American Journal of Tropical Medicine and Hygiene最新文献

In the early coronavirus disease 2019 pandemic, limited understanding of severe acute respiratory syndrome coronavirus 2 transmission and fears of infection hindered mass dog vaccination efforts in dog rabies-affected areas. Interruption of dog rabies vaccination campaigns could lead to a rapid increase in the risk of human rabies. To address these challenges, we applied human-centered design (HCD) principles to develop a vaccination strategy that prioritizes safety while ensuring dog rabies vaccination continuity in Arequipa, Peru, a rabies-affected area. We describe the process of rapid prototyping and testing undertaken by our research team to adapt the vaccination process in response to a health crisis. A multidisciplinary team met twice a week to prototype a fixed-point vaccination campaign that ensured distancing and reduction of fomite transmission while allowing for the continuation of dog vaccination. Field notes and videos informed successive meetings. The final prototype was used in rabies hotspots. In 4 weeks, six prototypes of safe booths and supporting safety protocols were designed, and two copies of each prototype were field tested. During testing, additional innovations were identified and implemented, including virtual vaccine certificates and online data collection forms. The final prototype was implemented across 251 sites, and 17,876 dogs were vaccinated. Using HCD principles, we swiftly developed a mass vaccination strategy that provided safety and enabled the maintenance of rabies vaccination programs. This work highlights the importance of innovative and adaptive approaches to address public health challenges in times of crisis.

Mass testing with antigen-detecting rapid diagnostic tests (Ag-RDT), including testing of asymptomatic individuals, is expected to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections. Mass testing was offered at large gatherings to determine the SARS-CoV-2 case detection rate and the acceptance and cost of implementing this community testing strategy. In 49 high-attendance venues in Kiambu County, Kenya, from June to September 2022, individuals 2 years and older were offered coronavirus disease 2019 (COVID-19) testing, vaccination, and participation in a survey. Polymerase chain reaction (PCR) testing and genome sequencing were conducted for those testing positive by Ag-RDT and those testing negative but with COVID-19 symptoms. Costs were collected from financial records, budgets, and invoices and estimated from a health systems perspective using a micro-costing method. A total of 4,062 individuals were offered testing. The testing acceptance was 3,174/4,062 (78.1%). The case detection rate was 34/3,174 (1.07%; 95% CI: 0.7-1.4%), and 11/34 (32%) of the positives were asymptomatic. The PCR results were available for 27 Ag-RDT‒positive participants and 14 Ag-RDT‒negative participants with SARS-CoV-2 symptoms and were positive in 24/27 (88.9%) and 4/14 (28.6%), respectively. Circulating variants were identified in 11 participants. Community mobilization was the major cost driver (26%) followed by purchase of SARS-CoV-2 Ag-RDTs (20.5%). The cost per individual tested was USD $15.89, and the cost per individual tested positive for SARS-CoV-2 was USD $1,484. The study demonstrates that SARS-CoV-2 Ag-RDTs could be used for identification of SARS-CoV-2 infections in both symptomatic and asymptomatic individuals at mass gatherings.

The rapid diagnosis of coronavirus disease 2019 (COVID-19) is critical for comprehensive public health response strategies, and self-testing with antigen rapid diagnostic tests (Ag-RDTs) presents opportunities to test in hard-to-reach communities. Therefore, we evaluated the acceptability, feasibility, and uptake of Ag-RDT self-testing at the community level in Tanzania. From June to October 2022, symptomatic individuals or those with recent contact with a known or suspected COVID-19 patient were offered assisted testing and self-testing within mining communities and at transport hubs. This study included a cross-sectional survey before and after implementation. Participants were assessed for their acceptability and uptake of the nasal Ag-RDT self-test and their preference for nasal Ag-RDT self-testing. The survey data were collected in Open Data Kit, whereas the Ag-RDT results in the community were recorded by using the COVISUSPECT Mobile Application. Data analysis was performed by using STATA and R Statistical Software. A total of 538 individuals were screened, and 454 (84.4%) consented to be tested. The preference for self-testing was relatively low (33%), and the majority of participants (67%) opted to be assisted by a healthcare professional. Of the participants who opted for testing, 149 (32.8%) were able to self-test. Generally, there was no major difference in the various assessed parameters between the baseline and end-line surveys. The results from fitting multiple logistic regression indicated that after controlling for age, participants living in Dodoma were significantly less likely to opt for self-testing (odds ratio = 0.54; P-value = 0.023) compared with those living in Dar es Salaam. There was no significant difference in self-testing between participants living in Mara and those living in Dar es Salaam (odds ratio = 0.7; P-value = 0.179). After controlling for region, older (≥40 years) participants were significantly less likely to self-test compared with participants aged 18 to <40 years (odds ratio = 0.47; P-value = 0.002). The intervention was well-accepted in all areas in which Ag-RDTs were deployed. Our findings can therefore support the Ministry of Health by increasing accessibility to severe acute respiratory syndrome coronavirus 2 testing in the hard-to-reach communities in response to the next COVID-19 wave.

Since 2015, the Zambia National Malaria Elimination Centre has conducted routine data quality audits in Central, Southern, and Western provinces, but trends in data reporting accuracy have not been examined. Routine data quality audit data collected at health facilities reporting into the monthly health management information system (HMIS) and weekly malaria rapid reporting system (MRRS) were used to measure data reporting accuracy trends from 2015 to 2022 and potential influencing factors using three data elements: outpatient department attendance and rapid diagnostic test (RDT)-tested cases for HMIS and MRRS, total confirmed cases for HMIS only, and RDT-positive cases for MRRS only. Reporting accuracies for HMIS and MRRS data elements and the percentage of facilities reporting with high accuracy (≥85%) improved over this period. Low-accuracy (<70%) health facilities were uncommon, accounting for less than 15% of facilities for HMIS and MRRS. With each successive DQA visit, the proportion of facilities with high accuracy increased from visits 1 to 8: 23% to 56% (HMIS) and 42% to 85% (MRRS). No correlation was observed between facility size or incidence and overall accuracy for HMIS and MRRS. Starting in 2017, about 40-50% of health facilities appeared to be overreporting incidence in comparison with their register-based incidence. The risk stratification determined by register-based and reported incidences matched in more than 70% of facilities. Routine data quality audits conducted between 2015 and 2022 in Central, Southern, and Western provinces showed an improvement in malaria data reporting accuracy.

Acute undifferentiated febrile illnesses (AUFIs) are short-duration infectious diseases with nonspecific symptoms. In Thailand, common AUFIs include dengue, malaria, leptospirosis, scrub typhus, and typhoid fever. This study aimed to determine the case numbers of AUFI etiologies in Thailand before coronavirus disease 2019 (COVID-19) (phase 1 from January 2018 to February 2020) and during the COVID-19 pandemic with preventive measures (phase 2 from March 2020 to April 2022), and the loosening of the preventive measures (phase 3 from May 2022 to December 2022). We used Thailand's national database from 2018 to 2022 to determine the case numbers of AUFIs and geographic heat maps to identify endemic areas in Thailand. The case numbers of malaria, dengue, leptospirosis, typhoid, and scrub typhus significantly decreased during phase 2 (preventive measures) (P = 0.02), and cases of malaria and leptospirosis increased during phase 3 (loosened preventive measures) (P = 0.01). In 2022, malaria and leptospirosis increased by 39% and 48%, respectively, compared with the previous year. Malaria increased in western Thailand along the border between Thailand and Myanmar, where malaria preventive measures were insufficient, whereas leptospirosis increased in northern Thailand. The epidemiology of acute febrile diseases changes significantly depending on the global epidemic of infectious diseases such as COVID-19 and the implementation of preventive measures, such as face masks, hand hygiene, social distancing, and stay-at-home and lockdown measures.

Australian guidelines for the treatment of cellulitis are informed by data from temperate, metropolitan centers. It is uncertain if these guidelines are equally applicable in tropical Australia, where the population, access to healthcare, and array of potential pathogens are quite different. This retrospective study examined adults admitted to Cairns Hospital in tropical Queensland, Australia, who were treated with intravenous antibiotics for a principal diagnosis of cellulitis in 2019. The study aimed to describe the epidemiological, clinical, and microbiological findings in these cases and the resulting implications for patient management. There were 305 episodes of cellulitis; a potential pathogen was identified in 93/305 (30%), most commonly Staphylococcus aureus (45/93, 48%) or Group A Streptococcus (16/93, 17%). There was one case of Burkholderia pseudomallei. Initial treatment was most commonly with narrow spectrum β-lactam antibiotics with flucloxacillin prescribed in 170/305 (56%) and cefazolin prescribed in 74/305 (26%). Overall, 4/305 (1%) died or were admitted to the intensive care unit (ICU) within 30 days, 123/305 (40%) had an inpatient stay >48 hours, and 63/305 (21%) were readmitted to hospital within 30 days. Every patient who subsequently died or required ICU admission had an elevated early warning score (EWS ≥3) on admission. An EWS ≥3 on admission also predicted an inpatient stay of >48 hours (odds ratio [OR]: 3.2, 95% CI: 1.7-6.0; P <0.001) and 30-day readmission (OR: 2.3, 95% CI: 1.2-4.6; P = 0.01). The etiology of cellulitis in tropical Queensland, Australia, is very similar to that seen in temperate regions, enabling the use of standard management algorithms for patients with cellulitis in the region.

Elderly primigravidae refers to women who become pregnant for the first time from age 35 years and above. Advanced maternal age is a known risk factor for numerous maternal and perinatal complications. This study sought to determine pregnancy outcomes of elderly primigravidae at the Korle-Bu Teaching Hospital (KBTH). A retrospective cohort study was conducted. Women who had their first delivery at KBTH from January 1, 2015 to December 31, 2017 had their demographic and obstetrics and gynecology history and maternal and fetal outcomes retrieved from the department's electronic database. Women aged 35 years or more who had their first delivery within the study period constituted the exposed, whereas those between 20 and 34 were considered unexposed. Modified Poisson regression with robust error variance estimation and the log link function between the sociodemographic and obstetric factors and maternal and fetal outcomes to estimate adjusted risk ratios (aRRs) and 95% CI were used. Of 29,243 total deliveries, elderly primigravidae constituted 1.81% (530/29,243). Maternal outcomes associated with elderly primigravidae were increased incidence of Caesarean section or instrument delivery (aRR [95% CI] = 1.73 [1.56-1.92]) and prolonged length of stay in hospital (aRR [95% CI] = 1.14 [1.06-1.23]). Fetal outcome associated with the elderly primigravidae was stillbirth (aRR [95% CI] = 1.91 [1.25-2.91]). Elderly primigravidae therefore require more intensive monitoring, even in the absence of any obvious maternal complications. These findings will help in counseling and in the shared decision-making for delivery of elderly primigravidae.

Climate change, driven primarily by greenhouse gas emissions from the Global North, is increasing the frequency and intensity of tropical cyclones in Mozambique. After Cyclones Idai and Kenneth in 2019, Cabo Delgado experienced its most severe cholera outbreak in decades. This study explores the factors associated with the prevalence of acute watery diarrhea (AWD) and cholera among people exposed to both climate disasters and armed conflicts in Mozambique. This cross-sectional, community-based study assessed the prevalence and predictors of cholera and AWD in Cabo Delgado Province. Trained community health workers conducted a structured face-to-face survey in December 2023. Associations between variables were investigated using the χ2 test or Fisher's exact test, and a logistic regression model identified independent risk factors for cholera-like events. The study included 1,615 households and 8,366 people from six districts of Cabo Delgado Province. Children under 14 years old comprised 88% of the population, and 37.9% of households included internally displaced people. Overall, 4.3% of households experienced AWD or cholera within 3 months. Multivariable analysis identified factors associated with AWD, including study district (P <0.0001), overcrowding (P = 0.02), access to safe water (P <0.0001), and handwashing (P = 0.004). Among people exposed to climate disasters, factors associated with cholera or AWD were overcrowding and lack of access to safe water and handwashing facilities. These findings can guide policymakers in designing targeted climate adaptation interventions.

Conventional diagnostic systems struggled to meet the fluctuating demand for testing across the different waves of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the feasibility and effectiveness of the walkthrough (WT) approach in extending access to COVID-19 testing to high-risk populations traditionally underrepresented at health facilities (HFs) and to observe its impact on testing demand. An interventional study was implemented in markets (WT markets) and ports (WT ports) in Maputo City and Province, Mozambique. Demographic, epidemiological, and clinical data were collected for patients testing for COVID-19 in HFs and at WTs, and a nasal swab COVID-19 antigen rapid diagnostic test (Ag-RDT) was administered. Overall, testing rates at WTs were higher than those at HFs. At WTs, 4,452 of 4,457 participants were eligible and screened for COVID-19. Most participants were fully vaccinated for COVID-19 and had no symptoms or comorbidities (62.1% at WT markets and 87.9% at WT ports). During the baseline phase, the incidence testing rate of Ag-RDTs in intervention health facilities near the WTs was approximately one-fifth (P <0.001) of that in the control HFs located far from the WTs. In the control HFs, the incidence testing rate decreased significantly during the intervention period, whereas in intervention HFs, the incidence testing rate increased by approximately four times (P = 0.005). During times of low positivity rates and limited patient flow, the WT testing points may not yield the expected results in lowering the incidence testing rate within HFs. The WT may constitute an alternative approach to increasing the screening of infectious and noncommunicable diseases.

The likelihood of antimicrobial failure in COVID-19 patients with bacterial superinfection arises from both phenotypic (biofilms) and genotypic mechanisms. This cross-sectional study aimed to determine the inhibitory concentrations of quinolones-nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and levofloxacin-in biofilm formers (minimum biofilm inhibitory concentration [MBIC]) and nonformers (minimum inhibitory concentration [MIC]) and correlate inhibitory concentrations with plasmid-mediated quinolone resistance (PMQR) genes in quinolone-resistant bacteria isolated from COVID-19 inpatients. Quinolone-resistant bacteria (n = 193), verified through disc diffusion, were tested for quinolone inhibitory concentrations using broth microdilution and biofilm formation using microtiter plate methods. The polymerase chain reaction was used to detect PMQR genes. Study variables were analyzed using SPSS v.17.0, with a significance level set at P <0.05. MIC-to-MBIC median fold increases for ciprofloxacin, ofloxacin, and levofloxacin were 128 (2-8,192), 64 (4-1,024), and 32 (4-512) in gram-positive cocci (GPC, n = 43), respectively, whereas they were 32 (4-8,192), 32 (4-2,048), and 16 (2-1,024) in fermentative gram-negative bacilli (F-GNB, n = 126) and 16 (4-4,096), 64 (2-64), and 16 (8-512) in nonfermentative gram-negative bacilli (NF-GNB, n = 24). In biofilm-forming F-GNB and NF-GNB, qnrB (10/32 versus 3/10), aac(6')-Ib-cr (10/32 versus 4/10), and qnrS (9/32 versus 0/10) genes were detected. A 32-fold median increase in the MIC-to-MBIC of ciprofloxacin was significantly (P <0.05) associated with qnrA in F-GNB and qnrS in NF-GNB. Biofilms formed by F-GNB and NF-GNB were significantly associated with the aac(6')-Ib-cr and qnrS genes, respectively. Nearly one-third of the superinfecting bacteria in COVID-19 patients formed biofilms and had at least one PMQR gene, thus increasing the need for quinolones at higher inhibitory concentrations.