American Journal of Tropical Medicine and Hygiene最新文献

Laboratory benchmarking allows objective analysis of the analytical performance of malaria rapid diagnostic tests (RDTs). We present the analytical detection limits of the Rapigen BIOCREDIT Malaria Ag Pf/Pv (pLDH/pLDH), the Rapigen BIOCREDIT Malaria Ag Pf (pLDH/HRPII), and two best-in-class WHO-prequalified comparator RDTs, generated using standardized panels containing recombinant antigen, in vitro cultured parasites, international standards, and clinical samples. Detection limit antigen concentrations of HRP2, PfLDH, and PvLDH were determined for the Rapigen and comparator RDTs. Detection of antigens in international units (IU)/mL was also evaluated. The Rapigen Ag Pf (pLDH/HRPII) detected 3.9 and 3.9 IU/mL for PfLDH and HRP2, respectively, and the Ag Pf/Pv (pLDH/pLDH) detected 3.9 and 5.0 IU/mL for PfLDH and PvLDH, respectively. The comparator HRP2/PfLDH and HRP2/PvLDH detected 15.6 and 31.3 IU/mL for HRP2 and PfLDH and 15.6 and 50.0 IU/mL for HRP2 and PvLDH, respectively. The RDT clinical sensitivity was predicted through application of analytical detection limits to antigen concentration distributions from clinical symptomatic and asymptomatic cases. Febrile cases would be detected in a majority by both standard and Rapigen RDTs, but incremental increases in sensitivity in the Rapigen RDTs may be important for clinical cases currently missed by microscopy. Rapigen RDTs were predicted to have improved detection of asymptomatic cases and infections with parasites carrying hrp2 deletions through more sensitive PfLDH detection. Through the benchmarking and simulation of clinical sensitivity, a method for rapidly assessing the ability of new RDTs to meet clinical needs using high-sensitivity antigen distribution data is presented.

The objective of this study was to evaluate the knowledge level and perception of dengue fever management among Peruvian physicians and to determine the factors associated with higher knowledge. We conducted an analytical cross-sectional study based on an online survey. To evaluate the factors associated with a high level of knowledge (≥70% of correct answers), we used crude (cPR) and adjusted (aPR) prevalence ratios by the Poisson regression model. Of 359 respondents (median age: 33 years; male: 56.5%), 78.8% achieved a high level of knowledge. Multivariable analysis showed an independent association with having read the Peruvian clinical practice guidelines for dengue management (aPR: 1.29; 95% CI: 1.12-1.49), having experience in treating patients (aPR: 1.32; 95% CI: 1.03-1.68), and having treated cases frequently (aPR: 1.22; 95% CI: 1.02-1.46). Residing in the eastern macroregion (aPR: 0.83; 95% CI: 0.71-0.97) was associated with a low level of knowledge. In conclusion, Peruvian physicians had a high level of knowledge about dengue fever. This was associated with having clinical experience in dengue management. However, given the low level of knowledge in the eastern macroregion, educational campaigns are necessary in this area.

Vaccine hesitancy has played a major role in slowing the global COVID-19 response. Using cross-sectional, primarily qualitative data collected in four rural districts in Zambia, we aimed to explore community perceptions of COVID-19 disease and vaccines, including perceived motivators, cues to action, benefits, and barriers to vaccine uptake as guided by the Health Belief Model. In-depth interviews (IDIs) were conducted in late 2021 with women of reproductive age who were enrolled in an early childhood development study. Although two-thirds of the 106 respondents reported low perceived risk of catching COVID-19, they expressed concern that the COVID-19 pandemic had impacted their daily lives and feared effects of the disease. They had generally positive beliefs that the vaccine would be accepted among their communities when it became more widely available. Reported motivators to vaccine uptake included desire for protection against COVID-19 and understanding vaccine purpose, due to ongoing education from health personnel, neighbors, friends, radio, and church leaders. Misinformation or reported bad experiences served as cues away from vaccine uptake. Examples of misinformation included the vaccine causing COVID-19 or another disease and death and vaccines being associated with the devil and against Christian beliefs. Accounts of pain after receiving the vaccine also discouraged uptake. Perceived benefits included a desire to be protected from the disease, belief in the effectiveness of the vaccine, fear of catching COVID-19, and belief the vaccine would limit negative effects. Health system implementers and policy makers should consider recipient motivators and cues to action to further increase vaccination rates.

Lymphedema, hydrocele, and acute adenolymphangitis (ADL) are chronically disabling consequences in patients with lymphatic filariasis (LF). Provision of morbidity management and disability prevention and concurrent mass drug administration of anthelmintics are two pillars for elimination of LF. This study assessed the impact of strict hygiene protocols with or without doxycycline on the progression of filarial lymphedema. A randomized, placebo-controlled, double-blind trial was conducted in two regions in Tanzania. We enrolled 362 participants with lymphedema stages 1-3 assigned into three treatment groups of doxycycline 200 mg once daily, doxycycline 100 mg once daily, or matching placebo for 42 days in addition to hygiene measures. The participants were followed every 2 months for 2 years. Twenty-four months after treatment onset, 17.7% of participants displayed improved limb conditions, including 15/104 (14.4%) in the doxycycline 200 mg group, 16/105 (15.2%) in the doxycycline 100 mg group, and 25/107 (23.4%) in the placebo group. During the first 6 months after treatment, the number of participants experiencing an ADL attack was significantly lower in the doxycycline groups than in the placebo group. The study also found that hygiene was one of the factors associated with preventing the occurrence of acute attacks over the whole study period. Doxycycline 100 mg was a significant factor for the halt of progression (odds ratio: 0.53, P = 0.0239) when both legs if affected at baseline were considered. These findings emphasize the importance of practicing hygiene in reducing the occurrence of ADL attacks and the benefits of doxycycline with regards to acute attacks and halt of progression.

The largest outbreak of human leishmaniasis in Europe took place in Fuenlabrada, Spain, between 2009 and 2017. The University Hospital "12 de Octubre" in Madrid serves the population residing in three districts of Madrid located just north of the outbreak area (Villaverde, Usera, and Carabanchel). Villaverde and Usera are connected by rail to the outbreak area, unlike Carabanchel. We performed a retrospective study including all cases of leishmaniasis diagnosed between 2011 and 2020. Fifty-one cases were documented. In the districts connected by rail to the outbreak area, a higher-than-expected incidence was observed (13.45-15.55 versus 5.2 per 100,000 inhabitants). Apart from the linear distance from the place of residence to the railway tracks, no differences in terms of demographics or risk factors were detected between the populations of the districts. We hypothesize that the direct connection with the outbreak area by rail could explain the higher incidence observed in Villaverde and Usera.

Gold mining communities in the Amazon region typically have limited access to public health services. In Suriname, the Ministry of Health Malaria Program (MoH-MP) works with community health workers (CHWs), people from mining communities without a formal medical degree, to provide malaria diagnostic and treatment services. During the COVID-19 pandemic, the MoH-MP trained 21 of these CHWs in COVID-19 outreach and testing, using rapid antigen tests for symptomatic persons in their communities; afterward, a mixed methods research approach was used to investigate whether including COVID-19 services in the tasks of the CHWs was feasible and accepted among gold mining populations. Also, CHWs took part in active case detection missions to proactively offer COVID-19 testing to all inhabitants of specific mining areas, regardless of symptoms. In the 6 months of field implementation (May-October 2022), 1,300 persons were tested for COVID-19, among whom 28.7% were women. Eight percent tested positive. Of the 312 asymptomatic persons tested, 2.2% tested positive. Qualitative semi-structured interviews with the CHWs and quantitative pre- and postintervention surveys revealed that the communities appreciated the nearby and free COVID-19 testing opportunity. The intervention motivated individuals who otherwise would not have been tested to test for COVID-19. Twenty-nine percent of those who had tested at least once for COVID-19 reported that their most recent test was conducted through the services of the CHWs. The results suggest that integrating COVID-19 testing into other CHW services can lower health access barriers in difficult-to-reach populations in remote communities.

Gastroenteritis is the frequent clinical manifestation of infection by Campylobacter spp., whereas invasive infections such as bacteremia are less commonly reported. We report 12 cases of Campylobacter bacteremia from a tertiary-care hospital in India and describe their relatively unique characteristics compared with the previously published reports. These cases were detected after the introduction of new blood culture media. The most common symptoms were fever (eight cases, 67%), abdominal pain (six cases, 50%), and vomiting (four cases, 33%), whereas only two cases (17%) had diarrhea. Chronic liver disease was the common underlying condition affecting eight patients (75%). The median Child-Pugh and Model for End-Stage Liver Disease scores were 9 (interquartile range: 7-9.5) and 20 (interquartile range: 15-23) respectively. Campylobacter jejuni was isolated in six patients (50%), two of whom had preceding diarrhea and one patient who had culture evidence of C. jejuni in ascitic fluid. The in-hospital mortality was 8%, but this was due to subsequent Escherichia coli sepsis.

Substantial gains have been achieved in the control of visceral leishmaniasis (VL) in the four endemic states of India; however, cases are sporadically reported from other nonendemic regions of India such as the sub-Himalayan region, which can be a hurdle to VL elimination. We analyzed VL reports published from the sub-Himalayan regions of India over seven decades (1967-2023) in this systematic review. Medline, Embase, Scopus, and Web of Science were searched for VL cases from sub-Himalayan regions of India. The demographic data, clinical presentation, diagnostic modality, treatment, outcomes of the cases, and overall year-wise and geographical distribution of the cases were analyzed; studies on the sand fly vector were also included. From 535 articles, 33 studies were included in the analysis. Overall, 228 patients were diagnosed with VL in the sub-Himalayan region of India from 1967 to 2023. These cases were reported from Uttarakhand (n = 178), Himachal Pradesh (n = 39), and Jammu and Kashmir (n = 11). Most patients (88.4%) did not have a history of travel outside their native places. Three pediatric cases were reported from Jammu and Kashmir. The DNA of Leishmania donovani was detected in four of the 52 (7.7%) sand flies collected from Himachal Pradesh. The published literature points toward the existence of local transmission of VL in the sub-Himalayan region of India, strongly substantiated by the emergence of pediatric VL in some places. Thus, these difficult-to-reach hilly states of India will require focused surveillance for VL to successfully achieve elimination goals.