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Zika virus (ZIKV) is a positive sense RNA virus of the Flaviviridae family, which includes several medically notable arboviruses such as dengue (DENV), yellow fever, Japanese encephalitis virus, and West [...]

We believe a lack of transparency undermines both the credibility of, and interest in, stated choice studies among policy makers. Unlike articles reporting the results of contingent valuation studies, papers in the stated choice literature rarely present simple tabulations of raw response data (that is, a table or graph showing the percentage of respondents agreeing to purchase a good or service, or vote for a proposed management plan as a function of price). We describe an approach for adding "policy" tasks to a standard orthogonal-in-attribute-levels research design that allows the researcher to plot raw responses as a function of changes in only one characteristic of the offered good or service. We demonstrate this approach using data from a stated choice study of private demand for cholera and typhoid vaccines in Kolkata, India, carried out in the summer of 2004.

Author(s): Lorenz von Seidlein 1,2,*, Hannah Wood 3, Otis Sloan Brittain 3, Lucy Tusting 4, Alexa Bednarz 5, Salum Mshamu 6, Catherine Kahabuka 6, Jacqueline Deen 7, David Bell 8, [...]

Objective To describe and analyse the characteristics of oral cholera vaccination campaigns; Including location, target population, logistics, vaccine coverage and delivery costs. Methods We searched PubMed, the World Health Organization (WHO) website and the Cochrane database with no date or language restrictions. We contacted public health personnel, experts In the field and in ministries of health and did targeted web searches. Findings A total of 33 documents were included In the analysis. One country, Viet Nam, incorporates oral cholera vaccination into its public health programme and has administered approximately 10.9 million vaccine doses between 1997 and 2012. In addition, over 3 million doses of the two WHO pre-qualified oral cholera vaccines have been administered in more than 16 campaigns around the world between 1997 and 2014. These campaigns have either been pre-emptive or reactive and have taken place under diverse conditions, such as in refugee camps or natural disasters. Estimated two-dose coverage ranged from 46 to 88% of the target population. Approximate delivery cost per fully immunized person ranged from 0.11-3.99 United States dollars. Conclusion Experience with oral cholera vaccination campaigns continues to Increase. Public health officials may draw on this experience and conduct oral cholera vaccination campaigns more frequently. Objectif Decrire et analyser les caracteristiques des campagnes de vaccination orale contre le cholera; y compris le site, la population cible, la logistique, la couverture vaccinale et les couts de distribution. Methodes Nous avons effectue des recherches dans PubMed, le site Internet de l'Organisation mondiale de la Sante (OMS) et la base de donnees Cochrane sans aucune restriction de date ou de langue. Nous avons contacte des membres du personnel de la sante publique, des experts travaillant dans le domaine et dans les ministeres de la Sante et nous avons cible les recherches sur Internet. Resultats Nous avons inclus 33 documents au total dans l'analyse. Un seul pays, le Viet Nam, inclut la vaccination orale anticholerlque dans son programme de sante publique et a administre environ 10,9 millions de doses de vacclns entre 1997 et 2012. En outre, plus de 3 millions de doses des deux vaccins oraux anticholeriques prequalifies de I'OMS ont ete administres dans plus de 16 campagnes de vaccination dans le monde entier entre 1997 et 2014. Ces campagnes ont ete menees en prevention ou en reaction et ont eu lieu dans diverses conditions, comme dans des camps de refugies ou lors de catastrophes naturelles. La couverture estimee des deux doses etait comprise entre 46 et 88% de la population cible. Les frais de distribution approximatifs par personne entierement vaccinee sont compris entre 0,11 et 3,99 dollars. Conclusion L'experience avec les campagnes de vaccination orale contre le cholera continue a se developper. Les responsables de la sante publique peuvent tirer profit de cette experience et mener plus frequemment des campagnes de vaccination orale contre le cholera. Objetivo Describir y analizar las caracteristicas de las campanas de vacunacion oral contra el colera, incluyendo la ubicacion, la poblacion objetivo, la logistica, los costes de cobertura y la entrega de vacunas. Metodos Realizamos busquedas en PubMed, la pagina web de la Organizacion Mundial de la salud (OMS) y la base de datos Cochrane sin restricciones de fechas ni idioma. Nos pusimos en contacto con el personal de salud publica, expertos del sector y los ministerios de salud, y realizamos busquedas especificas en la web. Resultados Se incluyo un total de 33 documentos en el analisis. Un pais, Viet Nam, incorpora vacunas orales contra el colera en su programa de salud publica y ha administrado aproximadamente 10,9 millones de dosis de vacunas entre 1997 y 2012. Ademas, se han administrado mas 3 de millones de dosis de las dos vacunas orales contra el colera orales que cumplen con los requisitos de la OMS en mas de 16 campanas en todo el mundo realizadas entre 1997 y 2014. Estas campanas han sido preventivas o reactivas, y se han llevado a cabo en diversas condiciones, como en campamentos de refugiados o desastres naturales. La cobertura estimada de dos dosis oscilo entre el 46 y 88% de la poblacion objetivo. El coste aproximado del suministro por persona completamente inmunizada oscilo entre 0,11 y 3,99 dolares de los Estados Unidos. Conclusion La experiencia con las campanas de vacunacion oral contra el colera sigue aumentando. Los funcionarios de salud publica pueden aprovechar esta experiencia y realizar campanas de vacunacion orales contra el colera con mayor frecuencia., Introduction Vibrio cholerae O1 and O139 causes severe diarrhoea and the main strategies to prevent the disease are to promote hygiene and to ensure safe water and sanitation. These basic [...]

Author(s): Lorenz von Seidlein 1,2,*, Jacqueline L. Deen 3 The technology for a killed oral cholera vaccine (OCV) was developed by Jan Holmgren and colleagues in Sweden in the 1970s [...]

OBJECTIVE: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition. METHODS: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation. FINDINGS: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition. CONCLUSION: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.

To the Editor: We wish to thank Date et al. for their clear discussion of the arguments against the use of oral cholera vaccines (OCVs) in Haiti in 2010-11 (7). [...]

Objective To define mortality patterns in an urban slum in Kolkata, India, in the context of a cholera and typhoid fever project. Methods In a well-defined population that was under surveillance for 18 months, we followed a dynamic cohort of 63 788 residents whose households were visited monthly by community health workers to identify deaths. Trained physicians performed verbal autopsies and experienced senior physicians assigned the primary cause of death according to the International classification of diseases, 10th edition. We tabulated causes of death in accordance with Global Burden of Disease 2000 categories and assessed overall and cause-specific mortality rates per age group and gender. Findings During 87 921 person-years of follow-up, we recorded 544 deaths. This gave an overall mortality rate of 6.2 per 1000 person-years. We assigned a cause to 89% (482/544) of the deaths. The leading causes of death, in descending order, were cardiovascular diseases (especially among adults aged over 40 years), cancer, respiratory ailments and digestive disorders. Most deaths in children under 5 years of age were caused by tuberculosis, respiratory infections and diarrhoeal diseases. Conclusion Although the most common causes of death in children were infectious, non-communicable diseases were predominant among adults. There is a need for continuing interventions against infectious diseases in addition to new and innovative strategies to combat non-infectious conditions. Objectif Definir des modeles de mortalite dans un quartier urbain pauvre de Kolkata en Inde, dans le contexte d'un projet cholera et fievre typhoide. Methodes Au sein d'une population bien definie, surveillee pendant 18 mois, nous avons suivi une cohorte dynamique de 63788 residents dont les foyers ont ete visites chaque mois par des professionnels communautaires de la sante pour identifier les deces. Des medecins competents ont realise des autopsies verbales et des professeurs experts ont reference la cause primaire du deces a partir de la Classification internationale des maladies, 10e edition. Nous avons mis en tableau les causes de deces conformement aux categories du <> et nous avons evalue les taux de mortalite generaux et pour cause specifique par tranche d'age et par sexe. Resultats Au cours des 87921 personnes-annees de suivi, nous avons enregistre 544 deces. Cela donne un taux de mortalite total de 6,2 par 1 000 personnes-annees. Nous avons attribue une cause a 89% (482/544) des deces. Les principales causes de deces, par ordre decroissant, etaient des maladies cardio-vasculaires (surtout parmi les adultes ages de 40 ans et plus), des cancers, des maladies respiratoires et des troubles digestifs. La plupart des deces chez les enfants de moins de 5 ans ont ete causes par la tuberculose, des infections respiratoires et des maladies diarrheiques. Conclusion Alors que les causes de deces les plus communes chez les enfants etaient d'origine infectieuse, les maladies non transmissibles ont ete predominantes chez les adultes. Des interventions en continu sont necessaires contre les maladies infectieuses, conjointement a ales strategies nouvelles et innovatrices pour combattre les conditions non infectieuses. Objetivos Definir los patrones de mortalidad en un barrio urbano pobre de Kolkata, India, dentro dei contexto de un proyecto contra el colera y la fiebre tifoidea. Metodos En una poblacion bien definida y sometida a vigilancia durante 18 meses se realizo el seguimiento de un conjunto de 63 788 residentes, cuyos hogares recibieron visitas mensuales, dei personai sanitario comunitario para identificar las defunciones. Las entrevistas con los familiares y allegados de las personas fallecidas fueron realizadas por medicos expertos, y los directores medicos atribuyeron la causa principal de la muerte siguiendo la Clasificacion Intemacional de Enfermedades, 10.a edicion. Las causas de la muerte se clasificaron segun las categorias de la Carga Mundial de Morbilidad dei 2000 y se evaluaron las tasas de mortalidad general y especifica de cada caso en funcion dei grupo de edad y dei sexo. Resultados Se registraron 544 muertes durante el seguimiento de 87921 anos-persona. Estos datos generaron una tasa de mortalidad de 6,2 por 1000 anos-persona. En el 89% de las muertes (482/544) se asigno una causa. Las principales causas de defuncion, en orden descendente, fueron: las enfermedades cardiovasculares (fundamentalmente, entre los adultos mayores de 40 anos), el cancer, las enfermedades respiratorias y los trastornos digestivos. La mayoria de las muertes acaecidas en ninos menores de cinco anos se debieron a la tuberculosis, las infecciones respiratorias y las enfermedades diarreicas. Conclusion Aunque las causas mas frecuentes de muerte infantil fueron las infecciosas, en los adultos predominaron las enfermedades infecciosas no contagiosas. Es necesario continuar con las intervenciones contra las enfermedades infecciosas, asi como iniciar estrategias nuevas e innovadoras para luchar contra las enfermedades no infecciosas., Introduction Mortality data are important indicators of population health and are crucial for setting priorities for health interventions and research. However, in areas with scanty resources little reliable information is [...]

ABSTRACT Background The burden of shigellosis is greatest in resource-poor countries. Although this diarrheal disease has been thought to cause considerable morbidity and mortality in excess of 1,000,000 deaths globally [...]

Objective We aimed to determine the burden of bacillary dysentery in China, its cross-regional variations, trends in morbidity and mortality, the causative bacterial species and antimicrobial resistance patterns. Methods We extracted and integrated governmental statistics and relevant medical literature published from 1991 to 2000. Data were also collected from one general hospital each for the six provinces and Jin-an district, Shanghai, representative of six geographical regions and a modern city. Findings In 2000, 0.8-1.7 million episodes of bacillary dysentery occurred of which 0.5 to 0.7 million were treated at health-care facilities and 0.15-0.20 million patients were hospitalized. The highest morbidity and mortality rates were among the youngest and oldest age groups. Bacillary dysentery peaked during the summer months. The major causative species was Shigella flexneri (86%) and the predominant S. flexneriserotype was 2a (80%). About 74-80% of Shigella isolates remained susceptible to fluorinated quinolones. Conclusion We conclude that while morbidity and mortality due to bacillary dysentery has decreased considerably in China in the past decade due to increasing access to affordable health care and antibiotics, a considerable burden exists among the youngest and oldest age groups and in regions with low economic development. We suggest that while a vaccine would be effective for short- and medium-term control of bacillary dysentery, improved water supply, sanitation, and hygiene are likely to be required for long-term control. Bulletin of the World Health Organization 2006;84:561-568. Resume Evolution de la dysenterie bacillaire et charge de morbidite due a cette maladie en Chine (1991-2000) Objectif L&apos;etude visait a determiner la charge de dysenterie bacillaire en Chine, les variations interregionales, les tendances de la morbidite et de la mortalite, les agents etiologiques bacteriens et les schemas de resistance aux antimicrobiens. Methodes Les statistiques publiques et les documents medicaux pertinents publies de 1991 a 2000 ont ete extraits et pris en compte dans l&apos;etude. On a egalement recueilli des donnees aupres d&apos;un hopital general de chacune des six provinces considerees et du district de Jin an a Shanghai, ces hopitaux etant representatifs de six regions geographiques et d&apos;une ville moderne. Resultats En 2000, 0,8 a 1,7 million d&apos;episodes de dysenterie bacillaire on ete enregistres, dont 0,5 a 0,7 million ont ete traites dans des etablissements de soins et 150 000 a 200 000 ont donne lieu a des hospitalisations. Les taux de morbidite et de mortalite les plus eleves ont ete releves parmi les classes d&apos;age correspondant aux plus jeunes et aux plus ages. La dysenterie bacillaire a atteint un pic au cours des mois d&apos;ete. Le principal agent etiologique etait Shigella flexneri (86 %) et le serotype predominant de S. flexnefi etait le serotype 2a (80 %). De 74 % a 80 % des isolements de Shigella etaient sensibles aux quinolones fluores. Conclusion Malgre une baisse considerable de la morbidite et de la mortalite dues a la dysenterie bacillaire en Chine au cours de la derniere decennie, imputable a l&apos;amelioration de l&apos;acces a des soins de sante et a des antibiotiques a des prix abordables, une importante charge de morbidite subsiste chez les classes d&apos;age extremes et dans les regions faiblement developpees sur le plan economique. Si un vaccin constituerait un moyen efficace a court et a moyen terme pour lutter contre la dysenterie bacillaire, il est probable que la lutte a long terme contre cette maladie exige une amelioration de l&apos;approvisionnement en eau, des installations d&apos;assainissement et de l&apos;hygiene. Resumen Disenteria bacilar: tendencias v caraa de morbilidad en China (1991-2000) Objetivo Decidimos determinar la carga de disenteria bacilar en China, las diferencias interregionales en ese sentido, las tendencias de la morbilidad y la mortalidad, las especies bacterianas causantes, y la distribucion de la resistencia a los antimicrobianos. Metodos Procedimos a extraer e integrar estadisticas gubernamentales y publicaciones medicas relacionadas aparecidas entre 1991 y 2000. Tambien obtuvimos datos de un hospital general de cada una de las seis provincias consideradar y dei distrito de Jin-an, Shanghai, como informacion representativa de seis regiones geograficas y una ciudad moderna. Resultados En 2000 se produjeron entre 0,8 y 1,7 millones de episodios de disenteria bacilar, de los cuales 0,5 - 0,7 millones fueron tratados en establecimientos de salud, y 0,15 - 0,20 millones fueron hospitalizados. Las mayores tasas de morbilidad y mortalidad fueron las registradas entre los grupos mas jovenes y en las personas mayores. La disenteria bacilar alcanzo la maxima cota en los meses de verano. La principal especie causante fue Shigella flexneri (86%), con la variante 2a como serotipo predominante (80%). Aproximadamente un 74%--80% de las colonias de Shigella seguian siendo vulnerables a las quinolonas fluoradas. Conclusion Aunque la morbimortalidad por disenteria bacilar ha disminuido considerablemente en China durante el ultimo decenio, gracias al mayor acceso a la atencion sanitaria y los antibioticos, sigue habiendo una carga considerable de la enfermedad entre los grupos mas jovenes y de mayor edad, asi como en las regiones con bajo desarrollo economico. En nuestra opinion, aunque una vacuna seria una opcion eficaz para controlar la disenteria bacilar a corto y medio plazo, todo control a largo plazo exigira probablemente mejoras del abastecimiento de agua, el saneamiento y la higiene. [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Globally, morbidity and mortality due to diarrhoea has decreased from 4.6 million deaths in 1982 to 3.3 million in 1992 to 2.5 million in 2003. (1-3) A review published [...]

Author(s): Jacqueline Deen * In tropical Asia and Latin America, dengue is a significant public health threat. Several characteristics of the disease contribute to this high sense of priority, including [...]

Abstract Background The annual incidence and temporal trend of severe malaria and community-acquired bacteraemia during a four-year period in Muheza, Tanzania was assessed. Methods Data on severely ill febrile children aged 2 months to 14 years from three prospective studies conducted at Muheza District Hospital from 2006 to 2010 was pooled and analysed. On admission, each enrolled child had a thin and thick blood film and at least one rapid diagnostic test for falciparum malaria, as well as a blood culture. The annual incidence of bacteraemia and severe malaria among children coming from Muheza was calculated and their temporal trend was assessed. Results Overall, 1, 898 severe falciparum malaria and 684 bacteraemia cases were included. Of these, 1, 356 (71%) and 482 (71%), respectively, were from the referral population of Muheza. The incidence of falciparum malaria and all-cause bacteraemia in Muheza decreased five-fold and three-fold, respectively, from the first to the fourth year of surveillance (p < 0.0001). During this period, the median ages of children from Muheza admitted with severe malaria increased from 1.7 to 2.5 years (p < 0.0001). The reduction in all-cause bacteraemia was mainly driven by the 11-fold decline in the incidence of non-typhoidal salmonellosis. The annual incidences of Haemophilus influenzae and pneumococcal invasive bacterial infections decreased as well but were much fewer in number. Conclusions These results add to the growing evidence of the decline in malaria associated with a decrease in non-typhoidal salmonellosis and possibly other bacteraemias. Malarial prevention and control strategies may provide a greater benefit than the mere reduction of malaria alone.

Abstract Background Typhoid fever remains a significant health problem in many developing countries. A rapid test with a performance comparable to that of blood culture would be highly useful. A rapid diagnostic test for typhoid fever, Tubex®, is commercially available that uses particle separation to detect immunoglobulin M directed towards Salmonella Typhi O9 lipopolysaccharide in sera. Methods We assessed the sensitivity and specificity of the Tubex test among Tanzanian children hospitalized with febrile illness using blood culture as gold standard. Evaluation was done considering blood culture confirmed S. Typhi with non-typhi salmonella (NTS) and non - salmonella isolates as controls as well as with non-salmonella isolates only. Results Of 139 samples tested with Tubex, 33 were positive for S. Typhi in blood culture, 49 were culture-confirmed NTS infections, and 57 were other non-salmonella infections. Thirteen hemolyzed samples were excluded. Using all non - S. Typhi isolates as controls, we showed a sensitivity of 79% and a specificity of 89%. When the analysis was repeated excluding NTS from the pool of controls we showed a sensitivity of 79% and a specificity of 97%. There was no significant difference in the test performance using the two different control groups (p > 0.05). Conclusion This first evaluation of the Tubex test in an African setting showed a similar performance to those seen in some Asian settings. Comparison with the earlier results of a Widal test using the same samples showed no significant difference (p > 0.05) for any of the performance indicators, irrespective of the applied control group.

Abstract Background The diagnosis of typhoid fever is confirmed by culture of Salmonella enterica serotype Typhi (S. typhi). However, a more rapid, simpler, and cheaper diagnostic method would be very useful especially in developing countries. The Widal test is widely used in Africa but little information exists about its reliability. Methods We assessed the performance of the Widal tube agglutination test among febrile hospitalized Tanzanian children. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of various anti-TH and -TO titers using culture-confirmed typhoid fever cases as the "true positives" and all other febrile children with blood culture negative for S. typhi as the "true negatives." Results We found that 16 (1%) of 1,680 children had culture-proven typhoid fever. A single anti-TH titer of 1:80 and higher was the optimal indicator of typhoid fever. This had a sensitivity of 75%, specificity of 98%, NPV of 100%, but PPV was only 26%. We compared our main findings with those from previous studies. Conclusion Among febrile hospitalized Tanzanian children with a low prevalence of typhoid fever, a Widal titer of ≥ 1:80 performed well in terms of sensitivity, specificity, and NPV. However a test with improved PPV that is similarly easy to apply and cost-efficient is desirable.

Little is known about the causes of enteric fever in Asia. Most cases are believed to be caused by Salmonella enterica serovar Typhi and the remainder by S. Paratyphi A. [...]

To the Editor: Cholera outbreaks caused by toxigenic Vibrio cholerae serogroup O1 frequently occur in many sub-Saharan African countries. The serogroup O1 is classified into two biotypes, classical and El [...]

Cholera: A Continuing Public Health Threat The emergence of cholera in Haiti highlighted the difficulties in containing cholera outbreaks with only safe water, sanitation, hygiene, and appropriate case management. In [...]

Abstract Background: Exposure of the individual to contaminated food or water correlates closely with the risk for enteric fever. Since public health interventions such as water improvement or vaccination campaigns are implemented for groups of individuals we were interested whether risk factors not only for the individual but for households, neighbourhoods and larger areas can be recognised? Methods: We conducted a large enteric fever surveillance study and analyzed factors which correlate with enteric fever on an individual level and factors associated with high and low risk areas with enteric fever incidence. Individual level data were linked to a population based geographic information systems. Individual and household level variables were fitted in Generalized Estimating Equations (GEE) with the logit link function to take into account the likelihood that household factors correlated within household members. Results: Over a 12-month period 80 typhoid fever cases and 47 paratyphoid fever cases were detected among 56,946 residents in two bustees (slums) of Kolkata, India. The incidence of paratyphoid fever was lower (0.8/1000/year), and the mean age of paratyphoid patients was older (17.1 years) than for typhoid fever (incidence 1.4/1000/year, mean age 14.7 years). Residents in areas with a high risk for typhoid fever had lower literacy rates and economic status, bigger household size, and resided closer to waterbodies and study treatment centers than residents in low risk areas. Conclusion: There was a close correlation between the characteristics detected based on individual cases and characteristics associated with high incidence areas. Because the comparison of risk factors of populations living in high versus low risk areas is statistically very powerful this methodology holds promise to detect risk factors associated with diseases using geographic information systems.