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Treatment and prevention of epilepsy in onchocerciasis-endemic areas is urgently needed. 盘尾丝虫病流行地区迫切需要治疗和预防癫痫。
IF 8.1 1区 医学 Pub Date : 2024-01-12 DOI: 10.1186/s40249-024-01174-8
Robert Colebunders, Joseph Nelson Siewe Fodjo, Olivia Kamoen, Luís-Jorge Amaral, Amber Hadermann, Chiara Trevisan, Mark J Taylor, Julia Gauglitz, Achim Hoerauf, Yasuaki Sato, Katja Polman, María-Gloria Basáñez, Dan Bhwana, Thomson Lakwo, Gasim Abd-Elfarag, Sébastien D Pion

Background: There is increasing epidemiological evidence supporting the association between onchocerciasis and seizures, reinforcing the concept of onchocerciasis-associated epilepsy (OAE). The aim of this paper is to provide an update on the new knowledge about OAE and to propose recommendations to the World Health Organization how to address this public health problem.

Main text: During the 2nd International Workshop on OAE held on 19-21 September, 2023, in Antwerp, Belgium, participants recognised OAE as a substantial yet neglected public health problem, particularly in areas of sub-Saharan Africa where onchocerciasis remains hyperendemic. Evidence from prospective population-based studies suggest that strengthening onchocerciasis elimination efforts leads to a significant reduction of OAE incidence. There is a need to validate an OAE case definition to estimate the burden of disease and identify onchocerciasis-endemic areas requiring intensification of onchocerciasis elimination programmes and integration of epilepsy care. It is expected that raising awareness about OAE will boost the population uptake of ivermectin. The implementation of a community-based epilepsy treatment programme offering free anti-seizure medications (ASMs) has shown high effectiveness in reducing the frequency of seizures and improving the overall quality of life of people with epilepsy.

Conclusions: To reduce OAE burden, enhanced collaboration between onchocerciasis and mental health programmes at community, national, and international levels is required. Urgent efforts are needed to ensure the uninterrupted provision of free ASMs in onchocerciasis-endemic areas. Furthermore, OAE should be included in the quantification of the onchocerciasis disease burden.

背景:越来越多的流行病学证据支持盘尾丝虫病与癫痫发作之间的关联,从而强化了盘尾丝虫病相关癫痫(OAE)的概念。本文旨在提供有关 OAE 的最新知识,并就如何解决这一公共卫生问题向世界卫生组织提出建议:在 2023 年 9 月 19-21 日于比利时安特卫普举行的第二届 OAE 国际研讨会上,与会者认识到 OAE 是一个严重但被忽视的公共卫生问题,尤其是在盘尾丝虫病仍然高发的撒哈拉以南非洲地区。来自前瞻性人群研究的证据表明,加强消除盘尾丝虫病的工作可显著降低 OAE 发病率。有必要验证 OAE 病例定义,以估算疾病负担,并确定需要加强消除盘尾丝虫病计划和整合癫痫护理的盘尾丝虫病流行地区。预计提高人们对 OAE 的认识将促进伊维菌素的普及。实施社区癫痫治疗计划,免费提供抗癫痫药物(ASMs),在减少癫痫发作频率和改善癫痫患者整体生活质量方面显示出很高的有效性:为减轻 OAE 负担,需要在社区、国家和国际层面加强盘尾丝虫病和精神健康计划之间的合作。需要做出紧急努力,确保在盘尾丝虫病流行地区不间断地提供免费的 ASM。此外,应将 OAE 纳入盘尾丝虫病疾病负担的量化中。
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引用次数: 0
Using intersectional gender analysis to identify challenges in tuberculosis care at four health care facilities in Uganda. 利用性别交叉分析,确定乌干达四家医疗机构在结核病护理方面面临的挑战。
IF 8.1 1区 医学 Pub Date : 2024-01-05 DOI: 10.1186/s40249-023-01171-3
Winters Muttamba, Samson Omongot, Irene Najjingo, Roseline Nuwarinda, Esther Buregyeya, Mariam Otmani Del Barrio, Rosemary Morgan, Bruce Kirenga, Sarah Ssali

Background: Tuberculosis (TB) care could be considered as a continuum from symptom recognition, decision to seek care, diagnosis, treatment initiation and treatment completion, with care along the continuum influenced by several factors. Gender dimensions could influence TB care, and indeed, more men than women are diagnosed with TB each year. The study was done to identify social stratifiers that intersect with gender to influence TB care.

Methods: A cross-sectional qualitative study was done at four health facilities in 3 districts in central Uganda between October 2020 and December 2020. Data was collected from patients seeking a diagnosis or on TB treatment through focus group discussions and key informant interviews. Key themes around gender guided by a gender and intersectionality lens were developed and thereafter thematic content analysis was done.

Results: Women have increased vulnerability to TB due to bio mass exposure through roles like cooking. Women have increased access to health care services as they interface with the health care system frequently given their role as child bearers and child care givers. Men have a duty to provide for their families and this most often is prioritised over healthcare seeking, and together with belief that they are powerful beings leads to poor healthcare seeking habits and delays in healthcare seeking. Decisions on when and where to seek care were not straightforward for women, who most often rely on their husbands/partners to make decisions.

Conclusions: Men and women experience challenges to TB care, and that these challenges are deeply rooted in roles assigned to them and further compounded by masculinity. These challenges need to be addressed through intersectional gender responsive interventions if TB control is to be improved.

背景:结核病(TB)治疗可被视为从症状识别、决定就医、诊断、开始治疗到完成治疗的一个连续过程,而这一连续过程中的治疗受多种因素的影响。性别因素可能会影响结核病护理,事实上,每年被诊断为结核病的男性多于女性。本研究旨在确定与性别交叉影响结核病护理的社会分层因素:2020 年 10 月至 2020 年 12 月期间,在乌干达中部 3 个地区的 4 家医疗机构开展了一项横断面定性研究。通过焦点小组讨论和关键信息提供者访谈,从寻求诊断或接受结核病治疗的患者那里收集数据。在性别和交叉性视角的指导下,围绕性别制定了关键主题,随后进行了主题内容分析:结果:由于从事烹饪等工作而接触大量生物,妇女更容易感染结核病。妇女作为孩子的养育者和照顾孩子的人,经常与医疗保健系统打交道,因此她们获得医疗保健服务的机会更多。男性有责任养家糊口,这往往比寻求医疗保健服务更重要,再加上他们认为自己是强大的生命,导致了不良的就医习惯和就医延误。对于妇女来说,何时何地就医并不是一个简单的决定,她们通常要依靠丈夫/伴侣来做决定:结论:男性和女性在结核病护理方面都面临挑战,这些挑战深深植根于赋予他们的角色,并因男性气质而进一步加剧。如果要改善结核病控制,就需要通过跨部门的促进性别平等干预措施来应对这些挑战。
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引用次数: 0
A potential transition from a concentrated to a generalized HIV epidemic: the case of Madagascar. 从艾滋病毒集中流行到普遍流行的潜在转变:马达加斯加的情况。
IF 8.1 1区 医学 Pub Date : 2023-12-07 DOI: 10.1186/s40249-023-01164-2
David Alonso, Xavier Vallès

Background: HIV expansion is controlled by a range of interrelated factors, including the natural history of HIV infection and socio-economical and structural factors. However, how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood. We aim to explore these mechanisms, using Madagascar as a case-study.

Methods: We developed a compartmental dynamic model using available data from Madagascar, a country with a contrasting concentrated epidemic, to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.

Results: The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022, and prevalence reaching stabilization by 2033 within 9 to 24% in the studied (10 out of 11) cities, similar to high-prevalence regions in Southern Africa. The late/slow introduction of HIV and  circumcision, a widespread traditional practice in Madagascar, could have slowed down HIV propagation, but, given the key interplay between risky behaviors associated to young women and acute infections prevalence, mediated by transactional sex, the protective effect of circumcision is currently insufficient to contain the expansion of the disease in Madagascar.

Conclusions: These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic. This case-study model could help to understand how this HIV epidemic transition occurs.

背景:艾滋病毒的扩展受一系列相互关联的因素控制,包括艾滋病毒感染的自然历史和社会经济和结构因素。然而,它们如何在特定情况下动态相互作用,以推动从弱势群体集中的艾滋病毒流行向普遍流行的转变,人们知之甚少。我们的目标是探索这些机制,以马达加斯加为例进行研究。方法:我们利用来自马达加斯加的可用数据开发了一个分区动态模型,马达加斯加是一个对比集中的流行病国家,以探索这些因素之间的相互作用,特别考虑商业和交易性行为作为艾滋病毒感染的驱动因素。结果:该模型预测,在2020-2022年期间出现拐点的s型流行曲线,到2033年,在所研究的(11个城市中的10个)城市中,流行率将在9%至24%之间达到稳定,与南部非洲的高流行地区类似。艾滋病毒和包皮环切术(马达加斯加广泛的传统做法)的引入较晚或较慢,本可以减缓艾滋病毒的传播,但是,鉴于与年轻妇女有关的危险行为与由交易性行为介导的急性感染流行之间的关键相互作用,包皮环切术的保护作用目前不足以遏制该疾病在马达加斯加的蔓延。结论:这些结果表明,马达加斯加可能正在经历从艾滋病毒集中流行到普遍流行的无声过渡。这种个案研究模式可以帮助理解这种艾滋病毒流行的转变是如何发生的。
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引用次数: 0
Evaluating active leprosy case identification methods in six districts of Nepal. 评估尼泊尔六个县的主动麻风病例识别方法。
IF 8.1 1区 医学 Pub Date : 2023-12-06 DOI: 10.1186/s40249-023-01153-5
Ram Kumar Mahato, Uttam Ghimire, Madhav Lamsal, Bijay Bajracharya, Mukesh Poudel, Prashnna Napit, Krishna Lama, Gokarna Dahal, David T S Hayman, Ajit Kumar Karna, Basu Dev Pandey, Chuman Lal Das, Krishna Prasad Paudel

Background: Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment.

Methods: Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated.

Results: New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ2 = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ2 = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81).

Conclusions: The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.

背景:自2009年以来,尼泊尔已实现并持续消除麻风病这一公共卫生问题,但仍有17个县和3个省(占尼泊尔人口的41%,即10,907,128人)尚未消除麻风病。小儿病例和二级残疾(G2D)分别表明麻风病最近才传播和诊断较晚,因此有必要积极、及早发现病例。这项业务研究旨在确定最适合早期病例检测的方法,确定基于社区的麻风病流行病学,及早发现隐性麻风病例并及时治疗:在尼泊尔麻风病负担最重的两个省--马德什省(全国病例占40%)和蓝毗尼省(全国病例占18%)以及马德什省、蓝毗尼省和巴格马蒂省的高危监狱人群中进行了积极的病例检测。病例检测通过以下方式进行:(1) 对易感人群进行逐户访问(n = 26,469);(2) 在马德什省和蓝毗尼省对接触者进行检查和追踪(n = 7608);(3) 在尼泊尔马德什省、蓝毗尼省和巴格马蒂省对监狱人群进行筛查(n = 4428)。计算了每种方法的每例直接医疗和非医疗成本:每 10 万名接受筛查的人口中,接触者追踪的新病例发现率最高(250 例),其次是入户访问(102 例)和监狱筛查(45 例)。然而,逐户访问发现每个病例的成本最低[每例 76 500 尼泊尔卢比],其次是接触追踪(每例 90 286 尼泊尔卢比)和监狱筛查(每例 298 300 尼泊尔卢比)。挨家挨户筛查和接触追踪筛查的病例比例分别为59:41和68:32;女性/男性比例分别为63:37和57:43;两种方法的儿科病例比例均为11%;二级残疾(G2D)比例分别为11%和5%。家庭接触者和邻居接触者患麻风病的几率没有明显差异[几率比(OR)=1.4,95%置信区间(CI):0.24-5.85],MB 病例接触者和 PB 病例接触者患麻风病的几率也没有明显差异(OR = 0.7,95% CI 0.26-2.0)。MB 病例(0.32%,95% CI 0.07-0.94%)和 PB 病例(0.13%,95% CI 0.03-0.73)的家庭接触者的发病率无明显差异(χ2 = 0.07,df = 1,P = 0.9)以及 MB 病例(0.23%,0.1-0.46)和 PB 病例(0.48%,0.19-0.98)的邻居接触者(χ2 = 0.8,df = 1,P = 0.7)。接种卡介苗并伴有疤痕对麻风病有显著的保护作用(OR = 0.42,0.22-0.81):结论:最有效的病例识别方法是接触追踪,其次是在易感人群中进行入户访问和在监狱中进行筛查,尽管入户访问成本更低。研究结果表明,社区中存在隐性病例、近期传播和晚期诊断,并强调了早期病例检测的重要性。
{"title":"Evaluating active leprosy case identification methods in six districts of Nepal.","authors":"Ram Kumar Mahato, Uttam Ghimire, Madhav Lamsal, Bijay Bajracharya, Mukesh Poudel, Prashnna Napit, Krishna Lama, Gokarna Dahal, David T S Hayman, Ajit Kumar Karna, Basu Dev Pandey, Chuman Lal Das, Krishna Prasad Paudel","doi":"10.1186/s40249-023-01153-5","DOIUrl":"10.1186/s40249-023-01153-5","url":null,"abstract":"<p><strong>Background: </strong>Nepal has achieved and sustained the elimination of leprosy as a public health problem since 2009, but 17 districts and 3 provinces with 41% (10,907,128) of Nepal's population have yet to eliminate the disease. Pediatric cases and grade-2 disabilities (G2D) indicate recent transmission and late diagnosis, respectively, which necessitate active and early case detection. This operational research was performed to identify approaches best suited for early case detection, determine community-based leprosy epidemiology, and identify hidden leprosy cases early and respond with prompt treatment.</p><p><strong>Methods: </strong>Active case detection was undertaken in two Nepali provinces with the greatest burden of leprosy, Madhesh Province (40% national cases) and Lumbini Province (18%) and at-risk prison populations in Madhesh, Lumbini and Bagmati provinces. Case detection was performed by (1) house-to-house visits among vulnerable populations (n = 26,469); (2) contact examination and tracing (n = 7608); in Madhesh and Lumbini Provinces and, (3) screening prison populations (n = 4428) in Madhesh, Lumbini and Bagmati Provinces of Nepal. Per case direct medical and non-medical costs for each approach were calculated.</p><p><strong>Results: </strong>New case detection rates were highest for contact tracing (250), followed by house-to-house visits (102) and prison screening (45) per 100,000 population screened. However, the cost per case identified was cheapest for house-to-house visits [Nepalese rupee (NPR) 76,500/case], followed by contact tracing (NPR 90,286/case) and prison screening (NPR 298,300/case). House-to-house and contact tracing case paucibacillary/multibacillary (PB:MB) ratios were 59:41 and 68:32; female/male ratios 63:37 and 57:43; pediatric cases 11% in both approaches; and grade-2 disabilities (G2D) 11% and 5%, respectively. Developing leprosy was not significantly different among household and neighbor contacts [odds ratios (OR) = 1.4, 95% confidence interval (CI): 0.24-5.85] and for contacts of MB versus PB cases (OR = 0.7, 95% CI 0.26-2.0). Attack rates were not significantly different among household contacts of MB cases (0.32%, 95% CI 0.07-0.94%) and PB cases (0.13%, 95% CI 0.03-0.73) (χ<sup>2</sup> = 0.07, df = 1, P = 0.9) and neighbor contacts of MB cases (0.23%, 0.1-0.46) and PB cases (0.48%, 0.19-0.98) (χ<sup>2</sup> = 0.8, df = 1, P = 0.7). BCG vaccination with scar presence had a significant protective effect against leprosy (OR = 0.42, 0.22-0.81).</p><p><strong>Conclusions: </strong>The most effective case identification approach here is contact tracing, followed by house-to-house visits in vulnerable populations and screening in prisons, although house-to-house visits are cheaper. The findings suggest that hidden cases, recent transmission, and late diagnosis in the community exist and highlight the importance of early case detection.</p>","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":"12 1","pages":"111"},"PeriodicalIF":8.1,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138488741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Five years of post-validation surveillance of lymphatic filariasis in Thailand. 泰国淋巴丝虫病五年验证后监测。
IF 8.1 1区 医学 Pub Date : 2023-12-06 DOI: 10.1186/s40249-023-01158-0
Prapapan Meetham, Rawadee Kumlert, Deyer Gopinath, Siriporn Yongchaitrakul, Tanaporn Tootong, Sunsanee Rojanapanus, Chantana Padungtod

Background: The World Health Organization (WHO) validated Thailand in 2017 as having eliminated lymphatic filariasis (LF) as a public health problem with recommendations for continued surveillance. This article describes measures and progress made in Thailand with post-validation surveillance (PVS) of LF from 2018 until 2022.

Methods: The implementation unit (IU) is a sub-village in 11 former LF endemic provinces. Human blood surveys are targeted in 10% of IUs each year. In Wuchereria bancrofti areas, filaria antigen test strips (FTS) are used, and in Brugia malayi areas, antibody test kits (Filaria DIAG RAPID) are used. Positive cases are confirmed by thick blood film (TBF) and polymerase chain reaction (PCR). Vector surveys for mosquito species identification and dissection for microfilaria (Mf)/filarial larvae are done in 1% of IUs where human blood surveys are conducted. Human blood surveys using FTS are conducted among migrants in five provinces. Surveillance of cats is done in areas that previously recorded > 1.0% Mf rate among cats. Morbidity management and disability prevention (MMDP) are done every 2 years in LF-endemic areas where chronic disease patients reside.

Results: From 2018 to 2022, in a total of 357 IUs in 11 provinces, human blood surveys were conducted in 145 IUs (41%) with an average population coverage of 81%. A total of 22,468 FTS and 27,741 FilariaDIAG RAPID were performed. 27 cases were detected: 3 cases of W. bancrofti in Kanchanaburi province and 24 cases of B. malayi in Narathiwat province. 4 cases of W. bancrofti were detected in two provinces through routine public health surveillance. Vector surveys in 47 IUs detected B. malayi Mf filarial larvae only in Narathiwat province. Chronic LF patients reduced from 114 in 2017 to 76 in 2022. Surveys among 7633 unregistered migrants yielded 12 cases of W. bancrofti. Mf rate among cats in Narathiwat province declined from 1.9% in 2018 to 0.7% in 2022. MMDP assessments revealed gaps in healthcare provider's management of chronic cases due to staff turnover.

Conclusions: In 2022, after 5 years of PVS, Thailand re-surveyed 41% of its previously endemic IUs and demonstrated ongoing transmission in only one province of Narathiwat, where Mf prevalence is below the WHO provisional transmission threshold of 1%. This study highlights the importance of continued disease surveillance measures and vigilance among health care providers in LF receptive areas.

背景:世界卫生组织(WHO)于2017年确认泰国已消除淋巴丝虫病(LF)这一公共卫生问题,并建议继续开展监测。本文介绍了泰国从2018年至2022年对LF进行验证后监测(PVS)的措施和进展:方法:实施单位(IU)是 11 个前 LF 流行省份的分村。每年在 10%的 IU 中开展人类血液调查。在盘尾丝虫病地区使用丝虫抗原试纸(FTS),在马来丝虫地区使用抗体检测试剂盒(Filaria DIAG RAPID)。阳性病例通过厚血片(TBF)和聚合酶链反应(PCR)确认。在进行人类血液调查的 1%的 IU 进行病媒调查,以确定蚊子种类并解剖微丝蚴/丝虫幼虫。在五个省份的移民中使用 FTS 进行人类血液调查。在以前记录到猫的 Mf 感染率大于 1.0% 的地区对猫进行监测。在慢性病患者居住的 LF 流行地区,每两年开展一次发病率管理和残疾预防(MMDP):从 2018 年到 2022 年,在 11 个省共 357 个 IU 中,对 145 个 IU(41%)进行了人类血液调查,平均人口覆盖率为 81%。共进行了 22,468 次 FTS 和 27,741 次 FilariaDIAG RAPID。共发现 27 个病例:尖竹汶府(Kanchanaburi)发现 3 例班克罗夫蒂丝虫病例,那拉提瓦府(Narathiwat)发现 24 例马拉毅丝虫病例。通过常规公共卫生监测,两个府发现了 4 例班克罗夫蒂虫病例。47 个国际单位的病媒调查仅在那拉提瓦府发现了马来丝虫幼虫。慢性丝虫病患者从 2017 年的 114 人减少到 2022 年的 76 人。对 7633 名未登记注册的移民进行的调查发现了 12 例班氏丝虫病例。那拉提瓦府的猫感染率从2018年的1.9%降至2022年的0.7%。MMDP评估显示,由于人员流动,医疗服务提供者在管理慢性病例方面存在差距:2022 年,在 PVS 持续 5 年之后,泰国重新调查了 41% 以前流行的 IU,仅在 Narathiwat 一省发现了持续传播,该省的 Mf 感染率低于世界卫生组织暂定传播阈值 1%。这项研究强调了继续采取疾病监测措施和提高低浓集疫区医疗服务提供者警惕性的重要性。
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引用次数: 0
13-Valent pneumococcal conjugate vaccines vaccination innovative strategy in Weifang City, China: a case study. 潍坊市13价肺炎球菌结合疫苗接种创新策略:个案研究
IF 8.1 1区 医学 Pub Date : 2023-12-01 DOI: 10.1186/s40249-023-01165-1
Jiachen Wang, Yujue Wang, Ruoyu Xu, Ting Zhang, Yanyan Jiang, Yuanyuan Wang, Yi Wang, Yuanze Du, Wenxue Sun, Kai Deng, Weizhong Yang, Zengwu Wang, Luzhao Feng, Chunping Wang

The World Health Organization (WHO) prioritizes pneumococcal disease as a vaccine-preventable disease and recommends the inclusion of pneumococcal conjugate vaccines (PCV) in national immunization programs worldwide. However, PCV is not included in the National Immunization Program in China and has low vaccination coverage due to its high cost. To address this, Weifang City implemented an innovative strategy for a 13-valent PCV (PCV13) on June 1, 2021. This strategy aimed to provide one dose of PCV13 free of charge for children aged 6 months to 2 years in registered households and to adopt a commercial insurance model with one dose of PCV13 free of charge in 2023 for children over 2 years old. The Health Commission of Weifang and other departments conducted a comprehensive investigation and considered various factors, such as vaccine effectiveness, safety, accessibility, vaccine price, and immunization schedules, for eligible children (under 5 years old). Stakeholder opinions were also solicited before implementing the policy. The Commission negotiated with various vaccine manufacturers to maximize its negotiating power and reduce vaccine prices. The implementation plan was introduced under the Healthy Weifang Strategy. Following the implementation of this strategy, the full course of vaccination coverage increased significantly from 0.67 to 6.59%. However, vaccination coverage is still lower than that in developed countries. Weifang's PCV13 vaccination innovative strategy is the first of its kind in Chinese mainland and is an active pilot of non-immunization program vaccination strategies. To further promote PCV13 vaccination, Weifang City should continue to implement this strategy and explore appropriate financing channels. Regions with higher levels of economic development can innovate the implementation of vaccine programs, broaden financing channels, improve accessibility to vaccination services, and advocate for more localities to incorporate PCV13 into locally expanded immunization programs or people-benefiting projects. A monitoring and evaluation system should also be established to evaluate implementation effects.

世界卫生组织(WHO)将肺炎球菌病列为一种疫苗可预防的疾病,并建议将肺炎球菌结合疫苗(PCV)纳入全世界的国家免疫规划。然而,PCV在中国并未被纳入国家免疫规划,并且由于其成本较高,疫苗接种覆盖率较低。为解决这一问题,潍坊市于2021年6月1日实施了13价PCV13的创新策略。该战略旨在为登记家庭的6个月至2岁儿童免费提供一剂PCV13疫苗,并在2023年采用商业保险模式,为2岁以上儿童免费提供一剂PCV13疫苗。潍坊市卫生健康委员会等部门对符合条件的儿童(5岁以下)进行了全面调查,考虑了疫苗有效性、安全性、可及性、疫苗价格、免疫时间表等各方面因素。在实施政策之前,也征求了利益相关者的意见。委员会与各疫苗制造商进行谈判,以最大限度地提高其谈判能力并降低疫苗价格。《实施计划》是在健康潍坊战略框架下出台的。在实施这一战略之后,整个过程的疫苗接种覆盖率从0.67%显著增加到6.59%。然而,疫苗接种覆盖率仍低于发达国家。潍坊市的PCV13疫苗接种创新战略是中国大陆首个创新战略,是非免疫规划疫苗接种战略的积极试点。为了进一步推广PCV13疫苗接种,潍坊市应继续实施这一战略,并探索适当的融资渠道。经济发展水平较高的地区可创新疫苗规划实施,拓宽融资渠道,改善疫苗接种服务可及性,并倡导更多地方将PCV13纳入地方扩大免疫规划或惠民项目。建立监测评价体系,对实施效果进行评价。
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引用次数: 0
Introduction of invasive mosquito species into Europe and prospects for arbovirus transmission and vector control in an era of globalization. 蚊种入侵欧洲及虫媒病毒传播和病媒控制在全球化时代的前景。
IF 8.1 1区 医学 Pub Date : 2023-11-30 DOI: 10.1186/s40249-023-01167-z
Renke Lühken, Norbert Brattig, Norbert Becker

Background: Mosquito research in Europe has a long history, primarily focused on malaria vectors. In recent years, invasive mosquito species like the Asian tiger mosquito (Aedes albopictus) and the spread of arboviruses like dengue virus, chikungunya virus or bluetongue virus have led to an intensification of research and monitoring in Europe. The risk of further dissemination of exotic species and mosquito-borne pathogens is expected to increase with ongoing globalization, human mobility, transport geography, and climate warming. Researchers have conducted various studies to understand the ecology, biology, and effective control strategies of mosquitoes and associated pathogens.

Main body: Three invasive mosquito species are established in Europe: Asian tiger mosquito (Aedes albopictus), Japanese bush mosquito (Ae. japonicus), and Korean bush mosquito (Aedes koreicus). Ae. albopictus is the most invasive species and has been established in Europe since 1990. Over the past two decades, there has been an increasing number of outbreaks of infections by mosquito-borne viruses in particular chikungunya virus, dengue virus or Zika virus in Europe primary driven by Ae. albopictus. At the same time, climate change with rising temperatures results in increasing threat of invasive mosquito-borne viruses, in particular Usutu virus and West Nile virus transmitted by native Culex mosquito species. Effective mosquito control programs require a high level of community participation, going along with comprehensive information campaigns, to ensure source reduction and successful control. Control strategies for container breeding mosquitoes like Ae. albopictus or Culex species involve community participation, door-to-door control activities in private areas. Further measures can involve integration of sterile insect techniques, applying indigenous copepods, Wolbachia sp. bacteria, or genetically modified mosquitoes, which is very unlike to be practiced as standard method in the near future.

Conclusions: Climate change and globalization resulting in the increased establishment of invasive mosquitoes in particular of the Asian tiger mosquito Ae. albopictus in Europe within the last 30 years and increasing outbreaks of infections by mosquito-borne viruses warrants intensification of research and monitoring. Further, effective future mosquito control programs require increase in intense community and private participation, applying physical, chemical, biological, and genetical control activities.

背景:欧洲的蚊子研究历史悠久,主要集中在疟疾媒介上。近年来,亚洲虎蚊(白纹伊蚊)等入侵蚊子物种以及登革热病毒、基孔肯雅病毒或蓝舌病病毒等虫媒病毒的传播导致欧洲加强了研究和监测。随着全球化、人类流动、交通地理和气候变暖,外来物种和蚊媒病原体进一步传播的风险预计会增加。研究人员进行了各种研究,以了解蚊子和相关病原体的生态学、生物学和有效控制策略。正文:欧洲已确定三种入侵蚊种:亚洲虎蚊(白纹伊蚊)、日本丛蚊(伊蚊)。韩国丛蚊(伊蚊)。Ae。白纹伊蚊是最具侵入性的物种,自1990年以来已在欧洲建立。在过去二十年中,越来越多的蚊媒病毒感染爆发,特别是基孔肯雅病毒、登革热病毒或寨卡病毒,主要由伊蚊驱动。蚊。与此同时,气候变化导致气温上升,导致入侵性蚊媒病毒的威胁增加,特别是由本地库蚊传播的乌苏图病毒和西尼罗河病毒。有效的蚊虫控制规划需要社区的高度参与,并配合全面的信息宣传活动,以确保减少源头和成功控制。容器孳生伊蚊的控制策略。白纹伊蚊或库蚊种类涉及社区参与,在私人区域进行挨家挨户的控制活动。进一步的措施可以包括整合昆虫不育技术,应用本地桡足类动物、沃尔巴克氏菌或转基因蚊子,这在不久的将来很难作为标准方法实施。结论:气候变化和全球化导致入侵蚊种增加,尤其是亚洲虎蚊。白纹伊蚊在过去30年在欧洲的流行,以及越来越多的蚊媒病毒感染暴发,值得加强研究和监测。此外,未来有效的蚊虫控制计划需要加强社区和私人的积极参与,运用物理、化学、生物和基因控制活动。
{"title":"Introduction of invasive mosquito species into Europe and prospects for arbovirus transmission and vector control in an era of globalization.","authors":"Renke Lühken, Norbert Brattig, Norbert Becker","doi":"10.1186/s40249-023-01167-z","DOIUrl":"10.1186/s40249-023-01167-z","url":null,"abstract":"<p><strong>Background: </strong>Mosquito research in Europe has a long history, primarily focused on malaria vectors. In recent years, invasive mosquito species like the Asian tiger mosquito (Aedes albopictus) and the spread of arboviruses like dengue virus, chikungunya virus or bluetongue virus have led to an intensification of research and monitoring in Europe. The risk of further dissemination of exotic species and mosquito-borne pathogens is expected to increase with ongoing globalization, human mobility, transport geography, and climate warming. Researchers have conducted various studies to understand the ecology, biology, and effective control strategies of mosquitoes and associated pathogens.</p><p><strong>Main body: </strong>Three invasive mosquito species are established in Europe: Asian tiger mosquito (Aedes albopictus), Japanese bush mosquito (Ae. japonicus), and Korean bush mosquito (Aedes koreicus). Ae. albopictus is the most invasive species and has been established in Europe since 1990. Over the past two decades, there has been an increasing number of outbreaks of infections by mosquito-borne viruses in particular chikungunya virus, dengue virus or Zika virus in Europe primary driven by Ae. albopictus. At the same time, climate change with rising temperatures results in increasing threat of invasive mosquito-borne viruses, in particular Usutu virus and West Nile virus transmitted by native Culex mosquito species. Effective mosquito control programs require a high level of community participation, going along with comprehensive information campaigns, to ensure source reduction and successful control. Control strategies for container breeding mosquitoes like Ae. albopictus or Culex species involve community participation, door-to-door control activities in private areas. Further measures can involve integration of sterile insect techniques, applying indigenous copepods, Wolbachia sp. bacteria, or genetically modified mosquitoes, which is very unlike to be practiced as standard method in the near future.</p><p><strong>Conclusions: </strong>Climate change and globalization resulting in the increased establishment of invasive mosquitoes in particular of the Asian tiger mosquito Ae. albopictus in Europe within the last 30 years and increasing outbreaks of infections by mosquito-borne viruses warrants intensification of research and monitoring. Further, effective future mosquito control programs require increase in intense community and private participation, applying physical, chemical, biological, and genetical control activities.</p>","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":"12 1","pages":"109"},"PeriodicalIF":8.1,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Influence of urbanization on schistosomiasis infection risk in Anhui Province based on sixteen year's longitudinal surveillance data: a spatio-temporal modelling study. 城市化对安徽省血吸虫病感染风险的影响——基于16年纵向监测数据的时空模型研究
IF 8.1 1区 医学 Pub Date : 2023-11-29 DOI: 10.1186/s40249-023-01163-3
Xin Liu, Yang Sun, Yun Yin, Xiaofeng Dai, Robert Bergquist, Fenghua Gao, Rui Liu, Jie Liu, Fuju Wang, Xiao Lv, Zhijie Zhang

Background: Urbanization greatly affects the natural and social environment of human existence and may have a multifactoral impact on parasitic diseases. Schistosomiasis, a common parasitic disease transmitted by the snail Oncomelania hupensis, is mainly found in areas with population aggregations along rivers and lakes where snails live. Previous studies have suggested that factors related to urbanization may influence the infection risk of schistosomiasis, but this association remains unclear. This study aimed to analyse the effect of urbanization on schistosomiasis infection risk from a spatial and temporal perspective in the endemic areas along the Yangtze River Basin in China.

Methods: County-level schistosomiasis surveillance data and natural environmental factor data covering the whole Anhui Province were collected. The urbanization level was characterized based on night-time light data from the Defense Meteorological Satellite Program Operational Linescan System (DMSP-OLS) and the National Polar-Orbiting Partnership's Visible Infrared Imaging Radiometer Suite (NPP-VIIRS). The geographically and temporally weighted regression model (GTWR) was used to quantify the influence of urbanization on schistosomiasis infection risk with the other potential risk factors controlled. The regression coefficient of urbanization was tested for significance (α = 0.05), and the influence of urbanization on schistosomiasis infection risk was analysed over time and across space based on significant regression coefficients. Variables studied included climate, soil, vegetation, hydrology and topography.

Results: The mean regression coefficient for urbanization (0.167) is second only to the leached soil area (0.300), which shows that the urbanization is the most important influence factors for schistosomiasis infection risk besides leached soil area. The other important variables are distance to the nearest water source (0.165), mean minimum temperature (0.130), broadleaf forest area (0.105), amount of precipitation (0.073), surface temperature (0.066), soil bulk density (0.037) and grassland area (0.031). The influence of urbanization on schistosomiasis infection risk showed a decreasing trend year by year. During the study period, the significant coefficient of urbanization level increased from - 0.205 to - 0.131.

Conclusions: The influence of urbanization on schistosomiasis infection has spatio-temporal heterogeneous. The urbanization does reduce the risk of schistosomiasis infection to some extend, but the strength of this influence decreases with increasing urbanization. Additionally, the effect of urbanization on schistosomiasis infection risk was greater than previous reported natural environmental factors. This study provides scientific basis for understanding the influence of urbanization on schistosomiasis, and also provides the feasible research methods for other

背景:城市化极大地影响了人类生存的自然和社会环境,并可能对寄生虫病产生多因素影响。血吸虫病是一种由钉螺传播的常见寄生虫病,主要发生在钉螺聚居的河流和湖泊沿岸地区。以往的研究表明,城市化相关因素可能影响血吸虫病的感染风险,但这种关联尚不清楚。本研究旨在从时空角度分析长江流域血吸虫病流行区城市化对血吸虫病感染风险的影响。方法:收集安徽省县级血吸虫病监测资料和自然环境因子资料。城市化水平的特征是基于来自国防气象卫星计划操作线性扫描系统(DMSP-OLS)和国家极轨道伙伴关系的可见红外成像辐射计套件(NPP-VIIRS)的夜间灯光数据。采用地理和时间加权回归模型(GTWR)量化城市化对血吸虫病感染风险的影响,同时控制其他潜在危险因素。对城市化回归系数进行显著性检验(α = 0.05),并基于显著回归系数分析城市化对血吸虫病感染风险的时间和空间影响。研究的变量包括气候、土壤、植被、水文和地形。结果:城市化的平均回归系数(0.167)仅次于淋滤土面积(0.300),表明城市化是除淋滤土面积外最重要的血吸虫感染风险影响因素。其他重要变量为离最近水源的距离(0.165)、平均最低气温(0.130)、阔叶林面积(0.105)、降水量(0.073)、地表温度(0.066)、土壤容重(0.037)和草地面积(0.031)。城市化对血吸虫病感染风险的影响呈逐年下降趋势。研究期间,城市化水平显著系数由- 0.205上升至- 0.131。结论:城市化对血吸虫病感染的影响具有时空异质性。城市化确实在一定程度上降低了血吸虫病感染的风险,但这种影响的强度随着城市化的增加而减弱。此外,城市化对血吸虫病感染风险的影响大于以往报道的自然环境因素。本研究为了解城市化对血吸虫病的影响提供了科学依据,也为其他类似研究回答城市化对疾病风险的影响问题提供了可行的研究方法。
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引用次数: 0
Accelerating Pneumococcal Conjugate Vaccine introductions in Indonesia: key learnings from 2017 to 2022. 加速在印度尼西亚推广肺炎球菌结合疫苗:2017年至2022年的主要经验教训。
IF 8.1 1区 医学 Pub Date : 2023-11-28 DOI: 10.1186/s40249-023-01161-5
Anithasree Athiyaman, Putri Herliana, Atiek Anartati, Niken Widyastuti, Prima Yosephine, Gertrudis Tandy, Sherli Karolina

Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enable the introduction in country in the early 2010s. Starting in 2017, Clinton Health Access Initiative and partners supported the government of Indonesia with evidence-based decision-making and implementation support for introducing PCV into the routine immunization program. Indonesia has since accelerated PCV roll out, with nationwide reach achieved in 2022. On the path to PCV introduction, several challenges were observed that impacted decision making on whether and on how to optimally roll out PCV, resulting in significant introduction delays; including (1) a complex country context with a devolved government structure, fragmented domestic funding streams, and an imminent transition out of major immunization donor (Gavi) support; (2) strong preference to use domestically sourced products, with limited experience accessing global pooled procurement mechanism including for vaccines; and (3) concerns around programmatic feasibility and sustainability. This case study documents key insights into the challenges experienced and how those were systematically addressed to accelerate new vaccine introduction in Indonesia, with support from local and global stakeholders over time. The learnings would be beneficial for other countries yet to introduce critical new vaccines, in particular those with similar archetype as Indonesia e.g., middle-income countries with domestic manufacturing capacity and/or countries recently transitioning out of Gavi support.

尽管印度尼西亚的肺炎球菌疾病和经济负担很高,并且有兴趣引入肺炎球菌结合疫苗(PCV),但在2010年代初制定一项全面战略以加速并使其能够在该国引入方面存在挑战。从2017年开始,克林顿健康获取倡议及其合作伙伴为印度尼西亚政府提供基于证据的决策和实施支持,以将PCV纳入常规免疫规划。此后,印度尼西亚加快了PCV的推广,并于2022年实现了全国推广。在引入PCV的过程中,我们观察到一些挑战,这些挑战影响了是否以及如何最佳地推出PCV的决策,导致引入的严重延迟;包括(1)复杂的国家环境,政府结构下放,国内资金流分散,以及即将从主要免疫捐助方(全球免疫联盟)的支持过渡;(2)强烈倾向于使用国内采购的产品,在获取包括疫苗在内的全球集中采购机制方面经验有限;(3)对方案可行性和可持续性的关注。本案例研究记录了对所经历的挑战以及如何在当地和全球利益攸关方的长期支持下系统地应对这些挑战以加速印度尼西亚新疫苗引进的关键见解。这些经验教训将有利于其他尚未引进关键新疫苗的国家,特别是那些与印度尼西亚具有类似原型的国家,例如具有国内生产能力的中等收入国家和/或最近从全球疫苗免疫联盟的支持中过渡出来的国家。
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引用次数: 0
Chromosome-scale genome of the human blood fluke Schistosoma mekongi and its implications for public health. 人血吸虫血吸虫染色体尺度基因组及其对公共卫生的意义。
IF 8.1 1区 医学 Pub Date : 2023-11-28 DOI: 10.1186/s40249-023-01160-6
Minyu Zhou, Lian Xu, Dahua Xu, Wen Chen, Jehangir Khan, Yue Hu, Hui Huang, Hang Wei, Yiqing Zhang, Phiraphol Chusongsang, Kanthi Tanasarnprasert, Xiang Hu, Yanin Limpanont, Zhiyue Lv

Background: Schistosoma mekongi is a human blood fluke causing schistosomiasis that threatens approximately 1.5 million humans in the world. Nonetheless, the limited available S. mekongi genomic resources have hindered understanding of its biology and parasite-host interactions for disease management and pathogen control. The aim of our study was to integrate multiple technologies to construct a high-quality chromosome-level assembly of the S. mekongi genome.

Methods: The reference genome for S. mekongi was generated through integrating Illumina, PacBio sequencing, 10 × Genomics linked-read sequencing, and high-throughput chromosome conformation capture (Hi-C) methods. In this study, we conducted de novo assembly, alignment, and gene prediction to assemble and annotate the genome. Comparative genomics allowed us to compare genomes across different species, shedding light on conserved regions and evolutionary relationships. Additionally, our transcriptomic analysis focused on genes associated with parasite-snail interactions in S. mekongi infection. We employed gene ontology (GO) enrichment analysis for functional annotation of these genes.

Results: In the present study, the S. mekongi genome was both assembled into 8 pseudochromosomes with a length of 404 Mb, with contig N50 and scaffold N50 lengths of 1168 kb and 46,759 kb, respectively. We detected that 43% of the genome consists of repeat sequences and predicted 9103 protein-coding genes. We also focused on proteases, particularly leishmanolysin-like metalloproteases (M8), which are crucial in the invasion of hosts by 12 flatworm species. Through phylogenetic analysis, it was discovered that the M8 gene exhibits lineage-specific amplification among the genus Schistosoma. Lineage-specific expansion of M8 was observed in blood flukes. Additionally, the results of the RNA-seq revealed that a mass of genes related to metabolic and biosynthetic processes were up-regulated, which might be beneficial for cercaria production.

Conclusions: This study delivers a high-quality, chromosome-scale reference genome of S. mekongi, enhancing our understanding of the divergence and evolution of Schistosoma. The molecular research conducted here also plays a pivotal role in drug discovery and vaccine development. Furthermore, our work greatly advances the understanding of host-parasite interactions, providing crucial insights for schistosomiasis intervention strategies.

背景:米孔血吸虫是一种引起血吸虫病的人血吸虫,威胁着全世界约150万人。然而,有限的湄孔假丝酵母菌基因组资源阻碍了对其生物学和寄生虫-宿主相互作用的理解,不利于疾病管理和病原体控制。本研究的目的是整合多种技术,构建高质量的湄孔蝇基因组染色体水平组装。方法:整合Illumina、PacBio测序、10 × Genomics linked-read测序和高通量染色体构象捕获(high-throughput chromosome构象捕获,Hi-C)等方法,构建mekongi参比基因组。在这项研究中,我们进行了从头组装、比对和基因预测来组装和注释基因组。比较基因组学使我们能够比较不同物种的基因组,揭示保守区域和进化关系。此外,我们的转录组学分析侧重于与血吸虫感染中寄生虫-蜗牛相互作用相关的基因。我们使用基因本体(GO)富集分析对这些基因进行功能注释。结果:在本研究中,湄孔线虫基因组均组装成8条假染色体,长度为404 Mb,其中contig N50和scaffold N50长度分别为1168 kb和46,759 kb。我们检测到43%的基因组由重复序列组成,并预测了9103个蛋白质编码基因。我们还关注了蛋白酶,特别是利什曼溶素样金属蛋白酶(M8),它在12种扁虫入侵宿主中起着至关重要的作用。通过系统发育分析,发现M8基因在血吸虫属中表现出谱系特异性扩增。在血吸虫中观察到M8的谱系特异性扩增。此外,RNA-seq结果显示,大量与代谢和生物合成过程相关的基因被上调,这可能有利于尾蚴的产生。结论:本研究提供了一个高质量的、染色体尺度的湄孔血吸虫参考基因组,增强了我们对血吸虫分化和进化的认识。在这里进行的分子研究在药物发现和疫苗开发中也起着关键作用。此外,我们的工作极大地促进了对宿主-寄生虫相互作用的理解,为血吸虫病的干预策略提供了重要的见解。
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Infectious Diseases of Poverty
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