Tropical Medicine and Infectious Disease最新文献

Seasonal malaria chemoprevention (SMC) is a strategy recommended by the World Health Organization for children aged 3-59 months in the Sahel and sub-Sahel regions where malaria transmission is seasonal. In Côte d'Ivoire, malaria remains a high priority and accounts for the majority of consultations and deaths in children under five. The recent revision of the criteria for the introduction of seasonal malaria chemoprevention has made the north of Côte d'Ivoire, where malaria transmission is seasonal, eligible for the SMC. We conducted a pilot study in this part of the country to assess the acceptability and feasibility of five cycles of SMC in 1701 children. Seasonal malaria chemoprevention with sulfadoxine-pyrimethamine + amodiaquine (SP + AQ) was administered monthly to eligible children over five months. A qualitative approach and quantitative surveys were used to assess the strategy acceptability and feasibility in the study area. Overall, there was a positive perception, attitude, and adherence towards the seasonal malaria chemoprevention in this study area.

Background: Onchocerciasis, or river blindness, is one of the neglected tropical diseases (NTDs) that the WHO has set out to eliminate. To reach this elimination target, a number of challenges must be met, and the essential measures set out in the road map for NTDs 2021-2030 must be implemented. More than 99% of infected people live in 31 countries in sub-Saharan Africa. Our objective was to assess the impact of onchocerciasis interventions in Africa.

Methodology: A systematic peer review of the existing literature following the PRISMA guidelines was performed between November 2021 and April 2022. We selected studies on onchocerciasis control measures in Africa since the implementation of the first Onchocerciasis Control Programme (OCP) measures in 1974. All scientific articles indexed in the PubMed, Scopus, Embase, and CENTRAL databases written in Spanish, English, French, German, and Portuguese were considered. The study protocol was registered in the PROSPERO database.

Results: A total of 63 articles met the inclusion criteria and were finally selected. Publications were found from 19 out of 31 African endemic countries. The main intervention retained in the different published studies was mass distribution of ivermectin (n = 51). According to our results, 11 African countries have managed to interrupt transmission of onchocerciasis in at least one area in the country; 11 countries have not achieved this goal, while 1 country has managed to eliminate the disease, but it has resurged.

Conclusions: Control interventions showed a positive impact on the fight against onchocerciasis, demonstrating that these activities are effective. Nevertheless, they were not sufficient to achieve the proposed goals for a variety of reasons. Therefore, different aspects should be considered in order to fulfil the targets proposed by the WHO to be reached in 2030.

The urbanization process has led to significant changes in the landscape, shifting the epidemiological profile of the visceral leishmaniasis (VL) in Brazil. Dogs are considered the main urban reservoir of VL, whose infections precede cases in humans. In order to understand the socio-environmental determinants associated with canine visceral leishmaniasis (CVL), we conducted a spatial analysis of CVL cases in northeastern Brazil from 2013 to 2015, georeferencing 3288 domiciled dogs. We used linear mixed models to understand the ecoepidemiological determinants of CVL spatial relative risk (CVL SRR). Our findings indicate heterogeneity in CVL distribution, with 1 km diameter clusters potentially connected within an estimated 4.9 km diameter by the Ripley-K statistic. In our best-fit model, the CVL SRR was positively correlated with the proportion of households with literate heads, with trees, and with open sewage, but negatively correlated with vegetation phenology and mean income of the census sector. Here, we discuss the potential maintenance source of urban CVL clusters on a One Health framework. These findings highlight the complex interplay of socioeconomic and environmental factors in shaping the spatial distribution of CVL.

Background: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China.

Methods: A spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran's I and Getis-Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA).

Results: In total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001-1.035).

Conclusions: This study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success.

Indoor residual spraying (IRS) and the use of insecticide-treated bednets for malaria vector control have contributed substantially to a reduction in malaria disease burden. However, these control tools have important shortcomings including being donor-dependent, expensive, and often failing because of insufficient uptake. We assessed the safety and efficacy of a user-friendly, locally tailored malaria vector control approach dubbed "Hut Decoration for Malaria Control" (HD4MC) based on the incorporation of a WHO-approved insecticide, Actellic^® 300 CS, into a customary hut decoration practice in rural Uganda where millions of the most vulnerable and malaria-prone populations live in mud-walled huts. Three hundred sixty households were randomly assigned to either the HD4MC (120 households), IRS (120 households) or control group without any wall treatment (120 households). Entomological indices were assessed using pyrethrum spray catching, CDC light traps and human landing catches. The Actellic^® 300 CS toxicity on acetylcholinesterase activity among applicators of HD4MC was evaluated using the Test-mate (Model 400) erythrocyte acetylcholinesterase (AChE) test V.2, whereas toxicity in household occupants was monitored clinically. The Actellic^® 300 CS level in house dust was analyzed using reversed-phase high-performance liquid chromatography (RP-HPLC). Entomological indices were compared between the three study arms at 1.5, 3 and 6 months post-intervention. HD4MC- and IRS-treated huts had a significantly reduced malaria vector density and feeding rate compared to control huts. There was no significant reduction in acetylcholinesterase activity at 1.5 and 24 h post exposure. Actellic^® 300 CS exposure did not result in any serious adverse events among the household occupants. In conclusion, HD4MC was safe and had comparable efficacy to canonical IRS.

Mass gatherings are associated with the spread of communicable diseases. Some studies have suggested that acquisition of antimicrobial resistance (AMR) may be associated with attendance at specific mass gatherings. This systematic review aimed to synthesise evidence on the association between attendance at mass gatherings and antimicrobial resistance (AMR) and assess the prevalence of AMR at mass gatherings. A literature search of the Cochrane, Medline, Scopus, and Embase databases was performed. Studies were included if they reported original data, involved mass gatherings, and reported AMR results. Of 5559 titles screened, 44 studies met the inclusion criteria, most of which (n = 40) involved religious mass gatherings. The heterogeneity of the studies precluded a meta-analysis, hence a narrative synthesis by organism was conducted. A significant increase in antibiotic-resistant Escherichia coli and Klebsiella pneumoniae was reported following Hajj, as was a rise in gastrointestinal carriage of extended-spectrum β-lactamase (ESBL) or carbapenemase genes. Carriage of Streptococcus pneumoniae isolates non-susceptible to one or more antibiotics was also shown to increase from pre-Hajj to post-Hajj. There appears to be an association between attendance at mass gatherings and the acquisition of some AMR phenotypes and genotypes in some significant human pathogens, including E. coli and S. pneumoniae.

Echinococcosis is one of the most serious and life-threatening parasitic zoonoses worldwide caused by the larvae of the Echinococcus genus [...].

(1) Background: Globally, an estimated 1.7 million adolescents (aged 10-19 years) were living with HIV in 2023, with 82% residing in sub-Saharan Africa. For ALHIV, transitioning to adult care involves assuming responsibility for their own health and disease management, posing significant challenges to persistent engagement in care. There is a paucity in health policies guiding this transition in many sub-Saharan African countries. Overburdened and poorly functioning health systems struggle to provide optimal care for ALHIV amidst the rising HIV pandemic in this priority population. (2) Methods: This study employed a mixed-methods design, comprising a descriptive qualitative study with healthcare workers and managers and a cross-sectional survey to examine the practices and pathways in which the transition to adult HIV care occurs in the Cape Town Metropole, South Africa. (3) Results: We delineate three distinct ways in which transition occurs (transfer-only, adolescent-friendly, and supportive transition). A successful transition involves a sufficient level of self-management of their chronic condition and healthcare journey, which is preceded by adequate preparation pre-transition, and the monitoring of engagement post-transition. This ideally requires developing relevant health policies and implementing guidelines signaling political will and providing the impetus and agency of implementation at the service level in South Africa.

Introduction: Cryptococcal meningitis is a major cause of death in HIV/AIDS patients due to the existence of Cryptococcus neoformans in the central nervous system. Our objective was to evaluate the prevalence of Cryptococcus antigenuria in a population of HIV-infected patients in Libreville, Gabon. Patients and Methods: This study was conducted from April to October 2021 at the Infectious Diseases ward of the Centre Hospitalier Universitaire de Libreville. Hospitalized patients with HIV were included. The detection of cryptococcal antigen (CrAg) in urine was performed using the Pastorex Crypto Plus Kit. Results: Out of the 255 PLHIV, 142 benefited from the CrAg detection. The prevalence of urine CrAg was 24.6% (n = 35). The majority of CrAg+ patients (82.8%; n = 29) were under 55 years old. Almost three-quarters of them (n = 25; 71.4%) had CD4 counts < 200, and 80.0% (n = 28) were at WHO clinical stages III and IV. All patients with neck stiffness at admission had a CrAg positive test. Conclusion: This study showed a non-negligible prevalence of Cryptococcal urinary antigen in HIV-infected patients with neurological symptoms. These data underline the importance of CrAg screening in routine care for better management of PLHIV.

The elimination of lymphatic filariasis (LF) as a public health problem remains an ongoing challenge in the Pacific region. This study reports on antigen (Ag) and microfilaria (Mf) prevalence in Samoa in 2019, 7-9 months after the completion of the first round of triple-drug mass drug administration (MDA). It evaluates the effectiveness of the intervention for reducing Ag prevalence to below a 2% threshold, and how this differs between 5-9-year-olds and ≥10-year-olds. We surveyed 30 randomly selected and five purposefully selected primary sampling units (PSUs) in Samoa in 2018 (1-3 months post-triple-drug MDA) and, again, in 2019. In each PSU, we conducted a community survey of 15-20 households and a convenience survey of 5-9-year-old children. A finger-prick blood sample was collected from all participants to test for Ag and Mf. Demographic details were also collected. There was no significant change in adjusted Ag prevalence in the 30 randomly selected PSUs between 2018 (3.9% [95% CI: 2.7-5.6%]) and 2019 (4.1% [95% CI 2.7-5.9%]). Significantly higher Ag prevalence was observed in participants aged ≥10 years (4.6%, 95% CIs 3.0-6.7%) compared to 5-9-year-olds (1.1%, 95% CIs 0.5-2.2%), supporting existing evidence that post-MDA surveillance should not be based on Ag prevalence among 6-7-year-olds. A single round of triple-drug MDA was insufficient to break LF transmission in Samoa 7-9 months post-MDA.