Cutaneous anthrax outbreak associated with handling dead animals, Rhino Camp sub-county: Arua District, Uganda, January–May 2018

Abstract Background On 18 January 2018 a 40 year old man presented with skin lesions at Rhino Camp Health Centre. A skin lesion swab was collected on 20 January 2018 and was confirmed by PCR at Uganda Virus Research Institute on 21 January 2018. Subsequently, about 9 persons were reported to have fallen ill after reporting contact with livestock that died suddenly. On 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. We investigated to determine the scope and mode of transmission and exposures associated with identified anthrax to guide control and prevention measures. Methods We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December 2017 to 31 May 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test. Results We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (affected proportion: 12/10,000). Mean age of case-persons was 33 years (SD: 22). The outbreak lasted for 5 months, from January 2018–May 2018, peaking in February. Skinning (risk ratio = 2.7, 95% CI = 1.1–6.7), dissecting (RR = 3.0, 95% CI = 1.2–7.6), and carrying dead animals (RR = 2.7, 95% CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of animals (RR = 2.9, 95% CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95% CI 0.9–5.9). We found evidence of animal remains on pastureland. Conclusion Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

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Cutaneous Anthrax Outbreak Associated with Handling Dead Animals, Rhino Camp Sub-county: Arua District, Uganda, January-May 2018

10.21203/rs.3.rs-38244/v3 ◽

2020 ◽

Author(s):

Vivian Ntono ◽

Daniel Eurien ◽

Lilian Bulage ◽

Daniel Kadobera ◽

Julie Harris ◽

...

Keyword(s):

Health Workers ◽

Clinical Sample ◽

Health Centre ◽

Skin Lesions ◽

Suspected Case ◽

Prevention Measures ◽

Epidemic Curve ◽

Multiple Exposures ◽

Increased Risk ◽

Cutaneous Anthrax

Abstract Background: On the 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. About 9 persons fell ill after reported contact with livestock that died suddenly. We investigated to determine the scope, mode of transmission and exposures associated with identified anthrax, to guide control and prevention measures.Methods: We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December, 2017 to 31 May, 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test.Results: We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (AR: 12/10,000). Mean age of case-persons was 33years (SD: 22).The epidemic curve shows that the outbreak lasted for 5 months, from January 2018-May 2018, peaking in February.Skinning(RR=2.7, 95%CI=1.1-6.7), dissecting (RR=3.0, 95%CI=1.2-7.6), and carrying the dead animals (RR=2.7, 95%CI=1.1-6.7) were associated with increased risk of illness, as were carrying dissected parts of the animal (RR=2.9, 95%CI 1.3-6.5) and preparing and cooking the meat (RR=2.3, 95%CI 2.7-8.1). We found evidence of animal remains on pastureland.Conclusion: Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

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Cutaneous Anthrax Outbreak Associated with Handling Dead Animals, Rhino Camp Sub-county: Arua District, Uganda, January-May 2018

10.21203/rs.3.rs-38244/v1 ◽

2020 ◽

Author(s):

Vivian Ntono ◽

Daniel Eurien ◽

Lilian Bulage ◽

Daniel Kadobera ◽

Julie Harris ◽

...

Keyword(s):

Health Workers ◽

Clinical Sample ◽

Health Centre ◽

Skin Lesions ◽

Suspected Case ◽

Prevention Measures ◽

Epidemic Curve ◽

Multiple Exposures ◽

Increased Risk ◽

Cutaneous Anthrax

Abstract BackgroundOn the 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. Many persons fell ill after reported contact with livestock that died suddenly. We investigated to determine the scope, mode of transmission and exposures associated with identified anthrax, to guide control and prevention measures.MethodsWe defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December, 2017 to 31 May, 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test.ResultsWe identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (AR: 12/10,000). Mean age of case-persons was 33 years (SD: 22).The epidemic curve shows that the outbreak lasted for 5 months, from January 2018-May 2018, peaking in February.Skinning(RR = 2.7, 95%CI = 1.1–6.7), dissecting (RR = 3.0, 95%CI = 1.2–7.6), and carrying the dead animals (RR = 2.7, 95%CI = 1.1–6.7) were associated with increased risk of illness, as were carrying dissected parts of the animal (RR = 2.9, 95%CI 1.3–6.5) and preparing and cooking the meat (RR = 2.3, 95%CI 2.7–8.1). We found evidence of animal remains on pastureland.ConclusionMultiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

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Cutaneous Anthrax Outbreak Associated with Handling Dead Animals, Rhino Camp Sub-county: Arua District, Uganda, January-May2018

10.21203/rs.3.rs-38244/v2 ◽

2020 ◽

Author(s):

Vivian Ntono ◽

Daniel Eurien ◽

Lilian Bulage ◽

Daniel Kadobera ◽

Julie Harris ◽

...

Keyword(s):

Health Workers ◽

Clinical Sample ◽

Health Centre ◽

Skin Lesions ◽

Suspected Case ◽

Prevention Measures ◽

Epidemic Curve ◽

Multiple Exposures ◽

Increased Risk ◽

Cutaneous Anthrax

Abstract Background: On the 9 February 2018, Arua District notified Uganda Ministry of Health of a confirmed anthrax outbreak among humans in Rhino Camp sub-county. Many persons fell ill after reported contact with livestock that died suddenly. We investigated to determine the scope, mode of transmission and exposures associated with identified anthrax, to guide control and prevention measures. Methods: We defined a suspected cutaneous anthrax case as onset of skin lesions (e.g., papule, vesicle, or eschar) in a person residing in Rhino Camp sub-county, Arua District from 25 December, 2017 to 31 May, 2018. A confirmed case was a suspected case with PCR-positivity for Bacillus anthracis from a clinical sample. We identified cases by reviewing medical records at Rhino Camp Health Centre. We also conducted additional case searches in the affected community with support from Community Health Workers. In a retrospective cohort study, we interviewed all members of households in which at least one person had contact with the carcasses of or meat from animals suspected to have died of anthrax. We collected and tested hides of implicated animals using an anthrax rapid diagnostic test.Results: We identified 14 case-patients (1 confirmed, 13 suspected); none died. Only males were affected (AR: 12/10,000). Mean age of case-persons was 33years (SD: 22).The epidemic curve shows that the outbreak lasted for 5 months, from January 2018-May 2018, peaking in February.Skinning(RR=2.7, 95%CI=1.1-6.7), dissecting (RR=3.0, 95%CI=1.2-7.6), and carrying the dead animals (RR=2.7, 95%CI=1.1-6.7) were associated with increased risk of illness, as were carrying dissected parts of the animal (RR=2.9, 95%CI 1.3-6.5) and preparing and cooking the meat (RR=2.3, 95%CI 2.7-8.1). We found evidence of animal remains on pastureland.Conclusion: Multiple exposures to the hides and meat of animals that died suddenly were associated with this cutaneous anthrax outbreak in Arua District. We recommended public education about safe disposal of carcasses of livestock that die suddenly.

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SARS-CoV-2 screening prevalence in educational staff in Berlin, Germany, June-December 2020

10.1101/2021.05.19.21257452 ◽

2021 ◽

Author(s):

Sophia Kindzierski ◽

Welmoed van Loon ◽

Johanna Theuring ◽

Franziska Hommes ◽

Eberhard Thombansen ◽

...

Keyword(s):

Infection Prevalence ◽

Occupational Hazards ◽

Prevention Measures ◽

School Settings ◽

Occupational Risks ◽

Increased Risk ◽

Control And Prevention ◽

Educational Staff ◽

Infection Control And Prevention ◽

Pandemic Wave

SARS-CoV-2 infections in childcare and school settings potentially bear occupational risks to educational staff. We analyzed data derived from voluntary, PCR-based screening of childcare educators and teachers attending five testing sites in Berlin, Germany, between June and December 2020. Within seven months, 17,491 tests were performed (4,458 educators, 13,033 teachers). Participants were largely female (72.9%), and median age was 41 years. Overall, SARS-CoV-2 infection prevalence was 1.2% (95%CI, 1.1-1.4%). Prevalence in educational staff largely resembled community incidence until the start of the second pandemic wave in mid-September 2020, when an unsteady prevalence plateau was reached. Then, infection prevalence in teachers (1.2% [95%CI, 0.8-1.8%]) did not significantly differ from the population prevalence (0.9% [0.6-1.4%]) but it was increased in educators (2.6% [1.6-4.0%]; aOR, 1.6 [1.3-2.0]). Irrespective of occupation, those that reported contact to a confirmed SARS-CoV-2 case outside of work had increased risk of infection (aOR, 3.0 [95%CI, 1.5-5.5]). In a step-wise backwards selection, the best set of associated factors with SARS-CoV-2 infection involved age, occupation, and calendar week. These results are in line with findings that teachers do not bear an increased risk of SARS-CoV-2 infection, while childcare educators do. Infection control and prevention measures need to be strengthened in child care settings to further reduce respective occupational hazards. At the same time, the private environment appears to be the main source of SARS-CoV-2 infection for educational staff.

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Outbreak of cutaneous anthrax in Musalimadugu village, Chittoor district, Andhra Pradesh, India, July-August 2011

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2635 ◽

2012 ◽

Vol 6 (10) ◽

pp. 695-699 ◽

Cited By ~ 9

Author(s):

Ramesh Reddy ◽

Geetha Parasadini ◽

Prasada Rao ◽

Chengappa K Uthappa ◽

Manoj V Murhekar

Keyword(s):

Risk Factors ◽

Attack Rate ◽

Andhra Pradesh ◽

Community Education ◽

Population Attributable Fraction ◽

Skin Lesions ◽

Suspected Case ◽

Gram Staining ◽

Potential Risk Factors ◽

Cutaneous Anthrax

Background: In August 2011, Chittoor district authorities reported a cluster of suspected human anthrax cases, to Andhra Pradesh state surveillance unit. We investigated this cluster to confirm its etiology, describe its magnitude, identify potential risk-factors and make recommendations for preventing similar outbreaks in future. Methods: We searched for suspected cutaneous anthrax cases defined as a painless skin lesion (papule, vesicle or eschar) that appeared between July-August 2011 in resident of Musalimadugu. We collected information about clinical details as well as smears from skin lesions from suspected case-patients and described the outbreak by time, place and person.We conducted a retrospective cohort study among villagers aged ≥ 15 years to identify risk factors for acquiring the infection. Results: During 24 June-7August 2011, 16 livestock in the village died. Smears from 5 animals showed gram positive, spore bearing, bacillus characteristic of Bacillus anthracis. Villagers butchered and skinned the dead animals, sold the skin and consumed the meat after boiling it for 2 hours. The outbreak in humans started on 30 July, and 9 suspected cases of cutaneous anthrax (attack rate: 2%, no deaths) occurred till 7 August. The attack rate was higher among those aged 15 years or more. All the smears were negative on gram staining. Persons who had handled [Relative risk (RR): 56, 95% confidence interval (CI): 8.4 -571.8, population attributable fraction (PAF): 87%)], skinned (RR: 28, 95% CI: 8.4-93, PAF=54%) and slaughtered (RR: 21, 95% CI: 6.5-68.4, PAF: 42%) dead animals were at higher risk. Conclusions: We recommended ciprofloxacin prophylaxis to close family contacts, community education to avoid slaughtering of dead/ ill livestock and vaccination of the livestock in the area.

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COVID-19 and Its Symptoms’ Panoply: A Case-Control Study of 919 Suspected Cases in Locked-Down Ovar, Portugal

Portuguese Journal of Public Health ◽

10.1159/000514925 ◽

2021 ◽

pp. 1-8

Author(s):

Regina Sá ◽

Tiago Pinho-Bandeira ◽

Guilherme Queiroz ◽

Joana Matos ◽

João Duarte Ferreira ◽

...

Keyword(s):

Large Scale ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Case Definition ◽

Suspected Case ◽

Risk Characteristics ◽

Increased Risk ◽

Wide Range ◽

Control Study

Background: Ovar was the first Portuguese municipality to declare active community transmission of SARS-CoV-2, with total lockdown decreed on March 17, 2020. This context provided conditions for a large-scale testing strategy, allowing a referral system considering other symptoms besides the ones that were part of the case definition (fever, cough, and dyspnea). This study aims to identify other symptoms associated with COVID-19 since it may clarify the pre-test probability of the occurrence of the disease. Methods: This case-control study uses primary care registers between March 29 and May 10, 2020 in Ovar municipality. Pre-test clinical and exposure-risk characteristics, reported by physicians, were collected through a form, and linked with their laboratory result. Results: The study population included a total of 919 patients, of whom 226 (24.6%) were COVID-19 cases and 693 were negative for SARS-CoV-2. Only 27.1% of the patients reporting contact with a confirmed or suspected case tested positive. In the multivariate analysis, statistical significance was obtained for headaches (OR 0.558), odynophagia (OR 0.273), anosmia (OR 2.360), and other symptoms (OR 2.157). The interaction of anosmia and odynophagia appeared as possibly relevant with a borderline statistically significant OR of 3.375. Conclusion: COVID-19 has a wide range of symptoms. Of the myriad described, the present study highlights anosmia itself and calls for additional studies on the interaction between anosmia and odynophagia. Headaches and odynophagia by themselves are not associated with an increased risk for the disease. These findings may help clinicians in deciding when to test, especially when other diseases with similar symptoms are more prevalent, namely in winter.

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Knowledge and practices regarding malaria and the National Treatment Guidelines among public health workers in Equatorial Guinea

Malaria Journal ◽

10.1186/s12936-020-03528-7 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Marta Blanco ◽

Pablo Suárez-Sanchez ◽

Belén García ◽

Jesús Nzang ◽

Policarpo Ncogo ◽

...

Keyword(s):

Public Health ◽

Treatment Guidelines ◽

Health Workers ◽

Health Centre ◽

Regional Hospital ◽

Malaria Treatment ◽

Diagnosis And Treatment ◽

Equatorial Guinea ◽

Public Health Facilities ◽

Health Centres

Abstract Background In 2018, an estimated 228 million cases of malaria occurred worldwide. Countries are far from having achieved reasonable levels of national protocol compliance among health workers. Lack of awareness of treatment protocols and treatment resistance by prescribers threatens to undermine progress when it comes to reducing the prevalence of this disease. This study sought to evaluate the degree of knowledge and practices regarding malaria diagnosis and treatment amongst prescribers working at the public health facilities of Bata, Equatorial Guinea. Methods A cross-sectional survey was conducted in October-December 2017 amongst all public health professionals who attended patients under the age of 15 years, with suspected malaria in the Bata District of Equatorial Guinea. Practitioners were asked about their practices and knowledge of malaria and the National Malaria Treatment Guidelines. A bivariate analysis and a logistic regression model were used to determine factors associated with their knowledge. Results Among the 44 practitioners interviewed, 59.1% worked at a Health Centre and 40.9% at the District Hospital of Bata. Important differences in knowledge and practices between hospital and health centre workers were found. Clinical diagnosis was more frequently by practitioners at the health centres (p = 0.059), while microscopy confirmation was more frequent at regional hospital (100%). Intramuscular artemether was the anti-malarial most administrated at the health centres (50.0%), while artemether-lumefantrine was the treatment most used at the regional hospital (66.7%). Most practitioners working at public health facilities (63.6%) have a low level of knowledge regarding the National Malaria Treatment Guidelines. While knowledge regarding malaria, the National Malaria Treatment Guidelines and treatment resistances is low, it was higher amongst hospital workers than amongst practitioners at health centres. Conclusions It is essential to reinforce practitioners’ knowledge, treatment and diagnosis practices and use of the National Malaria Treatment Guidelines in order to improve malaria case management and disease control in the region. A specific malaria training programme ensuring ongoing updates training is necessary in order to ensure that greater experience does not entail obsolete knowledge and, consequently, inadequate diagnosis and treatment practices.

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Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

BMC Health Services Research ◽

10.1186/s12913-021-06151-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mtisunge Joshua Gondwe ◽

Marc Y. R. Henrion ◽

Thomasena O’Byrne ◽

Clemens Masesa ◽

Norman Lufesi ◽

...

Keyword(s):

Clinical Diagnosis ◽

Health Workers ◽

Health Centre ◽

Treatment Algorithm ◽

Secondary Level ◽

Support Staff ◽

Health Care Facilities ◽

Severe Illness ◽

Primary Health ◽

Sick Children

Abstract Background Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses. Methods We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions. Results Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility. Conclusions Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

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Survey of Saliva Components and Virus Sensors for Prevention of COVID-19 and Infectious Diseases

Biosensors ◽

10.3390/bios11010014 ◽

2020 ◽

Vol 11 (1) ◽

pp. 14

Author(s):

Priya Dave ◽

Roberto Rojas-Cessa ◽

Ziqian Dong ◽

Vatcharapan Umpaichitra

Keyword(s):

Infectious Diseases ◽

Dental Health ◽

The United States ◽

Human Saliva ◽

Field Application ◽

Future Research ◽

Prevention Measures ◽

Control And Prevention ◽

Close Distance

The United States Centers for Disease Control and Prevention considers saliva contact the lead transmission mean of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19). Saliva droplets or aerosols expelled by sneezing, coughing, breathing, and talking may carry this virus. People in close distance may be exposed directly to these droplets or indirectly when touching the droplets that fall on surrounding surfaces and ending up contracting COVID-19 after touching the mucosa tissue of their faces. It is of great interest to quickly and effectively detect the presence of SARS-CoV-2 in an environment, but the existing methods only work in laboratory settings, to the best of our knowledge. However, it may be possible to detect the presence of saliva in the environment and proceed with prevention measures. However, detecting saliva itself has not been documented in the literature. On the other hand, many sensors that detect different organic components in saliva to monitor a person’s health and diagnose different diseases, ranging from diabetes to dental health, have been proposed and they may be used to detect the presence of saliva. This paper surveys sensors that detect organic and inorganic components of human saliva. Humidity sensors are also considered in the detection of saliva because a large portion of saliva is water. Moreover, sensors that detect infectious viruses are also included as they may also be embedded into saliva sensors for a confirmation of the presence of the virus. A classification of sensors by their working principles and the substances they detect is presented, including the sensors’ specifications, sample size, and sensitivity. Indications of which sensors are portable and suitable for field application are presented. This paper also discusses future research and challenges that must be resolved to realize practical saliva sensors. Such sensors may help minimize the spread of not only COVID-19 but also other infectious diseases.

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Migrants’ Quarantine and COVID-19 Pandemic in Italy: a Medico-anthropological View

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00993-2 ◽

2021 ◽

Author(s):

Silvia Di Meo ◽

Enrico Bentivegna

Keyword(s):

Risk Factor ◽

Global Health ◽

Infection Control ◽

Social Inequalities ◽

Patient Relationship ◽

Prevention Measures ◽

Cultural Aspects ◽

Health Response ◽

Control And Prevention ◽

Infection Control And Prevention

AbstractThe COVID-19 pandemic represents an important risk factor for migrants’ health. Paul Farmer highlighted the risk of global health response in emergency conditions exacerbating global and social inequalities. We argue that this is the case for quarantine ships and migrants’ management during the pandemic. Every aspect of infection-control and prevention measures acquires detention characteristics in these situations. With emphasis to the evolution of the doctor-patient relationship and to the anthropological and cultural aspects that were established during the pandemic, this article aims to provide an integrated view where physicians and anthropologists collaborate to deepen the understanding of the topic.

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