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Abstract Background Q fever is a zoonotic disease, caused by Gram negative bacterium C. burnetii, which imparts significant socio-economic burden due to production and reproductive loss (abortion, stillbirth, and infertility) in ruminants and debilitating clinical disease in human populations. While sheep and goats are considered the primary reservoirs of infection to humans, infection can also result from exposure to cattle. Recent studies indicate that in Ethiopia Q fever is a disease of growing public health interest. The top cattle producing region in Ethiopia is the Oromia region and Jimma is the zone that ranks first in the population of cattle within Oromia. While in Jimma zone livestock production plays an important role in people’s livelihoods and nutrition, to date, there is no available report on seroprevalence of Q fever in cattle. This is particularly important due to the low dairy farm biosecurity in Jimma town. This study aimed to evaluate the potential risk for public health from cattle production; a specific objective of this study included the estimation of the seroprevalence of C. burnetii infection and its potential risk factors in dairy cattle and cattle for slaughter in Jimma Town. Results The seroprevalence of C. burnetii in cattle present at dairy farms was significantly lower compared to cattle presented at slaughterhouse [6.17% (95% CI: 3.41–10.13) and 11.79% (95% CI: 7.63–17.17), respectively; (P = 0.04)]. As the age of dairy cattle increase by 1 year, they were 1.51 more likely to be positive of C. burnetii [OR = 1.51 (95%CI: 1.30–1.75; (P = 0.000)]. Cattle managed in semi-intensive production systems were 8.08 more likely to be C. burnetii seropositive compared to intensively managed dairy cattle [OR = 8.08 (95%CI: 1.03–63.68); P = 0.047]. Dairy cattle with access to nuisance animals like dogs, cats and mice were 5.65 more likely to be C. burnetii seropositive compared to dairy cattle without access to these animals. On the other hand, dairy cattle that have no tick infestation are 93% less likely to be seropositive for C. burnetii [OR = 0.07 (95%CI: 0.01–0.74); P = 0.027]. Concerning farm-level data, farms of larger herd sizes were 1.03 more likely to be C. burnetii seropositive than small herd farms [OR = 1.03 (95%CI: 0.99–1.06)]. The result from slaughterhouse indicates that as the age of cattle increase by 1 year their chance of being C. burnetii seropositive increases by 2.27 [OR = 2.27 (95%CI: 1.93–2.68); p = 0.000]. Conclusion Considering its zoonotic and economic burden the seroprevalence of Q fever recorded in this study is of eminent public health concern with a farm-level and slaughterhouse seroprevalence of 6.17 and 11.79% respectively. Based on modifiable risk factors identified in this study, Q fever management plans better be focused on health education and awareness campaigns for abattoir workers and dairy farm workers. Dairy farm Q fever management plans should contemplate improved dairy herd biosecurity with regards to cattle tick infestation, keeping different livestock species segregated and avoiding mixing of herd with others with unknown health status.

Abstract Background Schistosomiasis and infection by soil-transmitted helminths are some of the world’s most prevalent neglected tropical diseases. Infection by more than one parasite (co-infection) is common and can contribute to clinical morbidity in children. Geostatistical analyses of parasite infection data are key for developing mass drug administration strategies, yet most methods ignore co-infections when estimating risk. Infection status for multiple parasites can act as a useful proxy for data-poor individual-level or environmental risk factors while avoiding regression dilution bias. Conditional random fields (CRF) is a multivariate graphical network method that opens new doors in parasite risk mapping by (i) predicting co-infections with high accuracy; (ii) isolating associations among parasites; and (iii) quantifying how these associations change across landscapes. Methods We built a spatial CRF to estimate infection risks for Ascaris lumbricoides, Trichuris trichiura, hookworms (Ancylostoma duodenale and Necator americanus) and Schistosoma mansoni using data from a national survey of Rwandan schoolchildren. We used an ensemble learning approach to generate spatial predictions by simulating from the CRF’s posterior distribution with a multivariate boosted regression tree that captured non-linear relationships between predictors and covariance in infection risks. This CRF ensemble was compared against single parasite gradient boosted machines to assess each model’s performance and prediction uncertainty. Results Parasite co-infections were common, with 19.57% of children infected with at least two parasites. The CRF ensemble achieved higher predictive power than single-parasite models by improving estimates of co-infection prevalence at the individual level and classifying schools into World Health Organization treatment categories with greater accuracy. The CRF uncovered important environmental and demographic predictors of parasite infection probabilities. Yet even after capturing demographic and environmental risk factors, the presences or absences of other parasites were strong predictors of individual-level infection risk. Spatial predictions delineated high-risk regions in need of anthelminthic treatment interventions, including areas with higher than expected co-infection prevalence. Conclusions Monitoring studies routinely screen for multiple parasites, yet statistical models generally ignore this multivariate data when assessing risk factors and designing treatment guidelines. Multivariate approaches can be instrumental in the global effort to reduce and eventually eliminate neglected helminth infections in developing countries.

Abstract Background The modifiable areal unit problem (MAUP) arises when the support size of a spatial variable affects the relationship between prevalence and environmental risk factors. Its effect on schistosomiasis modelling studies could lead to unreliable parameter estimates. The present research aims to quantify MAUP effects on environmental drivers of Schistosoma japonicum infection by (i) bringing all covariates to the same spatial support, (ii) estimating individual-level regression parameters at 30 m, 90 m, 250 m, 500 m and 1 km spatial supports, and (iii) quantifying the differences between parameter estimates using five models. Methods We modelled the prevalence of Schistosoma japonicum using sub-provinces health outcome data and pixel-level environmental data. We estimated and compared regression coefficients from convolution models using Bayesian statistics. Results Increasing the spatial support to 500 m gradually increased the parameter estimates and their associated uncertainties. Abrupt changes in the parameter estimates occur at 1 km spatial support, resulting in loss of significance of almost all the covariates. No significant differences were found between the predicted values and their uncertainties from the five models. We provide suggestions to define an appropriate spatial data structure for modelling that gives more reliable parameter estimates and a clear relationship between risk factors and the disease. Conclusions Inclusion of quantified MAUP effects was important in this study on schistosomiasis. This will support helminth control programmes by providing reliable parameter estimates at the same spatial support and suggesting the use of an adequate spatial data structure, to generate reliable maps that could guide efficient mass drug administration campaigns.

Abstract Background Korean surveillance program for bovine brucellosis was improved by extending it to beef slaughterhouses and by pre-movement testing of bulls on May 2005 (Intervention 1). The bovine brucellosis surveillance program was further extended to beef cattle farms with more than 10 heads of cattle on June 2006 (Intervention 2). Methods To quantify the temporal relationship between bovine and human brucellosis, a time-series analysis was conducted using Korean national notification data reported between January 2004 and December 2014. Results Our findings indicate that while during the pre-intervention phase (January 2004 to March 2005) there was no significant temporal relationship between the incidences of bovine and human brucellosis, significant temporal relationships were observed after Intervention 1 (June 2005 to June 2006, no lag, β = 0.57, p = 0.04), and Intervention 2 (July 2006 to June 2007, 1-month lag, β = 0.65, p = 0.03). Furthermore, significant changes in incidence in human were observed after Intervention 1 (β = − 0.17 per 10 million-people, p = 0.03) and Intervention 2 (β = − 0.19 per 10 million-people, p = 0.04). Conclusions These findings indicated the changes of a nationwide comprehensive surveillance programme targeting all cattle is required for effective reduction in the human population.

Abstract Background Labrador retrievers are reportedly predisposed to many disorders but accurate prevalence information relating to the general population are lacking. This study aimed to describe demography, mortality and commonly recorded diseases in Labrador retrievers under UK veterinary care. Methods The VetCompass™ programme collects electronic patient record data on dogs attending UK primary-care veterinary practices. Demographic analysis covered all33,320 Labrador retrievers in the VetCompass™ database under veterinary care during 2013 while disorder and mortality data were extracted from a random sample of 2074 (6.2%) of these dogs. Results Of the Labrador retrievers with information available, 15,427 (46.4%) were female and 15,252 (53.6%) were male. Females were more likely to be neutered than males (59.7% versus 54.8%, P

Abstract Background Spatial modelling studies of schistosomiasis (SCH) are now commonplace. Covariate values are commonly extracted at survey locations, where infection does not always take place, resulting in an unknown positional exposure mismatch. The present research aims to: (i) describe the nature of the positional exposure mismatch in modelling SCH helminth infections; (ii) delineate exposure areas to correct for such positional mismatch; and (iii) validate exposure areas using human positive cases. Methods To delineate exposure areas to Schistosoma japonicum, a spatial Bayesian network (sBN) was constructed. It uses data on exposure risk factors such as: potential sites for snails’ accessibility, geographical distribution of snail infection rate, and cost of the community to access nearby water bodies. Prior and conditional probabilities were obtained from the literature and inserted as weights based on their relative contribution to exposure; these probabilities were then used to calculate joint probabilities of exposure within the sBN. Results High values of probability of S. japonicum exposure correspond to polygons where snails could potentially be present, for instance in wet soils and areas with low slopes, but also where people can easily access water bodies. Low correlation (R 2 = 0.3) was found between the percentage of human cases and the delineated probabilities of exposure when validation buffers are generated over the human cases. Conclusions The utility of a probabilistic method for the identification of exposure areas for S. japonicum, with wider application for other water-borne infections, was demonstrated. From a public health perspective, the schistosomiasis exposure sBN developed in this study could be used to guide local schistosomiasis control teams to specific potential areas of exposure, and improve efficiency of mass drug administration campaigns in places where people are likely to be exposed to the infection.

Abstract Background Foot-and-mouth disease (FMD) is an acute viral disease of cloven-hoofed animals with high economic impact. FMD remains endemic in Iran particularly in the livestock-dense province of Khorasan Razavi in northeastern Iran where FMD outbreaks continuously occur. In this study, we aimed to quantify risk factors for the recurrence of FMD outbreaks in Iran by analyzing a time-series of FMD outbreak data from the province of Khorasan Razavi. Results This study used FMD outbreak data collected from 2012 to 2014. Data were collected by local offices of the Iranian Animal Disease Department and the veterinarian of the veterinary council of the Khorasan Razavi province. An outbreak investigation questionnaire was delivered to 127 farms, including 46 case farms (FMD-infected) and 81 control farms (FMD-free). To quantify and compare the odds of exposure to a risk factor in FMD-infected farms versus FMD-free farms, logistic regression models were built using SPSS software version 16. Our results of multivariable logistic regression indicate that hygienic status of the farm (OR = 11.83; CI = 3.38–41.43), FMD vaccination status (OR = 0.06; CI = 0.01–0.68), transportation of livestock (OR = 0.40; CI = 0.163–0.981) and inhibition of livestock dealers’ entry into the farm (OR = 0.36; CI = 0.12–1.09) were identified as important risk factors for farm-level FMD infection. Conclusion This study generated much needed evidence on a set of modifiable risk factors for the recurrence of FMD outbreaks in the high risk province of Khorasan Razavi. This information can be used to improve existing national FMD control program and suggest new guidelines to prevent FMD outbreaks in the country.

Abstract Background Leptospirosis morbidity and mortality rates in China have decreased since the 2000s. Further analyses of the spatiotemporal and demographic changes occurring in the last decade and its implication on estimates of disease burden are required to inform intervention strategies. In this study, we quantified the epidemiological shift and geographical heterogeneity in the burden of leptospirosis during 2005–2015 in China. Methods We used reported leptospirosis case data from 1st January 2005 to 31st of December 2015 that routinely collected by the China Information System for Disease Control and Prevention (CISDCP) to analyze the epidemiological trend and estimate the burden in terms of disability-adjusted life-years (DALYs) over space, time, and demographical groups. Results A total of 7763 cases were reported during 2005–2015. Of which, 2403 (31%) cases were the laboratory-confirmed case. Since 2005, the notified incidence rate was gradually decreased (P 0.05). During 2005–2015, we estimated a total of 10 313 DALYs were lost due to leptospirosis comprising a total of 1804 years-lived with disability (YLDs) and 8509 years-life lost (YLLs). Males had the highest burden of disease (7149 DALYs) compared to females (3164 DALYs). The highest burden estimate was attributed to younger individuals aged 10–19 years who lived in southern provinces of China. During 2005–2015, this age group contributed to approximately 3078 DALYs corresponding to 30% of the total DALYs lost in China. Yet, our analysis indicated a declining trend in burden estimates (P

Abstract Background Q fever is a zoonotic disease caused by Coxiella burnetii. This bacterium survives harsh conditions and attaches to dust, suggesting environmental dispersal is a risk factor for outbreaks. Spatial epidemiology studies collating evidence on Q fever geographical contamination gradients are needed, as human cases without occupational exposure are increasing worldwide. Methods We used a systematic literature search to assess the role of distance from ruminant holdings as a risk factor for human Q fever outbreaks. We also collated evidence for other putative drivers of C. burnetii geographical dispersal. Results In all documented outbreaks, infective sheep or goats, not cattle, was the likely source. Evidence suggests a prominent role of airborne dispersal; Coxiella burnetii travels up to 18 km on gale force winds. In rural areas, highest infection risk occurs within 5 km of sources. Urban outbreaks generally occur over smaller distances, though evidence on attack rate gradients is limited. Wind speed / direction, spreading of animal products, and stocking density may all contribute to C. burnetii environmental gradients. Conclusions Q fever environmental gradients depend on urbanization level, ruminant species, stocking density and wind speed. While more research is needed, evidence suggests that residential exclusion zones around holdings may be inadequate to contain this zoonotic disease, and should be species-specific.

Abstract Background Human echinococcoses are parasitic helminth infections that constitute a serious public health concern in several regions across the world. Cystic (CE) and alveolar echinococcosis (AE) in China represent a high proportion of the total global burden of these infections. This study was conducted to predict the spatial distribution of human seropositivity for Echinococcus species in Xiji County, Ningxia Hui Autonomous Region (NHAR), with the aim of identifying communities where targeted prevention and control efforts are required. Methods Bayesian geostatistical models with environmental and demographic covariates were developed to predict spatial variation in the risk of human seropositivity for Echinococcus granulosus (the cause of CE) and E. multilocularis (the cause of AE). Data were collected from three cross-sectional surveys of school children conducted in Xiji County in 2002–2003, 2006–2007 and 2012–2013. Environmental data were derived from high-resolution satellite images and meteorological data. Results The overall seroprevalence of E. granulosus and E. multilocularis was 33.4 and 12.2%, respectively, across the three surveys. Seropositivity for E. granulosus was significantly associated with summer and winter precipitation, landscape fragmentation variables and the extent of areas covered by forest, shrubland, water and bareland/artificial surfaces. Seropositivity for E. multilocularis was significantly associated with summer and winter precipitations, landscape fragmentation variables and the extent of shrubland and water bodies. Spatial correlation occurred over greater distances for E. granulosus than for E. multilocularis. The predictive maps showed that the risk of seropositivity for E. granulosus expanded across Xiji during the three surveys, while the risk of seropositivity for E. multilocularis became more confined in communities located in the south. Conclusions The identification of high-risk areas for seropositivity for these parasites, and a better understanding of the role of the environment in determining the transmission dynamics of Echinococcus spp. may help to guide and monitor improvements in human echinococcosis control strategies by allowing targeted allocation of resources.

Abstract Background Human cystic (CE) and alveolar (AE) echinococcoses are zoonotic parasitic diseases that can be influenced by environmental variability and change through effects on the parasites, animal intermediate and definitive hosts, and human populations. We aimed to assess and quantify the spatiotemporal patterns of human echinococcoses in Ningxia Hui Autonomous Region (NHAR), China between January 1994 and December 2013, and examine associations between these infections and indicators of environmental variability and change, including large-scale landscape regeneration undertaken by the Chinese authorities. Methods Data on the number of human echinococcosis cases were obtained from a hospital-based retrospective survey conducted in NHAR for the period 1 January 1994 through 31 December 2013. High-resolution imagery from Landsat 4/5-TM and 8-OLI was used to create single date land cover maps. Meteorological data were also collected for the period January 1980 to December 2013 to derive time series of bioclimatic variables. A Bayesian spatio-temporal conditional autoregressive model was used to quantify the relationship between annual cases of CE and AE and environmental variables. Results Annual CE incidence demonstrated a negative temporal trend and was positively associated with winter mean temperature at a 10-year lag. There was also a significant, nonlinear effect of annual mean temperature at 13-year lag. The findings also revealed a negative association between AE incidence with temporal moving averages of bareland/artificial surface coverage and annual mean temperature calculated for the period 11–15 years before diagnosis and winter mean temperature for the period 0–4 years. Unlike CE risk, the selected environmental covariates accounted for some of the spatial variation in the risk of AE. Conclusions The present study contributes towards efforts to understand the role of environmental factors in determining the spatial heterogeneity of human echinococcoses. The identification of areas with high incidence of CE and AE may assist in the development and refinement of interventions for these diseases, and enhanced environmental change risk assessment.

Abstract Background Investigating the effect of successive annual deworming rounds on the spatiotemporal distribution of infection prevalence and numbers at risk for soil-transmitted helminths (STHs) can help identify communities nearing elimination and those needing further interventions. In this study, we aim to quantify the impact of an 8-year mass drug administration (MDA) programme (from 2007 to 2014) on the spatiotemporal distribution of prevalence of STH infections and to estimate the number of school-aged children infected with STHs in Burundi. Methods During annual longitudinal school-based surveys in Burundi between 2007 and 2011, STH infection and anthropometric data for a total of 40,656 children were collected; these data were supplemented with data from a national survey conducted in 2014. Bayesian model based geostatistics (MBG) were used to generate predictive prevalence maps for each STH species and year. The numbers of children at-risk of infection per district between 2008 and 2014 were estimated as the product of the predictive prevalence maps and population density maps. Results Overall, the degree of spatial clustering of STH infections decreased between 2008 and 2011; in 2014 the geographical clusters of all STH infections reappeared. The reduction in prevalence was small for Ascaris lumbricoides and Trichuris trichiura in the centre and central north of the country. Our predictive prevalence maps for hookworm indicate a reduction in prevalence along the periphery of the country. The predicted number of children infected with any STH species decreased substantially between 2007 and 2011, but in 2014 there was an increase in the predicted number of children infected with A. lumbricoides and T. trichiura. In 2014, the districts with the highest predicted number of children infected with A. lumbricoides, T. trichiura and hookworms were Kibuye district (n = 128,903), Mabayi district (n = 35,302) and Kiremba (n = 87,511), respectively. Conclusions While the MDA programme in Burundi resulted in a reduction in STH prevalence, this reduction was spatiotemporally heterogeneous, with some pockets of high prevalence remaining, suggesting that treatment coverage and complementary interventions should be evaluated to improve impact.

Abstract Objectives The Central Dry Zone (CDZ) is one of the most important livestock production areas of Myanmar. However, there is an eminent lack of information on the attitudes and traditional beliefs of local farmers and livestock supply chain actors in CDZ of Myanmar on the public health implications. A modified data collection instrument of the Health Belief model was developed to investigate attitudes, beliefs and barriers to the application of recommended zoonotic disease prevention. Study design Cross-sectional study. Method Data analyses were conducted considering a two-phase multilevel mixed effect binomial generalized linear models modelling approach. Results The availability of information about zoonosis to supply chain actors influenced their confidence to implement preventive actions (OR = 1.5, p = 0.045 for cattle diseases; OR = 1.5, p = 0.022 for village chicken diseases). Supply chain actors were more likely aware of zoonosis transmitted by cattle compared to livestock farmers (OR = 0.3, p = 0.005 for cattle farmers), while people not rearing or trading small ruminants and/or poultry were less likely to be aware of the zoonotic risk associated with these animals (p

Abstract Background Despite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated. Methods A negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk. Results The final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus. Conclusions These findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.

Abstract Background Canine allergic dermatitis is a common diagnosis in veterinary practices which can lead to secondary infections requiring treatment with antimicrobials. A previous study suggested that dogs treated with oclacitinib in an Australian referral hospital required fewer courses of antimicrobial therapy compared to dogs receiving other anti-pruritic treatments. This study aimed to quantify the effect of oclacitinib treatment on the use of antimicrobials and other therapies in general practice veterinary clinics across Australia. A retrospective case-controlled review of patient records was designed to investigate the number of courses of antimicrobials and other therapies in dogs that received oclacitinib (Apoquel®), compared with those who received an anti-pruritic treatment that was not oclacitinib. Results The target population included canine patients with a presumptive diagnosis of allergic dermatitis presenting between 2008 and 2018 to general practices contributing to the VetCompass Australia database. Patient records of interest were identified using search terms relating to allergic dermatitis, resulting in over 700,000 observations. Multivariable logistic regression models were developed to determine whether cases were prescribed fewer antimicrobial courses than controls, after adjusting for the presence of concurrent skin infections or infectious agents in ears. Our results indicate that fewer antimicrobial courses were prescribed in the cases compared to the controls. After adjusting for the concurrent skin infections, there was a significant reduction in the use of cefovecin [OR:0.62(0.39–0.98), P = 0.043], chlorhexidine [OR:0.57(0.42–0.77), P

Abstract Background The Central Dry Zone (CDZ) of Myanmar is a critical region of livestock production. This region supports 10 million people whose livelihoods depend on small-scale, dry-land agriculture, but it is also one of the poorest regions of Myanmar. Little is known about the constraints to animal health in multi-species livestock farms in this region or the relationships between husbandry practices and measures of the success of livestock rearing such as income, and successful health management. Results In this study, we describe associations between husbandry practices and animal health problems affecting different body systems. We also develop a biosecurity and livestock disease prevention index by taking account of different activities (i.e. treatment, vaccination, reducing disease transmission practice, sanitation) that can be compared between livestock species, estimate the income generated from livestock production, and identify factors influencing these parameters. Cross-sectional study was used to collect data on livestock production and health from cattle (N = 382), sheep, goat (N = 303) and village chicken (N = 327) farmers in 40 villages of the CDZ. Survey-design based techniques and F-statistics, ordinal, and binomial regression were used for data analysis. Our results indicate that a significant proportion of farmers’ income in the CDZ comes from crop production (43.2%) and livestock production (23.1%) and the rest of the farmers’ income is derived from trading, supported by other relatives and employment. Our results indicate that animal health management practices, herd/flock size, and experience of farmers contributed significantly to the presence of animal health problems, in particular related to the physical, respiratory and digestive systems. Animal health management was usually conducted in traditional ways. Among different livestock species farms, cattle farms (cattle median BDPI: 45; IQR: 35–55) practised better biosecurity than other livestock species farms (i.e. small ruminant and village chicken farms) (small ruminant and village chicken BDPI: 10; IQR: 0–20). Interestingly, the ownership groups (i.e. rearing singly or multispecies) did not show any impact on biosecurity and disease prevention index of the farms. Conclusions This study identified good practice households and these findings will be useful for designing intervention trials to improve the production and health outcomes evaluated in this study.

Abstract Background Influenza and pneumococcal vaccine uptake in the older population aged 65 years or over of Hong Kong dramatically increased since the 2003 SARS outbreak. This study is aimed to evaluate the impact of increased coverage of influenza and pneumococcal vaccines by comparing the change of disease burden in the older population of Hong Kong, with the burden in the older population of Brisbane with relatively high vaccine coverage in the past fifteen years. Methods Time series segmented regression models were applied to weekly numbers of cause-specific mortality or hospitalization of Hong Kong and Brisbane. Annual excess rates of mortality or hospitalization associated with influenza in the older population were estimated for the pre-SARS (reference period), post-SARS and post-pandemic period, respectively. The rate ratios (RRs) between these periods were also calculated to assess the relative change of disease burden. Results Compared to the pre-SARS period, excess rates of mortality associated with influenza during the post-SARS period in Hong Kong decreased for cardiorespiratory diseases (RR = 0.90, 95% CI 0.80, 1.01), stroke (RR = 0.74, 95% CI 0.50, 1.09), and ischemic heart diseases (RR = 0.45, 95% CI 0.34, 0.58). The corresponding RRs in Brisbane were 0.79 (95% CI 0.54, 1.15), 0.33 (0.13, 0.80), and 1.09 (0.62, 1.90), respectively. Only the mortality of ischemic heart diseases showed a greater reduction in Hong Kong than in Brisbane. During the post-pandemic period, excess rates of all-cause mortality increased in Hong Kong, but to a lesser extent than in Brisbane (RR = 1.41 vs 2.39). Conclusion A relative decrease (or less of an increase) of influenza disease burden was observed in the older population of Hong Kong after increased coverage of influenza and pneumococcal vaccines in this population, as compared to those of Brisbane where vaccination rates remained stable. The lack of significant findings in some disease categories highlights the challenges of evaluating the benefits of vaccination at the population level.

Abstract Background In China canine rabies poses a serious public health problem in that human mortality ranks the second highest globally. While rabies health education interventions are advocated by WHO to be critical components of modern rabies control and prevention programs, available studies have not adequately investigated the relative efficacy of their implementation in at-risk populations. This study aims to measure and compare the effect on knowledge and protective behavior towards rabies of health education interventions that include a novel Short Messaging Service via cell phone (SMS) and rabies health information sessions (IS). Methods The study used a between-subject design involving repeated measures of rabies-related KAP (knowledge, attitude and practice). A total of 350 randomly selected villagers were randomly allocated into three intervention (SMS, IS and SMS + IS) and one control group. The content of SMS and IS covered topics about rabies prevention and route of transmission. The SMS intervention consisted of ten separate messages delivered three times two weeks after the pretest; the IS intervention was conducted once immediately after the pretest. A validated questionnaire was used to capture demographic information and KAP information. Ordinary Least Squares regression was used to contrast the effects of interventions. Results Our results indicate that overall SMS outperforms IS at improving knowledge and protective behavior against rabies. Our results suggest that a combined intervention of SMS and IS can result in higher scores than any of the two in isolation. The impact of SMS, IS and SMS + IS is greatest on knowledge, followed by attitude and practice scores. Conclusion This study demonstrated that health communication modes based on SMS, IS and a combination of the two are all effective to improve rabies-related KAP in the short term. These findings highlight the potential usefulness of SMS as an additional tool for public health communication and promotion; further studies are needed to investigate the long term benefits of these interventions on the reduction of dog bites and resulting human rabies incidence.

Abstract Background Soil-transmitted helminth (STH) infections are highly prevalent in the Philippines. Mapping the prevalence and high-intensity of STH co-infections can help guide targeted intervention programmes to reduce morbidity, especially among vulnerable school-aged children. In this study, we aimed to predict the spatial distribution of the prevalence of Ascaris lumbricoides and Trichuris trichiura co-infection and infection intensity classes in the Philippines to identify populations most in need of interventions. Methods Data on STH infections from 29,919 individuals during the nationwide parasitological survey in 2005 to 2007 were included in the analysis. To geographically predict the prevalence of A. lumbricoides and T. trichiura co-infections and infection intensity classes, Bayesian multinomial geostatistical models were built including age, sex, environmental variables and a geostatistical random effect. The number of individuals co-infected and belonging to each of the infection intensity classes in 2017 was forecast by combining our predictive prevalence maps with population density maps. Results Our models showed that school-aged children (5–19 years) are most at risk of A. lumbricoides and T. trichiura co-infections and of moderate/high infection intensity compared to other age groups. We identified target provinces where the likelihood of STH-associated morbidity was highest: Luzon (Bulacan, Benguet, Cavite, Sorsogon, Metropolitan Manila, Pampanga and Rizal), the Visayas (Cebu, Iloilo, Leyte and Negros Occidental), and in Mindanao (Agusan Del Norte, Davao Del Sur, Davao Oriental, Lanao Del Sur, Maguindanao, Misamis Oriental, Sulu and Zamboanga Del Sur). Luzon had the highest estimated number of school-aged children with A. lumbricoides and T. trichiura co-infections (estimated total 89,400), followed by the Visayas (38,300) and Mindanao (20,200). Conclusions Our study provided epidemiological evidence to highlight national priority areas for controlling co-infections and high intensity infections in the Philippines. Our maps could assist more geographically targeted interventions to reduce the risk of STH-associated morbidity in the Philippines.

Abstract Background The transmission of soil-transmitted helminths (STHs) is associated with poverty, poor hygiene behaviour, lack of clean water and inadequate waste disposal and sanitation. Periodic administration of benzimidazole drugs is the mainstay for global STH control but it does not prevent re-infection, and is unlikely to interrupt transmission as a stand-alone intervention. Findings We reported recently on the development and successful testing in Hunan province, PR China, of a health education package to prevent STH infections in Han Chinese primary school students. We have recently commenced a new trial of the package in the ethnically diverse Xishuangbanna autonomous prefecture in Yunnan province and the approach is also being tested in West Africa, with further expansion into the Philippines in 2015. Conclusions The work in China illustrates well the direct impact that health education can have in improving knowledge and awareness, and in changing hygiene behaviour. Further, it can provide insight into the public health outcomes of a multi-component integrated control program, where health education prevents re-infection and periodic drug treatment reduces prevalence and morbidity.