1
|
Finger F, Lemaitre J, Juin S, Jackson B, Funk S, Lessler J, Mintz E, Dely P, Boncy J, Azman AS. Inferring the proportion of undetected cholera infections from serological and clinical surveillance in an immunologically naive population. medRxiv 2023:2023.11.01.23297461. [PMID: 37961651 PMCID: PMC10635253 DOI: 10.1101/2023.11.01.23297461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Most infections with pandemic Vibrio cholerae are thought to result in subclinical disease and are not captured by surveillance. Previous estimates of the ratio of infections to clinical cases have varied widely (2 to 100). Understanding cholera epidemiology and immunity relies on the ability to translate between numbers of clinical cases and the underlying number of infections in the population. We estimated the infection incidence during the first months of an outbreak in a cholera-naive population using a Bayesian vibriocidal antibody titer decay model combining measurements from a representative serosurvey and clinical surveillance data. 3,880 suspected cases were reported in Grande Saline, Haiti, between 20 October 2010 and 6 April 2011 (clinical attack rate 18.4%). We found that more than 52.6% (95% Credible Interval (CrI) 49.4-55.7) of the population ≥2 years showed serologic evidence of infection, with a lower infection rate among children aged 2-4 years (35.5%; 95%CrI 24.2-51.6) compared with people ≥5 years (53.1%; 95%CrI 49.4-56.4). This estimated infection rate, nearly three times the clinical attack rate, with underdetection mainly seen in those ≥5 years, has likely impacted subsequent outbreak dynamics. Our findings show how seroincidence estimates improve understanding of links between cholera burden, transmission dynamics and immunity.
Collapse
Affiliation(s)
- Flavio Finger
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Epicentre, Paris, France
| | - Joseph Lemaitre
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stanley Juin
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Brendan Jackson
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin Lessler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Mintz
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Dely
- Ministère de la Santé Publique et de la Population, Port au Prince, Haiti
| | - Jacques Boncy
- Ministère de la Santé Publique et de la Population, Port au Prince, Haiti
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
2
|
Davis WW, Mohammed Y, Abdilahi I, Kim S, Salah AA, McAteer J, Abayneh A, Moges B, Gallagher K, Mintz E. Food as a Driver of a Cholera Epidemic in Jijiga, Ethiopia-June 2017. Am J Trop Med Hyg 2023; 108:963-967. [PMID: 37011894 PMCID: PMC10160893 DOI: 10.4269/ajtmh.22-0734] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/28/2023] [Indexed: 04/05/2023] Open
Abstract
We conducted a case-control study to identify risk and protective factors during a cholera outbreak in Jijiga, Ethiopia, in June 2017. A case-patient was defined as anyone > 5 years old with at least three loose stools in 24 hours who was admitted to a cholera treatment center in Jijiga on or after June 16, 2017. Two controls were matched to each case by type of residency (rural or urban) and age group. We enrolled 55 case-patients and 102 controls from June 16 to June 23, 2017. Identified risk factors for cholera were male sex, eating cold food, and eating food outside the home. Eating hot food was protective, as was reported handwashing after defecation; no other reported water, sanitation, and hygiene factors were associated with cholera risk. Recommendations included continuing messaging about safe food handling practices at home, the dangers of consuming meals prepared away from home, and the importance of hand hygiene practices.
Collapse
Affiliation(s)
- William W. Davis
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Sunkyung Kim
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jarred McAteer
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aschalew Abayneh
- Ethiopia Public Health Institute, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Beyene Moges
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
3
|
Ochieng C, Chen JC, Osita MP, Katz LS, Griswold T, Omballa V, Ng’eno E, Ouma A, Wamola N, Opiyo C, Achieng L, Munywoki PK, Hendriksen RS, Freeman M, Mikoleit M, Juma B, Bigogo G, Mintz E, Verani JR, Hunsperger E, Carleton HA. Molecular characterization of circulating Salmonella Typhi strains in an urban informal settlement in Kenya. PLoS Negl Trop Dis 2022; 16:e0010704. [PMID: 36007074 PMCID: PMC9451065 DOI: 10.1371/journal.pntd.0010704] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/07/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022] Open
Abstract
A high burden of Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) bacteremia has been reported from urban informal settlements in sub-Saharan Africa, yet little is known about the introduction of these strains to the region. Understanding regional differences in the predominant strains of S. Typhi can provide insight into the genomic epidemiology. We genetically characterized 310 S. Typhi isolates from typhoid fever surveillance conducted over a 12-year period (2007–2019) in Kibera, an urban informal settlement in Nairobi, Kenya, to assess the circulating strains, their antimicrobial resistance attributes, and how they relate to global S. Typhi isolates. Whole genome multi-locus sequence typing (wgMLST) identified 4 clades, with up to 303 pairwise allelic differences. The identified genotypes correlated with wgMLST clades. The predominant clade contained 290 (93.5%) isolates with a median of 14 allele differences (range 0–52) and consisted entirely of genotypes 4.3.1.1 and 4.3.1.2. Resistance determinants were identified exclusively in the predominant clade. Determinants associated with resistance to aminoglycosides were observed in 245 isolates (79.0%), sulphonamide in 243 isolates (78.4%), trimethoprim in 247 isolates (79.7%), tetracycline in 224 isolates (72.3%), chloramphenicol in 247 isolates (79.6%), β-lactams in 239 isolates (77.1%) and quinolones in 62 isolates (20.0%). Multidrug resistance (MDR) determinants (defined as determinants conferring resistance to ampicillin, chloramphenicol and cotrimoxazole) were found in 235 (75.8%) isolates. The prevalence of MDR associated genes was similar throughout the study period (2007–2012: 203, 76.3% vs 2013–2019: 32, 72.7%; Fisher’s Exact Test: P = 0.5478, while the proportion of isolates harboring quinolone resistance determinants increased (2007–2012: 42, 15.8% and 2013–2019: 20, 45.5%; Fisher’s Exact Test: P<0.0001) following a decline in S. Typhi in Kibera. Some isolates (49, 15.8%) harbored both MDR and quinolone resistance determinants. There were no determinants associated with resistance to cephalosporins or azithromycin detected among the isolates sequenced in this study. Plasmid markers were only identified in the main clade including IncHI1A and IncHI1B(R27) in 226 (72.9%) isolates, and IncQ1 in 238 (76.8%) isolates. Molecular clock analysis of global typhoid isolates and isolates from Kibera suggests that genotype 4.3.1 has been introduced multiple times in Kibera. Several genomes from Kibera formed a clade with genomes from Kenya, Malawi, South Africa, and Tanzania. The most recent common ancestor (MRCA) for these isolates was from around 1997. Another isolate from Kibera grouped with several isolates from Uganda, sharing a common ancestor from around 2009. In summary, S. Typhi in Kibera belong to four wgMLST clades one of which is frequently associated with MDR genes and this poses a challenge in treatment and control. Typhoid fever is a major public health concern in endemic regions. Understanding the circulating strains of S. Typhi, could provide insight into the genomic epidemiology and guide in the choice of appropriate antibiotics. In this paper, our aim was to characterize S. Typhi strains causing invasive disease in Kibera, where a high typhoid burden has been described. We also aim to understand the evolutionary history of these strains and how antimicrobial resistance determinants have changed over time. We found that there was low diversity of S. Typhi observed in Kibera isolates with isolates grouping into 4 wgMLST clades and five genotypes. The majority (93.5%) of the isolates belonged to genotype 4.3.1; phylodynamic analysis suggest isolates of this genotype from Kibera are related to other 4.3.1 isolates from Africa and this genotype has been introduced multiple times in Kibera. This genotype in particular warrants close monitoring to inform antibiotic strategy in this population. Furthermore, concurrent detection of gene markers for MDR and quinolone resistance in some isolates raise concern about the potential emergence of extensive drug resistant (XDR) strains. Additional surveillance is needed in Kibera to monitor changing trends in resistance that may require altering clinical treatment, and to inform other preventive measures such as typhoid-conjugate vaccine introduction.
Collapse
Affiliation(s)
- Caroline Ochieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Jessica C. Chen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mike Powel Osita
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Lee S. Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Taylor Griswold
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Omballa
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Eric. Ng’eno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Alice Ouma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Newton Wamola
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Christine Opiyo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Loicer Achieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Patrick K. Munywoki
- Centers for Disease Control and Prevention-Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Rene S. Hendriksen
- Technical University of Denmark, National Food Institute, DTU-Food. Kemitorvet, Denmark
| | - Molly Freeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Mikoleit
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bonventure Juma
- Centers for Disease Control and Prevention-Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Eric Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer R. Verani
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention-Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Centers for Disease Control and Prevention-Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Heather A. Carleton
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| |
Collapse
|
4
|
Medalla F, Watkins LF, Hughes M, Birhane M, Dorough L, Griffin C, Reynolds J, Caidi H, Webb HE, Mintz E, Gutelius B, Langley G. 165. Emergence of Extensively Drug-Resistant Salmonella enterica Serotype Typhi Infections—United States, 2008–2020. Open Forum Infect Dis 2021. [PMCID: PMC8644279 DOI: 10.1093/ofid/ofab466.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/18/2022] Open
Abstract
Background Typhoid fever, caused by Salmonella Typhi, is fatal in 12%–30% of patients not treated with appropriate antibiotics. In 2016, a large outbreak of extensively drug-resistant (XDR) Typhi infections began in Pakistan with cases reported globally, including the United States. In 2021, the Centers for Disease Control and Prevention (CDC) issued a health advisory on XDR infections among U.S. residents without international travel. We describe resistance of Typhi infections diagnosed in the United States to help guide treatment decisions. Methods Typhoid fever is a nationally notifiable disease. Health departments report cases to CDC through the National Typhoid and Paratyphoid Fever Surveillance system. Isolates are submitted to the National Antimicrobial Resistance Monitoring System for antimicrobial susceptibility testing (AST) using broth microdilution. AST results are categorized by Clinical and Laboratory Standards Institute criteria. We defined XDR as resistant to ceftriaxone, ampicillin, chloramphenicol, and co-trimoxazole, and nonsusceptible to ciprofloxacin. Results During 2008–2019, of 4,637 Typhi isolates, 52 (1%) were ceftriaxone resistant (axo-R); 71% were ciprofloxacin nonsusceptible, 1 azithromycin resistant (azm-R), and none meropenem resistant. XDR was first detected in 2018, in 2% of 474 isolates and increased to 7% of 535 in 2019. Of the 52 axo-R isolates, 46 were XDR, of which 45 were from travelers to Pakistan, and one from a non-traveler; 6 were not XDR, of which 4 were linked to travel to Iraq. In preliminary 2020 reports, 23 isolates were XDR; 14 were from travelers to Pakistan, 8 from non-travelers, and 1 from someone with unknown travel status. Among those with XDR infection, median age was 11 years (range 1–62), 54% were female, and 62% were from 6 states. Conclusion Ceftriaxone-resistant Typhi infections, mostly XDR, are increasing. Clinicians should ask patients with suspected Typhi infections about travel and adjust treatment based on susceptibility results. Carbapenem, azithromycin, or both may be considered for empiric therapy of typhoid fever among travelers to Pakistan or Iraq and in uncommon instances when persons report no international travel. Ceftriaxone is an empiric therapy option for travelers to countries other than Pakistan and Iraq. ![]()
Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
| | - Louise Francois Watkins
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Meseret Birhane
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | - Layne Dorough
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Hayat Caidi
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | - Hattie E Webb
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, Atlanta, Georgia
| | - Eric Mintz
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Gayle Langley
- Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
5
|
Appiah GD, Mpimbaza A, Lamorde M, Freeman M, Kajumbula H, Salah Z, Kugeler K, Mikoleit M, White PB, Kapisi J, Borchert J, Sserwanga A, Van Dyne S, Mead P, Kim S, Lauer AC, Winstead A, Manabe YC, Flick RJ, Mintz E. Salmonella Bloodstream Infections in Hospitalized Children with Acute Febrile Illness-Uganda, 2016-2019. Am J Trop Med Hyg 2021; 105:37-46. [PMID: 33999850 DOI: 10.4269/ajtmh.20-1453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/19/2021] [Indexed: 12/23/2022] Open
Abstract
Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1-4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P < 0.001). Children with Salmonella BSIs did not differ significantly in length of hospitalization or mortality from children with BSI resulting from other organisms. Serotype and antimicrobial susceptibility results were available for 49 Salmonella isolates, including 35 (71%) non-typhoidal serotypes and 14 Salmonella serotype Typhi (Typhi). Among Typhi isolates, 10 (71%) were multi-drug resistant and 13 (93%) had decreased ciprofloxacin susceptibility. Salmonella strains, particularly non-typhoidal serotypes and drug-resistant Typhi, were the most common cause of BSI. These data can inform regional Salmonella surveillance in East Africa and guide empiric therapy and prevention in Uganda.
Collapse
Affiliation(s)
- Grace D Appiah
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arthur Mpimbaza
- 2Infectious Disease Research Collaboration, Kampala, Uganda.,3Child Health and Development Center, Makerere University, Kampala, Uganda
| | | | - Molly Freeman
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry Kajumbula
- 5Department of Microbiology, Makerere University, Kampala, Uganda
| | - Zainab Salah
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kiersten Kugeler
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Matthew Mikoleit
- 7Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Porscha Bumpus White
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Kapisi
- 2Infectious Disease Research Collaboration, Kampala, Uganda
| | - Jeff Borchert
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | | | - Susan Van Dyne
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Mead
- 6Division of Vector-Borne Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado
| | - Sunkyung Kim
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ana C Lauer
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Winstead
- 8Division of Parasitic Disease and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yukari C Manabe
- 9Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert J Flick
- 9Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric Mintz
- 1Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
6
|
Nanzaluka FH, Davis WW, Mutale L, Kapaya F, Sakubita P, Langa N, Gama A, N’cho HS, Malambo W, Murphy J, Blackstock A, Mintz E, Riggs M, Mukonka V, Sinyange N, Yard E, Brunkard J. Risk Factors for Epidemic Cholera in Lusaka, Zambia-2017. Am J Trop Med Hyg 2020; 103:646-651. [PMID: 32458780 PMCID: PMC7410454 DOI: 10.4269/ajtmh.20-0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/03/2020] [Accepted: 04/20/2020] [Indexed: 11/07/2022] Open
Abstract
On October 6, 2017, the Zambia Ministry of Health declared a cholera outbreak in Lusaka. By December, 1,462 cases and 38 deaths had occurred (case fatality rate, 2.6%). We conducted a case-control study to identify risk factors and inform interventions. A case was any person with acute watery diarrhea (≥ 3 loose stools in 24 hours) admitted to a cholera treatment center in Lusaka from December 16 to 21, 2017. Controls were neighbors without diarrhea during the same time period. Up to two controls were matched to each case by age-group (1-4, 5-17, and ≥ 18 years) and neighborhood. Surveyors interviewed cases and controls, tested free chlorine residual (FCR) in stored water, and observed the presence of soap in the home. Conditional logistic regression was used to generate matched odds ratios (mORs) based on subdistricts and age-groups with 95% CIs. We enrolled 82 cases and 132 controls. Stored water in 71% of case homes had an FCR > 0.2 mg/L. In multivariable analyses, those who drank borehole water (mOR = 2.4, CI: 1.1-5.6), had close contact with a cholera case (mOR = 6.2, CI: 2.5-15), and were male (mOR = 2.5, CI: 1.4-5.0) had higher odds of being a cholera case than their matched controls. Based on these findings, we recommended health education about household water chlorination and hygiene in the home. Emergency responses included providing chlorinated water through emergency tanks and maintaining adequate FCR levels through close monitoring of water sources.
Collapse
Affiliation(s)
- Francis H. Nanzaluka
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - William W. Davis
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lwito Mutale
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Fred Kapaya
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Patrick Sakubita
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Nelia Langa
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Angela Gama
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Hammad S. N’cho
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Warren Malambo
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Murphy
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Blackstock
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Mintz
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret Riggs
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Victor Mukonka
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- School of Medicine, Copperbelt University, Lusaka, Zambia
| | - Nyambe Sinyange
- Ministry of Health, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Ellen Yard
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- U.S. Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Joan Brunkard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
7
|
McAteer J, Derado G, Hughes M, Bhatnagar A, Medalla F, Chatham-Stevens K, Appiah GD, Mintz E. Typhoid Fever in the US Pediatric Population, 1999-2015: Opportunities for Improvement. Clin Infect Dis 2020; 73:e4581-e4589. [PMID: 33247585 DOI: 10.1093/cid/ciaa914] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Typhoid fever in the United States is acquired primarily through international travel by unvaccinated travelers. There is currently no typhoid vaccine licensed in the United States for use in children <2 years. METHODS We reviewed Salmonella enterica serotype Typhi infections reported to the Centers for Disease Control and Prevention (CDC) and antimicrobial-resistance data on Typhi isolates in CDC's National Antimicrobial Resistance Monitoring System from 1999 through 2015. RESULTS 5131 cases of typhoid fever were diagnosed and 5004 Typhi isolates tested for antimicrobial susceptibility. Among 1992 pediatric typhoid fever patients, 1616 (81%) had traveled internationally within 30 days of illness onset, 1544 (81%) of 1906 were hospitalized (median duration, 6 days; range, 0-50), and none died. Forty percent (799) were <6 years old; 12% were <2 years old. Based on age and travel destination, 1435 (83%) of 1722 pediatric patients were vaccine-eligible; only 68 (5%) of 1361 were known to be vaccinated. Of 2003 isolates tested for antimicrobial susceptibility, 1216 (61%) were fluoroquinolone-nonsusceptible, of which 272 (22%) were also resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole (multidrug-resistant [MDR]). All were susceptible to ceftriaxone and azithromycin. MDR and fluoroquinolone-nonsusceptible isolates were more common in children than adults (16% vs 9%, P < .001, and 61% vs 54%, P < .001, respectively). Fluoroquinolone nonsusceptibility was more common among travel-associated than domestically acquired cases (70% vs 17%, P < .001). CONCLUSIONS Approximately 95% of currently vaccine-eligible pediatric travelers were unvaccinated, and antimicrobial-resistant infections were common. New public health strategies are needed to improve coverage with currently licensed vaccines. Introduction of an effective pretravel typhoid vaccine for children <2 years could reduce disease burden and prevent drug-resistant infections.
Collapse
Affiliation(s)
- Jarred McAteer
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael Hughes
- Atlanta Research and Education Foundation, Inc, Atlanta, Georgia, USA
| | - Amelia Bhatnagar
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Felicita Medalla
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kevin Chatham-Stevens
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Grace D Appiah
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Disease, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
8
|
François Watkins LK, Winstead A, Appiah GD, Friedman CR, Medalla F, Hughes MJ, Birhane MG, Schneider ZD, Marcenac P, Hanna SS, Godbole G, Walblay KA., Wiggington AE, Leeper M, Meservey EH, Tagg KA, Chen JC, Abubakar A, Lami F, Asaad AM, Sabaratnam V, Ikram A, Angelo KM, Walker A, Mintz E. Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq - United States, 2018-2019. MMWR Morb Mortal Wkly Rep 2020; 69:618-622. [PMID: 32437343 PMCID: PMC7357342 DOI: 10.15585/mmwr.mm6920a2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Winstead A, Strysko J, Relan P, Conners EE, Martinsen AL, Lopez V, Arons M, Masunda KP, Mukeredzi I, Manyara J, Duri C, Mashe T, Phiri I, Poncin M, Sreenivasan N, Aubert RD, Fuller L, Balachandra S, Mintz E, Manangazira P. Notes from the Field: Cholera Outbreak — Zimbabwe, September 2018–March 2019. MMWR Morb Mortal Wkly Rep 2020; 69:527-528. [PMID: 32352952 PMCID: PMC7206988 DOI: 10.15585/mmwr.mm6917a3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
10
|
Mutale LS, Winstead AV, Sakubita P, Kapaya F, Nyimbili S, Mulambya NL, Nanzaluka FH, Gama A, Mwale V, Kim S, Ngosa W, Yard E, Sinyange N, Mintz E, Brunkard J, Mukonka V. Risk and Protective Factors for Cholera Deaths during an Urban Outbreak-Lusaka, Zambia, 2017-2018. Am J Trop Med Hyg 2020; 102:534-540. [PMID: 31933465 PMCID: PMC7056416 DOI: 10.4269/ajtmh.19-0678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/11/2019] [Accepted: 11/16/2019] [Indexed: 01/03/2023] Open
Abstract
The Republic of Zambia declared a cholera outbreak in Lusaka, the capital, on October 6, 2017. By mid-December, 20 of 661 reported cases had died (case fatality rate 3%), prompting the CDC and the Zambian Ministry of Health through the Zambia National Public Health Institute to investigate risk factors for cholera mortality. We conducted a study of cases (cholera deaths from October 2017 to January 2018) matched by age-group and onset date to controls (persons admitted to a cholera treatment center [CTC] and discharged alive). A questionnaire was administered to each survivor (or relative) and to a family member of each decedent. We used univariable exact conditional logistic regression to calculate matched odds ratios (mORs) and 95% CIs. In the analysis, 38 decedents and 76 survivors were included. Median ages for decedents and survivors were 38 (range: 0.5-95) and 25 (range: 1-82) years, respectively. Patients aged > 55 years and those who did not complete primary school had higher odds of being decedents (matched odds ratio [mOR] 6.3, 95% CI: 1.2-63.0, P = 0.03; mOR 8.6, 95% CI: 1.8-81.7, P < 0.01, respectively). Patients who received immediate oral rehydration solution (ORS) at the CTC had lower odds of dying than those who did not receive immediate ORS (mOR 0.1, 95% CI: 0.0-0.6, P = 0.02). Cholera prevention and outbreak response should include efforts focused on ensuring access to timely, appropriate care for older adults and less educated populations at home and in health facilities.
Collapse
Affiliation(s)
| | | | | | - Fred Kapaya
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | | | | | | | - Angela Gama
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Vivian Mwale
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
| | - Sunkyung Kim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Ngosa
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Ellen Yard
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Nyambe Sinyange
- Zambia Field Epidemiology Training Program, Lusaka, Zambia
- Zambia National Public Health Institute, Lusaka, Zambia
| | - Eric Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joan Brunkard
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
11
|
Jankowitz BT, Gross BA, Mintz E, Jalgaonkar U, Marchesiello D, Girdhar G, Jadhav AP, Jovin TG. Safety and Efficacy Evaluation of Aspiration Thrombectomy With Large Bore Catheters in a Porcine Model. World Neurosurg 2019; 132:e409-e417. [PMID: 31470150 DOI: 10.1016/j.wneu.2019.08.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Thrombectomy with aspiration catheters has shown to be effective for treatment of intracranial large vessel occlusion (LVO). We present preclinical evaluation of the safety and efficacy of React68 and React71 (Medtronic PLC, Irvine, CA) catheters in animal models of LVO. METHODS In vivo evaluation of catheter safety was performed in superficial cervical, internal maxillary, and renal arteries in a porcine model with or without clot (LVO). Animals were survived for 3 days and 30 days. Angiographic outcomes, usability, and histological parameters were compared for treatment with React68, React71, and ACE68 (Penumbra, Alameda, CA) catheters. RESULTS The in vivo angiographic analysis in a porcine thrombectomy LVO model demonstrated that there was no statistically significant difference in the rate of Thrombolysis in Cerebral Infarction scale 2b/3 recanalization between React68, React71, and ACE68 catheters. There were no physical or neurologic deficits in any of the treated animals throughout the survival period. Histologic analysis showed statistically non-inferior safety profile of React68 and React71 catheters relative to ACE68 catheters, with minimal but similar mild internal elastic lamina disruption and smooth muscle loss, but a lack of inflammation, fibrin deposits, and changes in the adventitia at both time points examined. CONCLUSIONS React68 and React71 aspiration catheters have an excellent safety, efficacy, and usability profile in animal models of LVO.
Collapse
Affiliation(s)
- Brian T Jankowitz
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Pittsburgh, Pennsylvania, USA
| | - Bradley A Gross
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | - Ashutosh P Jadhav
- Stroke Institute, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tudor G Jovin
- Department of Neurology, Cooper Neurological Institute, Camden, New Jersey, USA
| |
Collapse
|
12
|
Stanaway JD, Reiner RC, Blacker BF, Goldberg EM, Khalil IA, Troeger CE, Andrews JR, Bhutta ZA, Crump JA, Im J, Marks F, Mintz E, Park SE, Zaidi AKM, Abebe Z, Abejie AN, Adedeji IA, Ali BA, Amare AT, Atalay HT, Avokpaho EFGA, Bacha U, Barac A, Bedi N, Berhane A, Browne AJ, Chirinos JL, Chitheer A, Dolecek C, El Sayed Zaki M, Eshrati B, Foreman KJ, Gemechu A, Gupta R, Hailu GB, Henok A, Hibstu DT, Hoang CL, Ilesanmi OS, Iyer VJ, Kahsay A, Kasaeian A, Kassa TD, Khan EA, Khang YH, Magdy Abd El Razek H, Melku M, Mengistu DT, Mohammad KA, Mohammed S, Mokdad AH, Nachega JB, Naheed A, Nguyen CT, Nguyen HLT, Nguyen LH, Nguyen NB, Nguyen TH, Nirayo YL, Pangestu T, Patton GC, Qorbani M, Rai RK, Rana SM, Ranabhat CL, Roba KT, Roberts NLS, Rubino S, Safiri S, Sartorius B, Sawhney M, Shiferaw MS, Smith DL, Sykes BL, Tran BX, Tran TT, Ukwaja KN, Vu GT, Vu LG, Weldegebreal F, Yenit MK, Murray CJL, Hay SI. The global burden of typhoid and paratyphoid fevers: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis 2019; 19:369-381. [PMID: 30792131 PMCID: PMC6437314 DOI: 10.1016/s1473-3099(18)30685-6] [Citation(s) in RCA: 372] [Impact Index Per Article: 74.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/17/2018] [Accepted: 11/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Efforts to quantify the global burden of enteric fever are valuable for understanding the health lost and the large-scale spatial distribution of the disease. We present the estimates of typhoid and paratyphoid fever burden from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, and the approach taken to produce them. METHODS For this systematic analysis we broke down the relative contributions of typhoid and paratyphoid fevers by country, year, and age, and analysed trends in incidence and mortality. We modelled the combined incidence of typhoid and paratyphoid fevers and split these total cases proportionally between typhoid and paratyphoid fevers using aetiological proportion models. We estimated deaths using vital registration data for countries with sufficiently high data completeness and using a natural history approach for other locations. We also estimated disability-adjusted life-years (DALYs) for typhoid and paratyphoid fevers. FINDINGS Globally, 14·3 million (95% uncertainty interval [UI] 12·5-16·3) cases of typhoid and paratyphoid fevers occurred in 2017, a 44·6% (42·2-47·0) decline from 25·9 million (22·0-29·9) in 1990. Age-standardised incidence rates declined by 54·9% (53·4-56·5), from 439·2 (376·7-507·7) per 100 000 person-years in 1990, to 197·8 (172·0-226·2) per 100 000 person-years in 2017. In 2017, Salmonella enterica serotype Typhi caused 76·3% (71·8-80·5) of cases of enteric fever. We estimated a global case fatality of 0·95% (0·54-1·53) in 2017, with higher case fatality estimates among children and older adults, and among those living in lower-income countries. We therefore estimated 135·9 thousand (76·9-218·9) deaths from typhoid and paratyphoid fever globally in 2017, a 41·0% (33·6-48·3) decline from 230·5 thousand (131·2-372·6) in 1990. Overall, typhoid and paratyphoid fevers were responsible for 9·8 million (5·6-15·8) DALYs in 2017, down 43·0% (35·5-50·6) from 17·2 million (9·9-27·8) DALYs in 1990. INTERPRETATION Despite notable progress, typhoid and paratyphoid fevers remain major causes of disability and death, with billions of people likely to be exposed to the pathogens. Although improvements in water and sanitation remain essential, increased vaccine use (including with typhoid conjugate vaccines that are effective in infants and young children and protective for longer periods) and improved data and surveillance to inform vaccine rollout are likely to drive the greatest improvements in the global burden of the disease. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
13
|
N’cho HS, Masunda KP, Mukeredzi I, Manangazira P, Govore E, Duri C, Aubert RD, Martin H, Gonese E, Vere M, Tippett Barr BA, Balachandra S, Strysko J, Davis WW, Appiah GD, Mintz E. Notes from the Field: Typhoid Fever Outbreak — Harare, Zimbabwe, October 2017–February 2018. MMWR Morb Mortal Wkly Rep 2019; 68:44-45. [DOI: 10.15585/mmwr.mm6802a5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
14
|
Chatham-Stephens K, Medalla F, Hughes M, Appiah GD, Aubert RD, Caidi H, Angelo KM, Walker AT, Hatley N, Masani S, Nash J, Belko J, Ryan ET, Mintz E, Friedman CR. Emergence of Extensively Drug-Resistant Salmonella Typhi Infections Among Travelers to or from Pakistan - United States, 2016-2018. MMWR Morb Mortal Wkly Rep 2019; 68:11-13. [PMID: 30629573 PMCID: PMC6342547 DOI: 10.15585/mmwr.mm6801a3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
15
|
Kukla M, McKay N, Rheingans R, Harman J, Schumacher J, Kotloff KL, Levine MM, Breiman R, Farag T, Walker D, Nasrin D, Omore R, O'Reilly C, Mintz E. The effect of costs on Kenyan households' demand for medical care: why time and distance matter. Health Policy Plan 2018; 32:1397-1406. [PMID: 29036378 DOI: 10.1093/heapol/czx120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/14/2022] Open
Abstract
In an environment of constrained resources, policymakers must identify solutions for financing and delivering health services that are efficient and sustainable. However, such solutions require that policymakers understand the complex interaction between household utilization patterns, factors influencing household medical decisions, and provider performance. This study examined whether and under what conditions out-of-pocket, transportation, and time costs influenced Kenyan households' choice of medical provider for childhood diarrhoeal illnesses. It compared these decisions with the actual cost and quality of those providers to assess strategies for increasing the utilization of high quality, low-cost primary care. This study analyzed nationally-representative survey data through several multinomial nested logit models. On average, time costs accounted for the greatest share of total costs. Households spent the most time and transportation costs utilizing public care, yet were more likely to incur catastrophic time and out-of-pocket costs seeking private care for their child's diarrhoeal illness. Out-of-pocket, transportation, and time costs influenced households' choice of provider, though demand was cost inelastic and households were most responsive to transportation costs. Poorer households were the most responsive to changes in all cost types and most likely to self-treat or utilize informal care. Many households utilized informal care that, relative to formal care, cost the same but was of worse quality-suggesting that such households were making poor medical decisions for their children. To achieve public policy objectives, such as financial risk protection for childhood illnesses and equitable access to primary care, policymakers could focus on three areas: (1) refine financing strategies for further reducing household out-of-pocket costs; (2) reduce or subsidize time and transportation costs for households seeking public and private care; and (3) increase transparency of costs and quality to improve household decisions.
Collapse
Affiliation(s)
- Matt Kukla
- Health Finance and Governance Project, Abt Associates Inc., Bethesda, MD, USA
| | - Niccie McKay
- Department of Health Services Research, Mgmt and Policy, University of Florida, FL, USA
| | - Richard Rheingans
- Department of Sustainable Development, Appalachian State University, Boone, NC, USA
| | - Jeff Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University, FL, USA
| | - Jessica Schumacher
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Karen L Kotloff
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Myrone M Levine
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Robert Breiman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - Tamer Farag
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Damian Walker
- Data and Analytics, Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Dilruba Nasrin
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Richard Omore
- Centers of Disease Control and Prevention, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ciara O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers of Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers of Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
16
|
McAteer JB, Danda S, Nhende T, Manamike P, Parayiwa T, Tarupihwa A, Tapfumanei O, Manangazira P, Mhlanga G, Garone DB, Martinsen A, Aubert RD, Davis W, Narra R, Balachandra S, Tippett Barr BA, Mintz E. Notes from the Field: Outbreak of Vibrio cholerae Associated with Attending a Funeral - Chegutu District, Zimbabwe, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:560-561. [PMID: 29771875 PMCID: PMC6048946 DOI: 10.15585/mmwr.mm6719a6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Sinyange N, Brunkard JM, Kapata N, Mazaba ML, Musonda KG, Hamoonga R, Kapina M, Kapaya F, Mutale L, Kateule E, Nanzaluka F, Zulu J, Musyani CL, Winstead AV, Davis WW, N’cho HS, Mulambya NL, Sakubita P, Chewe O, Nyimbili S, Onwuekwe EV, Adrien N, Blackstock AJ, Brown TW, Derado G, Garrett N, Kim S, Hubbard S, Kahler AM, Malambo W, Mintz E, Murphy J, Narra R, Rao GG, Riggs MA, Weber N, Yard E, Zyambo KD, Bakyaita N, Monze N, Malama K, Mulwanda J, Mukonka VM. Cholera Epidemic - Lusaka, Zambia, October 2017-May 2018. MMWR Morb Mortal Wkly Rep 2018; 67:556-559. [PMID: 29771877 PMCID: PMC6048949 DOI: 10.15585/mmwr.mm6719a5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
18
|
Mintz E. Taking aim at cholera. Lancet 2018; 391:1868-1870. [PMID: 29502906 DOI: 10.1016/s0140-6736(18)30543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Eric Mintz
- Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| |
Collapse
|
19
|
Morris JF, Murphy J, Fagerli K, Schneeberger C, Jaron P, Moke F, Juma J, Ochieng JB, Omore R, Roellig D, Xiao L, Priest JW, Narayanan J, Montgomery JM, Hill V, Mintz E, Ayers TL, O’Reilly CE. A Randomized Controlled Trial to Assess the Impact of Ceramic Water Filters on Prevention of Diarrhea and Cryptosporidiosis in Infants and Young Children-Western Kenya, 2013. Am J Trop Med Hyg 2018; 98:1260-1268. [PMID: 29611500 PMCID: PMC5953370 DOI: 10.4269/ajtmh.17-0731] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 09/19/2017] [Accepted: 02/07/2018] [Indexed: 11/07/2022] Open
Abstract
Cryptosporidium is a leading cause of diarrhea among Kenyan infants. Ceramic water filters (CWFs) are used for household water treatment. We assessed the impact of CWFs on diarrhea, cryptosporidiosis prevention, and water quality in rural western Kenya. A randomized, controlled intervention trial was conducted in 240 households with infants 4-10 months old. Twenty-six weekly household surveys assessed infant diarrhea and health facility visits. Stool specimens from infants with diarrhea were examined for Cryptosporidium. Source water, filtered water, and filter retentate were tested for Cryptosporidium and/or microbial indicators. To estimate the effect of CWFs on health outcomes, logistic regression models using generalized estimating equations were performed; odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Households reported using surface water (36%), public taps (29%), or rainwater (17%) as their primary drinking water sources, with no differences in treatment groups. Intervention households reported less diarrhea (7.6% versus 8.9%; OR: 0.86 [0.64-1.16]) and significantly fewer health facility visits for diarrhea (1.0% versus 1.9%; OR: 0.50 [0.30-0.83]). In total, 15% of intervention and 12% of control stools yielded Cryptosporidium (P = 0.26). Escherichia coli was detected in 93% of source water samples; 71% of filtered water samples met World Health Organization recommendations of < 1 E. coli/100 mL. Cryptosporidium was not detected in source water and was detected in just 2% of filter rinses following passage of large volumes of source water. Water quality was improved among CWF users; however, the short study duration and small sample size limited our ability to observe reductions in cryptosporidiosis.
Collapse
Affiliation(s)
- Jamae Fontain Morris
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of African-American Studies, Georgia State University, Atlanta, Georgia
| | - Jennifer Murphy
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kirsten Fagerli
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chandra Schneeberger
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter Jaron
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Fenny Moke
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - John B. Ochieng
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Dawn Roellig
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lihua Xiao
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey W. Priest
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jothikumar Narayanan
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Vince Hill
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
20
|
Davis WW, Chonzi P, Masunda KP, Shields LM, Mukeredzi I, Manangazira P, Govore E, Aubert RD, Martin H, Gonese E, Ochieng JB, Juma B, Ali H, Allen K, Barr BAT, Mintz E, Appiah GD. Notes from the Field: Typhoid Fever Outbreak - Harare, Zimbabwe, October 2016-March 2017. MMWR Morb Mortal Wkly Rep 2018; 67:342-343. [PMID: 29565843 PMCID: PMC5868204 DOI: 10.15585/mmwr.mm6711a7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
21
|
Bennett SD, Lowther SA, Chingoli F, Chilima B, Kabuluzi S, Ayers TL, Warne TA, Mintz E. Assessment of water, sanitation and hygiene interventions in response to an outbreak of typhoid fever in Neno District, Malawi. PLoS One 2018; 13:e0193348. [PMID: 29474394 PMCID: PMC5825105 DOI: 10.1371/journal.pone.0193348] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 07/27/2016] [Accepted: 02/09/2018] [Indexed: 11/19/2022] Open
Abstract
On May 2, 2009 an outbreak of typhoid fever began in rural villages along the Malawi-Mozambique border resulting in 748 illnesses and 44 deaths by September 2010. Despite numerous interventions, including distribution of WaterGuard (WG) for in-home water treatment and education on its use, cases of typhoid fever continued. To inform response activities during the ongoing Typhoid outbreak information on knowledge, attitudes, and practices surrounding typhoid fever, safe water, and hygiene were necessary to plan future outbreak interventions. In September 2010, a survey was administered to female heads in randomly selected households in 17 villages in Neno District, Malawi. Stored household drinking water was tested for free chlorine residual (FCR) levels using the N,N diethyl-p-phenylene diamine colorimetric method (HACH Company, Loveland, CO, USA). Attendance at community-wide educational meetings was reported by 56% of household respondents. Respondents reported that typhoid fever is caused by poor hygiene (77%), drinking unsafe water (49%), and consuming unsafe food (25%), and that treating drinking water can prevent it (68%). WaterGuard, a chlorination solution for drinking water treatment, was observed in 112 (56%) households, among which 34% reported treating drinking water. FCR levels were adequate (FCR ≥ 0.2 mg/L) in 29 (76%) of the 38 households who reported treatment of stored water and had stored water available for testing and an observed bottle of WaterGuard in the home. Soap was observed in 154 (77%) households, among which 51% reported using soap for hand washing. Educational interventions did not reach almost one-half of target households and knowledge remains low. Despite distribution and promotion of WaterGuard and soap during the outbreak response, usage was low. Future interventions should focus on improving water, sanitation and hygiene knowledge, practices, and infrastructure. Typhoid vaccination should be considered.
Collapse
Affiliation(s)
- Sarah D. Bennett
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Sara A. Lowther
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Benson Chilima
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Storn Kabuluzi
- Community Health Services Unit, Ministry of Health, Lilongwe, Malawi
| | - Tracy L. Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas A. Warne
- Division of Global HIV AIDS, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
22
|
Kabwama SN, Bulage L, Nsubuga F, Pande G, Oguttu DW, Mafigiri R, Kihembo C, Kwesiga B, Masiira B, Okullo AE, Kajumbula H, Matovu JK, Makumbi I, Wetaka M, Kasozi S, Kyazze S, Dahlke M, Hughes P, Sendagala JN, Musenero M, Nabukenya I, Hill VR, Mintz E, Routh J, Gómez G, Bicknese A, Zhu BP. Correction to: A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015. BMC Public Health 2017; 17:823. [PMID: 29047373 PMCID: PMC5648495 DOI: 10.1186/s12889-017-4801-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Fred Nsubuga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Gerald Pande
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - David Were Oguttu
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Ben Masiira
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Henry Kajumbula
- Makerere University College of Health Science Microbiology Laboratory, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Sam Kasozi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Melissa Dahlke
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | - Monica Musenero
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda
| | | | - Vincent R Hill
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Mintz
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janell Routh
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerardo Gómez
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amelia Bicknese
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
| |
Collapse
|
23
|
Kabwama SN, Bulage L, Nsubuga F, Pande G, Oguttu DW, Mafigiri R, Kihembo C, Kwesiga B, Masiira B, Okullo AE, Kajumbula H, Matovu JKB, Makumbi I, Wetaka M, Kasozi S, Kyazze S, Dahlke M, Hughes P, Sendagala JN, Musenero M, Nabukenya I, Hill VR, Mintz E, Routh J, Gómez G, Bicknese A, Zhu BP. A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015. BMC Public Health 2017; 17:23. [PMID: 28056940 PMCID: PMC5216563 DOI: 10.1186/s12889-016-4002-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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] [Received: 05/13/2016] [Accepted: 12/23/2016] [Indexed: 11/15/2022] Open
Abstract
Background On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a “strange disease” that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. Methods We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. Results From 17 February–12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60–49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90–11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. Conclusion Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-4002-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda.
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Fred Nsubuga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Gerald Pande
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - David Were Oguttu
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Christine Kihembo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Ben Masiira
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Allen Eva Okullo
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Henry Kajumbula
- Makerere University College of Health Science Microbiology Laboratory, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Milton Wetaka
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Sam Kasozi
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Simon Kyazze
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Melissa Dahlke
- Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | | | | | - Monica Musenero
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda
| | | | - Vincent R Hill
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Mintz
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janell Routh
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerardo Gómez
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amelia Bicknese
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,US Centers for Disease Control and Prevention, Kampala, Uganda
| |
Collapse
|
24
|
Chevallet M, Gallet B, Fuchs A, Jouneau PH, Um K, Mintz E, Michaud-Soret I. Metal homeostasis disruption and mitochondrial dysfunction in hepatocytes exposed to sub-toxic doses of zinc oxide nanoparticles. Nanoscale 2016; 8:18495-18506. [PMID: 27782264 DOI: 10.1039/c6nr05306h] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Increased production and use of zinc oxide nanoparticles (ZnO-NPs) in consumer products has prompted the scientific community to investigate their potential toxicity, and understand their impact on the environment and organisms. Molecular mechanisms involved in ZnO-NP toxicity are still under debate and focus essentially on high dose expositions. In our study, we chose to evaluate the effect of sub-toxic doses of ZnO-NPs on human hepatocytes (HepG2) with a focus on metal homeostasis and redox balance disruptions. We showed massive dissolution of ZnO-NPs outside the cell, transport and accumulation of zinc ions inside the cell but no evidence of nanoparticle entry, even when analysed by high resolution TEM microscopy coupled with EDX. Gene expression analysis highlighted zinc homeostasis disruptions as shown by metallothionein 1X and zinc transporter 1 and 2 (ZnT1, ZnT2) over-expression. Major oxidative stress response genes, such as superoxide dismutase 1, 2 and catalase were not induced. Phase 2 enzymes in term of antioxidant response, such as heme oxygenase 1 (HMOX1) and the regulating subunit of the glutamate-cysteine ligase (GCLM) were slightly upregulated, but these observations may be linked solely to metal homeostasis disruptions, as these actors are involved in both metal and ROS responses. Finally, we observed abnormal mitochondria morphologies and autophagy vesicles in response to ZnO-NPs, indicating a potential role of mitochondria in storing and protecting cells from zinc excess but ultimately causing cell death at higher doses.
Collapse
Affiliation(s)
- M Chevallet
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM), UMR 5249, Grenoble, France. and CEA, BIG, LCBM, Grenoble, France. and Université Grenoble Alpes, LCBM, Grenoble, France
| | - B Gallet
- Université Grenoble Alpes, IBS, Grenoble, France and CNRS, IBS, Grenoble, France and CEA, IBS, Grenoble, France
| | - A Fuchs
- CEA, BIG, DIR, Grenoble, France
| | - P H Jouneau
- CEA, INAC, Minatec campus, Grenoble, France and Université Grenoble Alpes, INAC-MEM-LEMMA, Grenoble, France
| | - K Um
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM), UMR 5249, Grenoble, France. and CEA, BIG, LCBM, Grenoble, France. and Université Grenoble Alpes, LCBM, Grenoble, France
| | - E Mintz
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM), UMR 5249, Grenoble, France. and CEA, BIG, LCBM, Grenoble, France. and Université Grenoble Alpes, LCBM, Grenoble, France
| | - I Michaud-Soret
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM), UMR 5249, Grenoble, France. and CEA, BIG, LCBM, Grenoble, France. and Université Grenoble Alpes, LCBM, Grenoble, France
| |
Collapse
|
25
|
Veronesi G, Deniaud A, Gallon T, Jouneau PH, Villanova J, Delangle P, Carrière M, Kieffer I, Charbonnier P, Mintz E, Michaud-Soret I. Visualization, quantification and coordination of Ag + ions released from silver nanoparticles in hepatocytes. Nanoscale 2016; 8:17012-17021. [PMID: 27722394 DOI: 10.1039/c6nr04381j] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Silver nanoparticles (AgNPs) can enter eukaryotic cells and exert toxic effects, most probably as a consequence of the release of Ag+ ions. Due to the elusive nature of Ag+ ionic species, quantitative information concerning AgNP intracellular dissolution is missing. By using a synchrotron nanoprobe, silver is visualized and quantified in hepatocytes (HepG2) exposed to AgNPs; the synergistic use of electron microscopy allows for the discrimination between nanoparticular and ionic forms of silver within a single cell. AgNPs are located in endocytosis vesicles, while the visualized Ag+ ions diffuse in the cell. The averaged NP dissolution rates, measured by X-ray absorption spectroscopy, highlight the faster dissolution of citrate-coated AgNPs with respect to the less toxic PVP-coated AgNPs; these results are confirmed at the single-cell level. The released Ag+ ions recombine with thiol-bearing biomolecules: the Ag-S distances measured in cellulo, and the quantitative evaluation of gene expression, provide independent evidence of the involvement of glutathione and metallothioneins in Ag+ binding. The combined use of cutting-edge imaging techniques, atomic spectroscopy and molecular biology brings insight into the fate of AgNPs in hepatocytes, and more generally into the physicochemical transformations of metallic nanoparticles in biological environments and the resulting disruption of metal homeostasis.
Collapse
Affiliation(s)
- G Veronesi
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France. and ESRF, The European Synchrotron, 71, Avenue des Martyrs, 38043 Grenoble, France
| | - A Deniaud
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France.
| | - T Gallon
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France.
| | - P-H Jouneau
- INAC-MEM, Université Grenoble Alpes, Grenoble, France and CEA, INAC-MEM, Grenoble, France
| | - J Villanova
- ESRF, The European Synchrotron, 71, Avenue des Martyrs, 38043 Grenoble, France
| | - P Delangle
- Université Grenoble Alpes, INAC-SCIB, F-38054 Grenoble, France and CEA, INAC-SyMMES, F-38054 Grenoble, France
| | - M Carrière
- Université Grenoble Alpes, INAC-SCIB, F-38054 Grenoble, France and CEA, INAC-SyMMES, F-38054 Grenoble, France
| | - I Kieffer
- BM30B/FAME beamline, ESRF, F-38043 Grenoble cedex 9, France and Observatoire des Sciences de l'Univers de Grenoble, UMS 832 CNRS Université Joseph Fourier, F-38041 Grenoble, France
| | - P Charbonnier
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France.
| | - E Mintz
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France.
| | - I Michaud-Soret
- CNRS, Laboratoire de Chimie et Biologie des Métaux (LCBM) UMR 5249 CNRS-CEA-UGA, F-38054 Grenoble, France and CEA, LCBM, F-38054 Grenoble, France and Université Grenoble Alpes, LCBM, F-38054 Grenoble, France.
| |
Collapse
|
26
|
Burnett E, Dalipanda T, Ogaoga D, Gaiofa J, Jilini G, Halpin A, Dietz V, Date K, Mintz E, Hyde T, Wannemuehler K, Yen C. Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands. PLoS Negl Trop Dis 2016; 10:e0004937. [PMID: 27548678 PMCID: PMC4993445 DOI: 10.1371/journal.pntd.0004937] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background In response to a 2011 cholera outbreak in Papua New Guinea, the Government of the Solomon Islands initiated a cholera prevention program which included cholera disease prevention and treatment messaging, community meetings, and a pre-emptive cholera vaccination campaign targeting 11,000 children aged 1–15 years in selected communities in Choiseul and Western Provinces. Methodology and Principal Findings We conducted a post-vaccination campaign, household-level survey about knowledge, attitudes, and practices regarding diarrhea and cholera in areas targeted and not targeted for cholera vaccination. Respondents in vaccinated areas were more likely to have received cholera education in the previous 6 months (33% v. 9%; p = 0.04), to know signs and symptoms (64% vs. 22%; p = 0.02) and treatment (96% vs. 50%; p = 0.02) of cholera, and to be aware of cholera vaccine (48% vs. 14%; p = 0.02). There were no differences in water, sanitation, and hygiene practices. Conclusions This pre-emptive OCV campaign in a cholera-naïve community provided a unique opportunity to assess household-level knowledge, attitudes, and practices regarding diarrhea, cholera, and water, sanitation, and hygiene (WASH). Our findings suggest that education provided during the vaccination campaign may have reinforced earlier mass messaging about cholera and diarrheal disease in vaccinated communities. We assessed knowledge, attitudes and practices of diarrhea and cholera disease and prevention in two areas of the Solomon Islands near Papua New Guinea. Both areas were ‘at risk’ for cholera disease and received messages about cholera prevention. Later, one of the areas also received vaccination against cholera. This was the first time cholera vaccine was administered to a population that had never reported cholera. Our survey found that people living in the area were cholera vaccine was administered were more likely to know the signs and symptoms and treatment of cholera, as well as be aware of cholera vaccine. We think this could be related to the extra education provided with vaccination. This was the first knowledge, attitudes, and practices survey about diarrhea and cholera disease and prevention and prevention in a population that had not been exposed to cholera.
Collapse
Affiliation(s)
- Eleanor Burnett
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | | | - Divi Ogaoga
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Jenny Gaiofa
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | | | - Alison Halpin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vance Dietz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kashmira Date
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eric Mintz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Terri Hyde
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathleen Wannemuehler
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Catherine Yen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
27
|
Blanton E, Wilhelm N, O'Reilly C, Muhonja E, Karoki S, Ope M, Langat D, Omolo J, Wamola N, Oundo J, Hoekstra R, Ayers T, De Cock K, Breiman R, Mintz E, Lantagne D. A rapid assessment of drinking water quality in informal settlements after a cholera outbreak in Nairobi, Kenya. J Water Health 2015; 13:714-725. [PMID: 26322757 DOI: 10.2166/wh.2014.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Populations living in informal settlements with inadequate water and sanitation infrastructure are at risk of epidemic disease. In 2010, we conducted 398 household surveys in two informal settlements in Nairobi, Kenya with isolated cholera cases. We tested source and household water for free chlorine residual (FCR) and Escherichia coli in approximately 200 households. International guidelines are ≥0.5 mg/L FCR at source, ≥0.2 mg/L at household, and <1 E. coli/100 mL. In these two settlements, 82% and 38% of water sources met FCR guidelines; and 7% and 8% were contaminated with E. coli, respectively. In household stored water, 82% and 35% met FCR guidelines and 11% and 32% were contaminated with E. coli, respectively. Source water FCR≥0.5 mg/L (p=0.003) and reported purchase of a household water treatment product (p=0.002) were associated with increases in likelihood that household stored water had ≥0.2 mg/L FCR, which was associated with a lower likelihood of E. coli contamination (p<0.001). These results challenge the assumption that water quality in informal settlements is universally poor and the route of disease transmission, and highlight that providing centralized water with ≥0.5 mg/L FCR or (if not feasible) household water treatment technologies reduces the risk of waterborne cholera transmission in informal settlements.
Collapse
Affiliation(s)
- Elizabeth Blanton
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie Wilhelm
- Tufts University, Boston, USA and 200 College Avenue, Medford, MA 02155, USA E-mail:
| | - Ciara O'Reilly
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Everline Muhonja
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Solomon Karoki
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Maurice Ope
- Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Daniel Langat
- Ministry of Public Health & Sanitation, Nairobi, Kenya
| | - Jared Omolo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya; Ministry of Public Health & Sanitation, Nairobi, Kenya
| | | | - Joseph Oundo
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert Hoekstra
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tracy Ayers
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin De Cock
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Robert Breiman
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya; Emory Global Health Institute, Emory University, Atlanta, GA, USA and Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniele Lantagne
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Tufts University, Boston, USA and 200 College Avenue, Medford, MA 02155, USA E-mail:
| |
Collapse
|
28
|
Bwire G, Malimbo M, Kagirita A, Makumbi I, Mintz E, Mengel MA, Orach CG. Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda. Am J Trop Med Hyg 2015; 93:534-8. [PMID: 26195468 PMCID: PMC4559692 DOI: 10.4269/ajtmh.14-0730] [Citation(s) in RCA: 11] [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: 11/19/2014] [Accepted: 05/12/2015] [Indexed: 11/07/2022] Open
Abstract
During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered.
Collapse
Affiliation(s)
- Godfrey Bwire
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Mugagga Malimbo
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Atek Kagirita
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Issa Makumbi
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Eric Mintz
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Martin A Mengel
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Christopher Garimoi Orach
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
29
|
Tohme RA, François J, Wannemuehler K, Iyengar P, Dismer A, Adrien P, Hyde TB, Marston BJ, Date K, Mintz E, Katz MA. Oral Cholera Vaccine Coverage, Barriers to Vaccination, and Adverse Events following Vaccination, Haiti, 2013. Emerg Infect Dis 2015; 21:984-91. [PMID: 25988350 PMCID: PMC4451924 DOI: 10.3201/eid2106.141797] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2013, the first government-led oral cholera vaccination (OCV) campaign in Haiti was implemented in Petite Anse and Cerca Carvajal. To evaluate vaccination coverage, barriers to vaccination, and adverse events following vaccination, we conducted a cluster survey. We enrolled 1,121 persons from Petite Anse and 809 persons from Cerca Carvajal, categorized by 3 age groups (1-4, 5-14, >15 years). Two-dose OCV coverage was 62.5% in Petite Anse and 76.8% in Cerca Carvajal. Two-dose coverage was lowest among persons >15 years of age. In Cerca Carvajal, coverage was significantly lower for male than female respondents (69% vs. 85%; p<0.001). No major adverse events were reported. The main reason for nonvaccination was absence during the campaign. Vaccination coverage after this campaign was acceptable and comparable to that resulting from campaigns implemented by nongovernmental organizations. Future campaigns should be tailored to reach adults who are not available during daytime hours.
Collapse
|
30
|
Carias C, Walters MS, Wefula E, Date KA, Swerdlow DL, Vijayaraghavan M, Mintz E. Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda. Vaccine 2015; 33:2079-85. [DOI: 10.1016/j.vaccine.2015.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 01/17/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
|
31
|
Painter JE, Walker AT, Pytell J, Nua MT, Soliai-Lemusu S, Mintz E, Ali I, Parsons M, Martin H, Beach M, Bowen A, Cope J. Notes from the field: outbreak of diarrheal illness caused by Shigella flexneri - American Samoa, May-June 2014. MMWR Morb Mortal Wkly Rep 2015; 64:30. [PMID: 25590684 PMCID: PMC4584797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
On May 9, 2014, a physician at hospital A in American Samoa noticed an abnormally high number of children presenting to the emergency department with bloody diarrhea. Based on preliminary testing of stool specimens, Entamoeba histolytica infection was suspected as a possible cause. Shigella was also suspected in a subset of samples. On May 22, the American Samoa Department of Health requested assistance from CDC with the outbreak investigation. The goals of the investigation were to establish the presence of an outbreak, characterize its epidemiology and etiology, and recommend control measures. The CDC field team reviewed the emergency department log book for cases of diarrheal illness during April 15-June 13, 2014. During this period, 280 cases of diarrheal illness were recorded, with a peak occurring on May 10. Twice as many cases occurred during this period in 2014 compared with the same period in 2011, the most recent year for which comparable surveillance data were available. Cases were widely distributed across the island. The highest number of cases occurred in children aged 0-9 years. Across age groups, cases were similarly distributed among males and females. These patterns are not consistent with the epidemiology of disease caused by E. histolytica, which tends to cause more cases in males of all ages.
Collapse
Affiliation(s)
- Julia E. Painter
- Epidemic Intelligence Service, CDC,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC,Corresponding author: Julia E. Painter, , 404-718-4388
| | - Allison Taylor Walker
- Epidemic Intelligence Service, CDC,Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jarratt Pytell
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | | | | | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Ibne Ali
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Michele Parsons
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Haley Martin
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Michael Beach
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Anna Bowen
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jennifer Cope
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| |
Collapse
|
32
|
Scobie HM, Nilles E, Kama M, Kool JL, Mintz E, Wannemuehler KA, Hyde TB, Dawainavesi A, Singh S, Korovou S, Jenkins K, Date K. Impact of a targeted typhoid vaccination campaign following cyclone Tomas, Republic of Fiji, 2010. Am J Trop Med Hyg 2014; 90:1031-8. [PMID: 24710618 DOI: 10.4269/ajtmh.13-0728] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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
After a category 4 cyclone that caused extensive population displacement and damage to water and sanitation infrastructure in Fiji in March 2010, a typhoid vaccination campaign was conducted as part of the post-disaster response. During June-December 2010, 64,015 doses of typhoid Vi polysaccharide vaccine were administered to persons ≥ 2 years of age, primarily in cyclone-affected areas that were typhoid endemic. Annual typhoid fever incidence decreased during the post-campaign year (2011) relative to preceding years (2008-2009) in three subdivisions where a large proportion of the population was vaccinated (incidence rate ratios and 95% confidence intervals: 0.23, 0.13-0.41; 0.24, 0.14-0.41; 0.58, 0.40-0.86), and increased or remained unchanged in 12 subdivisions where little to no vaccination occurred. Vaccination played a role in reducing typhoid fever incidence in high-incidence areas after a disaster and should be considered in endemic settings, along with comprehensive control measures, as recommended by the World Health Organization.
Collapse
Affiliation(s)
- Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Eric Nilles
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Mike Kama
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Jacob L Kool
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Eric Mintz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kathleen A Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Akanisi Dawainavesi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Sheetalpreet Singh
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Samuel Korovou
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kylie Jenkins
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Pacific Technical Support, World Health Organization, Suva, Fiji; Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Fiji Centre for Communicable Disease Control, Suva, Fiji; Health Information Unit, Ministry of Health, Suva, Fiji; Fiji Ministry of Health, Labasa, Fiji; Fiji Health Sector Improvement Program, Ministry of Health, Suva, Fiji
| |
Collapse
|
33
|
Imanishi M, Kweza PF, Slayton RB, Urayai T, Ziro O, Mushayi W, Francis-Chizororo M, Kuonza LR, Ayers T, Freeman MM, Govore E, Duri C, Chonzi P, Mtapuri-Zinyowera S, Manangazira P, Kilmarx PH, Mintz E, Lantagne D. Household water treatment uptake during a public health response to a large typhoid fever outbreak in Harare, Zimbabwe. Am J Trop Med Hyg 2014; 90:945-54. [PMID: 24664784 DOI: 10.4269/ajtmh.13-0497] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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
Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011-April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs.
Collapse
Affiliation(s)
- Maho Imanishi
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Walters MS, Routh J, Mikoleit M, Kadivane S, Ouma C, Mubiru D, Mbusa B, Murangi A, Ejoku E, Rwantangle A, Kule U, Lule J, Garrett N, Halpin J, Maxwell N, Kagirita A, Mulabya F, Makumbi I, Freeman M, Joyce K, Hill V, Downing R, Mintz E. Shifts in geographic distribution and antimicrobial resistance during a prolonged typhoid fever outbreak--Bundibugyo and Kasese Districts, Uganda, 2009-2011. PLoS Negl Trop Dis 2014; 8:e2726. [PMID: 24603860 PMCID: PMC3945727 DOI: 10.1371/journal.pntd.0002726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 09/08/2013] [Accepted: 01/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Salmonella enterica serovar Typhi is transmitted by fecally contaminated food and water and causes approximately 22 million typhoid fever infections worldwide each year. Most cases occur in developing countries, where approximately 4% of patients develop intestinal perforation (IP). In Kasese District, Uganda, a typhoid fever outbreak notable for a high IP rate began in 2008. We report that this outbreak continued through 2011, when it spread to the neighboring district of Bundibugyo. Methodology/Principal Findings A suspected typhoid fever case was defined as IP or symptoms of fever, abdominal pain, and ≥1 of the following: gastrointestinal disruptions, body weakness, joint pain, headache, clinically suspected IP, or non-responsiveness to antimalarial medications. Cases were identified retrospectively via medical record reviews and prospectively through laboratory-enhanced case finding. Among Kasese residents, 709 cases were identified from August 1, 2009–December 31, 2011; of these, 149 were identified during the prospective period beginning November 1, 2011. Among Bundibugyo residents, 333 cases were identified from January 1–December 31, 2011, including 128 cases identified during the prospective period beginning October 28, 2011. IP was reported for 507 (82%) and 59 (20%) of Kasese and Bundibugyo cases, respectively. Blood and stool cultures performed for 154 patients during the prospective period yielded isolates from 24 (16%) patients. Three pulsed-field gel electrophoresis pattern combinations, including one observed in a Kasese isolate in 2009, were shared among Kasese and Bundibugyo isolates. Antimicrobial susceptibility was assessed for 18 isolates; among these 15 (83%) were multidrug-resistant (MDR), compared to 5% of 2009 isolates. Conclusions/Significance Molecular and epidemiological evidence suggest that during a prolonged outbreak, typhoid spread from Kasese to Bundibugyo. MDR strains became prevalent. Lasting interventions, such as typhoid vaccination and improvements in drinking water infrastructure, should be considered to minimize the risk of prolonged outbreaks in the future. Typhoid fever is an acute febrile illness caused by the bacteria Salmonella Typhi and transmitted through food and water contaminated with the feces of typhoid fever patients or carriers. We investigated typhoid fever outbreaks in two neighboring Ugandan districts, Kasese and Bundibugyo, where typhoid fever outbreaks began in 2008 and 2011, respectively. In Kasese from August 2009–December 2011, we documented 709 cases of typhoid fever. In Bundibugyo from January–December 2011, we documented 333 cases. Salmonella Typhi from Bundibugyo and Kasese had indistinguishable molecular fingerprints; laboratory and epidemiological evidence indicate that the outbreak spread from Kasese to Bundibugyo. Salmonella Typhi isolated during our investigation were resistant to more antibiotics than isolates obtained from Kasese in 2009. Drinking water in both districts was fecally contaminated and the likely vehicle for the outbreaks. Our investigation highlights that in unchecked typhoid fever outbreaks, illness can become geographically dispersed and outbreak strains can become increasingly resistant to antibiotics. Lasting interventions, including investments in drinking water infrastructure and typhoid vaccination, are needed to control these outbreaks and prevent future outbreaks.
Collapse
Affiliation(s)
- Maroya Spalding Walters
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Janell Routh
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matthew Mikoleit
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Denis Mubiru
- Uganda Central Public Health Laboratory, Kampala, Uganda
| | - Ben Mbusa
- Bundibugyo District Health Office, Bundibugyo, Uganda
| | | | | | | | - Uziah Kule
- St. Paul's Health Centre, Kasese, Uganda
| | | | - Nancy Garrett
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jessica Halpin
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Nikki Maxwell
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Atek Kagirita
- Uganda Central Public Health Laboratory, Kampala, Uganda
| | | | | | - Molly Freeman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Joyce
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vince Hill
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
35
|
Schilling KA, Cartwright EJ, Stamper J, Locke M, Esposito DH, Balaban V, Mintz E. Diarrheal illness among US residents providing medical services in Haiti during the cholera epidemic, 2010 to 2011. J Travel Med 2014; 21:55-7. [PMID: 24383654 DOI: 10.1111/jtm.12075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 11/28/2022]
Abstract
Although nosocomial transmission of cholera is rare, two US healthcare workers (HCW) became ill with cholera after providing medical services during the Haiti cholera epidemic. To assess the incidence of diarrheal illness and explore preventive health behaviors practiced by US residents who provided medical services in Haiti, we conducted a cross-sectional, anonymous, web-based survey. We e-mailed 896 participants from 50 US-based, health-focused non-governmental organizations (NGOs), of whom 381 (43%) completed the survey. Fifty-six percent of respondents (n = 215) reported providing some care for patients with cholera. Diarrhea was reported by 31 (8%) respondents. One person was diagnosed with cholera by serologic testing. NGOs responding to international emergencies should ensure ample access to basic hygiene supplies and should promote their use to reduce the incidence of diarrheal illness among HCW working overseas.
Collapse
Affiliation(s)
- Katharine A Schilling
- Division of Foodborne, Waterborne, and Environmental Diseases, Waterborne Disease Prevention Branch, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Loharikar A, Briere E, Ope M, Langat D, Njeru I, Gathigi L, Makayotto L, Ismail AM, Thuranira M, Abade A, Amwayi S, Omolo J, Oundo J, De Cock KM, Breiman RF, Ayers T, Mintz E, O'Reilly CE. A national cholera epidemic with high case fatality rates--Kenya 2009. J Infect Dis 2013; 208 Suppl 1:S69-77. [PMID: 24101648 DOI: 10.1093/infdis/jit220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. METHODS We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. RESULTS In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. CONCLUSIONS High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.
Collapse
Affiliation(s)
- Anagha Loharikar
- Epidemic Intelligence Service, Office of Workforce and Career Development
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Baker KK, Sow SO, Kotloff KL, Nataro JP, Farag TH, Tamboura B, Doumbia M, Sanogo D, Diarra D, O'Reilly CE, Mintz E, Panchalingam S, Wu Y, Blackwelder WC, Levine MM. Quality of piped and stored water in households with children under five years of age enrolled in the Mali site of the Global Enteric Multi-Center Study (GEMS). Am J Trop Med Hyg 2013; 89:214-222. [PMID: 23836570 PMCID: PMC3741239 DOI: 10.4269/ajtmh.12-0256] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 04/14/2013] [Indexed: 01/15/2023] Open
Abstract
Water, sanitation, and hygiene information was collected during a matched case-control study of moderate and severe diarrhea (MSD) among 4,096 children < 5 years of age in Bamako, Mali. Primary use of piped water (conditional odds ratio [cOR] = 0.45; 0.34-0.62), continuous water access (cOR = 0.30; 0.20-0.43), fetching water daily (cOR = 0.77; 0.63-0.96), and breastfeeding (cOR = 0.65; 0.49-0.88) significantly reduced the likelihood of MSD. Fetching water in > 30 minutes (cOR = 2.56; 1.55-4.23) was associated with MSD. Piped tap water and courier-delivered water contained high (> 2 mg/L) concentrations of free residual chlorine and no detectable Escherichia coli. However, many households stored water overnight, resulting in inadequate free residual chlorine (< 0.2 mg/L) for preventing microbial contamination. Coliforms and E. coli were detected in 48% and 8% of stored household water samples, respectively. Although most of Bamako's population enjoys access to an improved water source, water quality is often compromised during household storage.
Collapse
Affiliation(s)
- Kelly K. Baker
- Center for Vaccine Development, Departments of Medicine and Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland; Centre pour le Développement des Vaccins du Mali (CVD-Mali), Centre National d'Appui à la Lutte Contre la Maladie (ex-Institut Marchoux), Bamako, Mali; Division of Foodborne, Waterborne and Environmental Diseases, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Christian KA, Ijaz K, Dowell SF, Chow CC, Chitale RA, Bresee JS, Mintz E, Pallansch MA, Wassilak S, McCray E, Arthur RR. What we are watching--five top global infectious disease threats, 2012: a perspective from CDC's Global Disease Detection Operations Center. Emerg Health Threats J 2013; 6:20632. [PMID: 23827387 PMCID: PMC3701798 DOI: 10.3402/ehtj.v6i0.20632] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/15/2013] [Accepted: 05/24/2013] [Indexed: 12/20/2022]
Abstract
Disease outbreaks of international public health importance continue to occur regularly; detecting and tracking significant new public health threats in countries that cannot or might not report such events to the global health community is a challenge. The Centers for Disease Control and Prevention's (CDC) Global Disease Detection (GDD) Operations Center, established in early 2007, monitors infectious and non-infectious public health events to identify new or unexplained global public health threats and better position CDC to respond, if public health assistance is requested or required. At any one time, the GDD Operations Center actively monitors approximately 30-40 such public health threats; here we provide our perspective on five of the top global infectious disease threats that we were watching in 2012: 1 avian influenza A (H5N1), 2 cholera, 3 wild poliovirus, 4 enterovirus-71, and 5 extensively drug-resistant tuberculosis11†Current address: Division of Integrated Biosurveillance, Armed Forces Health Surveillance Center, US Department of Defense, Silver Spring, MD, USA.
Collapse
Affiliation(s)
- Kira A Christian
- Division of Global Disease Detection and Emergency Response, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Wolf RA, Girouard N, Xu S, Meredith JC, Shofner ML, Cross L, Mintz E, Schueneman GT. Adhesion Improvements of Nanocellulose Composite Interfaces. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/j.1941-9635.2013.tb01022.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
41
|
O'Connor KA, Cartwright E, Loharikar A, Routh J, Gaines J, Fouché MDB, Jean-Louis R, Ayers T, Johnson D, Tappero JW, Roels TH, Archer WR, Dahourou GA, Mintz E, Quick R, Mahon BE. Risk factors early in the 2010 cholera epidemic, Haiti. Emerg Infect Dis 2012; 17:2136-8. [PMID: 22099118 PMCID: PMC3310583 DOI: 10.3201/eid1711.110810] [Citation(s) in RCA: 23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During the early weeks of the cholera outbreak that began in Haiti in October 2010, we conducted a case-control study to identify risk factors. Drinking treated water was strongly protective against illness. Our results highlight the effectiveness of safe water in cholera control.
Collapse
|
42
|
Date KA, Vicari A, Hyde TB, Mintz E, Danovaro-Holliday MC, Henry A, Tappero JW, Roels TH, Abrams J, Burkholder BT, Ruiz-Matus C, Andrus J, Dietz V. Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011. Emerg Infect Dis 2012; 17:2105-12. [PMID: 22099114 PMCID: PMC3310586 DOI: 10.3201/eid1711.110822] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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
Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.
Collapse
Affiliation(s)
- Kashmira A Date
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Kay MK, Cartwright EJ, Maceachern D, McCullough J, Barzilay E, Mintz E, Duchin JS, Macdonald K, Turnsek M, Tarr C, Talkington D, Newton A, Marfin AA. Vibrio mimicus infection associated with crayfish consumption, Spokane, Washington, 2010. J Food Prot 2012; 75:762-4. [PMID: 22488068 DOI: 10.4315/0362-028x.jfp-11-410] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a cluster of severe diarrheal disease caused by Vibrio mimicus infection among four persons who had consumed leftover crayfish the day after a private crayfish boil. Gastrointestinal illness caused by Vibrio mimicus has not been reported previously in Washington State. Three cases were laboratory confirmed by stool culture; using PCR, isolates were found to have ctx genes that encode cholera toxin (CT). Two of the cases were hospitalized under intensive care with a cholera-like illness. The illnesses were most likely caused by cross-contamination of cooked crayfish with uncooked crayfish; however, V. mimicus was not isolated nor were CT genes detected by PCR in leftover samples of frozen crayfish. Clinicians should be aware that V. mimicus can produce CT and that V. mimicus infection can cause severe illness.
Collapse
Affiliation(s)
- Meagan K Kay
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Loharikar A, Newton A, Rowley P, Wheeler C, Bruno T, Barillas H, Pruckler J, Theobald L, Lance S, Brown JM, Barzilay EJ, Arvelo W, Mintz E, Fagan R. Typhoid Fever Outbreak Associated With Frozen Mamey Pulp Imported From Guatemala to the Western United States, 2010. Clin Infect Dis 2012; 55:61-6. [DOI: 10.1093/cid/cis296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
45
|
Neil KP, Sodha SV, Lukwago L, O-tipo S, Mikoleit M, Simington SD, Mukobi P, Balinandi S, Majalija S, Ayers J, Kagirita A, Wefula E, Asiimwe F, Kweyamba V, Talkington D, Shieh WJ, Adem P, Batten BC, Zaki SR, Mintz E. A Large Outbreak of Typhoid Fever Associated With a High Rate of Intestinal Perforation in Kasese District, Uganda, 2008-2009. Clin Infect Dis 2012; 54:1091-9. [DOI: 10.1093/cid/cis025] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
46
|
Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS, Khaila T, Chilima B, Mallewa M, Kampondeni SD, Lowther SA, Capewell L, Date K, Townes D, Redwood Y, Schier JG, Nygren B, Tippett Barr B, Demby A, Phiri A, Lungu R, Kaphiyo J, Humphrys M, Talkington D, Joyce K, Stockman LJ, Armstrong GL, Mintz E. Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. Clin Infect Dis 2012; 54:1100-6. [PMID: 22357702 DOI: 10.1093/cid/cis012] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Salmonella enterica serovar Typhi causes an estimated 22 million cases of typhoid fever and 216 000 deaths annually worldwide. We investigated an outbreak of unexplained febrile illnesses with neurologic findings, determined to be typhoid fever, along the Malawi-Mozambique border. METHODS The investigation included active surveillance, interviews, examinations of ill and convalescent persons, medical chart reviews, and laboratory testing. Classification as a suspected case required fever and ≥1 other finding (eg, headache or abdominal pain); a probable case required fever and a positive rapid immunoglobulin M antibody test for typhoid (TUBEX TF); a confirmed case required isolation of Salmonella Typhi from blood or stool. Isolates underwent antimicrobial susceptibility testing and subtyping by pulsed-field gel electrophoresis (PFGE). RESULTS We identified 303 cases from 18 villages with onset during March-November 2009; 214 were suspected, 43 were probable, and 46 were confirmed cases. Forty patients presented with focal neurologic abnormalities, including a constellation of upper motor neuron signs (n = 19), ataxia (n = 22), and parkinsonism (n = 8). Eleven patients died. All 42 isolates tested were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; 4 were also resistant to nalidixic acid. Thirty-five of 42 isolates were indistinguishable by PFGE. CONCLUSIONS The unusual neurologic manifestations posed a diagnostic challenge that was resolved through rapid typhoid antibody testing in the field and subsequent blood culture confirmation in the Malawi national reference laboratory. Extending laboratory diagnostic capacity, including blood culture, to populations at risk for typhoid fever in Africa will improve outbreak detection, response, and clinical treatment.
Collapse
Affiliation(s)
- Emily Lutterloh
- Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Tabu C, Breiman RF, Ochieng B, Aura B, Cosmas L, Audi A, Olack B, Bigogo G, Ongus JR, Fields P, Mintz E, Burton D, Oundo J, Feikin DR. Differing burden and epidemiology of non-Typhi Salmonella bacteremia in rural and urban Kenya, 2006-2009. PLoS One 2012; 7:e31237. [PMID: 22363591 PMCID: PMC3283637 DOI: 10.1371/journal.pone.0031237] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [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] [Received: 12/09/2011] [Accepted: 01/05/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The epidemiology of non-Typhi Salmonella (NTS) bacteremia in Africa will likely evolve as potential co-factors, such as HIV, malaria, and urbanization, also change. METHODS As part of population-based surveillance among 55,000 persons in malaria-endemic, rural and malaria-nonendemic, urban Kenya from 2006-2009, blood cultures were obtained from patients presenting to referral clinics with fever ≥38.0°C or severe acute respiratory infection. Incidence rates were adjusted based on persons with compatible illnesses, but whose blood was not cultured. RESULTS NTS accounted for 60/155 (39%) of blood culture isolates in the rural and 7/230 (3%) in the urban sites. The adjusted incidence in the rural site was 568/100,000 person-years, and the urban site was 51/100,000 person-years. In both sites, the incidence was highest in children <5 years old. The NTS-to-typhoid bacteremia ratio in the rural site was 4.6 and in the urban site was 0.05. S. Typhimurium represented >85% of blood NTS isolates in both sites, but only 21% (urban) and 64% (rural) of stool NTS isolates. Overall, 76% of S. Typhimurium blood isolates were multi-drug resistant, most of which had an identical profile in Pulse Field Gel Electrophoresis. In the rural site, the incidence of NTS bacteremia increased during the study period, concomitant with rising malaria prevalence (monthly correlation of malaria positive blood smears and NTS bacteremia cases, Spearman's correlation, p = 0.018 for children, p = 0.16 adults). In the rural site, 80% of adults with NTS bacteremia were HIV-infected. Six of 7 deaths within 90 days of NTS bacteremia had HIV/AIDS as the primary cause of death assigned on verbal autopsy. CONCLUSIONS NTS caused the majority of bacteremias in rural Kenya, but typhoid predominated in urban Kenya, which most likely reflects differences in malaria endemicity. Control measures for malaria, as well as HIV, will likely decrease the burden of NTS bacteremia in Africa.
Collapse
Affiliation(s)
- Collins Tabu
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Robert F. Breiman
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
- International Emerging Infections Program, Global Disease Detection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Benjamin Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Barrack Aura
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Cosmas
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Allan Audi
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Beatrice Olack
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Juliette R. Ongus
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Patricia Fields
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers For Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eric Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers For Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Deron Burton
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
- International Emerging Infections Program, Global Disease Detection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joe Oundo
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Daniel R. Feikin
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Nairobi, Kenya
- International Emerging Infections Program, Global Disease Detection, Centers for Disease Control and Prevention, Nairobi, Kenya
| |
Collapse
|
48
|
Cavallaro EC, Harris JR, da Goia MS, dos Santos Barrado JC, da Nóbrega AA, de Alvarenga de Junior IC, Silva AP, Sobel J, Mintz E. Evaluation of pot-chlorination of wells during a cholera outbreak, Bissau, Guinea-Bissau, 2008. J Water Health 2011; 9:394-402. [PMID: 21942203 DOI: 10.2166/wh.2011.122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We evaluated the ability of UNICEF-designed pot-chlorinators to achieve recommended free residual chlorine (FRC) levels in well water in Bissau, Guinea-Bissau, during a cholera outbreak. Thirty wells were randomly selected from six neighbourhoods. Pot-chlorinators--perforated plastic bottles filled with gravel, sand and calcium hypochlorite granules--were placed in each well. FRC was measured before and 24, 48 and 72 h after placement and compared with World Health Organization (WHO)-recommended levels of 21 mg L(-1) for well water during cholera outbreaks and 0.2-5 mg L 1 in non-outbreak settings. Presence of well covers, distance from wells to latrines, and rainfall were noted. Complete post-chlorination data were collected from 26 wells. At baseline, no wells had FRC>0.09 mg L(-1). At 24, 48 and 72 h post-chlorination, 4 (15%), 1 (4%) and 0 wells had FRC>or=1 mg L(-1) and 16 (62%), 4 (15%) and 1 (4%) wells had FRC between 0.2 and 5 mg L(-1), respectively. Several families reported discontinuing household water chlorination after wells were treated with pot-chlorinators. Pot-chlorinators failed to achieve WHO-recommended FRC levels in well water during a cholera outbreak, and conveyed a false sense of security to local residents. Pot-chlorination should be discouraged and alternative approaches to well-water disinfection promoted.
Collapse
Affiliation(s)
- Elizabeth C Cavallaro
- Global WASH Epidemiology Team, Waterborne Diseases Prevention Branch (WDPB), Division of Foodborne, Bacterial, and Mycotic Diseases (DBFMD), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ndiege N, Chandrasekharan R, Radadia AD, Harris W, Mintz E, Masel RI, Shannon MA. Synthesis, Characterization, and Photoactivity of Ta2O5-Grafted SiO2 Nanoparticles. Chemistry 2011; 17:7685-93. [DOI: 10.1002/chem.201003500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Indexed: 11/08/2022]
|
50
|
Safaeian M, Gao YT, Sakoda LC, Quraishi SM, Rashid A, Wang BS, Chen J, Pruckler J, Mintz E, Hsing AW. Chronic typhoid infection and the risk of biliary tract cancer and stones in Shanghai, China. Infect Agent Cancer 2011; 6:6. [PMID: 21535882 PMCID: PMC3110129 DOI: 10.1186/1750-9378-6-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 05/02/2011] [Indexed: 01/06/2023] Open
Abstract
Previous studies have shown a positive association between chronic typhoid carriage and biliary cancers. We compared serum Salmonella enterica serovar Typhi antibody titers between biliary tract cancer cases, biliary stone cases without evidence of cancer, and healthy subjects in a large population-based case-control study in Shanghai, China. Participants included 627 newly diagnosed primary biliary tract cancer patients; 1,037 biliary stone cases (774 gallbladder and 263 bile-duct) and 959 healthy subjects without a history of cancer, randomly selected from the Shanghai Resident Registry. Overall only 6/2,293 (0.26%) were Typhi positive. The prevalence of Typhi was 1/457 (0.22%), 4/977 (0.41%), and 1/859 (0.12%) among cancer cases, biliary-stone cases, and population controls, respectively. We did not find an association between Typhi and biliary cancer in Shanghai, due to the very low prevalence of chronic carriers in this population. The low seroprevalence of S. Typhi in Shanghai is unlikely to explain the high incidence of biliary cancers in this population.
Collapse
Affiliation(s)
- Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|