Endemic Areas
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2021 ◽  
Wolfgang Bender

Japanese Encephalitis (JE) is an endemic vector-borne (mosquitoes) zoonotic flavivirus disease in Asia with severe neurological manifestations (case fatality rate CFR 20–30%; 30–50% of survivors with serious sequelae). Japanese Encephalitis Virus (JEV) is the leading cause of viral encephalitis in Asia and exposes an estimated 3 billion people to the risk of infection. Other regions of the world have conditions suiting JEV without circulation of the virus (yet). Most JEV infections are asymptomatic or only cause mild symptoms. 1 in 250 infections progresses to severe disease for which no specific treatment is yet available. Neutralizing antibodies develop after infection. In endemic areas this occurs usually during childhood followed by subclinical re-exposure with life-long immunity protecting against disease. Disease in adult populations in endemic areas is rare. General prevention includes avoidance of mosquito bites, e.g., repellents, long-sleeved clothes, coils and vaporizers. Vaccine prevention: Neutralizing antibodies (PRNT50 titer ≥ 1:10) is the correlate of protection. Vaccines currently used are live attenuated JE vaccines and recombinant chimeric JE vaccines (mostly in endemic countries) and cell culture-derived inactivated JE vaccines (travelers, endemic countries). As animal reservoirs of the JEV cannot be eradicated, universal vaccination of humans can control the disease in humans. Optimal JE control in endemic countries is limited by issues around vaccine supply, surveillance (burden of disease underestimation), and resource competition / prioritization.

Gupta Umesh Prasad ◽  
Bhandari Amrit ◽  
Giri Dhruba ◽  
Adhikari Sushmita ◽  
Paudel Sangita ◽  

Sickle cell disease (SCD) is prevalent in malaria-endemic areas because the gene for sickle cell provides its carrier with resistance against malaria. In Nepal, malaria is prevalent in Terai, hence the susceptibility of SCD is high in this region. Being indigenous to the Terai, thousands of people in the Tharu communities of the Banke districting Nepal are believed to have suffered from sickle cell disease. The objective of this study was to find out the status of sickle cell disease among the Tharu population of Banke district, Nepal. A cross-sectional, experimental study was performed among systematically randomly selected 275 samples from 3 Village Development Committee (VDCs). All the samples were first screened for the presence of sickle hemoglobin using the sickle solubility test method in Bheri Zonal Hospital. Then all sickle solubility positive samples were further processed for alkaline hemoglobin electrophoresis by using Interlab GenioS electrophoresis instrument. Out of a total 275 samples, 33 (12.0%) samples were confirmed as sickle solubility test positive. Among which, sickle cell trait was the most common disorder found grossing to 81.8%, followed by homozygous sickle cell disease; (15.2 %). One case (3.0%) of compound heterozygous sickle beta-thalassemia was also found.The Males were found to be more affected than females with ratio of 1.4:1.1. The highest frequency of SCD was found to be in 11-20 age groups comprising about 36.4%. Dangaura Tharu (51.5%) was the most common ethnic group with this disorder. The findings of this study indicate SCD is prevalent among the Tharu population in Banke district of Province-5, Nepal

Carl Boodman ◽  
Jay Keystone ◽  
Isaac I. Bogoch

BACKGROUND: Leprosy is uncommon in Canada. However, immigration from leprosy-endemic areas has introduced the infection to a Canadian context in which most doctors have little knowledge of the disease. Although post-exposure chemoprophylaxis (PEP) is reported to decrease leprosy transmission, no Canadian guidelines advise clinical decision making about leprosy PEP. Here, we characterize the practice patterns of Canadian infectious disease specialists with respect to leprosy PEP and screening of household contacts by yearly physical examinations. METHODS: Canadian infectious disease specialists with known experience treating leprosy were identified using university faculty lists. An online anonymous survey was distributed. Certain questions allowed more than one response. RESULTS: The survey response rate was 46.5% (20/43). Thirty-five percent responded that PEP is needed for household contacts, 40.0% responded that PEP is not needed for household contacts, and 25.0% did not know whether PEP is needed (multinomial test p = 0.79). Twenty-five percent responded that PEP should be given to all household contacts, 62.5% responded that PEP should be given to contacts of multibacillary cases, and 25.0% responded that PEP should be given to contacts who are genetically related to the index case. For specialists who prescribe PEP, 57.1% use rifampicin, ofloxacin (levofloxacin), and minocycline; 14.3% prescribe single-dose rifampicin; and 28.6% prescribe multiple doses of rifampicin (multinomial test p = 0.11). In addition, 68.4% recommend yearly screening of household contacts, whereas 31.6% do not (multinomial test p = 0.17). CONCLUSION: Consensus among Canadian infectious diseases specialists is lacking regarding leprosy PEP and screening of household contacts.

2021 ◽  
Emilie Javelle ◽  
Aurélie Mayet ◽  
Rodrigue S Allodji ◽  
Catherine Marimoutou ◽  
Chrystel Lavagna ◽  

ABSTRACT Background Antibiotics are growth promotors used in animal farming. Doxycycline (DOXY) is a tetracycline antibiotic taken daily and continued 1 month after return to protect against malaria during travel and deployment in endemic areas. We evaluated DOXY impact on body weight in military international travelers. Materiel and Methods A prospective cohort analysis was conducted in 2016-2018, recruiting 170 French soldiers before a 4-month assignment overseas. Many clinical data including anthropometric measures by an investigator were collected before and after deployment. Weight gain was defined by an increase of 2% from baseline. The study protocol was supported by the French Armed Forces Health Services and approved by the French ethics committee (IRB no. 2015–A01961–48, ref promoter 2015RC0). Written, informed consent was obtained with signature from each volunteer before inclusion. Results After deployment, 84 soldiers were followed up. Overall, 38/84 (45%) were deployed to Mali with DOXY malaria prophylaxis, and others were deployed to Iraq or Lebanon without malaria prophylaxis according to international recommendations. Body weight increased in 24/84 (30%), of whom 14/24 (58%) were exposed to DOXY. In bivariate analysis, DOXY had a positive but not significant effect on weight gain (P-value = .4). In the final logistic regression model (Fig. 3), weight gain after deployment positively correlated with an increase in waist circumference (odds ratio [OR] 1.23 with 95% CI [1.06-1.47]) suggesting fat gain; with sedentary work (OR 5.34; 95% CI [1.07-31.90]); and with probiotic intake (OR 5.27; 95% CI [1.51-20.40]). Weight impact of probiotics was more important when associated with DOXY intake (OR 6.86; 95% CI [1.52-38.1]; P-value = .016). Conclusions Doxycycline (DOXY) malaria prophylaxis during several months did not cause significant weight gain in soldiers. Further studies are required in older and less sportive traveling populations, and to investigate a cumulative effect over time and recurrent DOXY exposure. Doxycycline (DOXY) may enhance other growth-promoting factors including fatty food, sedentariness, and strain-specific probiotics contained in fermented dairy products which are also used as growth promotors.

Viruses ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2145
Mariangela Stefania Fiori ◽  
Luca Ferretti ◽  
Matteo Floris ◽  
Federica Loi ◽  
Antonello Di Nardo ◽  

African swine fever virus (ASFV) is one of the pathogens of highest concern worldwide. Despite different virus lineages co-circulating in several areas, dual infections in the same animal have been rarely observed, suggesting that ASF superinfections are infrequent events. Here we present the first genome-wide detection and analysis of two intragenotype dual ASFV infections. The dual infections have been detected in a hunted wild boar and in a pig carcass, both infected by ASFV genotype I in Sardinia in 1984 and 2018, respectively. We characterize the genetic differences between the two sequences, their intra-host frequency, and their phylogenetic relationship among fully sequenced ASFV strains from Sardinia. Both dual infections involve pairs of closely related but different viruses that were circulating in Sardinia in the same period. The results imply that dual ASFV infections or similar ASFV strains are more common than expected, especially in ASF endemic areas, albeit difficult to detect.

Genes ◽  
2021 ◽  
Vol 12 (11) ◽  
pp. 1693
Diego Peres Alonso ◽  
Marcus Vinicius Niz Alvarez ◽  
Paulo Eduardo Martins Ribolla ◽  
Jan E. Conn ◽  
Tatiane Marques Porangaba de Oliveira ◽  

Mosquito susceptibility to Plasmodium spp. infection is of paramount importance for malaria occurrence and sustainable transmission. Therefore, understanding the genetic features underlying the mechanisms of susceptibility traits is pivotal to assessing malaria transmission dynamics in endemic areas. The aim of this study was to investigate the susceptibility of Nyssorhynchus darlingi—the dominant malaria vector in Brazil—to Plasmodium spp. using a reduced representation genome-sequencing protocol. The investigation was performed using a genome-wide association study (GWAS) to identify mosquito genes that are predicted to modulate the susceptibility of natural populations of the mosquito to Plasmodium infection. After applying the sequence alignment protocol, we generated the variant panel and filtered variants; leading to the detection of 202,837 SNPs in all specimens analyzed. The resulting panel was used to perform GWAS by comparing the pool of SNP variants present in Ny. darlingi infected with Plasmodium spp. with the pool obtained in field-collected mosquitoes with no evidence of infection by the parasite (all mosquitoes were tested separately using RT-PCR). The GWAS results for infection status showed two statistically significant variants adjacent to important genes that can be associated with susceptibility to Plasmodium infection: Cytochrome P450 (cyp450) and chitinase. This study provides relevant knowledge on malaria transmission dynamics by using a genomic approach to identify mosquito genes associated with susceptibility to Plasmodium infection in Ny. darlingi in western Amazonian Brazil.

2021 ◽  
Vol 15 (10) ◽  
pp. e0009403
Andualem Deneke Beyene ◽  
Fikreab Kebede ◽  
Belete Mengistu Mammo ◽  
Biruck Kebede Negash ◽  
Addisalem Mihret ◽  

Background Ethiopia aims to eliminate lymphatic filariasis by 2020, through a dual approach of mass drug administration to interrupt transmission and morbidity control which includes making hydrocele surgery available in all endemic areas. Locating patients requiring surgery, providing high quality surgeries, and following up patients are all formidable challenges for many resource-challenged or difficult-to-reach communities. To date, hydrocele surgery in Ethiopia has only occurred when a patient has the knowledge, time and resources to travel to regional hospitals. Ethiopia tested the novel approach of using a surgical camp, defined as mobilizing, transporting, providing surgery at a static site, and following up of a large cohort of hydrocele patients within a hospital’s catchment area, to address delays in seeking and receiving care. Methodology and results Health extension workers mobilized 252 patients with scrotal swelling from a list of 385 suspected hydrocele cases from seven endemic districts in the region of Beneshangul-Gumuz. Clinical health workers and surgeons confirmed 119 as eligible for surgery. Of 70 additional patients who self-referred, 56 were eligible for surgery. Over a two-week period at a regional hospital, 175 hydrocele excision surgeries were conducted. After discharge three days after surgery, trained clinical health workers followed up with the patients on Day 5, Day 8, Day 14 and 1st-month benchmarks with a randomized follow-up of a selection of patients conducted at 9–12 months. There were no post-operative complications upon discharge at Day 3 and 22, while minor complications occurred (12.6%) between Day 3 and one month. The 9–12 month follow-up found patients self-reported an improvement in quality of life, health and economic status. Conclusion A hydrocele surgery camp was effective at providing a large number of quality surgeries in a short time. Using peripheral health workers to mobilize and follow up patients helped address delays in seeking and receiving quality care. Mainstreaming patient mobilization and follow-up into a community health system could be effective in other countries. The camp’s results also influenced two regions in Ethiopia to change their policies in order to offer free hydrocele surgery (including patient transport, consultation, surgery, diagnostic tests and necessary medications).

M. Farouk Chughlay ◽  
Karen I. Barnes ◽  
Myriam El Gaaloul ◽  
Nada Abla ◽  
Jörg J Möhrle ◽  

Despite repeated malaria infection, individuals living in malaria endemic areas remain vulnerable to re-infection. The Janus kinase (JAK1/2) inhibitor ruxolitinib could potentially disrupt the parasite-induced dysfunctional immune response when administered with anti-malarial therapy. This randomized, single-blind, placebo-controlled, single center phase 1 trial investigated the safety, tolerability, pharmacokinetic and pharmacodynamic profile of ruxolitinib and the approved antimalarial artemether-lumefantrine in combination. Ruxolitinib pharmacodynamics were assessed by inhibition of phosphorylation of signal transducer and activator of transcription 3 (pSTAT3). Eight healthy male and female participants aged 18–55 years were randomized to either ruxolitinib (20 mg) ( n = 6) or placebo ( n = 2) administered 2 h after artemether-lumefantrine (80/480 mg) twice daily for three days. Mild adverse events occurred in six participants (four ruxolitinib; two placebo). The combination of artemether-lumefantrine and ruxolitinib was well tolerated, with adverse events and pharmacokinetics consistent with the known profiles of both drugs. The incidence of adverse events and artemether, dihydroartemisinin (the major active metabolite of artemether) and lumefantrine exposure were not affected by ruxolitinib co-administration. Ruxolitinib co-administration resulted in a 3-fold greater pSTAT3 inhibition compared to placebo (geometric mean ratio: 3.01 [90%CI 2.14, 4.24]), with a direct and predictable relationship between ruxolitinib plasma concentrations and %pSTAT3 inhibition. This study supports the investigation of the combination of artemether-lumefantrine and ruxolitinib in healthy volunteers infected with Plasmodium falciparum malaria. (This study has been registered at ClinicalTrials.gov under registration no. NCT04456634).

2021 ◽  
pp. 2735-2738
Louise Bach Kmetiuk ◽  
Monique Paiva de Campos ◽  
Renato van Wilpe Bach ◽  
Ana Pérola Drulla Brandão ◽  
Ivan Roque de Barros-Filho ◽  

Background and Aim: Although wild boar hunting activities and the hunting dog trade in the Atlantic Forest and Cerrado biomes of Brazil overlap both with endemic and with non-endemic areas for visceral leishmaniasis, no study to date has focused on Leishmania spp. exposure among hunting dogs and hunters. The aim of the present study was to assess the presence of Leishmania spp. antibodies in hunting dogs and hunters in different anthropized areas of two Brazilian biomes. Materials and Methods: Blood samples were collected from 170 hunting dogs and 46 hunters between October 2016 and May 2018. The presence of antibodies against Leishmania spp. in hunting dogs was screened through a dual-path platform immunochromatographic test (DPP rapid test; Bio-Manguinhos/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil) and in hunters through an rK39-based rapid immunochromatographic test. Both tests were used in accordance with Brazilian Ministry of Health recommendations. Results: Overall, although antibodies were detected through the immunochromatographic test in 3/170 (0.02%) of these female asymptomatic hunting dogs, all living in anthropized areas of the Atlantic Forest biome in South Brazil, no sample was confirmed through the enzyme-linked immunosorbent assay. All the hunters were non-reactive in the rapid immunochromatographic test. Conclusion: Our study on three suspicious hunting dogs has suggested that Leishmania (Leishmania) infantum may circulate both in endemic and non-endemic areas in Brazil. In addition, a high rate of hunting dog replacement due to death and trade may have led to less chance of infection and transmission between animals and between animals and humans, which would corroborate the outcomes reported here. Further studies should be conducted to fully establish whether hunting dogs and hunters may be used as sentinels in other areas endemic for Leishmania spp.

2021 ◽  
Vol 21 (1) ◽  
Chanapong Rojanaworarit ◽  
Luz Claudio ◽  
Nopporn Howteerakul ◽  
Auamduan Siramahamongkol ◽  
Pattraravith Ngernthong ◽  

Abstract Background Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand. Methods A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as ‘cases’ while their counterparts were ‘controls’ for a subsequent case–control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008–2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error. Result There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7–1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PRcrude–PRadjusted)/PRadjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates. Conclusions In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.

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