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Pollett S, Johansson MA, Reich NG, Brett-Major D, Del Valle SY, Venkatramanan S, Lowe R, Porco T, Berry IM, Deshpande A, Kraemer MUG, Blazes DL, Pan-Ngum W, Vespigiani A, Mate SE, Silal SP, Kandula S, Sippy R, Quandelacy TM, Morgan JJ, Ball J, Morton LC, Althouse BM, Pavlin J, van Panhuis W, Riley S, Biggerstaff M, Viboud C, Brady O, Rivers C. Correction: Recommended reporting items for epidemic forecasting and prediction research: The EPIFORGE 2020 guidelines. PLoS Med 2023; 20:e1004316. [PMID: 37976465 PMCID: PMC10656116 DOI: 10.1371/journal.pmed.1004316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1003793.].
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Ledesma JR, Isaac CR, Dowell SF, Blazes DL, Essix GV, Budeski K, Bell J, Nuzzo JB. Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure. BMJ Glob Health 2023; 8:e012203. [PMID: 37414431 PMCID: PMC10335545 DOI: 10.1136/bmjgh-2023-012203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Previous studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality. METHODS We indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist. RESULTS The GHS Index was negatively associated with excess COVID-19 CMRs (table 2; β= -0.21, 95% CI= -0.35 to -0.08). Greater capacities related to prevention (β= -0.11, 95% CI= -0.22 to -0.00), detection (β= -0.09, 95% CI= -0.19 to -0.00), response (β = -0.19, 95% CI= -0.36 to -0.01), international commitments (β= -0.17, 95% CI= -0.33 to -0.01) and risk environments (β= -0.30, 95% CI= -0.46 to -0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist). CONCLUSION The first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available.
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Affiliation(s)
- Jorge Ricardo Ledesma
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Scott F Dowell
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - David L Blazes
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | | | - Jennifer B Nuzzo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Pandemic Center, Brown University School of Public Health, Providence, Rhode Island, USA
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Pollett S, Johansson MA, Reich NG, Brett-Major D, Del Valle SY, Venkatramanan S, Lowe R, Porco T, Berry IM, Deshpande A, Kraemer MUG, Blazes DL, Pan-ngum W, Vespigiani A, Mate SE, Silal SP, Kandula S, Sippy R, Quandelacy TM, Morgan JJ, Ball J, Morton LC, Althouse BM, Pavlin J, van Panhuis W, Riley S, Biggerstaff M, Viboud C, Brady O, Rivers C. Recommended reporting items for epidemic forecasting and prediction research: The EPIFORGE 2020 guidelines. PLoS Med 2021; 18:e1003793. [PMID: 34665805 PMCID: PMC8525759 DOI: 10.1371/journal.pmed.1003793] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The importance of infectious disease epidemic forecasting and prediction research is underscored by decades of communicable disease outbreaks, including COVID-19. Unlike other fields of medical research, such as clinical trials and systematic reviews, no reporting guidelines exist for reporting epidemic forecasting and prediction research despite their utility. We therefore developed the EPIFORGE checklist, a guideline for standardized reporting of epidemic forecasting research. METHODS AND FINDINGS We developed this checklist using a best-practice process for development of reporting guidelines, involving a Delphi process and broad consultation with an international panel of infectious disease modelers and model end users. The objectives of these guidelines are to improve the consistency, reproducibility, comparability, and quality of epidemic forecasting reporting. The guidelines are not designed to advise scientists on how to perform epidemic forecasting and prediction research, but rather to serve as a standard for reporting critical methodological details of such studies. CONCLUSIONS These guidelines have been submitted to the EQUATOR network, in addition to hosting by other dedicated webpages to facilitate feedback and journal endorsement.
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Affiliation(s)
- Simon Pollett
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Michael A. Johansson
- Division of Vector-Borne Diseases, Centers for Disease Control & Prevention, San Juan, Puerto Rico, United States of America
| | - Nicholas G. Reich
- University of Massachusetts–Amherst, School of Public Health and Health Sciences, Amherst, Massachusetts, United States of America
| | - David Brett-Major
- University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sara Y. Del Valle
- Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | - Srinivasan Venkatramanan
- Biocomplexity Institute and Initiative, University of Virginia, Charlottesville, Virginia, United States of America
| | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases and Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Barcelona Institute for Global Health, Barcelona, Spain
| | - Travis Porco
- University of California at San Francisco, San Francisco, California, United States of America
| | - Irina Maljkovic Berry
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Alina Deshpande
- Los Alamos National Laboratory, Los Alamos, New Mexico, United States of America
| | | | - David L. Blazes
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Wirichada Pan-ngum
- Mahidol-Oxford Tropical Medicine Research Unit and Department of Tropical Hygiene, Mahidol University, Thailand
| | - Alessandro Vespigiani
- Network Science Institute, Northeastern University, Boston, Massachusetts, United States of America
| | - Suzanne E. Mate
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Sheetal P. Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sasikiran Kandula
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Rachel Sippy
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, New York, United States of America
| | - Talia M. Quandelacy
- Division of Vector-Borne Diseases, Centers for Disease Control & Prevention, San Juan, Puerto Rico, United States of America
| | - Jeffrey J. Morgan
- Catholic University of America, Washington, DC, United States of America
| | - Jacob Ball
- U.S. Army Public Health Center, Edgewood, Maryland, United States of America
| | - Lindsay C. Morton
- Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance, Silver Spring, Maryland, United States of America
- George Washington University, Milken Institute School of Public Health, Washington, DC, United States of America
| | - Benjamin M. Althouse
- University of Washington, Seattle, Washington, United States of America
- Institute for Disease Modeling, Bellevue, Washington, United States of America
- New Mexico State University, Las Cruces, New Mexico, United States of America
| | - Julie Pavlin
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States of America
| | - Wilbert van Panhuis
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
| | - Steven Riley
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College, London, United Kingdom
| | - Matthew Biggerstaff
- Influenza Division, Centers for Disease Control & Prevention, Atlanta, Georgia, United States of America
| | - Cecile Viboud
- Fogarty International Center, National Institutes for Health, Bethesda, Maryland, United States of America
| | - Oliver Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caitlin Rivers
- Johns Hopkins Center for Health Security, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Alsentzer E, Ballard SB, Neyra J, Vera DM, Osorio VB, Quispe J, Blazes DL, Loayza L. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerg Infect Dis 2020; 26:2196-2200. [PMID: 32818406 PMCID: PMC7454051 DOI: 10.3201/eid2609.191315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated the performance of X-bar chart, exponentially weighted moving average, and C3 cumulative sums aberration detection algorithms for acute diarrheal disease syndromic surveillance at naval sites in Peru during 2007–2011. The 3 algorithms’ detection sensitivity was 100%, specificity was 97%–99%, and positive predictive value was 27%–46%.
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Alsentzer E, Ballard SB, Neyra J, Vera DM, Osorio VB, Quispe J, Blazes DL, Loayza L. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerg Infect Dis 2020. [DOI: 10.3201/eid09.191315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Salmón-Mulanovich G, Blazes DL, Guezala V MC, Rios Z, Espinoza A, Guevara C, Lescano AG, Montgomery JM, Bausch DG, Pan WK. Individual and Spatial Risk of Dengue Virus Infection in Puerto Maldonado, Peru. Am J Trop Med Hyg 2018; 99:1440-1450. [PMID: 30298808 DOI: 10.4269/ajtmh.17-1015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dengue virus (DENV) affects more than 100 countries worldwide. Dengue virus infection has been increasing in the southern Peruvian Amazon city of Puerto Maldonado since 2000. We designed this study to describe the prevalence of past DENV infection and to evaluate risk factors. In 2012, we conducted a cross-sectional serosurvey and administered a knowledge, attitudes, and practices (KAP) questionnaire to members of randomly selected households. Sera were screened for antibodies to DENV by enzyme-linked immunosorbent assay and confirmed by plaque reduction neutralization test. We created indices for KAP (KAPi). We used SaTScan (Martin Kulldorff with Information Management Services Inc., Boston, MA) to detect clustering and created a multivariate model introducing the distance of households to potential vector and infection sources. A total of 505 participants from 307 households provided a blood sample and completed a questionnaire. Fifty-four percent of participants (95% confidence interval [CI]: 49.6; 58.5) had neutralizing antibodies to DENV. Higher values of KAPi were positively associated with having DENV antibodies in the multivariate analysis (odds ratio [ORII]: 1.6, 95% CI: 0.6, 2.4; ORIII: 2.7, 95% CI: 1.3, 5.5; and ORIV: 2.4, 95% CI: 1.2, 5.0). Older groups had lower chances of having been exposed to DENV than younger people (OR20-30: 0.5, 95% CI: 0.2, 0.8; OR31-45: 0.5, 95% CI: 0.3, 0.9; and OR>45: 0.6, 95% CI: 0.3, 1.3). Multivariate data analysis from the 270 households with location information showed male gender to have lower risk of past DENV infection (OR: 0.6, 95% CI: 0.4, 0.9). We conclude that risk of DENV infection in Puerto Maldonado is related to gender, age of the population, and location.
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Affiliation(s)
- Gabriela Salmón-Mulanovich
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David L Blazes
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, Washington.,U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Zonia Rios
- U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | | | | | - Andrés G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.,U.S. Naval Medical Research Unit No. 6, Lima, Peru
| | - Joel M Montgomery
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel G Bausch
- U.S. Naval Medical Research Unit No. 6, Lima, Peru.,Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - William K Pan
- Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, North Carolina
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Brinker AJ, Blazes DL. An outbreak of Leptospirosis among United States military personnel in Guam. Trop Dis Travel Med Vaccines 2017; 3:16. [PMID: 29093825 PMCID: PMC5661914 DOI: 10.1186/s40794-017-0059-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/28/2017] [Indexed: 12/22/2022]
Abstract
Background Leptospirosis is a bacterial zoonotic disease with worldwide distribution. Case presentation We describe and discuss the clinical course of a leptospirosis outbreak in a running club called the hash house harriers on Guam. Conclusions Leptospirosis is a potentialy life threatening disease, and has had a reemergence given the popularity of travel adventure sports, teams, and clubs around the world. This case presentation highlights the robust prescence of leptospirosis on Guam.
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Affiliation(s)
- Alyson J Brinker
- Guam Naval Hospital, Yigo, Guam.,U.S. Navy Hospital Guam, PSC 490 Box 7606 FPO, AP 96538-1600, Tutuhan, Guam
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Wolicki SB, Nuzzo JB, Blazes DL, Pitts DL, Iskander JK, Tappero JW. Public Health Surveillance: At the Core of the Global Health Security Agenda. Health Secur 2017; 14:185-8. [PMID: 27314658 DOI: 10.1089/hs.2016.0002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Global health security involves developing the infrastructure and capacity to protect the health of people and societies worldwide. The acceleration of global travel and trade poses greater opportunities for infectious diseases to emerge and spread. The International Health Regulations (IHR) were adopted in 2005 with the intent of proactively developing public health systems that could react to the spread of infectious disease and provide better containment. Various challenges delayed adherence to the IHR. The Global Health Security Agenda came about as an international collaborative effort, working multilaterally among governments and across sectors, seeking to implement the IHR and develop the capacities to prevent, detect, and respond to public health emergencies of international concern. When examining the recent West African Ebola epidemic as a case study for global health security, both strengths and weaknesses in the public health response are evident. The central role of public health surveillance is a lesson reiterated by Ebola. Through further implementation of the Global Health Security Agenda, identified gaps in surveillance can be filled and global health security strengthened.
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9
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Brett-Major DM, Scott PT, Crowell TA, Polyak CS, Modjarrad K, Robb ML, Blazes DL. Are you PEPped and PrEPped for travel? Risk mitigation of HIV infection for travelers. Trop Dis Travel Med Vaccines 2016; 2:25. [PMID: 28883969 PMCID: PMC5530928 DOI: 10.1186/s40794-016-0042-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/15/2016] [Indexed: 12/17/2022]
Abstract
The HIV pandemic persists globally and travelers are at risk for infection by the Human Immunodeficiency Virus (HIV). While HIV-focused guidelines delineate risk stratification and mitigation strategies for people in their home communities, travel issues are not addressed. In this review, direct and indirect evidence on HIV risk among travelers is explored. The burgeoning practice of employing pre-exposure prophylaxis (PrEP) with anti-retroviral therapy in the non-travel setting is introduced, as well as the more established use of post-exposure prophylaxis (PEP). Challenges in applying these lessons to travelers are discussed, and a new guidelines process is scoped and recommended.
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Affiliation(s)
- D M Brett-Major
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA.,Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD USA
| | - P T Scott
- Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - T A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - C S Polyak
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - K Modjarrad
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - M L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.,Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD USA
| | - D L Blazes
- Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD USA.,Bill and Melinda Gates Foundation, Seattle, WA USA
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10
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Blazes DL, Riddle MS, Ryan ET. The local importance of global infectious diseases. Trop Dis Travel Med Vaccines 2015; 1:5. [PMID: 28883937 PMCID: PMC5526363 DOI: 10.1186/s40794-015-0004-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/10/2022]
Affiliation(s)
- David L Blazes
- Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Mark S Riddle
- Naval Medical Research Center, Silver Spring, MD USA
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Salmon-Mulanovich G, Blazes DL, Lescano AG, Bausch DG, Montgomery JM, Pan WK. Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru. Am J Trop Med Hyg 2015. [PMID: 26217040 DOI: 10.4269/ajtmh.14-0755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ~65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness.
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Affiliation(s)
- Gabriela Salmon-Mulanovich
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - David L Blazes
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Andres G Lescano
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Daniel G Bausch
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - Joel M Montgomery
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
| | - William K Pan
- Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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12
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Ballard SB, Reaves EJ, Luna CG, Silva ME, Rocha C, Heitzinger K, Saito M, Apaza S, Espetia S, Blazes DL, Tilley DH, Guzmán Aguilar RC, Gilman RH, Bausch DG. Epidemiology and Genetic Characterization of Noroviruses among Adults in an Endemic Setting, Peruvian Amazon Basin, 2004-2011. PLoS One 2015; 10:e0131646. [PMID: 26161556 PMCID: PMC4498765 DOI: 10.1371/journal.pone.0131646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/05/2015] [Indexed: 11/24/2022] Open
Abstract
Background Successful vaccination strategies against norovirus will require understanding the burden of disease and relevant genotypes in populations. However, few data are available from cohort studies of adults living in low- and middle-income countries (LMIC). Materials and Methods We conducted a nested case-control study within a Peruvian military cohort to characterize the burden of norovirus infection, predominant genotypes, and associated symptoms from 2004 through 2011. Randomly selected case and control stools were tested for norovirus, bacteria, and parasites. The odds ratio of the association between norovirus infection and diarrhea was estimated using multiple logistic regression and co-infection adjusted attributable fractions were calculated. Results Of the 3,818 cohort study participants, 624 developed diarrhea. Overall and norovirus-associated diarrhea incidence rates were 42.3 and 6.0 per 100 person-years, respectively. The most prevalent norovirus genogroup was GII (72.5%, 29/40), which was associated with diarrhea (AOR 3.4, 95% CI: 1.3–8.7, P = 0.012). The co-infection adjusted GII attributable fraction was 6.4%. Discussion Norovirus was a frequent cause of diarrhea in an adult population followed longitudinally in an LMIC setting. Vaccine strategies should consider targeting adults in endemic settings and special populations that could serve as community transmission sources.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
- * E-mail:
| | - Erik J. Reaves
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - C. Giannina Luna
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Maria E. Silva
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Claudio Rocha
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Kristen Heitzinger
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonia Apaza
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Susan Espetia
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David L. Blazes
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Drake H. Tilley
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
| | | | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - Daniel G. Bausch
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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13
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Blazes DL, Mullins K, Smoak BL, Jiang J, Canal E, Solorzano N, Hall E, Meza R, Maguina C, Myers T, Richards AL, Laughlin L. Novel Bartonella agent as cause of verruga peruana. Emerg Infect Dis 2014; 19:1111-4. [PMID: 23764047 PMCID: PMC3713980 DOI: 10.3201/eid1907.121718] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
While studying chronic verruga peruana infections in Peru from 2003, we isolated a novel Bartonella agent, which we propose be named Candidatus Bartonella ancashi. This case reveals the inherent weakness of relying solely on clinical syndromes for diagnosis and underscores the need for a new diagnostic paradigm in developing settings.
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Affiliation(s)
- David L Blazes
- Uniformed Services University of the Health Sciences, Bethesda, Maryland 20910, USA.
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14
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Loayza-Alarico MJ, Lescano AG, Suarez-Ognio LA, Ramirez-Prada GM, Blazes DL. Epidemic activity after natural disasters without high mortality in developing settings. Disaster Health 2013; 1:102-109. [PMID: 28228992 PMCID: PMC5314928 DOI: 10.4161/dish.27283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/13/2013] [Accepted: 10/29/2013] [Indexed: 12/05/2022]
Abstract
Natural disasters with minimal human mortality rarely capture headlines but occur frequently and result in significant morbidity and economic loss. We compared the epidemic activity observed after a flood, an earthquake, and volcanic activity in Peru. Following post-disaster guidelines, healthcare facilities and evacuation centers surveyed 10–12 significant health conditions for ~45 days and compared disease frequency with Poisson regression. The disasters affected 20,709 individuals and 15% were placed in evacuation centers. Seven deaths and 6,056 health conditions were reported (mean: 0.29 per person). Health facilities reported fewer events than evacuation centers (0.06–0.24 vs. 0.65–2.02, P < 0.001) and disease notification increased 1.6 times after the disasters (95% CI: 1.5–1.6). Acute respiratory infections were the most frequent event (41–57%) and psychological distress was second/third (7.6% to 14.3%). Morbidity increased after disasters without substantial casualties, particularly at evacuation centers, with frequent respiratory infections and psychological distress. Post-disaster surveillance is valuable even after low-mortality events.
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Affiliation(s)
| | - Andres G Lescano
- Emerging Infections and Parasitology Departments; US Naval Medical Research Unit No. 6 (NAMRU-6); Lima, Peru; Universidad Peruana Cayetano Heredia; Lima, Peru
| | | | | | - David L Blazes
- Emerging Infections and Parasitology Departments; US Naval Medical Research Unit No. 6 (NAMRU-6); Lima, Peru
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15
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Blazes DL, Bondarenko JL, Burke RL, Vest KG, Fukuda MM, Perdue CL, Tsai AY, Thomas AC, Chandrasekera RM, Cockrill JA, Von Thun AM, Baliga P, Meyers M, Quintana M, Wurapa EK, Mansour MM, Dueger E, Yasuda CY, Lanata CF, Gray GC, Saylors KE, Ndip LM, Lewis S, Blair PJ, Sloberg PA, Thomas SJ, Lesho EP, Grogl M, Myers T, Ellison D, Ellis KK, Brown ML, Schoepp RJ, Shanks GD, Macalino GE, Eick-Cost AA, Russell KL, Sanchez JL. Contributions of the Global Emerging Infections Surveillance and Response System Network to global health security in 2011. US Army Med Dep J 2013:7-18. [PMID: 23584903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In its 15th year, the Global Emerging Infections Surveillance and Response System (GEIS) continued to make significant contributions to global public health and emerging infectious disease surveillance worldwide. As a division of the US Department of Defense's Armed Forces Health Surveillance Center since 2008, GEIS coordinated a network of surveillance and response activities through collaborations with 33 partners in 76 countries. The GEIS was involved in 73 outbreak responses in fiscal year 2011. Significant laboratory capacity-building initiatives were undertaken with 53 foreign health, agriculture and/or defense ministries, as well as with other US government entities and international institutions, including support for numerous national influenza centers. Equally important, a variety of epidemiologic training endeavors reached over 4,500 individuals in 96 countries. Collectively, these activities enhanced the ability of partner countries and the US military to make decisions about biological threats and design programs to protect global public health as well as global health security.
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Affiliation(s)
- David L Blazes
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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16
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Cruz CD, Forshey BM, Vallejo E, Agudo R, Vargas J, Blazes DL, Guevara C, Laguna-Torres VA, Halsey ES, Kochel TJ. Novel strain of Andes virus associated with fatal human infection, central Bolivia. Emerg Infect Dis 2013; 18:750-7. [PMID: 22515983 PMCID: PMC3358070 DOI: 10.3201/eid1805.111111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Interventions are needed to reduce human exposure to hantaviruses. To better describe the genetic diversity of hantaviruses associated with human illness in South America, we screened blood samples from febrile patients in Chapare Province in central Bolivia during 2008–2009 for recent hantavirus infection. Hantavirus RNA was detected in 3 patients, including 1 who died. Partial RNA sequences of small and medium segments from the 3 patients were most closely related to Andes virus lineages but distinct (<90% nt identity) from reported strains. A survey for IgG against hantaviruses among residents of Chapare Province indicated that 12.2% of the population had past exposure to >1 hantaviruses; the highest prevalence was among agricultural workers. Because of the high level of human exposure to hantavirus strains and the severity of resulting disease, additional studies are warranted to determine the reservoirs, ecologic range, and public health effect of this novel strain of hantavirus.
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17
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Eick-Cost AA, Tastad KJ, Guerrero AC, Johns MC, Lee SE, MacIntosh VH, Burke RL, Blazes DL, Russell KL, Sanchez JL. Effectiveness of seasonal influenza vaccines against influenza-associated illnesses among US military personnel in 2010-11: a case-control approach. PLoS One 2012; 7:e41435. [PMID: 22859985 PMCID: PMC3409214 DOI: 10.1371/journal.pone.0041435] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/22/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Following the 2009 influenza A/H1N1 (pH1N1) pandemic, both seasonal and pH1N1 viruses circulated in the US during the 2010-2011 influenza season; influenza vaccine effectiveness (VE) may vary between live attenuated (LAIV) and trivalent inactivated (TIV) vaccines as well as by virus subtype. MATERIALS AND METHODS Vaccine type and virus subtype-specific VE were determined for US military active component personnel for the period of September 1, 2010 through April 30, 2011. Laboratory-confirmed influenza-related medical encounters were compared to matched individuals with a non-respiratory illness (healthy controls), and unmatched individuals who experienced a non-influenza respiratory illness (test-negative controls). Odds ratios (OR) and VE estimates were calculated overall, by vaccine type and influenza subtype. RESULTS A total of 603 influenza cases were identified. Overall VE was relatively low and similar regardless of whether healthy controls (VE = 26%, 95% CI: -1 to 45) or test-negative controls (VE = 29%, 95% CI: -6 to 53) were used as comparison groups. Using test-negative controls, vaccine type-specific VE was found to be higher for TIV (53%, 95% CI: 25 to 71) than for LAIV (VE = -13%, 95% CI: -77 to 27). Influenza subtype-specific analyses revealed moderate protection against A/H3 (VE = 58%, 95% CI: 21 to 78), but not against A/H1 (VE = -38%, 95% CI: -211 to 39) or B (VE = 34%, 95% CI: -122 to 80). CONCLUSION Overall, a low level of protection against clinically-apparent, laboratory-confirmed, influenza was found for the 2010-11 seasonal influenza vaccines. TIV immunization was associated with higher protection than LAIV, however, no protection against A/H1 was noted, despite inclusion of a pandemic influenza strain as a vaccine component for two consecutive years. Vaccine virus mismatch or lower immunogenicity may have contributed to these findings and deserve further examination in controlled studies. Continued assessment of VE in military personnel is essential in order to better inform vaccination policy decisions.
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Affiliation(s)
- Angelia A. Eick-Cost
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Katie J. Tastad
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
| | - Alicia C. Guerrero
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Matthew C. Johns
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Seung-eun Lee
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Victor H. MacIntosh
- US Air Force School of Aerospace Medicine (USAFSAM), 711 Human Performance Wing, Wright Patterson Air Force Base, Ohio, United States of America
| | - Ronald L. Burke
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - David L. Blazes
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Kevin L. Russell
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Center (AFHSC), Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., (HJF), Bethesda, Maryland, United States of America
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18
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Villaran MV, Bayer A, Konda KA, Mendoza C, Quijandria H, Ampuero JS, Apolaya M, Palacios O, Lescano AG, Vega AM, Blazes DL, Kochel T, Montano SM. Condom use by partner type among military and police personnel in Peru. Am J Mens Health 2012; 6:266-72. [PMID: 22398988 DOI: 10.1177/1557988311431628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to analyze the rates of condom use among military and police populations in Peru, focusing on differences in use by type of partner. A Knowledge Attitudes and Practices survey was conducted among 6,808 military and police personnel in 18 Peruvian cities between August-September 2006 and September-October 2007. A total of 90.2% of the survey respondents were male; mean age was 37.8 years and 77.9% were married/cohabiting. In all, 99.5% reported having had sex; 89% of the participants had their last sexual contact with their stable partner, 9.7% with a nonstable partner, and 0.8% with a sex worker. Overall, 20.4% used a condom during their most recent sexual contact. Reasons for nonuse of condoms included the following: perception that a condom was not necessary (31.3%) and using another birth control method (26.7%). Prevention efforts against sexually transmitted diseases should focus on strengthening condom use, especially among individuals with nonstable partners.
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19
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Quandelacy TM, Johns MC, Andraghetti R, Hora R, Meynard JB, Montgomery JM, Roque VG, Blazes DL. The role of disease surveillance in achieving IHR compliance by 2012. Biosecur Bioterror 2011; 9:408-12. [PMID: 22074350 DOI: 10.1089/bsp.2011.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The World Health Organization's revised International Health Regulations (IHR (2005)) call for member state compliance by mid-2012. Variation in disease surveillance and core public health capacities will affect each member state's ability to meet this deadline. We report on topics presented at the preconference workshop, "The Interaction of Disease Surveillance and the International Health Regulations," held at the 2010 International Society for Disease Surveillance conference in Park City, Utah. Presenters were from the Pan American Health Organization (PAHO), the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), the Armed Forces Health Surveillance Center, U.S. Naval Research Unit Six, the Philippines' National Epidemiologic Center, and the French armed forces. The topics addressed were: an overview of the revised IHRs; disease surveillance systems implemented in Peru, the Philippines, and by the French armed forces; the capacity building efforts of the CDC; partnerships and contributions to IHR compliance from HHS; and the application of the IHRs to special populations. Results from the meeting evaluation indicate that many participants found the information useful in better understanding current efforts of the U.S. government and international organizations, areas for collaboration, and how the IHRs apply to their countries' public health systems. Topics to address at future workshops include progress and challenges to IHR implementation across all member states and additional examples of how disease surveillance supports the IHRs in resource-constrained countries. The preconference workshop provided the opportunity to convene public health experts from all regions of the world. Stronger collaborations and support to better detect and respond to public health events through building sustainable disease surveillance systems will not only help member states to meet IHR compliance by 2012, but will also improve pandemic preparedness and global health security.
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Affiliation(s)
- Talia M Quandelacy
- Division of Global Emerging Infections Surveillance and Response Systems, Armed Forces Health Surveillance Center, Silver Spring, Maryland 20904, USA
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20
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Johns M, Blazes DL, Fernandez J, Russell K, Chen DW, Loftis R. The United States Department of Defense and the International Health Regulations (2005): perceptions, pitfalls and progress towards implementation. Bull World Health Organ 2011; 89:234-5. [PMID: 21379420 DOI: 10.2471/blt.10.082321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 11/27/2022] Open
Affiliation(s)
- Matthew Johns
- Armed Forces Health Surveillance Center, Department of Defense, Silver Spring, USA.
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21
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Lewis SL, Feighner BH, Loschen WA, Wojcik RA, Skora JF, Coberly JS, Blazes DL. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings. PLoS One 2011; 6:e19750. [PMID: 21572957 PMCID: PMC3091876 DOI: 10.1371/journal.pone.0019750] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/15/2011] [Indexed: 11/18/2022] Open
Abstract
Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES) is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.
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Affiliation(s)
- Sheri L Lewis
- National Security Technology Department, The Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland, United States of America.
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22
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Sanchez JL, Johns MC, Burke RL, Vest KG, Fukuda MM, Yoon IK, Lon C, Quintana M, Schnabel DC, Pimentel G, Mansour M, Tobias S, Montgomery JM, Gray GC, Saylors K, Ndip LM, Lewis S, Blair PJ, Sjoberg PA, Kuschner RA, Russell KL, Blazes DL. Capacity-building efforts by the AFHSC-GEIS program. BMC Public Health 2011; 11 Suppl 2:S4. [PMID: 21388564 PMCID: PMC3092414 DOI: 10.1186/1471-2458-11-s2-s4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Mark M Fukuda
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - In-Kyu Yoon
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Chanthap Lon
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Miguel Quintana
- U.S. Army Public Health Command Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - David C Schnabel
- U.S. Army Medical Research Unit-Kenya, U.S. Embassy, Attn: MRU, United Nations Avenue, P.O. Box 606, Village Market 00621 Nairobi, Kenya
| | - Guillermo Pimentel
- Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Moustafa Mansour
- Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta, 10560, Indonesia
| | - Joel M Montgomery
- Naval Medical Research Center Detachment-Peru, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - Karen Saylors
- Global Viral Forecasting Initiative, One Sutter Street, Suite 600, San Francisco, CA 94104, USA
| | - Lucy M Ndip
- University of Buea, Department of Biochemistry and Microbiology, Faculty of Science, Post Office Box 63, Buea, South Western Province, Cameroon
| | - Sheri Lewis
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, MP2-160, Laurel, MD 20723-6099, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Paul A Sjoberg
- U.S. Air Force School of Aerospace Medicine, Public Health and Preventive Medicine Department, 2513 Kennedy Circle, Building 180, Brooks City-Base, TX 78235-5116, USA
| | - Robert A Kuschner
- Walter Reed Army Institute of Research, Building 503, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - the AFHSC-GEIS Capacity Building Writing Group
- Walter Reed Army Institute of Research, Building 503, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
- Kenyan Medical Research Institute, Mbagathi Post Office Box 54840, 00200, Nairobi, Kenya
- Landstuhl Regional Medical Center, CMR 402, Box 483, APO AE 09180, USA
- Makerere University Walter Reed Project, Plot 42, Nakasero Road, Post Office Box 16524, Kampala, Uganda
- Makerere University, Faculty of Veterinary Medicine & Medicine, Post Office Box 16524, Kampala, Uganda
- Navy Environmental and Preventive Medicine Unit Number 2, 1887 Powhatan Street, Norfolk, VA 23511-3394, USA
- PharmAccess Foundation, Skyway Building, Third Floor, Plot Number 149/32, Corner of Ohio Street/Sokoine Street, Post Office Box 635, Dar es Salaam, Tanzania
- Tanzania People’s Defence Forces, Defence Forces Headquarters Medical Services, Post Office Box 9203, Dar es Salaam, Tanzania
- U.S. Army Medical Department Activity & 65th Medical Brigade, Korea, Unit 15281, Box 769, APO AP 96205-5281
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702-5011, USA
- U.S. Army Public Health Command Region-Europe, Building 3810, CMR 402, Box 808, APO AE 09180
- U.S. Army Public Health Command Region-Pacific, Building 715, Camp Zama, Japan, Unit 45006, APO AP 96343-5006
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23
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Meyer WG, Pavlin JA, Hospenthal D, Murray CK, Jerke K, Hawksworth A, Metzgar D, Myers T, Walsh D, Wu M, Ergas R, Chukwuma U, Tobias S, Klena J, Nakhla I, Talaat M, Maves R, Ellis M, Wortmann G, Blazes DL, Lindler L. Antimicrobial resistance surveillance in the AFHSC-GEIS network. BMC Public Health 2011; 11 Suppl 2:S8. [PMID: 21388568 PMCID: PMC3092418 DOI: 10.1186/1471-2458-11-s2-s8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
International infectious disease surveillance has been conducted by the United States (U.S.) Department of Defense (DoD) for many years and has been consolidated within the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) since 1998. This includes activities that monitor the presence of antimicrobial resistance among pathogens. AFHSC-GEIS partners work within DoD military treatment facilities and collaborate with host-nation civilian and military clinics, hospitals and university systems. The goals of these activities are to foster military force health protection and medical diplomacy. Surveillance activities include both community-acquired and health care-associated infections and have promoted the development of surveillance networks, centers of excellence and referral laboratories. Information technology applications have been utilized increasingly to aid in DoD-wide global surveillance for diseases significant to force health protection and global public health. This section documents the accomplishments and activities of the network through AFHSC-GEIS partners in 2009.
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Affiliation(s)
- William G Meyer
- Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA.
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24
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Burke RL, Vest KG, Eick AA, Sanchez JL, Johns MC, Pavlin JA, Jarman RG, Mothershead JL, Quintana M, Palys T, Cooper MJ, Guan J, Schnabel D, Waitumbi J, Wilma A, Daniels C, Brown ML, Tobias S, Kasper MR, Williams M, Tjaden JA, Oyofo B, Styles T, Blair PJ, Hawksworth A, Montgomery JM, Razuri H, Laguna-Torres A, Schoepp RJ, Norwood DA, MacIntosh VH, Gibbons T, Gray GC, Blazes DL, Russell KL. Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic. BMC Public Health 2011; 11 Suppl 2:S6. [PMID: 21388566 PMCID: PMC3092416 DOI: 10.1186/1471-2458-11-s2-s6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Armed Forces Health Surveillance Center's Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system's surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system's worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS's support of a global network contributes to DoD's force health protection, while supporting global public health.
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Affiliation(s)
- Ronald L Burke
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Angelia A Eick
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Matthew C Johns
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Julie A Pavlin
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Richard G Jarman
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
| | - Jerry L Mothershead
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Miguel Quintana
- Public Health Region-South, Building 2472, Schofield Road, Fort Sam Houston, TX 78234, USA
| | - Thomas Palys
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
| | | | - Jian Guan
- Public Health Region-Pacific, Unit 45006, APO AE 96343, USA
| | - David Schnabel
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - John Waitumbi
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
| | - Alisa Wilma
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Candelaria Daniels
- Department of Defense Veterinary Food Analysis & Diagnostic Laboratory, 2472 Schofield Road, Suite 2630, Fort Sam Houston, TX 78234, USA
| | - Matthew L Brown
- USAMEDDAC-Korea, Microbiology Section, Unit 15244, Box 459, APO AP 96205, USA
| | - Steven Tobias
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Matthew R Kasper
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Maya Williams
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
| | - Jeffrey A Tjaden
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Buhari Oyofo
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Timothy Styles
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
| | - Patrick J Blair
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Anthony Hawksworth
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
| | - Joel M Montgomery
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Hugo Razuri
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Alberto Laguna-Torres
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Randal J Schoepp
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - David A Norwood
- U.S. Army Medical Research Institute of Infectious Diseases, Diagnostic Systems Division, 1425 Porter Street, Fort Detrick, MD 21702, USA
| | - Victor H MacIntosh
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Thomas Gibbons
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
| | - Gregory C Gray
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Post Office Box 100188, Gainesville, FL 32610, USA
| | - David L Blazes
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
| | - AFHSC-GEIS Influenza Surveillance Writing Group
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Armed Forces Research Institute of Medical Sciences, 315/6 Rajavithi Road, Bangkok, Thailand 10400
- Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Landstuhl Regional Medical Center, Department of Pathology and Area Laboratory Services, CMR 402, APO AE 09180, USA
- U.S. Embassy, Attention: MRU, United Nations Avenue, Post Office Box 606, Village Market 00621 Nairobi, Kenya
- Naval Medical Research Unit Number 2, Kompleks Pergudangan DEPKES R.I., JI. Percetakan Negara II No. 23, Jakarta 10560, Indonesia
- Naval Medical Research Unit No. 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- U.S. Navy Environmental Preventive Medicine Unit No. 2, 1887 Powhatan Street, Norfolk, VA 23511, USA
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA
- Naval Medical Research Center Detachment, Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
- U.S. Air Force School of Aerospace Medicine, 2513 Kennedy Circle, Building 180, Brooks City Base, TX 78235, USA
- Walter Reed Army Institute of Research, Emerging Infectious Diseases Research Unit, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
- Australian Army Malaria Institute, Gallipoli Barracks, Enoggera, QLD 4051, Australia
- Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA
- U.S. Navy and Marine Corps Public Health Center, 620 John Paul Jones Circle, Suite 1100, Portsmouth, VA 23708, USA
- Laboratory for Emerging Infectious Diseases, University of Buea, Post Office Box 63, Buea, Cameroon
- Global Viral Forecasting Initiative, 1 Sutter, Suite 600, San Francisco, CA 94104, USA
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Johns MC, Burke RL, Vest KG, Fukuda M, Pavlin JA, Shrestha SK, Schnabel DC, Tobias S, Tjaden JA, Montgomery JM, Faix DJ, Duffy MR, Cooper MJ, Sanchez JL, Blazes DL, Wangchuk S, Dorji T, Gibbons R, Iamsirithaworn S, Richardson J, Buathong R, Jarman R, Yoon IK, Shakya G, Ofula V, Coldren R, Bulimo W, Sang R, Omariba D, Obura B, Mwala D, Kasper M, Brice G, Williams M, Yasuda C, Barthel RV, Pimentel G, Meyers C, Kammerer P, Baynes DE, Metzgar D, Hawksworth A, Blair P, Ellorin M, Coon R, Macintosh V, Burwell K, Macias E, Palys T, Jerke K. A growing global network's role in outbreak response: AFHSC-GEIS 2008-2009. BMC Public Health 2011; 11 Suppl 2:S3. [PMID: 21388563 PMCID: PMC3092413 DOI: 10.1186/1471-2458-11-s2-s3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense's (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization's (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.
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Affiliation(s)
- Matthew C Johns
- Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA.
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Fukuda MM, Klein TA, Kochel T, Quandelacy TM, Smith BL, Villinski J, Bethell D, Tyner S, Se Y, Lon C, Saunders D, Johnson J, Wagar E, Walsh D, Kasper M, Sanchez JL, Witt CJ, Cheng Q, Waters N, Shrestha SK, Pavlin JA, Lescano AG, Graf PCF, Richardson JH, Durand S, Rogers WO, Blazes DL, Russell KL. Malaria and other vector-borne infection surveillance in the U.S. Department of Defense Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance program: review of 2009 accomplishments. BMC Public Health 2011; 11 Suppl 2:S9. [PMID: 21388569 PMCID: PMC3092419 DOI: 10.1186/1471-2458-11-s2-s9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Vector-borne infections (VBI) are defined as infectious diseases transmitted by the bite or mechanical transfer of arthropod vectors. They constitute a significant proportion of the global infectious disease burden. United States (U.S.) Department of Defense (DoD) personnel are especially vulnerable to VBIs due to occupational contact with arthropod vectors, immunological naiveté to previously unencountered pathogens, and limited diagnostic and treatment options available in the austere and unstable environments sometimes associated with military operations. In addition to the risk uniquely encountered by military populations, other factors have driven the worldwide emergence of VBIs. Unprecedented levels of global travel, tourism and trade, and blurred lines of demarcation between zoonotic VBI reservoirs and human populations increase vector exposure. Urban growth in previously undeveloped regions and perturbations in global weather patterns also contribute to the rise of VBIs. The Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) and its partners at DoD overseas laboratories form a network to better characterize the nature, emergence and growth of VBIs globally. In 2009 the network tested 19,730 specimens from 25 sites for Plasmodium species and malaria drug resistance phenotypes and nearly another 10,000 samples to determine the etiologies of non-Plasmodium species VBIs from regions spanning from Oceania to Africa, South America, and northeast, south and Southeast Asia. This review describes recent VBI-related epidemiological studies conducted by AFHSC-GEIS partner laboratories within the OCONUS DoD laboratory network emphasizing their impact on human populations.
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Affiliation(s)
- Mark M Fukuda
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Terry A Klein
- Force Health Protection and Preventive Medicine, 65th Medical Brigade, Unit 15281, APO AP 96205-5281 USA (Republic of Korea
| | - Tadeusz Kochel
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Talia M Quandelacy
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | | | - Jeff Villinski
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
| | - Delia Bethell
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Stuart Tyner
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Youry Se
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Chanthap Lon
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - David Saunders
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Jacob Johnson
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
| | - Eric Wagar
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Douglas Walsh
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
| | - Matthew Kasper
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
| | - Jose L Sanchez
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Clara J Witt
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Qin Cheng
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
| | - Norman Waters
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
| | - Sanjaya K Shrestha
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Julie A Pavlin
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Andres G Lescano
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Paul CF Graf
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - Jason H Richardson
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
| | - Salomon Durand
- US Naval Medical Research Center Detachment (NMRCD), Centro Medico Naval “CMST,” Av. Venezuela CDRA 36, Callao 2, Lima, Peru
| | - William O Rogers
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
| | - David L Blazes
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
| | - the AFHSC-GEIS Malaria and Vector Borne Infections Writing Group
- Armed Forces Health Surveillance Center, 2900 Linden Lane, Silver Spring, MD 20910, USA
- US Army Medical Component Armed Forces Research Institute of the Medical Sciences, APO AP 96546, Bangkok, Thailand
- US Army Medical Research Unit Kenya, United States Embassy, ATTN: MRU, United Nations Avenue, Post Office Box 606, Village Market, 00621 Nairobi, Kenya
- US Naval Medical Research Unit Number 3, Extension of Ramses Street, Adjacent to Abbassia Fever Hospital, Postal Code 11517, Cairo, Egypt
- US Navy Medical Research Unit-2, U.S. Embassy Unit 8166 Box P, APO AP 96546, Phnom Penh, Cambodia
- Australian Army Malaria Institute, Weary Dunlop Drive, Gallipoli Barracks, Enoggera, QLD 4051 Australia
- Naval Medical Research Center, 503 Robert Grant Ave. Silver Spring, MD 20910, USA
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Otto JL, Baliga P, Sanchez JL, Johns MC, Gray GC, Grieco J, Lescano AG, Mothershead JL, Wagar EJ, Blazes DL, Achila R, Baker W, Blair P, Brown M, Bulimo W, Byarugaba D, Coldren R, Cooper M, Ducatez M, Espinosa B, Ewings P, Guerrero A, Hawksworth T, Jackson C, Klena JD, Kraus S, Macintosh V, Mansour M, Maupin G, Maza J, Montgomery J, Ndip L, Pavlin J, Quintana M, Richard W, Rosenau D, Saeed T, Sinclair L, Smith I, Smith J, Styles T, Talaat M, Tobias S, Vettori J, Villinski J, Wabwire-Mangen F. Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005). BMC Public Health 2011; 11 Suppl 2:S5. [PMID: 21388565 PMCID: PMC3092415 DOI: 10.1186/1471-2458-11-s2-s5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military’s role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.
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Affiliation(s)
- Jean L Otto
- Armed Forces Health Surveillance Center, 11800 Tech Rd, Silver Spring, MD 20904, USA
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Johns MC, Blazes DL. International Health Regulations (2005) and the U.S. Department of Defense: building core capacities on a foundation of partnership and trust. BMC Public Health 2010; 10 Suppl 1:S4. [PMID: 21143826 PMCID: PMC3005576 DOI: 10.1186/1471-2458-10-s1-s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A cornerstone of effective global health surveillance programs is the ability to build systems that identify, track and respond to public health threats in a timely manner. These functions are often difficult and require international cooperation given the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by both humans and animals. As part of the U.S. Armed Forces Health Surveillance Center (AFHSC), the Department of Defense’s (DoD) Globa Emerging Infections Surveillance and Response System (AFHSC-GEIS) has developed a global network of surveillance sites over the past decade that engages in a wide spectrum of support activities in collaboration with host country partners. Many of these activities are in direct support of International Health Regulations (IHR[2005]). The network also supports host country military forces around the world, which are equally affected by these threats and are often in a unique position to respond in areas of conflict or during complex emergencies. With IHR(2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.
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Affiliation(s)
- Matthew C Johns
- Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System, 2900 Linden Lane, Silver Spring, MD 20910, USA.
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Salmón-Mulanovich G, Sovero M, Laguna-Torres VA, Kochel TJ, Lescano AG, Chauca G, Sanchez JF, Rodriguez F, Parrales E, Ocaña V, Barrantes M, Blazes DL, Montgomery JM. Frequency of human bocavirus (HBoV) infection among children with febrile respiratory symptoms in Argentina, Nicaragua and Peru. Influenza Other Respir Viruses 2010; 5:1-5. [PMID: 21138534 PMCID: PMC4066840 DOI: 10.1111/j.1750-2659.2010.00160.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Globally, respiratory infections are the primary cause of illness in developing countries, specifically among children; however, an etiological agent for many of these illnesses is rarely identified. OBJECTIVES Our study aimed to estimate the frequency of human bocavirus (HBoV) infection among pediatric populations in Argentina, Nicaragua and Peru. METHODS We conducted a cross-sectional study using stored samples of an influenza-like illness surveillance program. Irrespective of previous diagnosis, nasopharyngeal or nasal swab specimens were randomly selected and tested using real-time PCR from three sites during 2007 from patients younger than 6 years old. RESULTS A total of 568 specimens from Argentina (185), Nicaragua (192) and Peru (191) were tested. The prevalence of HBoV was 10·8% (95% CI: 6·3; 15·3) in Argentina, 33·3% in Nicaragua (95% CI: 26·6; 40·1) and 25·1% in Peru (95% CI: 18·9; 31·3). CONCLUSIONS These findings demonstrate circulation of HBoV in Argentina, Nicaragua and Peru among children with influenza-like symptoms enrolled in a sentinel surveillance program.
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Whitman TJ, Coyne PE, Magill AJ, Blazes DL, Green MD, Milhous WK, Burgess TH, Freilich D, Tasker SA, Azar RG, Endy TP, Clagett CD, Deye GA, Shanks GD, Martin GJ. An outbreak of Plasmodium falciparum malaria in U.S. Marines deployed to Liberia. Am J Trop Med Hyg 2010; 83:258-65. [PMID: 20682864 DOI: 10.4269/ajtmh.2010.09-0774] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2003, 44 U.S. Marines were evacuated from Liberia with either confirmed or presumed Plasmodium falciparum malaria. An outbreak investigation showed that only 19 (45%) used insect repellent, 5 (12%) used permethrin-treated clothing, and none used bed netting. Adherence with weekly mefloquine (MQ) was reported by 23 (55%). However, only 4 (10%) had serum MQ levels high enough to correlate with protection (> 794 ng/mL), and 9 (22%) had evidence of steady-state kinetics (MQ carboxy metabolite/MQ > 3.79). Tablets collected from Marines met USP identity and dissolution specifications for MQ. Testing failed to identify P. falciparum isolates with MQ resistance. This outbreak resulted from under use of personal protective measures and inadequate adherence with chemophrophylaxis. It is essential that all international travelers make malaria prevention measures a priority, especially when embarking to regions of the world with high transmission intensity such as west Africa..
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Affiliation(s)
- Timothy J Whitman
- Infectious Diseases Department, National Naval Medical Center, Bethesda, MD, USA.
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Jeremy Sueker J, Blazes DL, Johns MC, Blair PJ, Sjoberg PA, Tjaden JA, Montgomery JM, Pavlin JA, Schnabel DC, Eick AA, Tobias S, Quintana M, Vest KG, Burke RL, Lindler LE, Mansfield JL, Erickson RL, Russell KL, Sanchez JL. Influenza and respiratory disease surveillance: the US military's global laboratory-based network. Influenza Other Respir Viruses 2010; 4:155-61. [PMID: 20409212 PMCID: PMC4941663 DOI: 10.1111/j.1750-2659.2010.00129.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Please cite this paper as: Jeremy Sueker et al. (2010) Influenza and respiratory disease surveillance: the US military’s global laboratory‐based network. Influenza and Other Respiratory Viruses 4(3), 155–161. The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host‐country civilian and military personnel. This system represents a major part of the US Government’s contributions to the World Health Organization’s Global Influenza Surveillance Network and addresses Presidential Directive NSTC‐7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans.
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Affiliation(s)
- J Jeremy Sueker
- Armed Forces Health Surveillance Center, US Army Public Health Command (Provisional), Silver Spring, MD 20910, USA
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Johns MC, Eick AA, Blazes DL, Lee SE, Perdue CL, Lipnick R, Vest KG, Russell KL, DeFraites RF, Sanchez JL. Seasonal influenza vaccine and protection against pandemic (H1N1) 2009-associated illness among US military personnel. PLoS One 2010; 5:e10722. [PMID: 20502705 PMCID: PMC2873284 DOI: 10.1371/journal.pone.0010722] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 04/08/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction A novel A/H1N1 virus is the cause of the present influenza pandemic; vaccination is a key countermeasure, however, few data assessing prior seasonal vaccine effectiveness (VE) against the pandemic strain of H1N1 (pH1N1) virus are available. Materials and Methods Surveillance of influenza-related medical encounter data of active duty military service members stationed in the United States during the period of April–October 2009 with comparison of pH1N1-confirmed cases and location and date-matched controls. Crude odds ratios (OR) and VE estimates for immunized versus non-immunized were calculated as well as adjusted OR (AOR) controlling for sex, age group, and history of prior influenza vaccination. Separate stratified VE analyses by vaccine type (trivalent inactivated [TIV] or live attenuated [LAIV]), age groups and hospitalization status were also performed. For the period of April 20 to October 15, 2009, a total of 1,205 cases of pH1N1-confirmed cases were reported, 966 (80%) among males and over one-half (58%) under 25 years of age. Overall VE for service members was found to be 45% (95% CI, 33 to 55%). Immunization with prior season's TIV (VE = 44%, 95% CI, 32 to 54%) as well as LAIV (VE = 24%, 95% CI, 6 to 38%) were both found to be associated with protection. Of significance, VE against a severe disease outcome was higher (VE = 62%, 95% CI, 14 to 84%) than against milder outcomes (VE = 42%, 95% CI, 29 to 53%). Conclusion A moderate association with protection against clinically apparent, laboratory-confirmed Pandemic (H1N1) 2009-associated illness was found for immunization with either TIV or LAIV 2008–09 seasonal influenza vaccines. This association with protection was found to be especially apparent for severe disease as compared to milder outcome, as well as in the youngest and older populations. Prior vaccination with seasonal influenza vaccines in 2004–08 was also independently associated with protection.
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Affiliation(s)
- Matthew C Johns
- Division of GEIS Operations, Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America.
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Ashar R, Lewis S, Blazes DL, Chretien JP. Applying information and communications technologies to collect health data from remote settings: a systematic assessment of current technologies. J Biomed Inform 2009; 43:332-41. [PMID: 19961957 DOI: 10.1016/j.jbi.2009.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 11/25/2009] [Accepted: 11/25/2009] [Indexed: 11/28/2022]
Abstract
Modern information and communications technologies (ICTs) are now so feature-rich and widely available that they can be used to "capture," or collect and transmit, health data from remote settings. Electronic data capture can reduce the time necessary to notify public health authorities, and provide important baseline information. A number of electronic health data capture systems based on specific ICTs have been developed for remote areas. We expand on that body of work by defining and applying an assessment process to characterize ICTs for remote-area health data capture. The process is based on technical criteria, and assesses the feasibility and effectiveness of specific technologies according to the resources and constraints of a given setting. Our characterization of current ICTs compares different system architectures for remote-area health data capture systems. Ultimately, we believe that our criteria-based assessment process will remain useful for characterizing future ICTs.
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Affiliation(s)
- Raj Ashar
- The Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD 20723, USA.
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Ghersi BM, Blazes DL, Icochea E, Gonzalez RI, Kochel T, Tinoco Y, Sovero MM, Lindstrom S, Shu B, Klimov A, Gonzalez AE, Montgomery JM. Avian influenza in wild birds, central coast of Peru. Emerg Infect Dis 2009; 15:935-8. [PMID: 19523296 PMCID: PMC2727326 DOI: 10.3201/eid1506.080981] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine genotypes of avian influenza virus circulating among wild birds in South America, we collected and tested environmental fecal samples from birds along the coast of Peru, June 2006-December 2007. The 9 isolates recovered represented 4 low-pathogenicity avian influenza strains: subtypes H3N8, H4N5, H10N9, and H13N2.
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Abstract
Illnesses associated with seafood are an important public health concern worldwide, particularly considering the steady increase in seafood consumption. However, research about the risks associated with seafood products is scarce in developing countries. Histamine fish poisoning is the most common form of fish intoxication caused by seafood and usually presents as an allergic reaction. This condition occurs when fish are not kept appropriately refrigerated and histamine is formed in the tissues. Histamine levels of > 500 ppm usually are associated with clinical illness. We assessed histamine levels in fish from markets in Lima, Peru, with a quantitative competitive enzyme-linked immunosorbent assay. Thirty-eight specimens were purchased from wholesale and retail markets: 17 bonito (Sarda sarda), 16 mackerel (Scomber japonicus peruanus), and 5 mahi-mahi (Coryphaena hippurus). Seven fish (18%) had histamine levels of 1 to 10 ppm (three mackerel and four bonito) and three (8%) had > 10 ppm (three mackerel, 35 to 86 ppm). Fish from retail markets had detectable histamine levels (> 1 ppm) more frequently than did fish bought at wholesale fish markets: 9 (36%) of 25 fish versus 1 (8%) of 13 fish, respectively (P = 0.063). Higher histamine levels were correlated with later time of purchase during the day (Spearman's rho = 0.37, P = 0.024). Mackerel purchased at retail markets after 2 p.m. had a 75% prevalence of histamine levels of > 10 ppm. Mackerel purchased late in the day in retail markets frequently contained high histamine levels, although the overall prevalence of elevated histamine levels was low. Despite the small sample, our findings highlight the need to reinforce seafood safety regulations and quality control in developing countries such as Peru.
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Espinosa BJ, Chacaltana J, Mulder M, Franco MP, Blazes DL, Gilman RH, Smits HL, Hall ER. Comparison of culture techniques at different stages of brucellosis. Am J Trop Med Hyg 2009; 80:625-627. [PMID: 19346389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The lysis centrifugation technique is preferred for culturing Brucella spp. at all stages of brucellosis because it yields 25% more positive results and on average provides results 10 days earlier than the Ruiz-Castaneda method. This lysis method is inexpensive and easier to use and may be used in laboratories with limited expertise or equipment if all safety precautions are taken.
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Espinosa BJ, Chacaltana J, Blazes DL, Franco MP, Hall ER, Smits HL, Mulder M, Gilman RH. Comparison of Culture Techniques at Different Stages of Brucellosis. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.80.625] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Huaman MA, Araujo-Castillo RV, Soto G, Neyra JM, Quispe JA, Fernandez MF, Mundaca CC, Blazes DL. Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation. BMC Med Inform Decis Mak 2009; 9:16. [PMID: 19272165 PMCID: PMC2667397 DOI: 10.1186/1472-6947-9-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 03/10/2009] [Indexed: 11/17/2022] Open
Abstract
Background A timely detection of outbreaks through surveillance is needed in order to prevent future pandemics. However, current surveillance systems may not be prepared to accomplish this goal, especially in resource limited settings. As data quality and timeliness are attributes that improve outbreak detection capacity, we assessed the effect of two interventions on such attributes in Alerta, an electronic disease surveillance system in the Peruvian Navy. Methods 40 Alerta reporting units (18 clinics and 22 ships) were included in a 12-week prospective evaluation project. After a short refresher course on the notification process, units were randomly assigned to either a phone, visit or control group. Phone group sites were called three hours before the biweekly reporting deadline if they had not sent their report. Visit group sites received supervision visits on weeks 4 & 8, but no phone calls. The control group sites were not contacted by phone or visited. Timeliness and data quality were assessed by calculating the percentage of reports sent on time and percentage of errors per total number of reports, respectively. Results Timeliness improved in the phone group from 64.6% to 84% in clinics (+19.4 [95% CI, +10.3 to +28.6]; p < 0.001) and from 46.9% to 77.3% on ships (+30.4 [95% CI, +16.9 to +43.8]; p < 0.001). Visit and control groups did not show significant changes in timeliness. Error rates decreased in the visit group from 7.1% to 2% in clinics (-5.1 [95% CI, -8.7 to -1.4]; p = 0.007), but only from 7.3% to 6.7% on ships (-0.6 [95% CI, -2.4 to +1.1]; p = 0.445). Phone and control groups did not show significant improvement in data quality. Conclusion Regular phone reminders significantly improved timeliness of reports in clinics and ships, whereas supervision visits led to improved data quality only among clinics. Further investigations are needed to establish the cost-effectiveness and optimal use of each of these strategies.
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Lescano AR, Blazes DL, Montano SM, Kochel T, Moran Z, Lescano AG, Martin GJ. Supporting the creation of new institutional review boards in developing countries: the U.S. Naval Medical Research Center Detachment experience. Mil Med 2009; 173:975-7. [PMID: 19160615 DOI: 10.7205/milmed.173.10.975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The U.S. Naval Medical Research Center Detachment (NMRCD) has worked in Peru since 1983, conducting research on diseases of military importance in large part by interacting with multiple research partners across the scientific community of Central America and South America. Over the years, NMRCD has had research collaborations in Guatemala, Nicaragua, Costa Rica, Belize, Honduras, Suriname, Venezuela, Colombia, Ecuador, Bolivia, Chile, Uruguay, Paraguay, and Argentina. In addition to the various infectious diseases research collaborations, NMRCD has supported capacity building for research ethics and the creation of new institutional review boards. This article describes the contributions of NMRCD to research ethics training in Central America and South America, with specific emphasis on the support given to the creation of new institutional review boards.
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Affiliation(s)
- A Roxana Lescano
- U.S. Naval Medical Research Center Detachment, Peru, Unit 3800, American Embassy, APO AA 34031
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Salmón-Mulanovich G, Utz G, Lescano AG, Bentzel DE, Blazes DL. Rapid response to a case of mumps: implications for preventing transmission at a medical research facility. Salud Publica Mex 2009; 51:34-38. [PMID: 19180311 PMCID: PMC4080888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 08/25/2008] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To prevent transmission among the staff and potentially among the non-human primate (NHP) colony at the U.S. Naval Medical Research Center Detachment in Peru, where an active case of mumps was discovered in a senior laboratory technician in Sep 03, 2007. MATERIAL AND METHODS Subjects at the research facility were interviewed and potentially susceptible contacts were tested for mumps IgG. RESULTS In total, 81 out of 106 staff members (76%) had close contact with the case. Only 6/81 (7%) had MMR, 33 (41%) reported having had mumps, and 8 of 45 (18%) of the potentially susceptible individuals did not have immunity (IgG > 20.0). All the susceptible, exposed individuals received MMR vaccine. There were no secondary cases and access to the NHP colony was restricted. DISCUSSION Immediate and thorough investigation and occupational health response were imperative in preventing secondary cases of mumps among humans and NHP.
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Soto G, Araujo-Castillo RV, Neyra J, Fernandez M, Leturia C, Mundaca CC, Blazes DL. Challenges in the implementation of an electronic surveillance system in a resource-limited setting: Alerta, in Peru. BMC Proc 2008; 2 Suppl 3:S4. [PMID: 19025681 PMCID: PMC2587690 DOI: 10.1186/1753-6561-2-s3-s4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Infectious disease surveillance is a primary public health function in resource-limited settings. In 2003, an electronic disease surveillance system (Alerta) was established in the Peruvian Navy with support from the U.S. Naval Medical Research Center Detachment (NMRCD). Many challenges arose during the implementation process, and a variety of solutions were applied. The purpose of this paper is to identify and discuss these issues. METHODS This is a retrospective description of the Alerta implementation. After a thoughtful evaluation according to the Centers for Disease Control and Prevention (CDC) guidelines, the main challenges to implementation were identified and solutions were devised in the context of a resource-limited setting, Peru. RESULTS After four years of operation, we have identified a number of challenges in implementing and operating this electronic disease surveillance system. These can be divided into the following categories: (1) issues with personnel and stakeholders; (2) issues with resources in a developing setting; (3) issues with processes involved in the collection of data and operation of the system; and (4) issues with organization at the central hub. Some of the challenges are unique to resource-limited settings, but many are applicable for any surveillance system. For each of these challenges, we developed feasible solutions that are discussed. CONCLUSION There are many challenges to overcome when implementing an electronic disease surveillance system, not only related to technology issues. A comprehensive approach is required for success, including: technical support, personnel management, effective training, and cultural sensitivity in order to assure the effective deployment of an electronic disease surveillance system.
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Affiliation(s)
- Giselle Soto
- Emerging Infections Program, U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru
| | - Roger V Araujo-Castillo
- Emerging Infections Program, U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru
| | - Joan Neyra
- Emerging Infections Program, U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru
| | | | | | - Carmen C Mundaca
- Emerging Infections Program, U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru
| | - David L Blazes
- Emerging Infections Program, U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru
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Lescano AG, Larasati RP, Sedyaningsih ER, Bounlu K, Araujo-Castillo RV, Munayco-Escate CV, Soto G, Mundaca CC, Blazes DL. Statistical analyses in disease surveillance systems. BMC Proc 2008; 2 Suppl 3:S7. [PMID: 19025684 PMCID: PMC2587693 DOI: 10.1186/1753-6561-2-s3-s7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The performance of disease surveillance systems is evaluated and monitored using a diverse set of statistical analyses throughout each stage of surveillance implementation. An overview of their main elements is presented, with a specific emphasis on syndromic surveillance directed to outbreak detection in resource-limited settings. Statistical analyses are proposed for three implementation stages: planning, early implementation, and consolidation. Data sources and collection procedures are described for each analysis. During the planning and pilot stages, we propose to estimate the average data collection, data entry and data distribution time. This information can be collected by surveillance systems themselves or through specially designed surveys. During the initial implementation stage, epidemiologists should study the completeness and timeliness of the reporting, and describe thoroughly the population surveyed and the epidemiology of the health events recorded. Additional data collection processes or external data streams are often necessary to assess reporting completeness and other indicators. Once data collection processes are operating in a timely and stable manner, analyses of surveillance data should expand to establish baseline rates and detect aberrations. External investigations can be used to evaluate whether abnormally increased case frequency corresponds to a true outbreak, and thereby establish the sensitivity and specificity of aberration detection algorithms. Statistical methods for disease surveillance have focused mainly on the performance of outbreak detection algorithms without sufficient attention to the data quality and representativeness, two factors that are especially important in developing countries. It is important to assess data quality at each state of implementation using a diverse mix of data sources and analytical methods. Careful, close monitoring of selected indicators is needed to evaluate whether systems are reaching their proposed goals at each stage.
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Affiliation(s)
- Andres G Lescano
- US Naval Medical Research Center Detachment (NMRCD), Lima, Peru.
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Lescano AR, Blazes DL, Montano SM, Moran Z, Naquira C, Ramirez E, Lie R, Martin GJ, Lescano AG, Zunt JR. Research ethics training in Peru: a case study. PLoS One 2008; 3:e3274. [PMID: 18818763 PMCID: PMC2538562 DOI: 10.1371/journal.pone.0003274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 08/15/2008] [Indexed: 11/18/2022] Open
Abstract
With the rapidly increasing number of health care professionals seeking international research experience, comes an urgent need for enhanced capacity of host country institutional review boards (IRB) to review research proposals and ensure research activities are both ethical and relevant to the host country customs and needs. A successful combination of distance learning, interactive courses and expert course instructors has been applied in Peru since 2004 through collaborations between the U.S. Naval Medical Research Center Detachment, the University of Washington and the Department of Clinical Bioethics of the National Institutes of Health to provide training in ethical conduct of research to IRB members and researchers from Peru and other Latin American countries. All training activities were conducted under the auspices of the Peruvian National Institute of Health (INS), Ministry of Health. To date, 927 people from 12 different Latin American countries have participated in several of these training activities. In this article we describe our training model.
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Affiliation(s)
- A Roxana Lescano
- United States Naval Medical Research Center Detachment, Lima, Peru.
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Chretien JP, Burkom HS, Sedyaningsih ER, Larasati RP, Lescano AG, Mundaca CC, Blazes DL, Munayco CV, Coberly JS, Ashar RJ, Lewis SH. Syndromic surveillance: adapting innovations to developing settings. PLoS Med 2008; 5:e72. [PMID: 18366250 PMCID: PMC2270304 DOI: 10.1371/journal.pmed.0050072] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The tools and strategies of syndromic surveillance, say the authors, hold promise for improving public health security in developing countries.
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Affiliation(s)
- Jean-Paul Chretien
- Department of Defense Global Emerging Infections Surveillance and Response System, Silver Spring, Maryland, United States of America.
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Bentzel DE, Espinosa BJ, Canal E, Blazes DL, Hall ER. Susceptibility of owl monkeys (Aotus nancymaae) to experimental infection with Bartonella bacilliformis. Comp Med 2008; 58:76-80. [PMID: 19793460 PMCID: PMC2703158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 06/20/2007] [Accepted: 08/03/2007] [Indexed: 05/28/2023]
Abstract
Bartonellosis, caused by Bartonella bacilliformis, is a clinically significant disease in parts of South America, where it is characterized by fever and hemolytic anemia during the often-fatal acute stage and warty skin eruptions during chronic disease. In this study, we evaluated owl monkeys (Aotus nancymaae) as a potential model for studying the immunogenicity and pathology of bartonellosis. Two groups of animals (n = 3 per group) received either 9.5 x 10(7) CFU B. bacilliformis by the ID route or 1.1 x 10(6) CFU by the IV route and were followed for 140 d. Animals were evaluated by physical exam, complete blood count or hematocrit (or both); infection was confirmed by Giemsa staining of blood smears, PCR amplification, and blood culture. On days 7 and 21, Giemsa-stained blood smears from both groups contained organisms (1% to 4% of erythrocytes). All blood cultures and PCR tests were negative. Complete blood counts and chemistry panels showed no difference from baseline. Serology revealed a greater than 4-fold increase in the IgM titer (compared with baseline levels) in the 3 animals from the ID group and 1 animal from the IV group. On day 35, a dermal lesion was excised from the inguinal region of 1 monkey from each group, with a second lesion excised on day 84 from the same monkey in the IV group. However the histopathology and immunostaining of these samples were not consistent with B. bacilliformis. The present study shows that owl monkeys can be infected with B. bacilliformis, but additional dosage studies are necessary to evaluate the usefulness of this species as a disease model for human bartonellosis.
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Affiliation(s)
- David E Bentzel
- Laboratory Animal Program, Naval Medical Research Center Detachment, Lima, Peru.
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Affiliation(s)
- Andres G Lescano
- U.S. Naval Medical Research Center Detachment (NMRCD), Lima, Peru.
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Chretien JP, Blazes DL, Coldren RL, Lewis MD, Gaywee J, Kana K, Sirisopana N, Vallejos V, Mundaca CC, Montano S, Martin GJ, Gaydos JC. The importance of militaries from developing countries in global infectious disease surveillance. Bull World Health Organ 2007; 85:174-80. [PMID: 17486207 PMCID: PMC2636235 DOI: 10.2471/blt.06.037101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 12/04/2006] [Indexed: 11/27/2022] Open
Abstract
Military forces from developing countries have become increasingly important as facilitators of their government's foreign policy, taking part in peacekeeping operations, military exercises and humanitarian relief missions. Deployment of these forces presents both challenges and opportunities for infectious disease surveillance and control. Troop movements may cause or extend epidemics by introducing novel agents to susceptible populations. Conversely, military units with disease surveillance and response capabilities can extend those capabilities to civilian populations not served by civilian public health programmes, such as those in remote or post-disaster settings. In Peru and Thailand, military health organizations in partnership with the military of the United States use their laboratory, epidemiological, communications and logistical resources to support civilian ministry of health efforts. As their role in international affairs expands, surveillance capabilities of militaries from developing countries should be enhanced, perhaps through partnerships with militaries from high-income countries. Military-to-military and military-to-civilian partnerships, with the support of national and international civilian health organizations, could also greatly strengthen global infectious disease surveillance, particularly in remote and post-disaster areas where military forces are present.
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Affiliation(s)
- Jean-Paul Chretien
- Department of Defense, Global Emerging Infections Surveillance and Response System, Silver Spring, MD 20910, USA.
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Abstract
OBJECTIVE To describe risks for, and microbiology and antimicrobial resistance patterns of, war trauma associated infections from Operation Iraqi Freedom. BACKGROUND : The invasion of Iraq resulted in casualties from high-velocity gunshot, shrapnel, and blunt trauma injuries as well as burns. Infectious complications of these unique war trauma injuries have not been described since the 1970s. METHODS Retrospective record review of all trauma casualties 5 to 65 years of age evacuated from the Iraqi theatre to U.S. Navy hospital ship, USNS Comfort, March to May 2003.War trauma-associated infection was defined by positive culture from a wound or sterile body fluid (ie, blood, cerebrospinal fluid) and at least two of the following infection-associated signs/symptoms: fever, dehiscence, foul smell, peri-wound erythema, hypotension, and leukocytosis. A comparison of mechanisms of injury, demographics, and clinical variables was done using multivariate analysis. RESULTS Of 211 patients, 56 met criteria for infection. Infections were more common in blast injuries, soft tissue injuries, >3 wound sites, loss of limb, abdominal trauma, and higher Injury Severity Score (ISS). Wound infections accounted for 84% of cases, followed by bloodstream infections (38%). Infected were more likely to have had fever prior to arrival, and had higher probability of ICU admission and more surgical procedures. Acinetobacter species (36%) were the predominant organisms followed by Escherichia coli and Pseudomonas species (14% each). CONCLUSIONS Similar to the Vietnam War experience, gram-negative rods, particularly Acinetobacter species, accounted for the majority of wound infections cared for on USNS Comfort during Operation Iraqi Freedom. Multidrug resistance was common, with the exception of the carbapenem class, limiting antibiotic therapy options.
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Affiliation(s)
- Kyle Petersen
- Infectious Diseases Division and Department of Surgery, National Naval Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
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Maas KSJSM, Méndez M, Zavaleta M, Manrique J, Franco MP, Mulder M, Bonifacio N, Castañeda ML, Chacaltana J, Yagui E, Gilman RH, Guillen A, Blazes DL, Espinosa B, Hall E, Abdoel TH, Smits HL. Evaluation of brucellosis by PCR and persistence after treatment in patients returning to the hospital for follow-up. Am J Trop Med Hyg 2007; 76:698-702. [PMID: 17426173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Polymerase chain reaction (PCR) was applied to confirm the diagnosis of brucellosis and to study its clearance in response to the standard treatment regimen with doxycycline and rifampin at hospitals in Callao and Lima, Peru. The PCR confirmed the diagnosis in 23 (91.7%) patients with brucellosis including 12 culture-confirmed cases. For patients treated at the hospital in Callao, PCR was positive for all samples collected during and at the conclusion of treatment and for 76.9% of follow-up samples collected on average 15.9 weeks after completion of treatment. For patients treated at the hospital in Lima, PCR tests were positive for 81.8% of samples collected during treatment, for 33.3% of samples collected at the conclusion of treatment, and for > or = 50% of samples collected at first, second, and third post-treatment follow-up. Thus, Brucella DNA may persist in the serum weeks to months after completion of the standard treatment regimen.
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50
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Blazes DL, Sanders JW, Riddle MS. Case 32-2006: a girl with fever after a visit to Africa. N Engl J Med 2007; 356:527-8; author reply 528-9. [PMID: 17274115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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