A serological framework to investigate acute primary and post-primary dengue cases reporting across the Philippines

Abstract Background In dengue-endemic countries, targeting limited control interventions to populations at risk of severe disease could enable increased efficiency. Individuals who have had their first (primary) dengue infection are at risk of developing more severe secondary disease, thus could be targeted for disease prevention. Currently, there is no reliable algorithm for determining primary and post-primary (infection with more than one flavivirus) status from a single serum sample. In this study, we developed and validated an immune status algorithm using single acute serum samples from reporting patients and investigated dengue immuno-epidemiological patterns across the Philippines. Methods During 2015/2016, a cross-sectional sample of 10,137 dengue case reports provided serum for molecular (anti-DENV PCR) and serological (anti-DENV IgM/G capture ELISA) assay. Using mixture modelling, we re-assessed IgM/G seroprevalence and estimated functional, disease day-specific, IgG:IgM ratios that categorised the reporting population as negative, historical, primary and post-primary for dengue. We validated our algorithm against WHO gold standard criteria and investigated cross-reactivity with Zika by assaying a random subset for anti-ZIKV IgM and IgG. Lastly, using our algorithm, we explored immuno-epidemiological patterns of dengue across the Philippines. Results Our modelled IgM and IgG seroprevalence thresholds were lower than kit-provided thresholds. Individuals anti-DENV PCR+ or IgM+ were classified as active dengue infections (83.1%, 6998/8425). IgG− and IgG+ active dengue infections on disease days 1 and 2 were categorised as primary and post-primary, respectively, while those on disease days 3 to 5 with IgG:IgM ratios below and above 0.45 were classified as primary and post-primary, respectively. A significant proportion of post-primary dengue infections had elevated anti-ZIKV IgG inferring previous Zika exposure. Our algorithm achieved 90.5% serological agreement with WHO standard practice. Post-primary dengue infections were more likely to be older and present with severe symptoms. Finally, we identified a spatio-temporal cluster of primary dengue case reporting in northern Luzon during 2016. Conclusions Our dengue immune status algorithm can equip surveillance operations with the means to target dengue control efforts. The algorithm accurately identified primary dengue infections who are at risk of future severe disease.

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Estimating the annual dengue force of infection from the age of reporting primary infections across urban centres in endemic countries

BMC Medicine ◽

10.1186/s12916-021-02101-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Joseph R. Biggs ◽

Ava Kristy Sy ◽

Katharine Sherratt ◽

Oliver J. Brady ◽

Adam J. Kucharski ◽

...

Keyword(s):

Case Reports ◽

Dengue Infection ◽

Laboratory Data ◽

The Philippines ◽

Warning Signs ◽

Transmission Intensity ◽

Dengue Case ◽

Force Of Infection ◽

Regression Modelling ◽

The Mean

Abstract Background Stratifying dengue risk within endemic countries is crucial for allocating limited control interventions. Current methods of monitoring dengue transmission intensity rely on potentially inaccurate incidence estimates. We investigated whether incidence or alternate metrics obtained from standard, or laboratory, surveillance operations represent accurate surrogate indicators of the burden of dengue and can be used to monitor the force of infection (FOI) across urban centres. Methods Among those who reported and resided in 13 cities across the Philippines, we collected epidemiological data from all dengue case reports between 2014 and 2017 (N 80,043) and additional laboratory data from a cross-section of sampled case reports (N 11,906) between 2014 and 2018. At the city level, we estimated the aggregated annual FOI from age-accumulated IgG among the non-dengue reporting population using catalytic modelling. We compared city-aggregated FOI estimates to aggregated incidence and the mean age of clinically and laboratory diagnosed dengue cases using Pearson’s Correlation coefficient and generated predicted FOI estimates using regression modelling. Results We observed spatial heterogeneity in the dengue average annual FOI across sampled cities, ranging from 0.054 [0.036–0.081] to 0.249 [0.223–0.279]. Compared to FOI estimates, the mean age of primary dengue infections had the strongest association (ρ −0.848, p value<0.001) followed by the mean age of those reporting with warning signs (ρ −0.642, p value 0.018). Using regression modelling, we estimated the predicted annual dengue FOI across urban centres from the age of those reporting with primary infections and revealed prominent spatio-temporal heterogeneity in transmission intensity. Conclusions We show the mean age of those reporting with their first dengue infection or those reporting with warning signs of dengue represent superior indicators of the dengue FOI compared to crude incidence across urban centres. Our work provides a framework for national dengue surveillance to routinely monitor transmission and target control interventions to populations most in need.

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Is SARS-CoV-2 transmitted by asymptomatic and pre-symptomatic infected individuals?

Acta Medica Philippina ◽

10.47895/amp.v54i0.2644 ◽

2021 ◽

Vol 54 ◽

Author(s):

Abigail F. Melicor ◽

Katrina Loren R. Rey ◽

Leonila F. Dans

Keyword(s):

Case Reports ◽

Case Series ◽

The Philippines ◽

World Health ◽

Current Evidence ◽

Wide Confidence Interval ◽

Cross Sectional ◽

Viral Shedding ◽

Asymptomatic Patients ◽

Health Organization

KEY FINDINGSAsymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur.• Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with anysigns and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases areinfected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventuallydevelop symptoms.• As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic,but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic).• Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statisticalmodeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3studies reported no transmission from pre-symptomatic and asymptomatic cases.• Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reportedcontradicting results. The duration of viral shedding was significantly longer for symptomatic patients comparedto asymptomatic patients but similar for asymptomatic and pre-symptomatic patients.• Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimatedinfectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, butresults were imprecise due to a wide confidence interval.• The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize thepossibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggestsasymptomatic cases are less likely to transmit the virus than symptomatic cases.

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Paparan Organopospat Terhadap Kadar Kolinesterase Dalam Darah Petani Sayur

Jurnal Endurance ◽

10.22216/jen.v5i1.4562 ◽

2020 ◽

Vol 5 (1) ◽

pp. 7

Author(s):

Sugiarto Sugiarto ◽

Entianopa Entianopa ◽

Renny Listiawaty

Keyword(s):

At Risk ◽

Smoking Habit ◽

Sampling Technique ◽

Bivariate Analysis ◽

Chi Square ◽

Cross Sectional ◽

Purposive Sampling ◽

Vegetable Farmers ◽

Populations At Risk ◽

Test Kit

Vegetable farmers are one of the populations at risk of experiencing pesticide poisoning due to their activities of spraying using pesticides. This study aims to determine the exposure of organophosphate pesticides to the decrease in the activity of the cholinesterase enzyme in the blood of vegetable farmers. This research is an analytic study with cross sectional approach. The research sample was 88 farmers in Pal Merah Village. The sampling technique was purposive sampling. The study was conducted in June to August 2019. The instruments used were questionnaire and Livibond Cholinesterase Test Kit AF267. Data collection techniques by interview and blood examination. Data were analyzed univariately and bivariately using chi square test. As many as 35 (39.8%) respondents had disguised colinestrase levels, 66 people (75.0%) had a long risk exposure, 41 people (46.6%) had poor knowledge, 20 people (22.7%) were not good in the use of PPE, 39 people (44.3%) had a BMI at risk and 36 people (40.9%) had a smoking habit. The results of bivariate analysis showed that organopathic exposure and smoking habits were related to cholinesterase levels in vegetable farmers. It is recommended that farmers always use PPE, spray in the morning and evening, spray no more than 4 hours a day Petani sayur merupakan salah satu populasi yang berisiko mengalami keracunan pestisida akibat aktivitasnya melakukan penyemprotan menggunakan pestisida. Penelitian ini bertujuan untuk mengetahui paparan pestisida organofosfat terhadap penurunan aktivitas enzim kolinesterase dalam darah petani sayur. Penelitian ini merupakan penelitian analitik dengan pendekatan cross sectional. Sampel penelitian adalah petani yang ada di Kelurahan Pal Merah sebanyak 88 orang. Teknik pengambilan sampel dengan purposive sampling. Penelitian dilakukan pada bulan Juni s/d Agustus 2019. Intrumen yang digunakan adalah kuesioner dan Livibond Cholinesterase Test Kit AF267. Teknik pengumpulan data dengan cara wawancara dan pemeriksaan darah. Data dianalisis secara univariat dan bivariat dengan menggunakan uji chi square. Sebanyak 35 (39,8%) responden memiliki kadar kolinestrase tersamar, 66 orang (75,0%) memiliki lama pajanan berisiko, 41 orang (46,6%) memiliki pengetahuan kurang baik, 20 orang (22,7%) kurang baik dalam penggunaan APD, 39 orang (44,3%) memiliki IMT berisiko dan 36 orang (40,9%) memiliki kebiasaan merokok. Hasil analisis bivariat menunjukkan bahwa paparan organopospat dan kebiasaan merokok berhubungan dengan kadar kolinesterase pada petani sayur. Untuk itu disarankan kepada petani selalu menggunakan APD, menyemprot pada pagi dan sore hari, menyemprot tidak lebih dari 4 jam sehari

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Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: a US and EU Real-world Evidence Study

Acta Dermato Venereologica ◽

10.2340/actadv.v101.981 ◽

2021 ◽

Author(s):

Marieke M.B. Seyger ◽

Matthias Augustin ◽

Michael Sticherling ◽

Teresa Bachhuber ◽

Juanzhi Fang ◽

...

Keyword(s):

Severe Disease ◽

Topical Therapy ◽

Significant Proportion ◽

Unmet Need ◽

Severity Index ◽

Paediatric Population ◽

Cross Sectional Survey ◽

Psoriasis Area Severity Index ◽

Cross Sectional ◽

Pasi Score

This study is a retrospective analysis using data collected from the Adelphi Paediatric Psoriasis Disease-Specific Programme cross-sectional survey. Despite being treated for their psoriasis, a substantial proportion of paediatric patients presented with moderate (18.3%) or severe (1.3%) disease at sampling; 42.9% and 92.0% had a body surface area (BSA) of >10%, and 38.8% and 100.0% had a Psoriasis Area Severity Index (PASI) score >10, respectively. Overall, 69.9% of patients had only ever been treated with a topical therapy for their psoriasis. For patients with moderate or severe disease at sampling, 16.3% and 14.4% were currently receiving conventional systemics or biologic therapy, respectively. There is a clinical unmet need in this paediatric population; a considerable percentage of patients still experienced moderate or severe disease and persistent psoriasis symptoms, with numerous body areas affected. A significant proportion of patients were undertreated, which may explain the high burden of disease observed.

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Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland

10.1101/2021.10.29.21265674 ◽

2021 ◽

Author(s):

Kyra D Zens ◽

Phung Lang

Keyword(s):

At Risk ◽

Kidney Disease ◽

Vaccination Coverage ◽

Severe Disease ◽

Pneumococcal Vaccination ◽

Opportunistic Pathogen ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Factors Affecting ◽

Increased Risk

Streptococcus pneumoniae, or pneumococcus, is a common, opportunistic pathogen which can cause severe disease, particularly in adults 65+. In Switzerland, vaccination is recommended for children under 5 and for adults with health predispositions; vaccination of healthy adults 65+ is not recommended. In 2020 we conducted a nationwide, cross-sectional survey of vaccination records to evaluate pneumococcal vaccination coverage and factors affecting uptake among adults 18-85. We found that nationwide coverage was 4.5% without significant regional differences. Coverage was comparable between men and women and between those aged 18-39 (3.0%) and 40-64 (3.2%). Coverage was significantly higher among those 65-85 (9.6%). While 2.7% of individuals reporting no health predisposition were vaccinated, 14.8% with asthma or chronic pulmonary disease, 27.1% with immunosuppression, 12.9% with diabetes, 11.6% with heart, liver, or kidney disease, and 25.9% with >1 health risk were vaccinated. Adjusted odds of vaccination for all health predispositions except heart, liver, or kidney disease were significantly increased. Among unvaccinated individuals "not enough information about the topic" and "not suggested by a doctor/healthcare provider" were the major reasons for abstaining from vaccination. Respondents reporting a health predisposition were significantly less likely to report "not at increased risk due to chronic health conditions or age" as a reason for not being vaccinated (3.7% versus 29.1%) and were more likely to report willingness to be vaccinated in the future compared to those not-at-risk (54.2% versus 39.9%). Our results indicate that pneumococcal vaccination coverage in Switzerland is low among both individuals 65-85 and among those with predisposing health risks. It appears that at-risk individuals are aware of their increased risk, but feel they do not have enough information on the topic to seek vaccination, or have not been recommended a vaccination from their physician.

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Atherogenic Risk Assessment among Persons Living in Rural Uganda

Journal of Tropical Medicine ◽

10.1155/2016/7073894 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Clara Wekesa ◽

Gershim Asiki ◽

Ivan Kasamba ◽

Laban Waswa ◽

Steven J. Reynolds ◽

...

Keyword(s):

At Risk ◽

Cardiovascular Risk ◽

Significant Proportion ◽

Density Lipoprotein ◽

Population Based ◽

Risk Profile ◽

Atherogenic Index ◽

Physical Measurements ◽

Populations At Risk ◽

Independent Risk Factors

Background. Hypertension and dyslipidemia are independent risk factors for coronary heart disease and commonly coexist. Cardiovascular risk can be reliably predicted using lipid ratios such as the atherogenic index, a useful prognostic parameter for guiding timely interventions.Objective. We assessed the cardiovascular risk profile based on the atherogenic index of residents within a rural Ugandan cohort.Methods. In 2011, a population based survey was conducted among 7507 participants. Sociodemographic characteristics, physical measurements (blood pressure, weight, height, and waist and hip circumference), and blood sampling for nonfasting lipid profile were collected for each participant. Atherogenic risk profile, defined as logarithm base ten of (triglyceride divided by high density lipoprotein cholesterol), was categorised as low risk (<0.1), intermediate risk (0.1–0.24), and high risk (>0.24).Results. Fifty-five percent of participants were female and the mean age was 49.9 years (SD±20.2). Forty-two percent of participants had high and intermediate atherogenic risk. Persons with hypertension, untreated HIV infection, abnormal glycaemia, and obesity and living in less urbanised villages were more at risk.Conclusion. A significant proportion of persons in this rural population are at risk of atherosclerosis. Key identified populations at risk should be considered for future intervention against cardiovascular related morbidity and mortality. The study however used parameters from unfasted samples that may have a bearing on observed results.

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Cutaneous manifestations in COVID-19 patients in a district COVID care centre

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20214205 ◽

2021 ◽

Vol 7 (6) ◽

pp. 805

Author(s):

Prathyusha Dasari ◽

Swetha A. Chowdary ◽

Haritha Samanthula ◽

Soumya Ruvva

Keyword(s):

Case Reports ◽

Severe Disease ◽

Respiratory Illness ◽

Maculopapular Rash ◽

Skin Lesions ◽

Cross Sectional Study ◽

Cross Sectional ◽

Cutaneous Manifestations ◽

Skin Manifestations ◽

Indian Scenario

Background: COVID-19, initially started as respiratory illness and evolved to involve various systems. Skin has been the least targeted organ with manifestations limited to case reports and series in a foreign scenario. Here, we tried to understand a same in an Indian scenario.Methods: This was cross-sectional study done in district COVID centre among patients with a confirmed diagnosis of COVID-19 with cutaneous manifestations for 3 months. A detailed history, complete cutaneous examination was carried out. Timing in relation to other symptoms and severity was assessed.Results: Among the 1603 patients, 39 (2.4%) had skin manifestations. Urticaria (20.5%), petechiae/purpura (17.9%), pruritis (15.4%) were the most common followed by maculo-papular rash (7.7%), manifestations secondary to drugs (7.7%), diffuse hair fall (7.7%), pseudo-chilblains (5.1%), vesicular eruptions (5.1%), infections (5.1%), cellulitis, gangrene and livedoid vasculitis. Timing of skin lesions ranged from 2 days before (10.3%) onset of COVID-19 symptoms or diagnosis to 10 days after (69.2%). Urticaria, petechiae, maculopapular rash were seen more commonly in patients with fever and respiratory symptoms. Asymptomatic cases showed urticaria, petechiae and pseudo-chilblains. Majority were in mild and moderate disease and livedoid vasculitis patient had severe disease.Conclusions: Skin manifestations in COVID-19 are relatively uncommon in Indian scenario. However, few of the manifestations give a hint of infection while some correlate with the severity of disease.

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REACT-1 round 8 final report: high average prevalence with regional heterogeneity of trends in SARS-CoV-2 infection in the community in England during January 2021

10.1101/2021.01.28.21250606 ◽

2021 ◽

Cited By ~ 2

Author(s):

Steven Riley ◽

Oliver Eales ◽

Caroline E. Walters ◽

Haowei Wang ◽

Kylie E. C. Ainslie ◽

...

Keyword(s):

At Risk ◽

Severe Disease ◽

Care Home ◽

Healthcare Services ◽

Final Report ◽

Regional Heterogeneity ◽

Cross Sectional ◽

Asian Ethnicity ◽

Deprived Neighbourhoods ◽

East Midlands

AbstractIn early January 2021, England entered its third national lockdown of the COVID-19 pandemic to reduce numbers of deaths and pressure on healthcare services, while rapidly rolling out vaccination to healthcare workers and those most at risk of severe disease and death. REACT-1 is a survey of SARS-CoV-2 prevalence in the community in England, based on repeated cross-sectional samples of the population. Between 6th and 22nd January 2021, out of 167,642 results, 2,282 were positive giving a weighted national prevalence of infection of 1.57% (95% CI, 1.49%, 1.66%). The R number nationally over this period was estimated at 0.98 (0.92, 1.04). Prevalence remained high throughout, but with suggestion of a decline at the end of the study period. The average national trend masked regional heterogeneity, with robustly decreasing prevalence in one region (South West) and increasing prevalence in another (East Midlands). Overall prevalence at regional level was highest in London at 2.83% (2.53%, 3.16%). Although prevalence nationally was highest in the low-risk 18 to 24 year old group at 2.44% (1.96%, 3.03%), it was also high in those over 65 years who are most at risk, at 0.93% (0.82%, 1.05%). Large household size, living in a deprived neighbourhood, and Black and Asian ethnicity were all associated with higher levels of infections compared to smaller households, less deprived neighbourhoods and other ethnicities. Healthcare and care home workers, and other key workers, were more likely to test positive compared to other workers. If sustained lower prevalence is not achieved rapidly in England, pressure on healthcare services and numbers of COVID-19 deaths will remain unacceptably high.

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Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0211140 ◽

2019 ◽

Vol 14 (2) ◽

pp. e0211140

Author(s):

Alex L. Barwick ◽

Sheree E. Hurn ◽

Jaap J. van Netten ◽

Lloyd F. Reed ◽

Peter A. Lazzarini

Keyword(s):

At Risk ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Foot Ulceration ◽

Factors Associated ◽

Populations At Risk

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Knowledge, attitude and practice regarding dengue infection among parents of children hospitalized for dengue fever

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181509 ◽

2018 ◽

Vol 5 (3) ◽

pp. 893 ◽

Cited By ~ 1

Author(s):

Srinivasa S. ◽

Harish S. ◽

Shruthi Patel ◽

Ranganatha A. Devaranavadagi ◽

Bhavya G. ◽

...

Keyword(s):

Dengue Fever ◽

Severe Disease ◽

Dengue Infection ◽

Signs And Symptoms ◽

Bed Nets ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Preventive Practices ◽

Health Care Burden ◽

And Behavior

Background: Dengue fever is a rapidly emergent infection and is one of the leading causes of hospitalization and health care burden in India. Dengue vectors, human knowledge and behavior have each been reported to play an important role in the transmission of the disease. This study is aimed at assessing the knowledge regarding dengue fever, its transmission, identification of the disease and its complications and its preventive measures among the parents.Methods: This is a hospital based cross sectional survey among parents of dengue patients admitted in Department of Pediatrics, KIMS Bangalore during a period of 6 months. Parents were interviewed with pre-designed questionnaire. The questionnaire was divided into 4 parts-knowledge on 1) transmission, 2) signs and symptoms, 3) attitude towards the illness and 4) practices of prevention and treatment.Results: Overall 195 individuals were interviewed. 7% were illiterate while 17% had a college degree. 91% individuals knew mosquito as the vector, 32% identified clear stagnant water as the breeding place. 88% identified fever as a symptom while 22% knew about bleeding manifestations. 71% felt dengue as a severe disease and 84% had a positive attitude towards consulting a doctor for the illness. 58% relied on mats and coils for personal protection followed by bed nets (12%). Majority of the awareness was through television followed by radio and newspapers.Conclusions: It is of utmost significance to identify barriers to action and to seek ways to translate the knowledge of population about dengue into positive preventive practices that would ultimately reduce the transmission of dengue fever in the community.

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