Human parasitism by the exotic tick Dermacentor variabilis (Parasitiformes: Ixodida) in Brazil: report of an imported case

In June 2012, a tick was found parasitizing a man in the city of São Paulo, who had recently returned from a visit to Pennsylvania, in the northeast of the United States. The tick was removed and sent to the São Paulo State Department of Health, where it was identified as a male of the species Dermacentor variabilis (Say, 1821), according to the literature and taxonomic keys. The tick was subjected to a PCR test to search for rickettsiae, but the result was negative. The fact that a human entered Brazilian territory unaware that he was parasitized by a hard tick not belonging to the national tick fauna is significant because of the possibility that an exotic species could be introduced and take hold in this country. Another major risk to public health is that this arthropod could be infected with the bacterium Rickettsia rickettsii, as this ectoparasite is the main vector of Spotted Fever on the East Coast of North America.

Cross-Border Malaria Drivers and Risk Factors on the Brazil-Venezuela Border Between 2016 and 2018

Background Globally, cross-border importation of malaria has become a challenge to malaria elimination. The border areas between Brazil and Venezuela have experienced high numbers of imported cases due to increased population movement and migration out of Venezuela. This study aimed to identify risk factors for imported malaria and delineate imported malaria hotspots in Roraima, Brazil and Bolivar, Venezuela between 2016 and 2018.MethodsData on malaria surveillance cases from Roraima, Brazil and Bolivar, Venezuela from 2016 to 2018 were obtained from national surveillance systems: the Brazilian Malaria Epidemiology Surveillance Information System (SIVEP-Malaria), the Venezuelan Ministry of Health and other non-government organizations. A multivariable logistic regression model was used to identify the risk factors for imported malaria. Spatial autocorrelation in malaria incidence was explored using Getis-Ord (Gi*) statistics.ResultsDuring the study period, there were 11,270 (24.3%) and 4,072 (0.7%) imported malaria cases in Roraima, Brazil and Bolivar, Venezuela, respectively. In the multivariable logistic regression for Roraima, men were 28% less likely to be an imported case compared to women (Adjusted Odds Ratio [AOR]= 0.72; 95% confidence interval [CI] 0.665, 0.781). Ages 20-29 and 30-39 were 90% (AOR=1.90; 95% CI 1.649, 2.181) and 54% (AOR=1.54; 95% CI 1.331, 1.782) more likely to be an imported case compared to the 0-9 year age group, respectively. Imported cases were 197 times (AOR=197.03; 95% CI 175.094, 221.712) more likely to occur in miners than those working in agriculture and domestic work. In Bolivar, cases aged 10-19 (AOR=1.75; 95% CI 1.389, 2.192), 20-29 (AOR=2.48; 95% CI 1.957, 3.144), and 30-39 (AOR=2.29; 95% CI 1.803, 2.913) were at higher risk of being an imported case than those in the 0-9 year old group, with older age groups having a slightly higher risk compared to Roraima. Compared to agriculture and domestic workers, tourism, timber and fishing workers (AOR=6.38; 95% CI 4.393, 9.254) and miners (AOR=7.03; 95% CI 4.903, 10.092) were between six and seven times more likely to be an imported case. Spatial analysis showed the risk was higher along the international border in the municipalities of Roraima, Brazil.ConclusionTo achieve malaria elimination, cross-border populations in the hotspot municipalities will need targeted intervention strategies tailored to occupation, age and mobility status. Furthermore, all stakeholders, including implementers, policymakers, and donors, should support and explore the introduction of novel approaches to address these hard-to-reach populations with the most cost-effective interventions.

An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.

Strategi Alokasi Anggaran Dinas Kesehatan Kota Bogor Di Era Covid-19

Kewenangan pemerintah daerah dalam Pemerintah Pengganti Undang-Undang Nomor 1 Tahun 2020 adalah Pemerintah Daerah diberikan kewenangan untuk melakukan pengutamaan penggunaan alokasi anggaran untuk kegiatan tertentu (refocusing). Salah satu daerah di Indonesia yang terdampak Covid-19 adalah Kota Bogor, Kota Bogor merupakan salah satu kota yang dekat dengan Ibukota dan menjadi salah satu kota dengan penularan melalui imported case yang berasal dari luar daerah. Proporsi anggaran kesehatan Kota Bogor di tahun 2020 yang diprioritaskan untuk penanggulangan Covid-19. Tujuan penelitian ini menjelaskan keadaan anggaran Dinas Kesehatan Kota Bogor saat Covid-19 dan menjelaskan penggunaan anggaran Covid-19 sesuai dengan tujuan serta merumuskan strategi alokasi anggaran Dinas Kesehatan berdasarkan anggaran yang ada. Jenis dtaa yang digunakan dalam penelitian ini adalah data primer yang diperoleh melalui wawancara mendalam dengan pengambil kebajikan yang terkait dengan menggunakan kuesioner Analytical Hierarchy Process (AHP) dan data sekunder diperoleh dari Dinas Kesehatan, Badan Perencanaan dan Pembangunan Daerah dan Badan Keuangan Aset Daerah Kota Bogor.

A Clinical Comparison of Imported or Locally Acquired COVID-19 Suggests Declining Severity after Viral Passages at the Early Stage of the Pandemic in China

Objective: This retrospective, two-center study aimed to provide solid clinical evidence to support the viral attenuation theory after passages of SARS-CoV-2 during the early stages of the pandemic. Methods: Clinical characteristics and outcomes of 150 COVID-19 patients hospitalized in Wenzhou, China between January and April 2020 were compared. These patients had similar demographic characteristics. Infections of 77 patients who visited Wuhan within 14 days before symptom onset were categorized as imported cases and that of the remaining 73 patients who had no recent travel history were categorized as locally transmitted cases. Results: COVID-19 cases in Wenzhou appeared to be mostly mild at the early stages of the pandemic. There were no differences in clinical manifestations, laboratory testing results, and radiographic presentation between imported and locally transmitted cases in Wenzhou, except that a higher proportion of lymphopenia was found in the imported case group. Assessment of infection severity showed that severe conditions were observed in 10.7% of the patients, with the imported case group having a significantly higher rate (15.6%) than the locally transmitted case group (5.5%, x2 = 4.016, p = 0.045). Conclusion: Although, the clinical manifestations of locally acquired infections were indistinguishable from those imported from Wuhan, they were less likely to develop into severe medical conditions, suggesting the possibility of virulence attenuation after viral passages during the early stages of the pandemic.

Whole genome sequences of Treponema pallidum subsp. endemicum isolated from Cuban patients: the non-clonal character of isolates suggests a persistent human infection rather than a single outbreak

Bejel (endemic syphilis) is a neglected non-venereal disease caused by Treponema pallidum subsp. endemicum (TEN). Although it is mostly present in hot, dry climates, a few cases have been found outside of these areas. The aim of this work was the sequencing and analysis of TEN isolates obtained from "syphilis patients" in Cuba, which is not considered an endemic area for bejel. Genomes were obtained by pool segment genome sequencing or direct sequencing methods, and the bioinformatics analysis was performed according to an established pipeline. We obtained four genomes with 100%, 81.7%, 52.6%, and 21.1% of broad coverage, respectively. The sequenced genomes revealed a non-clonal character, with nucleotide variability ranging between 0.2–10.3 nucleotide substitutions per 100 kbp among the TEN isolates. Nucleotide changes affected 27 genes, and the analysis of the completely sequenced genome also showed a recombination event between tprC and tprI, in TP0488 as well as in the intergenic region between TP0127–TP0129. Despite limitations in the quality of samples affecting broad sequencing coverage, the determined non-clonal character of the isolates suggests a persistent infection in the Cuban population rather than a single outbreak caused by imported case.

Case report of the first cured patient with Mycobacterium Chimaera infection following cardiac valve replacement in the mainland of China

Background Mycobacterium chimaera infections subsequent to cardiac surgery are related to contaminated heater-cooler devices, with high mortality. Nevertheless, few studies have been reported in Asia. Case presentation We described the case of a 55-year-old man with Mycobacterium chimaera infection following cardiac surgery in the mainland of China. He was diagnosed with endocarditis caused by Mycobacterium chimaera subsequent to open heart surgery. Metagenomic next-generation sequencing (mNGS) and 16S rRNA gene PCR analysis were used to identify potential pathogens. The patient underwent redo valve replacement surgery and received combination therapy with azithromycin, ethambutol, linezolid, and amikacin. No signs of relapse were observed during the 11-month follow-up visit. Conclusions This is the first documented case of Mycobacterium chimaera infection following cardiac surgery in the mainland of China and the first documented transnational imported case worldwide. Moreover, mNGS is a novel diagnostic technology that can guide antimicrobial therapy prior to obtaining fluid/tissue culture results for Mycobacterium chimaera, providing a new approach for the detection of potential Mycobacterium chimaera infection.

Changing Transmission Dynamics Among Migrant, Indigenous and Mining Populations in a Malaria Hotspot in Northern Brazil: 2016 to 2020

Background Roraima state is the northernmost state in Brazil and the primary border-crossing point between Brazil and Venezuela. The uncontrolled surge of malaria in Venezuela, coupled with mass migration of Venezuelans to and from neighbouring countries and the uptick in informal mining in Roraima state, pose a serious threat to the broader region, especially to migrant, indigenous and mining populations, jeopardizing malaria elimination efforts. This study describes changes in the epidemiological profile of malaria in Roraima State related to time, place and populations at risk from 2016 to 2020. Methods De-identified malaria surveillance data were obtained from the Malaria Epidemiological Surveillance System from 2016 to 2020. Pearson’s chi-square tested different between imported and autochthonous cases. Multivariable logistic regression was used to identify risk factors for imported versus autochthonous cases by demographic characteristics. Results Odds of being an imported case were higher Plasmodium falciparum cases (AOR = 2.08). However, as the number of cases from Venezuela decreased in 2020 following closure of the border, the proportion of Plasmodium falciparum cases increased markedly, from 6.24% in 2019 to 18.50% in 2020. Over the 5-year period, the odds of being an imported case among miners were about nine times higher than the general population (AOR = 8.99). The proportion of total malaria cases that were among indigenous people increased from 33.09% in 2016 to 54.83% in 2020. Indigenous children had a higher burden of malaria with over 40% of cases in children 0 to 9 years old, compared to 8% in non-indigenous children 0 to 9 years old. In some municipalities, place of infection differed from place of notification, with a large proportion of cases in these municipalities reporting in Boa Vista. Conclusions Malaria remains a serious threat in Roraima state, especially among high-risk populations, such as miners, migrants, and indigenous people. As malaria cases have increased among indigenous people, miners, and the proportion of Plasmodium falciparum cases has increased, elimination efforts require understanding of these risk factors to tailor interventions appropriately. Furthermore, cross-border surveillance systems need to be urgently strengthened at formal and unofficial border points, especially since the border with Venezuela reopened in July 2021.

Study Of Malaria Cases Among Seafarers In Croatia And The Causes Of Ineffective Chemoprophylaxis Among Them

Introduction: Malaria in Croatia was endemic until 1954, when the last autochthonous cases were reported. Now we have imported cases and the disease still most commonly affects seafarers and workers temporarily employed in malaria endemic countries. The aim of this study was to investigate ineffective malaria chemoprophylaxis among Croatian seafarers. Materials and methods: This study used the data collected by questionnaires that followed every imported case of malaria in Croatia. In addition, a survey was conducted among the seafarers attending the Special education program at the Faculty of Maritime Studies in Split, regarding their attitudes / reasons for not using chemoprophylaxis using a short questionnaire. Results: From the 1st January 2007 to 31st December 2019 there was a total of 108 imported malaria cases in Croatia, of which 22 (20.37%) referred to seafarers. In situations reporting the information whether the infected seafarers used chemoprophylaxis, twenty seafarers (91% of the overall infected) responded that they had not used chemoprophylaxis, while two of them (9.0%) responded that they had used it incorrectly. Conclusion: It appears that the main reason for avoiding chemoprophylaxis is the fear of side-effects. Some of the respondents, particularly the young ones, stated that they were not vaccinated – which is a proof of ignorance, as the vaccine does not exist. How to familiarise and motivate maritime students and seafarers to participate actively in protection against malaria – this is an issue that is important not only in Croatia but, presumably, in other countries as well.