 m, 10 m at VES points 1, 2, 3, and 4, respectively in Karak, and at 152 m, 194 m, and 93 m at VES points 1, 2, and 3, respectively in Lakki Marwat, while at 125 m, 119 m and 80 m at VES points 1, 2 and 3, respectively in D. I. Khan. The southern region is predominantly poor, the northern and northeastern parts are high to very high, while the southwest part has moderate potential. Water depth is <40 m at very high potential, 40 to 70 meters at high potential, and 150 to 180 meters in poor zones. This study will help to enhance the applicability of integrated methodologies for groundwater investigations under arid conditions.

Pediatric water bead-related visits to United States emergency departments

ObjectiveTo evaluate the characteristics and trends of pediatric water bead-related visits to US emergency departments (EDs) using a large national database. MethodsData from the National Electronic Injury Surveillance System regarding ED visits by individuals <20 years old associated with water beads from January 1, 2007, through December 31, 2022, were retrospectively analyzed. ResultsBased on 307 reported cases, there were an estimated 8159 visits (95% CI: 4447-11,870) to US EDs from 2007 through 2022 involving water beads among <20-year-olds, and more than half (55.0%) of the 307 ED cases involved <5-year-olds. Most cases were treated and released (92.2%), which was consistent across all age groups. The proportion of cases admitted was highest among children <5 years old (10.1%), and this age group accounted for 17 of the 19 admissions (89.5%) in this study. All admissions among children <5 years old involved ingestions. Ingestion was the most common mechanism of injury (45.9%), followed by ear canal insertion (32.6%), nasal insertion (11.7%), and eye injury (8.8%). Although ingestions occurred most frequently among children one (28.4%) and two (23.4%) years of age, children 3 and 4 years old accounted for one-fifth of ingestions. The number of ED cases increased rapidly by 130.9% from 55 cases in 2021 to 127 in 2022. ConclusionsThe number of pediatric water bead-related ED visits is increasing rapidly. Children <5 years old are most commonly involved, usually via water bead ingestion. Increased prevention efforts are needed.

Water bead injuries by children presenting to emergency departments 2013-2023: An expanding issue.

A 2023 product recall has described the risk for morbidity and mortality for children ingesting water beads. We aimed to describe water bead exposure and management trends in the United States.We used the National Electronic Injury Surveillance System (NEISS) to identify water bead injuries from 2013 to 2023. Inclusion criteria were ages 0-17 years, diagnosis of ingested object/foreign body, and the narrative word(s) suggested water bead(s). NEISS supplied weights and variance variables to generate national estimates. There were 226 water bead injuries (66% ingestion). Children under age 2 years comprised 29% of injuries. Multiple water beads were involved in 56% of cases. There was a significant uptrend in water bead injury frequency after 2020. Sixteen (7%) cases required escalation of care. Water bead injuries are rising and appear to affect children of all ages. Children aged less than 5 years appear most vulnerable.