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Saha A, Browning C, Dandamudi R, Barton K, Graepel K, Cullity M, Abusalah W, Christine D, Rossi C, Drexler N, Basavaraju S, Annambhotia P, Guillamet RV, Eid AJ, Maliakkal J, Miller A, Hugge C, Dharnidharka VR, Kandula P, Moritz MJ. Donor-derived ehrlichiosis: two clusters following solid organ transplantation. Clin Infect Dis 2021; 74:918-923. [PMID: 34329411 DOI: 10.1093/cid/ciab667] [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: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
Ehrlichiosis has been infrequently described as transmissible through organ transplantation. Two donor derived clusters of ehrlichiosis are described here. During the summer of 2020, two cases of ehrlichiosis were reported to the Organ Procurement and Transplantation Network (OPTN) and the Centers for Disease Control and Prevention (CDC) for investigation. Additional transplant centers were contacted to investigate similar illness in other recipients and samples were sent to CDC. Two kidney recipients from a common donor developed fatal ehrlichiosis-induced hemophagocytic lymphocytic histiocytosis (HLH). Two kidney recipients and a liver recipient from another common donor developed ehrlichiosis. All three were successfully treated. Clinicians should consider donor-derived ehrlichiosis when evaluating recipients with fever early after transplantation after more common causes are ruled out, especially if the donor has epidemiological risk factors for infection. Suspected cases should be reported to the organ procurement organization (OPO) and the OPTN for further investigation by public health authorities.
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Affiliation(s)
- Aditi Saha
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Charles Browning
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Raja Dandamudi
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Kevin Barton
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Kevin Graepel
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Madeline Cullity
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Wala Abusalah
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Du Christine
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Carla Rossi
- Department of Infectious Disease, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Naomi Drexler
- Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pallavi Annambhotia
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Albert J Eid
- Division of Infectious Diseases, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Maliakkal
- Division of Pediatric Nephrology, Saint Louis University, Missouri, USA
| | - Aaron Miller
- Division of Pediatric Infectious Disease, Saint Louis University, Missouri, USA
| | - Christopher Hugge
- Division of Pediatric Hematology Oncology, Saint Louis University, Missouri, USA
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Washington University of Medicine St. Louis, Missouri, USA
| | - Praveen Kandula
- Renal and Pancreas Transplant Division and Department of Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Michael J Moritz
- Department of Transplant Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Alvarez-Hernandez G, Drexler N, Paddock CD, Licona-Enriquez JD, la Mora JDD, Straily A, Del Carmen Candia-Plata M, Cruz-Loustaunau DI, Arteaga-Cardenas VA. Community-based prevention of epidemic Rocky Mountain spotted fever among minority populations in Sonora, Mexico, using a One Health approach. Trans R Soc Trop Med Hyg 2021; 114:293-300. [PMID: 31819997 DOI: 10.1093/trstmh/trz114] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 10/26/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rocky Mountain spotted fever (RMSF) is a significant public health problem in Sonora, Mexico, resulting in thousands of cases and hundreds of deaths. Outbreaks of RMSF are perpetuated by heavy brown dog tick infestations in and around homes. During 2009-2015, there were 61 RMSF cases and 23 deaths in a single community of Sonora (Community A). METHODS An integrated intervention was carried out from March-November 2016 aimed at reducing tick populations with long-acting acaricidal collars on dogs, environmental acaricides applied to peri-domestic areas and RMSF education. Tick levels were measured by inspection of community dogs to monitor efficacy of the intervention. A similar neighborhood (Community B) was selected for comparison and received standard care (acaricide treatment and education). RESULTS The prevalence of tick-infested dogs in Community A declined from 32.5% to 8.8% (p<0.01). No new cases of RMSF were identified in this area during the subsequent 18 mo. By comparison, the percentage of tick-infested dogs in Community B decreased from 19% to 13.4% (p=0.36) and two cases were reported, including one death. CONCLUSIONS Community-based interventions using an integrated approach to control brown dog ticks can diminish the morbidity and mortality attributable to RMSF.
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Affiliation(s)
- Gerardo Alvarez-Hernandez
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Naomi Drexler
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Christopher D Paddock
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Jesus D Licona-Enriquez
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Jesus Delgado-de la Mora
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Anne Straily
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia
| | - Maria Del Carmen Candia-Plata
- Department of Medicine and Health Sciences, University of Sonora, Blvd. Luis D. Colosio SN, col. Centro, C.P. 83000, Hermosillo, Mexico
| | - Denica I Cruz-Loustaunau
- Ministry of Public Health Sonora, General Directorate for Health Promotion and Disease Prevention, Paseo del Canal y Comonfort, Col. Centro, C.P. 83000, Hermosillo,Mexico
| | - Vanessa A Arteaga-Cardenas
- Ministry of Public Health Sonora, General Directorate for Health Promotion and Disease Prevention, Paseo del Canal y Comonfort, Col. Centro, C.P. 83000, Hermosillo,Mexico
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Drexler N, Nichols Heitman K, Cherry C. Description of Eschar-Associated Rickettsial Diseases Using Passive Surveillance Data - United States, 2010-2016. MMWR Morb Mortal Wkly Rep 2020; 68:1179-1182. [PMID: 31895916 PMCID: PMC6943966 DOI: 10.15585/mmwr.mm685152a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Naomi Drexler
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Kristen Nichols Heitman
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Cara Cherry
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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Straily A, Drexler N, Cruz-Loustaunau D, Paddock CD, Alvarez-Hernandez G. Notes from the Field: Community-Based Prevention of Rocky Mountain Spotted Fever - Sonora, Mexico, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1302-1303. [PMID: 27880753 DOI: 10.15585/mmwr.mm6546a6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Rocky Mountain spotted fever (RMSF), a life-threatening tickborne zoonosis caused by Rickettsia rickettsii, is a reemerging disease in Mexico (1,2). R. rickettsii is an intracellular bacterium that infects vascular endothelium and can cause multisystem organ failure and death in the absence of timely administration of a tetracycline-class antibiotic, typically doxycycline. Epidemic RMSF, as described in parts of Arizona and Mexico, is associated with massive local infestations of the brown dog tick (Rhiphicephalus sanguineus sensu lato) on domestic dogs and in peridomestic settings that result in high rates of human exposure; for example, during 2003-2012, in Arizona the incidence of RMSF in the three most highly affected communities was 150 times the U.S. national average (3,4). In 2015, the Mexico Ministry of Health (MOH) declared an epidemiologic emergency because of high and sustained rates of RMSF in several states in northern Mexico, including the state of Sonora. During 2004-2015, a total of 1,129 cases and 188 RMSF deaths were reported from Sonora (Sonora MOH, unpublished data, 2016). During 2009-2015, one impoverished community (community A) in Sonora reported 56 cases of RMSF involving children and adolescents, with a case-fatality rate of 40% (Sonora MOH, unpublished data, 2016). Poverty and lack of timely access to health services are risk factors for severe RMSF. Children are especially vulnerable to infection, because they might have increased contact with dogs and spend more time playing around spaces where ticks survive (5). In Sonora, case fatality rates for children aged <10 years can be as high as 30%, which is almost four times the aggregate case-fatality rate reported for the general population of the state (8%) (2), and 10-13 times higher than the case-fatality rate described for this age group in the United States (2.4%) (6).
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Drexler N, Miller M, Gerding J, Todd S, Adams L, Dahlgren FS, Bryant N, Weis E, Herrick K, Francies J, Komatsu K, Piontkowski S, Velascosoltero J, Shelhamer T, Hamilton B, Eribes C, Brock A, Sneezy P, Goseyun C, Bendle H, Hovet R, Williams V, Massung R, McQuiston JH. Community-based control of the brown dog tick in a region with high rates of Rocky Mountain spotted fever, 2012-2013. PLoS One 2014; 9:e112368. [PMID: 25479289 PMCID: PMC4257530 DOI: 10.1371/journal.pone.0112368] [Citation(s) in RCA: 40] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/30/2014] [Indexed: 11/26/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF) transmitted by the brown dog tick (Rhipicephalus sanguineus sensu lato) has emerged as a significant public health risk on American Indian reservations in eastern Arizona. During 2003–2012, more than 250 RMSF cases and 19 deaths were documented among Arizona's American Indian population. The high case fatality rate makes community-level interventions aimed at rapid and sustained reduction of ticks urgent. Beginning in 2012, a two year pilot integrated tick prevention campaign called the RMSF Rodeo was launched in a ∼600-home tribal community with high rates of RMSF. During year one, long-acting tick collars were placed on all dogs in the community, environmental acaricides were applied to yards monthly, and animal care practices such as spay and neuter and proper tethering procedures were encouraged. Tick levels, indicated by visible inspection of dogs, tick traps and homeowner reports were used to monitor tick presence and evaluate the efficacy of interventions throughout the project. By the end of year one, <1% of dogs in the RMSF Rodeo community had visible tick infestations five months after the project was started, compared to 64% of dogs in Non-Rodeo communities, and environmental tick levels were reduced below detectable levels. The second year of the project focused on use of the long-acting collar alone and achieved sustained tick control with fewer than 3% of dogs in the RMSF Rodeo community with visible tick infestations by the end of the second year. Homeowner reports of tick activity in the domestic and peridomestic setting showed similar decreases in tick activity compared to the non-project communities. Expansion of this successful project to other areas with Rhipicephalus-transmitted RMSF has the potential to reduce brown dog tick infestations and save human lives.
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Affiliation(s)
- Naomi Drexler
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
- * E-mail:
| | - Mark Miller
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, Georgia, United States of America
| | - Justin Gerding
- Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, Georgia, United States of America
| | - Suzanne Todd
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
| | - Laura Adams
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, United States of America
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - F. Scott Dahlgren
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Nelva Bryant
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Erica Weis
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
- Inter-Tribal Council of Arizona Inc., Tribal Epidemiology Center, Phoenix, Arizona, United States of America
| | - Kristen Herrick
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Jessica Francies
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Kenneth Komatsu
- Arizona Department of Health Services, Department of Public Health Services, Phoenix, Arizona, United States of America
| | - Stephen Piontkowski
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Jose Velascosoltero
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Timothy Shelhamer
- Indian Health Service, Office of Environmental Health and Engineering, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Brian Hamilton
- Indian Health Service, Infection Control Nurse, Phoenix Area Unit, Phoenix, Arizona, United States of America
| | - Carmen Eribes
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Anita Brock
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Patsy Sneezy
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Cye Goseyun
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Harty Bendle
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Regina Hovet
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Velda Williams
- Tribe B, Department of Health and Human Services, Arizona, United States of America
| | - Robert Massung
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
| | - Jennifer H. McQuiston
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, Georgia, United States of America
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Ziperstein J, Dorkenoo M, Datagni M, Drexler N, Murphy M, Sodahlon Y, Mathieu E. Final program evaluation methods and results of a National Lymphedema Management Program in Togo, West Africa. J Epidemiol Glob Health 2014; 4:125-33. [PMID: 24857180 PMCID: PMC7366372 DOI: 10.1016/j.jegh.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/30/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022] Open
Abstract
In order to eliminate Lymphatic Filariasis (LF) as a public health problem, the World Health Assembly recommends an approach which includes interruption of transmission of infection and the alleviation of morbidity. In 2000, the Togolese National Program to Eliminate Lymphatic Filariasis (PNELF) started the annual mass drug administrations and in 2007, the program added a morbidity component for the management of lymphedema. This manuscript describes the methods of an evaluation aimed at assessing the strengths and weaknesses of the Togolese National Lymphedema Morbidity Program. The evaluation was conducted through in-depth interviews with stakeholders at each programmatic level. Interviews focused on message dissemination, health provider training, patient self-care practices, social dynamics, and program impact. The evaluation demonstrated that the program strengths include the standardization and in-depth training of health staff, dissemination of the program's treatment message, a positive change in the community's perception of lymphedema, and successful patient recruitment and training in care techniques. The lessons learned from this evaluation helped to improve Togo's program, but may also provide guidance and strategies for other countries desiring to develop a morbidity program. The methods of program evaluation described in this paper can serve as a model for monitoring components of other decentralized national health programs in low resource settings.
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Woodhall DM, Mkwanda S, Dembele M, Lwanga H, Drexler N, Dubray C, Harris J, Worrell C, Mathieu E. Exploring innovative ways to conduct coverage surveys for neglected tropical diseases in Malawi, Mali, and Uganda. Acta Trop 2014; 132:119-24. [PMID: 24462795 DOI: 10.1016/j.actatropica.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 10/18/2013] [Accepted: 01/09/2014] [Indexed: 11/29/2022]
Abstract
Currently, a 30-cluster survey to monitor drug coverage after mass drug administration for neglected tropical diseases is the most common methodology used by control programs. We investigated alternative survey methodologies that could potentially provide an estimation of drug coverage. Three alternative survey methods (market, village chief, and religious leader) were conducted and compared to the 30-cluster method in Malawi, Mali, and Uganda. In Malawi, drug coverage for the 30-cluster, market, village chief, and religious leader methods were 66.8% (95% CI 60.3-73.4), 74.3%, 76.3%, and 77.8%, respectively. In Mali, results for round 1 were 62.6% (95% CI 54.4-70.7), 56.1%, 74.8%, and 83.2%, and 57.2% (95% CI 49.0-65.4), 54.5%, 72.2%, and 73.3%, respectively, for round 2. Uganda survey results were 65.7% (59.4-72.0), 43.7%, 67.2%, and 77.6% respectively. Further research is needed to test different coverage survey methodologies to determine which survey methods are the most scientifically rigorous and resource efficient.
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Affiliation(s)
- Dana M Woodhall
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States.
| | - Square Mkwanda
- Ministry of Health, P.O. Box 30377, Capital City, Lilongwe 3, Malawi.
| | | | - Harriet Lwanga
- RTI Uganda, P.O. Box 1661, Buganda Road, Kampala, Uganda.
| | - Naomi Drexler
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Christine Dubray
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Jennifer Harris
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Caitlin Worrell
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
| | - Els Mathieu
- Parasitic Diseases Branch Centers for Disease Control Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States
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Mathieu E, Dorkenoo AM, Datagni M, Cantey PT, Morgah K, Harvey K, Ziperstein J, Drexler N, Chapleau G, Sodahlon Y. It is possible: availability of lymphedema case management in each health facility in Togo. Program description, evaluation, and lessons learned. Am J Trop Med Hyg 2013; 89:16-22. [PMID: 23690550 PMCID: PMC3748474 DOI: 10.4269/ajtmh.12-0453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/03/2013] [Indexed: 11/07/2022] Open
Abstract
Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each health facility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities.
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Affiliation(s)
- Els Mathieu
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Drexler N, Washington CH, Lovegrove M, Grady C, Milord MD, Streit T, Lammie P. Secondary mapping of lymphatic filariasis in Haiti-definition of transmission foci in low-prevalence settings. PLoS Negl Trop Dis 2012; 6:e1807. [PMID: 23071849 PMCID: PMC3469481 DOI: 10.1371/journal.pntd.0001807] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 07/19/2012] [Indexed: 11/24/2022] Open
Abstract
To eliminate Lymphatic filariasis (LF) as a public health problem, the World Health Organization (WHO) recommends that any area with infection prevalence greater than or equal to 1% (denoted by presence of microfilaremia or antigenemia) should receive mass drug administration (MDA) of antifilarial drugs for at least five consecutive rounds. Areas of low-antigen prevalence (< 1%) are thought to pose little risk for continued transmission of LF. Five low-antigen prevalence communes in Haiti, characterized as part of a national survey, were further assessed for transmission in this study. An initial evaluation of schoolchildren was performed in each commune to identify antigen-positive children who served as index cases for subsequent community surveys conducted among households neighboring the index cases. Global positioning system (GPS) coordinates and immunochromatographic tests (ICT) for filarial antigenemia were collected on approximately 1,600 persons of all ages in the five communes. The relationship between antigen-positive cases in the community and distance from index cases was evaluated using multivariate regression techniques and analyses of spatial clustering. Community surveys demonstrated higher antigen prevalence in three of the five communes than was observed in the original mapping survey; autochthonous cases were found in the same three communes. Regression techniques identified a significantly increased likelihood of being antigen-positive when living within 20 meters of index cases when controlling for age, gender, and commune. Spatial clustering of antigen-positive cases was observed in some, but not all communes. Our results suggest that localized transmission was present even in low-prevalence settings and suggest that better surveillance methods may be needed to detect microfoci of LF transmission.
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Affiliation(s)
- Naomi Drexler
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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