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The article discusses the growing concern of arboviral diseases such as dengue and chikungunya in travelers. The United States has recently approved the world's first chikungunya vaccine, which has shown promising results in terms of seroresponse and clinical benefit. The article also highlights the increasing incidence of dengue in travelers and the availability of a new dengue vaccine. The recommendations for the use of these vaccines vary among different expert groups, but the authors argue for broader recommendations to address the high burden of these diseases. Further research is needed to gather more data on the vaccines' effectiveness, safety, and duration of protection. [Extracted from the article]

Background: Neonatal infection, a leading cause of neonatal death in low- and middle-income countries, is often caused by pathogens acquired during childbirth. Clean delivery kits (CDKs) have shown efficacy in reducing infection-related perinatal and neonatal mortality. However, there remain gaps in our current knowledge, including the effect of individual components, the timeline of protection, and the benefit of CDKs in home and facility deliveries.Methods and Findings: A post hoc secondary analysis was performed using nonrandomized data from the Zambia Chlorhexidine Application Trial (ZamCAT), a community-based, cluster-randomized controlled trial of chlorhexidine umbilical cord care in Southern Province of Zambia from February 2011 to January 2013. CDKs, containing soap, gloves, cord clamps, plastic sheet, razor blade, matches, and candle, were provided to all pregnant women. Field monitors made a home-based visit to each participant 4 days postpartum, during which CDK use and newborn outcomes were ascertained. Logistic regression was used to study the association between different CDK components and neonatal mortality rate (NMR). Of 38,579 deliveries recorded during the study, 36,996 newborns were analyzed after excluding stillbirths and those with missing information. Gloves, cord clamps, and plastic sheets were the most frequently used CDK item combination in both home and facility deliveries. Each of the 7 CDK components was associated with lower NMR in users versus nonusers. Adjusted logistic regression showed that use of gloves (odds ratio [OR] 0.33, 95% CI 0.24-0.46), cord clamp (OR 0.51, 95% CI 0.38-0.68), plastic sheet (OR 0.46, 95% CI 0.34-0.63), and razor blade (OR 0.69, 95% CI 0.53-0.89) were associated with lower risk of newborn mortality. Use of gloves and cord clamp were associated with reduced risk of immediate newborn death (<24 hours). Reduction in risk of early newborn death (1-6 days) was associated with use of gloves, cord clamps, plastic sheets, and razor blades. In examining perinatal mortality (stillbirth plus neonatal death in the first 7 days of life), similar patterns were observed. There was no significant reduction in risk of late newborn mortality (7-28 days) with CDK use. Study limitations included potential recall bias of CDK use and inability to establish causality, as this was a secondary observational study.Conclusions: CDK use was associated with reductions in early newborn mortality at both home and facility deliveries, especially when certain kit components were used. While causality could not be established in this nonrandomized secondary analysis, given these beneficial associations, scaling up the use of CDKs in rural areas of sub-Saharan Africa may improve neonatal outcomes.Trial Registration: Name of trial: Zambia Chlorhexidine Application Trial (ZamCAT) Name of registry: Clinicaltrials.gov Trial number: NCT01241318. [ABSTRACT FROM AUTHOR]

Rationale For Review: In response to increased concerns about emerging infectious diseases, GeoSentinel, the Global Surveillance Network of the International Society of Travel Medicine in partnership with the US Centers for Disease Control and Prevention (CDC), was established in 1995 in order to serve as a global provider-based emerging infections sentinel network, conduct surveillance for travel-related infections and communicate and assist global public health responses. This review summarizes the history, past achievements and future directions of the GeoSentinel Network.Key Findings: Funded by the US CDC in 1996, GeoSentinel has grown from a group of eight US-based travel and tropical medicine centers to a global network, which currently consists of 68 sites in 28 countries. GeoSentinel has provided important contributions that have enhanced the ability to use destination-specific differences to guide diagnosis and treatment of returning travelers, migrants and refugees. During the last two decades, GeoSentinel has identified a number of sentinel infectious disease events including previously unrecognized outbreaks and occurrence of diseases in locations thought not to harbor certain infectious agents. GeoSentinel has also provided useful insight into illnesses affecting different traveling populations such as migrants, business travelers and students, while characterizing in greater detail the epidemiology of infectious diseases such as typhoid fever, leishmaniasis and Zika virus disease.Conclusions: Surveillance of travel- and migration-related infectious diseases has been the main focus of GeoSentinel for the last 25 years. However, GeoSentinel is now evolving into a network that will conduct both research and surveillance. The large number of participating sites and excellent geographic coverage for identification of both common and illnesses in individuals who have traversed international borders uniquely position GeoSentinel to make important contributions of travel-related infectious diseases in the years to come. [ABSTRACT FROM AUTHOR]

International travel volumes are recovering after the COVID-19 pandemic. We highlight the high risk of malaria for travellers to sub-Saharan Africa, and the continued need for health practitioners to prescribe and facilitate access to affordable antimalarial chemoprophylaxis, and to provide high quality diagnostic services and therapeutic care for case management. [ABSTRACT FROM AUTHOR]

Background: Zika virus has spread rapidly in the Americas and has been imported into many nonendemic countries by travelers.Objective: To describe clinical manifestations and epidemiology of Zika virus disease in travelers exposed in the Americas.Design: Descriptive, using GeoSentinel records.Setting: 63 travel and tropical medicine clinics in 30 countries.Patients: Ill returned travelers with a confirmed, probable, or clinically suspected diagnosis of Zika virus disease seen between January 2013 and 29 February 2016.Measurements: Frequencies of demographic, trip, and clinical characteristics and complications.Results: Starting in May 2015, 93 cases of Zika virus disease were reported. Common symptoms included exanthema (88%), fever (76%), and arthralgia (72%). Fifty-nine percent of patients were exposed in South America; 71% were diagnosed in Europe. Case status was established most commonly by polymerase chain reaction (PCR) testing of blood and less often by PCR testing of other body fluids or serology and plaque-reduction neutralization testing. Two patients developed Guillain-Barré syndrome, and 3 of 4 pregnancies had adverse outcomes (microcephaly, major fetal neurologic abnormalities, and intrauterine fetal death).Limitation: Surveillance data collected by specialized clinics may not be representative of all ill returned travelers, and denominator data are unavailable.Conclusion: These surveillance data help characterize the clinical manifestations and adverse outcomes of Zika virus disease among travelers infected in the Americas and show a need for global standardization of diagnostic testing. The serious fetal complications observed in this study highlight the importance of travel advisories and prevention measures for pregnant women and their partners. Travelers are sentinels for global Zika virus circulation and may facilitate further transmission.Primary Funding Source: Centers for Disease Control and Prevention, International Society of Travel Medicine, and Public Health Agency of Canada. [ABSTRACT FROM AUTHOR]

Background Teaming is an accepted approach in health care settings but rarely practiced at the community level in developing countries. Save the Children trained and deployed teams of volunteer community health workers (CHWs) and trained traditional birth attendants (TBAs) to provide essential newborn and curative care for children aged 0-59 months in rural Zambia. This paper assessed whether CHWs and trained TBAs can work as teams to deliver interventions and ensure a continuum of care for all children under-five, including newborns. Methods We trained CHW-TBA teams in teaming concepts and assessed their level of teaming prospectively every six months for two years. The overall score was a function of both teamwork and taskwork. We also assessed personal, community and service factors likely to influence the level of teaming. Results We created forty-seven teams of predominantly younger, male CHWs and older, female trained TBAs. After two years of deployment, twenty-one teams scored "high", twelve scored "low," and fourteen were inactive. Teamwork was high for mutual trust, team cohesion, comprehension of team goals and objectives, and communication, but not for decision making/planning. Taskwork was high for joint behavior change communication and outreach services with local health workers, but not for intra-team referral. Teams with members residing within one hour's walking distance were more likely to score high. Conclusion It is feasible for a CHW and a trained TBA to work as a team. This may be an approach to provide a continuum of care for children under-five including newborns. [ABSTRACT FROM AUTHOR]

The article focuses on Burden of Neonatal Sepsis in Low-resource Settings. Topics discussed include facility based delivery has been one of the major interventions to reduce both maternal and newborn morbidity and mortality associated with home births; and the growing demand for hospital-based obstetric and neonatal services without an attendant strengthening of infection prevention and control (IPC) has led to the unanticipated consequence.

An editorial is presented on the Dengue virus which is responsible for symptomatic cases of infection and deaths annually. The article discusses that Dengue has a major negative effect on stretched health care systems in low- and middle-income countries and also places a financial burden on households; and raising global temperatures due to climate change, widespread distribution of the mosquito vector Aedes aegypti, increasing urbanization, population growth, environmental conditions.

An editorial is presented on the why Did Mass Test and Treat Have No Effect on Malaria Prevalence in Western Kenya. The article discusses that major strategies include strengthening of malaria surveillance systems, development of ultrasensitive diagnostics to identify asymptomatic carriers of malaria parasites, reactive case detection, mass drug administration (MDA), and active infection detection.

Zika virus is a mosquito‐borne flavivirus which caused major epidemics in the Pacific and the Americas between 2013 and 2015. International travellers have previously acted as a sentinel population for Zika virus transmission in endemic areas, where local transmission may be incompletely captured by local surveillance systems. We report five recent European travellers returning from Thailand with Zika virus infection, highlighting the risk of ongoing endemic transmission in this popular tourist destination. [ABSTRACT FROM AUTHOR]

Background Dengue virus ( DENV) infections may occur in travelers. Objectives To determine prevalence of anti- DENV IgG antibody in travelers who lived in or visited dengue-endemic countries and to describe risk factors and characteristics associated with infection and subsequent anti- DENV IgG antibody presence. Methods Participants were enrolled from travel clinics of the Boston Area Travel Medicine Network from August 2008 through June 2009. Demographic information, trip duration, travel history, and a blood sample were collected. Serum samples were tested for anti- DENV IgG antibody by indirect IgG enzyme-linked immunosorbent assay ( ELISA), and antibody-mediated virus neutralization by plaque reduction neutralization test ( PRNT) for anti- DENV IgG antibody-positive and selected negative samples. Participants were stratified into group 1: born in dengue-endemic countries; group 2: born in nonendemic countries but lived continuously for ≥1 year in a dengue-endemic country; group 3: born in nonendemic countries and traveled to a dengue-endemic country for ≥2 weeks but <1 year. Results Six hundred travelers were enrolled. Anti- DENV IgG antibody was identified in 113 (19%) when tested by ELISA (51% in group 1, 40% in group 2, and 6.9% in group 3) and in 71 (12%) by PRNT (42% primary monotypic and 58% heterotypic reactive responses). Sensitivity and specificity of the ELISA based on PRNT results were 85% to 100% and 79% to 94%, assuming up to 15% misclassification of ELISA negative results. Presence of anti-DENV IgG antibody by ELISA was associated with years lived in dengue-endemic countries and birthplace in the Caribbean for group 1, receipt of Japanese encephalitis vaccine in group 3, and self-reported history of dengue in all three groups. Conclusions Nineteen percent of participants who were born, lived in, or traveled to dengue-endemic countries had anti- DENV IgG antibody by ELISA; 12% had antibodies by PRNT, 85% of whom had no history of dengue. Presence of DENV antibodies was associated with years lived in dengue-endemic countries and self-reported history of dengue. [ABSTRACT FROM AUTHOR]

Sickle cell disease ( SCD) is a chronic debilitating disorder affecting erythrocytes, which is especially prevalent throughout Sub- Saharan Africa and among individuals of African descent. Because malaria is thought to be a significant cause of morbidity and mortality in patients with SCD, malaria chemoprophylaxis is often recommended for these patients. In SCD, malaria chemoprophylaxis reduces malaria parasite count, anaemia and the need for blood transfusion, and improves clinical outcomes. However, the effectiveness of malaria chemoprophylaxis in the setting of SCD is based on a few studies conducted prior to the emergence of widespread antimalarial drug resistance. Consequently, it is uncertain what the optimal strategy for managing patients with SCD in malarious areas should be. Despite the widespread use of hydroxyurea in non-malarious regions, little is known about its effect in malaria-endemic areas or on malaria-related outcomes. On the one hand, hydroxyurea upregulates intercellular cell adhesion molecule 1 ( ICAM-1), the cell surface receptor for adhesion of Plasmodium falciparum-infected erythrocytes, and theoretically, it could enhance parasite replication. On the other hand, hydroxyurea increases levels of foetal haemoglobin, which is protective against malaria. We explore what is currently known about the interactions between SCD and malaria and review the published literature on the efficacy of malaria chemoprophylaxis in SCD. We also consider alternative strategies, including hydroxyurea, in the reduction of malaria-associated morbidity and mortality in patients with SCD. [ABSTRACT FROM AUTHOR]

To describe patterns of antimicrobial use for respiratory tract infections (RTIs) in older residents of long-term care facilities (LTCFs). Data from a prospective, randomized, controlled study of the effect of vitamin E supplementation on RTIs conducted from April 1998 through August 2001 were analyzed. Thirty-three LTCFs in the greater Boston area. Six hundred seventeen subjects aged 65 and older residing in LTCFs. RTIs, categorized as acute bronchitis, pneumonia, common cold, influenza-like illness, pharyngitis, and sinusitis, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. For cases in which drug treatment was administered, antibiotic use was rated as appropriate (when an effective drug was used), inappropriate (when a more-effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). Of 752 documented episodes of RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 2%, and unjustified in 19%. For acute bronchitis, treatment was appropriate in 35% and unjustified in 65% of cases. For pneumonia, treatment was appropriate in 87% of episodes. Of the most commonly used antimicrobials, macrolide use was unjustified in 43% of cases. No statistically significant differences in the patterns of antibiotic use were observed when stratified according to age, sex, race, or comorbid conditions, including diabetes mellitus, dementia, and chronic kidney disease. Antimicrobials were unjustifiably used for one-fifth of RTIs and more than two-thirds of cases of acute bronchitis, suggesting a need for programs to improve antibiotic prescribing at LTCFs. [ABSTRACT FROM AUTHOR]

Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex and Pseudoterranova decipiens. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, coastal regions of Europe, and the United States. Severe epigastric pain, resulting from larval invasion of the gastric mucosa, characterizes gastric anisakidosis; other syndromes are intestinal and ectopic. Allergic anisakidosis is a frequent cause of foodborne allergies in areas with heavy fish consumption or occupational exposure. Diagnosis and treatment of gastric disease is usually made by a compatible dietary history and visualization and removal of the larva(e) on endoscopy; serologic testing for anti-A. simplex immunoglobulin E can aid in the diagnosis of intestinal, ectopic and allergic disease. Intestinal and/or ectopic cases may require surgical removal; albendazole has been used occasionally. Preventive measures include adequately freezing or cooking fish. [ABSTRACT FROM AUTHOR]

Low zinc status may be a risk factor for pneumonia in the elderly. This special article reviews the magnitude of the problem of pneumonia (its prevalence, morbidity, and mortality) in the elderly, pneumonia's etiology, and the dysregulation of the immune system associated with increasing age. In addition, recent evidence from the literature is presented demonstrating that low zinc status (commonly reported in the elderly) impairs immune function, decreases resistance to pathogens, and is associated with increased incidence and duration of pneumonia, increased use and duration of antimicrobial treatment, and increased overall mortality in the elderly. Inadequate stores of zinc might, therefore, be a risk factor for pneumonia in the elderly. Randomized, double-blind, controlled studies are needed to determine the efficacy of zinc supplementation as a potential low-cost intervention to reduce morbidity and mortality due to pneumonia in this vulnerable population. [ABSTRACT FROM AUTHOR]

The article discusses the rapid spread of Zika virus in the Western Hemisphere. Topics mentioned include the febrile illness caused by the mosquito-borne flavivirus associated with rash, the outbreak reports from Natal in Rio Grande do Norte, Brazil in March 2015, and the use of acetaminophen for treating the headache or myalgia and fever with the prevention of avoidance to mosquitoes that can transmit the virus. It also mentioned the travel advise for pregnant women to Zika infected regions.

The proportion of the Latin American population above age 65 y is expected to rise substantially. To better define the prevalence of infectious diseases and micronutrient deficiencies, assess immunological status, and evaluate associations between nutritional status and infection, we performed a cross-sectional study of elderly Ecuadorians in a low-income penurban community in Quito, Ecuador. Culturally adapted questionnaires, delayed type hypersensitivity (DTH) skin response, micronutrient, and immunological assays were performed in randomly selected Ecuadorians aged ⩾65γ. Multiple linear and logistic regression models were developed to assess relationships between micronutrient concentrations and history of infection, DTH, and immune function. Participants (n = 352; mean age ± SD, 74.4 ± 6.4 yl recalled recent episodes of colds/influenza-like syndromes 162.8%), cough (61.0%), urinary tract infection (37.9%), diarrhea (32.2%), fever (24.1 %l, and pneumonia (3.5%). A prospective substudy of respiratory infections (RI) in 203 elderly revealed similar findings. Colds and pneumonia occurred in 42.8 and 7.9% of participants, respectively, during 737 person-weeks of observation (3.6 ± 1.1 wk per person). Anemia and micronutrient deficiencies, especially for vitamins C, D, B-6, and B-i 2 and folic acid and zinc, were common. Plasma vitamin C was associated with interferon-y(IFN7) (P< 0.011 and zinc with IFNy and interleukin-2 (each P < 0.0001). RI history was associated with any micronutrient deficiency (P < 0.001). The burden of infectious diseases, micronutrient deficiencies, and anemia was substantial in this elderly Ecuadorian population. Deficiencies of essential vitamins and minerals place these elderly adults at risk for infections through their negative impact on immune function. J. Nutr. 139:113-119, 2009. [ABSTRACT FROM AUTHOR]

The proportion of the population that is ≥60 years of age in sub-Saharan Africa (SSA) is increasing rapidly and is likely to constrain healthcare systems in the future. Nevertheless, the elderly are not a health policy priority for African countries. This paper reviews the nutritional and health status of older adults in SSA and their determinants. Literature was abstracted through the Medline, Google Scholar, and Dogpile databases using the following search terms: sub-Saharan Africa, older adults, nutrition, health. Findings showed that up to half (6–48%) of elderly Africans in SSA are underweight and almost a quarter (2.5–21%) are overweight, while 56% of older South Africans are obese. Low-quality diets contribute to poor nutritional status. Poverty, HIV/AIDS, and complex humanitarian emergencies are major determinants of undernutrition. Effective interventions need to consider socioeconomic, health, and demographic factors; social pensions may be the most cost-effective option for improving the health and nutritional status of the elderly in SSA. [ABSTRACT FROM AUTHOR]

Background. Expatriate corporate workers stationed in remote regions of developing countries with limited health care resources are at substantial risk for a variety of infectious diseases. Methods. A survey was carried out among expatriates working at a large power plant construction site in western Ghana in 1998 to evaluate their use of pretravel medical services, current knowledge, and behavioral practices in relation to food- and waterborne disease prevention, diarrhea, malaria, respiratory infections, alcohol use, and high-risk sexual activity. An anonymous, structured, and pretested questionnaire was used. Results. The response rate was 42 of 60 (70%). Most respondents were men (39 of 42, 93%) with previous international construction experience. Adherence to food and water safety recommendations decreased with time. Expatriates (15 of 23, 65%) from developed countries reported at least one episode of diarrhea, whereas no expatriates (0 of 9) from resource-poor countries reported diarrhea ( p < 0.001). Use of malaria chemoprophylaxis deteriorated with increasing duration of time on the job site. None of the expatriates (0 of 9) who had been on the site for more than a year was still taking an antimalarial compared to those who had been there for 3 months or less (13 of 16) ( p < 0.01). Forty-three percent (18 of 42) of the respondents reported having had a respiratory infection in the past 3 months. Only 38% (15 of 39) received preplacement education on human immunodeficiency virus (HIV) risk. A higher proportion of those who received pretravel HIV education used condoms always (4 of 5) than those who did not receive HIV education (1 of 5). Discussion. The use of health advice and preventive measures was generally low among the expatriate corporate survey respondents. Adherence to preventive measures declined with the increase in length of stay. Corporations need to develop appropriate health promotion strategies targeting their expatriates in developing countries. [ABSTRACT FROM AUTHOR]

Background. Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial. Methods. We conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery. Results. There were no differences between monthly IPTp (n = 224) and standard IPTp (n = 232) in placental malaria by histopathology (26% vs. 29%; relative risk [RR], 0.90 [95% confidence interval {CI}, 0.64 -1.26]) or placental parasitemia (2% vs. 4%; RR, 0.55 [95% CI, 0.17-1.79]). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks. Conclusions. In an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV. [ABSTRACT FROM AUTHOR]

This article presents a study on improved diagnostic testing and malaria treatment practices in Zambia. The objective of the study was to assess the association between the use of microscopy and rapid antigen-detection diagnostic tests (RDTs) and the prescription of antimalarials. The study concluded that despite efforts to expand the provision of malaria diagnostics in Zambia, they continue to be underused and patients with negative test results frequently receive antimalarials. Provisions of new tools to reduce inappropriate use of expensive treatments must be accompanied by a change in the clinical treatment of patients presenting with fever but lacking evidence of malaria infection.

Background: Concomitant with the substantial growth of the elderly population in the last decade, there has been a steady rise in the number of nursing home residents aged 65 years and older. Well designed, rigorously conducted clinical intervention trials provide an important source of data for evidence-based improvements in the medical care of nursing home residents. The information available on strategies for the recruitment and screening of participants for such studies in long-term care facilities, as well as the financial and time costs for carrying out these investigations, is limited.Methods: This report describes our experience in recruiting 617 nursing home residents for a multisite, double-blind, randomized, placebo-controlled trial designed to determine the efficacy of a 1-year period of vitamin E supplementation in preventing respiratory tract infections. Comparisons of the projected staffing costs and actual costs incurred are presented, using a retrospective method for the determination of unit costs.Results: Initially, 874 consents were obtained from 2815 potential participants, of which only 617 were enrolled. Each successful enrollment required an average of 15 hours of staff time at a combined personnel and supply cost of $515 per participant and a total study cost of $317,661. Several obstacles were encountered during the recruitment and enrollment process: resistance on the part of family or primary care provider; transfer out of facility; and changes in the medical condition of the patient, including death.Discussion: The results of this report should prove useful to investigators developing budgets for nursing home-based clinical trials by providing a more accurate determination of the personnel needed and the costs associated with recruitment and enrollment of participants. [ABSTRACT FROM AUTHOR]

Background: Large numbers of United States residents travel each year to countries where malaria, hepatitis A, hepatitis B and other vaccine-preventable diseases are prevalent. However, relatively little is known about how United States travelers perceive risks associated with travel or how they prepare for their international voyages. This airport survey was therefore performed to determine the travel health knowledge, attitudes and practices (KAP) of United States travelers. Methods: Questionnaires were administered to international travelers, aged 18 years or more, departing from the John F. Kennedy International Airport in New York who were going to destinations that were high risk for malaria or hepatitis A. Results: Overall, 404 questionnaires were completed, including 203 focused on malaria and 201 on vaccine-preventable diseases. Latin America and Asia were the most common destinations. Only 36% of travelers sought travel health advice, despite the fact that more than half prepared their trip at least a month in advance. Only 17% of travelers considered themselves at high risk for hepatitis A. Although the majority of travelers (73%) to a high-risk malaria-endemic region perceived malaria as a high health risk, only 46% of them were carrying antimalarial medications. Additionally, although the majority of travelers believed that vaccines were effective for prevention, few were vaccinated for their journey: 11% for tetanus, 14% for hepatitis A, 13% for hepatitis B, and 5% for yellow fever. Discussion: This airport survey demonstrated important shortcomings in the travel health KAP of international travelers. A substantial proportion of the travelers were not adequately protected against malaria, hepatitis A or hepatitis B. Future efforts need to focus on improving the level of awareness of travelers regarding their risk of disease acquisition overseas and the importance of pretravel education, immunizations, and malaria chemoprophylaxis. [ABSTRACT FROM AUTHOR]

We evaluated the Binax NOW Streptococcus pneumoniae urinary antigen assay by testing 210 healthy children aged 2-60 months living in urban slums of Quito, Ecuador. Healthy children with nasopharyngeal carriage of S. pneumoniae were significantly more likely to have positive urinary antigen test results than were children who were not carriers (30 of 138 vs. 3 of 71 children; x² 10.8; P<.001). The rate of nasopharyngeal carriage of S. pneumoniae decreased with in-creasing age; the lowest rates were found in children with the worst nutritional status. [ABSTRACT FROM AUTHOR]

The author discusses spread of a mosquito-borne pathogen chikungunya in North and South America along with Caribbean. He mentions that symptoms of chikungunya which include myalgia, headache and polyarthralgia. Topics discussed include chikungunya treatments such as intake of acetaminophen and nonsteroidal antiinflammatory drugs and preventions measures like application of insecticides and insecticide-treated bed nets.

Background: Approximately 6 million people worldwide are affected by Chagas disease, with many in the chronic phase of the disease (CCD). It is crucial to evaluate the effectiveness of benznidazole for CCD treatment. Methods/Principal findings: We updated a meta-analysis published in 2009 up to February 2021, including controlled trials (RCT) and prospective observational studies (OBS) that compared benznidazole vs placebo/no-treatment (P/nT). Main outcomes evaluated were clinical progression (CP) and seroreversion with subgroup analysis performed according to study design and participants' age. Parasitological response and safety were also described. We identified 879 articles and selected nine for inclusion (corresponding to eight studies). After adding the nine articles from the previous meta-analysis, 17 studies were analyzed corresponding to 6640 patients. The odds ratio (OR) for seroreversion in children treated with benznidazole vs P/nT was 38.3 (95%CI: 10.7–137) and 34.9 (95%CI: 1.96–624.09) in RCT and OBS, respectively. In adults the OR for seroreversion in OBS was 17.1 (95%CI: 2.3–129.1). CP was only evaluated in adults, where benznidazole did not demonstrate a beneficial effect: OR 0.93 (95%CI: 0.8–1.1) and OR 0.49 (95%CI:0.2–1.2) for RCT and OBS, respectively. Most outcomes were deemed to have a low level of certainty, except for the beneficial effect in children and the low efficacy in adults (moderate certainty). Conclusions: Benznidazole should be recommended for CCD in children, though this is only based on serological response and a moderate grade of evidence, while in adults benznidazole efficacy remains uncertain. More data on clinical efficacy of benznidazole in CCD is needed in both children and adults. Author summary: Chagas disease is a neglected parasitic disease, endemic in Latin America, where it supposes a public health problem. Moreover, thanks to population movements, its presence has significantly increased in non-endemic areas, where it has high rates of under-diagnosis. The only two treatments currently available (benznidazole, generally the first choice, and nifurtimox) date from 1960s and are poorly tolerated. Moreover, there is much uncertainty about their indication, dosage and benefits, especially in chronically infected adult populations. For this reason, we have update a meta-analysis published in 2009 on the effectiveness of benznidazole in chronic Chagas disease, analyzing data from 17 studies involving 6,640 patients. In the pediatric population the indication is well established thanks to some clinical trials carried out in the 1990s and the accumulated clinical experience so far. Most of the recent studies have been performed in adult populations; however, they provide low or very low certainty on the effectiveness of benznidazole except for patients with established cardiomyopathy, where benznidazole didn´t demonstrated benefit. We find that data on the treatment of indeterminate chronic infection are insufficient. Since no new drugs are expected in the near future, it would be desirable to launch trials with clinical outcomes and long follow-up periods to evaluate the efficacy of current drugs for the treatment of the indeterminate chronic Chagas disease. [ABSTRACT FROM AUTHOR]

Reports on a case of a woman who claimed to have passed a worm in her stool which, based on her description, was thought most likely to be an adult Ascaris lumbricoides worm. Lifespan of the worm; Information on how doctors detected that the woman manufactured her illness; Description of Munchausen syndrome.

The article reports on the yellow fever cases in travelers to Brazil in 2018. It notes that outbreak of yellow fever started in December 2016 and the disease was acquired on Ilha Grande by one human and one nonhuman primate. It explains that yellow fever is a fatal illness and can be prevented by vaccination.

The author discusses challenges related to vaccinations while confronting the resurgent threat from yellow fever (YF). Topics include shortages of YF vaccines in the U.S. as a result of manufacturing issues while relocating facilities, a fluctuation in the cost of YF vaccines resulting from availability, insurance coverage, and manufacturer's market strategies, and the World Health Organization's approval of fractional dosing of YF vaccines amid high demand resulting from concurrent outbreaks.

Anthropometric measures at birth, indexing prenatal growth, are associated with later cognitive development. Children in low- and middle-income countries (LMIC) are at elevated risk for impaired prenatal and early postnatal growth and enduring cognitive deficits. However, the associations of neonatal physical growth with neural activity are not well-characterized in LMIC contexts, given the dearth of early childhood neuroimaging research in these settings. The current study examined birth length, weight, and head circumference as predictors of EEG relative power over the first three years of life in rural Limpopo Province, South Africa, controlling for postnatal growth and socioeconomic status (SES). A larger head circumference at birth predicted lower relative gamma power, lower right hemisphere relative beta power, and higher relative alpha and theta power. A greater birth length also predicted lower relative gamma power. There were interactions with timepoints such that the associations of birth head circumference and length with EEG power were most pronounced at the 7-month assessment and were attenuated at the 17- and 36-month assessments. The results identify birth head circumference and length as specific predictors of infant neural activity within an under-resourced context. [ABSTRACT FROM AUTHOR]

Background: HIV+‐to‐HIV+ organ transplantation has demonstrated promise and is now authorized for research purposes in certain countries. However, organ transplantation is dependent on the availability of organ donors. We assessed the awareness and willingness to donate organs among people with HIV (PWH) in Uganda. Methods: We conducted a multicenter cross‐sectional study between October 2023 and January 2024 in four large HIV clinics in Northern Uganda. The study population consisted of PWH. A structured questionnaire was used to collect data regarding awareness, willingness, and beliefs regarding organ donation. Organ donation was defined as the willingness to be a living donor of a solid organ. We conducted multivariable logistic regression to assess for an association between willingness to donate organs and selected exposures. Data were analyzed in Stata version 15.0. Results are expressed as adjusted odds ratio (AOR) with 95% confidence intervals (CI). Results: A total of 232 participants were recruited. The mean age ± standard deviation of the participants was 42.2±11.8 years. All participants were on antiretroviral therapy. Sixty‐two (26.7%) had a CD4 count less than or equal to 200 cells/mm3. The majority (80.6%, n = 187) had ever heard of organ donation. Slightly more than a third (34.9%, n = 81) were willing to donate organs. Factors associated with willingness to be a living organ donor included being female (AOR: 1.56; 95% CI: 1.15−2.11), having a tertiary education level (AOR: 1.79; 95% CI: 1.03−3.11), average monthly income >500 000 UGX (135.1USD) (AOR: 5.5; 95% CI: 1.97−15.40), ever heard about organ donation (AOR: 5.4; 95% CI: 1.67−17.8), and attending an organ donation campaign (AOR: 2.0; 95% CI: 1.07−3.74). Conclusions: Awareness about organ donation was high but the willingness to be a living organ donor was low among PWH in Uganda. There is a need to sensitize the community about the need and benefits of organ donation with the involvement of media and the healthcare workers. [ABSTRACT FROM AUTHOR]

The article discusses the use of GeoSentinel, a global surveillance and research network, in detecting infectious disease outbreaks. The network collects standardized data from international travelers seeking healthcare and has identified several outbreaks in the past. The article highlights the challenges in outbreak detection and the potential of incorporating artificial intelligence (AI) algorithms to improve detection methods. It emphasizes the importance of multidisciplinary collaboration between data scientists and epidemiologists. The article concludes by discussing the advantages of analyzing GeoSentinel data using AI methods and the potential impact on public health responses and global disease control strategies. [Extracted from the article]

Fungal infections are common in HIV-infected individuals and significantly contribute to mortality. However, a substantial number of cases are undiagnosed before death. To determine the frequency of fungal pathogens in autopsy studies of people who died with HIV in Africa. We conducted a scoping review of autopsy studies conducted in Africa. PubMed, Scopus, Web of Science, Embase, Google Scholar, and African Journal Online. The review encompasses studies published from inception to September 2023, and no language restrictions were imposed during the search process. We included studies that reported histopathological or microbiological evidence for the diagnosis of fungal infections and other pathogens. Data were summarized using descriptive statistics and no meta-analysis was performed. We examined 30 articles reporting studies conducted between 1991 and 2019, encompassing a total of 13 066 HIV-infected decedents across ten African countries. In five studies, the autopsy type was not specified. Among those studies with specified autopsy types, 20 involved complete diagnostic autopsies, whereas 5 were categorized as partial or minimally invasive autopsies. There were 2333 pathogens identified, with 946 (40.5%) being mycobacteria, 856 (36.7%) fungal, 231 (3.8%) viral, 208 (8.9%) parasitic, and 92 (3.9%) bacterial. Of the 856 fungal pathogens identified, 654 (28.0%) were Cryptococcus species, 167 (7.2%) Pneumocystis jirovecii , 16 (0.69%) Histoplasma species, 15 (0.64%) Aspergillus species, and 4 (0.17%) Candida species. Other major non-fungal pathogens identified were cytomegalovirus 172 (7.37%) and Toxoplasma gondii 173 (7.42%). Invasive fungal infections occur in over one-third of people who succumb to HIV in Africa. In addition to cryptococcosis and Pneumocystis jirovecii pneumonia, integrating other priority fungal pathogen detection and management strategies into the broader framework of HIV care in Africa is recommended. This involves increasing awareness regarding the impact of fungal infections in advanced HIV disease and strengthening diagnostic and treatment capacity. [ABSTRACT FROM AUTHOR]

Background Chikungunya is an important travel-related disease because of its rapid geographical expansion and potential for prolonged morbidity. Improved understanding of the epidemiology of travel-related chikungunya infections may influence prevention strategies including education and vaccination. Methods We analysed data from travellers with confirmed or probable chikungunya reported to GeoSentinel sites from 2005 to 2020. Confirmed chikungunya was defined as a compatible clinical history plus either virus isolation, positive nucleic acid test or seroconversion/rising titre in paired sera. Probable chikungunya was defined as a compatible clinical history with a single positive serology result. Results 1202 travellers (896 confirmed and 306 probable) with chikungunya were included. The median age was 43 years (range 0–91; interquartile range [IQR]: 31–55); 707 (58.8%) travellers were female. Most infections were acquired in the Caribbean (28.8%), Southeast Asia (22.8%), South Central Asia (14.2%) and South America (14.2%). The highest numbers of chikungunya cases reported to GeoSentinel were in 2014 (28.3%), 2015 (14.3%) and 2019 (11.9%). The most frequent reasons for travel were tourism (n  = 592; 49.3%) and visiting friends or relatives (n  = 334; 27.7%). The median time to presentation to a GeoSentinel site was 23 days (IQR: 7–52) after symptom onset. In travellers with confirmed chikungunya and no other reported illnesses, the most frequently reported symptoms included musculoskeletal symptoms (98.8%), fever/chills/sweats (68.7%) and dermatologic symptoms (35.5%). Among 917 travellers with information available, 296 (32.3%) had a pretravel consultation. Conclusions Chikungunya was acquired by international travellers in almost 100 destinations globally. Vector precautions and vaccination where recommended should be integrated into pretravel visits for travellers going to areas with chikungunya or areas with the potential for transmission. Continued surveillance of travel-related chikungunya may help public health officials and clinicians limit the transmission of this potentially debilitating disease by defining regions where protective measures (e.g. pretravel vaccination) should be strongly considered. [ABSTRACT FROM AUTHOR]

Introduction: Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs. Methods: We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period. Results: Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period. Conclusion: The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A. [ABSTRACT FROM AUTHOR]

Background Universities returned to in-person learning in 2021 while SARS-CoV-2 spread remained high. At the time, it was not clear whether in-person learning would be a source of disease spread. Methods We combined surveillance testing, universal contact tracing, and viral genome sequencing to quantify introductions and identify likely on-campus spread. Results Ninety-one percent of viral genotypes occurred once, indicating no follow-on transmission. Less than 5% of introductions resulted in >3 cases, with 2 notable exceptions of 40 and 47 cases. Both partially overlapped with outbreaks defined by contact tracing. In both cases, viral genomics eliminated over half the epidemiologically linked cases but added an equivalent or greater number of individuals to the transmission cluster. Conclusions Public health interventions prevented within-university transmission for most SARS-CoV-2 introductions, with only 2 major outbreaks being identified January to May 2021. The genetically linked cases overlap with outbreaks identified by contact tracing; however, they persisted in the university population for fewer days and rounds of transmission than estimated via contact tracing. This underscores the effectiveness of test-trace-isolate strategies in controlling undetected spread of emerging respiratory infectious diseases. These approaches limit follow-on transmission in both outside-in and internal transmission conditions. [ABSTRACT FROM AUTHOR]

The article provides updated preconception guidance for Zika virus and sexual transmission. It mentions that U.S. Centers for Disease Control and Prevention has published updated guidelines for preconception planning for persons who have potential exposure to Zika virus. It reveals that Zika outbreaks have had an impact on both travelers and residents of affected countries.

The article discusses use of multiplex polymerase chain reaction (PCR) for determining aetiology of travellers' diarrhoea. Topics include use of molecular diagnostic approach for determining antibiotic use, utility of multiplex PCR for assessment of returning travellers with acute and chronic diarrhoea, and role for traditional microbiological methods.

Dengue infection rates are increasing globally largely because of environmental factors. In addition to recognizing and managing the disease, it is important for physicians to understand current and emerging approaches to vector control, including vaccines. [ABSTRACT FROM AUTHOR]

Background: Limited data exist regarding cardiac manifestations of Chagas disease in migrants living in non-endemic regions. Methods: A retrospective cohort analysis of 109 patients with Chagas disease seen at Boston Medical Center (BMC) between January 2016 and January 2023 was performed. Patients were identified by screening and testing migrants from endemic regions at a community health center and BMC. Demographic, laboratory, and cardiac evaluation data were collected. Results: Mean age of the 109 patients was 43 years (range 19–76); 61% were female. 79% (86/109) were diagnosed with Chagas disease via screening and 21% (23/109) were tested given symptoms or electrocardiogram abnormalities. Common symptoms included palpitations (25%, 27/109) and chest pain (17%, 18/109); 52% (57/109) were asymptomatic. Right bundle branch block (19%, 19/102), T-wave changes (18%, 18/102), and left anterior fascicular block (11%, 11/102) were the most common electrocardiogram abnormalities; 51% (52/102) had normal electrocardiograms. Cardiomyopathy stage was ascertained in 94 of 109 patients: 51% (48/94) were indeterminate stage A and 49% (46/94) had cardiac structural disease (stages B1-D). Clinical findings that required clinical intervention or change in management were found in 23% (25/109), and included cardiomyopathy, apical hypokinesis/aneurysm, stroke, atrial or ventricular arrhythmias, and apical thrombus. Conclusions: These data show high rates of cardiac complications in a cohort of migrants living with Chagas disease in a non-endemic setting. We demonstrate that Chagas disease diagnosis prompts cardiac evaluation which often identifies actionable cardiac disease and provides opportunities for prevention and treatment. Author summary: Chagas cardiomyopathy is a manifestation of end-organ damage from Trypanosoma cruzi parasitic infection. Most infections occur in Mexico, Central and South America but disease is present globally due to migration. Approximately 30% of those with Chagas disease develop cardiomyopathy years after infection from persistent heart muscle and conduction system inflammation, which can be life-threatening. Unfortunately, Chagas disease remains underdiagnosed and identifying those at risk for severe disease remains challenging. The 2018 American Heart Association guidelines recommend ECG and cardiac rhythm strip, but there is no consensus on the approach to further cardiac evaluation in the US or management of Chagas cardiomyopathy. This study retrospectively analyzed symptoms and cardiac examination of migrants predominantly from endemic Central American countries who were diagnosed with Chagas disease and received care at Boston Medical Center. Most patients were asymptomatic and nearly half had evidence of cardiomyopathy. Echocardiogram abnormalities were present in approximately one-third of asymptomatic individuals with normal ECGs. Some individuals had significant abnormalities found on heart rhythm monitors or cardiac magnetic resonance imaging which led to management changes. These findings underscore the importance of routine echocardiograms, consideration of cardiac rhythm monitoring, and thorough cardiac assessment in people with Chagas disease regardless of symptoms. [ABSTRACT FROM AUTHOR]

Abstract To reduce maternal mortality, countries must continue to seek ways to increase access to skilled care during pregnancy and delivery. In Zambia, while antenatal attendance is high, many barriers exist that prevent women from delivering with a skilled health provider. This study explores how the individuals closest to a pregnant woman in rural Zambia can influence a woman's decision to seek and her ability to access timely maternity care. At four rural health centers, a free listing (n = 167) exercise was conducted with mothers, fathers, and community elders. Focus group discussions (FGD) (n = 135) were conducted with mothers, fathers, mothers-in-law, and community health workers (CHWs) to triangulate findings. We analyzed the FGD data against a framework that overlaid the Three Delays Framework and the Social Ecological Model. Respondents cited husbands, female relatives, and CHWs as the most important influencers during a woman's maternity period. Husbands have responsibilities to procure resources, especially baby clothes, and provide the ultimate permission for a woman to attend ANC or deliver at a facility. Female relatives escort the woman to the facility, assist during her wait, provide emotional support, assist the nurse during delivery, and care for the woman after delivery. CHWs educate the woman during pregnancy about the importance of facility delivery. No specific individual has the role of assisting with the woman's household responsibilities or identifying transport to the health facility. When husbands, female relatives, or CHWs do not fulfill their roles, this presents a barrier to a woman deciding to deliver at the health facility (Delay 1) or reaching a health facility (Delay 2). An intervention to help women better plan for acquiring the needed resources and identifying the individuals to escort her and those to perform her household responsibilities could help to reduce these barriers to accessing timely maternal care. Highlights • First use of the Three Delays Framework combined with the Social Ecological Model. • Free listing and focus group discussions conducted with communities in rural Zambia. • Husbands, female relatives, CHWs influence a woman's access to maternity care. • Unfulfilled roles are barriers to women seeking and delivering at a health facility. • Birth preparedness intervention utilizing CHWs could reduce the interpersonal barriers. [ABSTRACT FROM AUTHOR]