RESUMO
Post-mortem medical examiner samples may be useful for sentinel surveillance of disorders usually detected by antibody determinations on specimens from ill patients or from surveys. We found anti-dengue IgM positivity in 3(23/780) and anti-dengue IgG positivity in 77(597/777) of sera obtained at the Puerto Rico medical examiner (Institute of Forensic Sciences) in December 2000, April 2001, and October 2001. This approach may be a useful alternative for estimating the population prevalence of serologic markers for dengue and other infectious diseases.
Assuntos
Humanos , Masculino , Feminino , Lactente , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Recém-Nascido , Cadáver , Dengue/sangue , Dengue/epidemiologia , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Vigilância da População/métodos , Dengue/diagnóstico , Dengue/imunologia , Porto RicoRESUMO
Leptospirosis is difficult to distinguish from dengue fever without laboratory confirmation. Sporadic cases/clusters of leptospirosis occur in Puerto Rico, but surveillance is passive and laboratory confirmation is rare. We tested for leptospirosis using an IgM ELISA on sera testing negative for dengue virus IgM antibody and conducted a case-control study assessing risk factors for leptospirosis, comparing clinical/laboratory findings between leptospirosis (case-patients) and dengue patients (controls). Among 730 dengue-negative sera, 36 (5%) were positive for leptospirosis. We performed post mortem testing for leptospirosis on 12 available specimens from suspected dengue-related fatalities; 10 (83%) tested positive. Among these 10 fatal cases, pulmonary hemorrhage and renal failure were the most common causes of death. We enrolled 42 case-patients and 84 controls. Jaundice, elevated BUN, hyperbilirubinemia, anemia, and leukocytosis were associated with leptospirosis (p < .01 for all). Male sex, walking in puddles, rural habitation, and owning horses were independently associated with leptospirosis. Epidemiological, clinical, and laboratory criteria may help distinguish leptospirosis from dengue and identify patients who would benefit from early antibiotic treatment.
Assuntos
Dengue/diagnóstico , Leptospirose/diagnóstico , Vigilância da População/métodos , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Pré-Escolar , Dengue/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Lactente , Leptospirose/etiologia , Leptospirose/mortalidade , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Fatores de RiscoRESUMO
Smallpox resulted in the death of 30 % of those who acquired it, so the preventive method discovered by Edward Jenner (London, 1798) spread very quickly. At the request in 1803 of Carlos IV, king of Spain, his government evaluated offers to carry smallpox vaccine to the colonies. The selected proposal, by doctor Francisco Xavier de Balmis, sought to take the lymph to America and Asia in a chain of arm to arm vaccination of foundlings. The Expedition set sail from Corunna on November 30, 1803, stopped in the Canary Isles, Puerto Rico, and Venezuela and after Caracas (1804) split in two groups. Balmis led some members of the Expedition to Cuba and Mexico. For the trip to the Philippines, in 1805, parents lent their children in exchange for economic compensation and the promise that the boys would be returned home. The Expedition returned to Mexico in August, 1807, but Balmis separately took vaccine to China and returned to Spain. Another contingent of the Expedition, under vice-director José Salvany, took vaccine to what we know as Colombia, Ecuador, Peru and Bolivia. His assistant Manuel Grajales reached the Chilean Patagonia in 1811. This article also comments on three principal themes - the institutional management of the scientific project, the conflicts that characterized its course, and the children's experience. The Vaccine Expedition was a brave and humanitarian endeavor, but also an extraordinary sanitary and administrative success. It was not until the twentieth century that a global eradication campaign eliminated smallpox in the world.
Assuntos
Humanos , Vacina Antivariólica/história , Vacinação/história , América LatinaRESUMO
From June 1, 1994 to May 31, 1995 a total of 24,700 cases of dengue (7.01/1,000 population) were reported to the laboratory-based surveillance system in Puerto Rico (1991-1994, annual average: 2.55/1,000). Dengue virus 2 predominated. The earliest indicator of epidemic activity was the virus isolation rate in May 1994 (14.0% versus 5.7% average). The male-to-female ratio among cases was 1:1.1; 65.4% were younger than 30 years (the 10 to 19 year age group had the highest incidence, 11.8/1,000). At least 5,687 cases (23.0%) showed a hemorrhagic manifestation; 4,662 (18.9%) were hospitalized, and 40 died (0.2%; 10 laboratory-positive). Two cases documented by laboratory were transmitted by unusual routes--intrapartum and through a bone marrow transplant. Among 2,004 hospitalized cases reported by infection control nurses, 139 (6.9%) fulfilled the criteria for dengue hemorrhagic fever (DHF) and another 13 cases (0.6%) had dengue shock syndrome. This epidemic produced the largest number of hospitalizations, DHF cases, and deaths from any dengue epidemic in Puerto Rico. Severity did not change throughout the year. Surveillance capabilities were maintained by temporary, simplified reporting methods, none of which could be recommended as the single method of choice for surveillance; each must be used (on site, or as a service available from a reference laboratory) at the right time in the epidemic cycle. The utility of comparisons of current and previous data underscores the value of long-term surveillance. Our analysis was unable to document whether significantly increased transmission occurred more often in cities where the water supply was rationed or where the local landfill was closed.
Assuntos
Dengue/epidemiologia , Dengue/prevenção & controle , Surtos de Doenças , Vigilância da População , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Vírus da Dengue/isolamento & purificação , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Estações do Ano , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controleRESUMO
From 1995 to 1997 dengue was reported in Puerto Rico at an average annual rate of 1.75/1,000 population, compared to 6.73 in 1994, an epidemic year. Dengue virus serotypes 1 (DEN-1), -2, and -4 were isolated each year, with DEN-2 predominating in 1995 and 1996, and DEN-4 in 1997. From 1995 through 1997 incidence was highest (0.61-0.77/1,000) in persons under 30 years of age; males and females were equally affected. Among positive cases, 28.3% to 37.9% were hospitalized; 28.9% to 35.2% had hemorrhagic manifestations; at least 1.1% to 1.6% fulfilled the criteria for dengue hemorrhagic fever/dengue shock syndrome; and 0.2% to 0.3% died. Neither hurricane preparations (1995) nor widespread floods (1996) seem to have affected dengue incidence. Most municipalities with the highest laboratory-diagnosed dengue rates in 1995 were in the eastern foothills of the central mountains, an area relatively spared by the 1994 epidemic. In the next two years, at least half of the municipalities with the highest laboratory-diagnosed dengue rates were in the west. The most intense municipal outbreak of this period (DEN-2, Villalba, 1995, rate of 11.67/1,000) is described to highlight the importance of local conditions and epidemiologic history in determining the risk of dengue.
Assuntos
Vírus da Dengue/classificação , Dengue/epidemiologia , Dengue/prevenção & controle , Vigilância da População , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Dengue/sangue , Vírus da Dengue/isolamento & purificação , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Estações do Ano , Dengue Grave/sangue , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controle , Distribuição por SexoRESUMO
The military physician Bailey K. Ashford (Washington, D. C., September 18, 1873--San Juan, Puerto Rico, November 1, 1934) is mostly remembered for having identified in 1899 the cause of fatal anemia prevalent among Puertorican peasants, but he was also a distinguished investigator of other diseases, and organizer of mass medical services, in peace and in war. In spite of Ashford's own sober statements, the great influence of his scientific work in Puerto Rico and the impact of his personality in patients and colleagues have helped cast him as a mythical figure. His personal archives (kept at the library of the University of Puerto Rico's Medical Sciences Campus) make clear that his autobiography presents only a selection among the episodes that would form a complete biography.
Assuntos
História do Século XIX , História do Século XX , Medicina Interna/história , Medicina Militar/história , Porto Rico , Estados UnidosRESUMO
BACKGROUND: Dengue, a mosquito-transmitted viral disease, is a risk for visitors in tropical and subtropical areas. Several participants in a community-assistance program in Tortola, British Virgin Islands, in August, 1995, reported dengue-like symptoms either before or soon after leaving the island. METHODS: We conducted a retrospective cohort study to determine the extent of the outbreak, risk factors for illness, and the proportion of inapparent infections. Program participants were interviewed by telephone or mail, and asked to submit a serum sample for dengue diagnosis. A clinically-diagnosed case of dengue was defined as a person with fever and two or more of the following: headache, retro-orbital pain, myalgia, arthralgia, rash, or hemorrhagic manifestations. Serum specimens were tested for virus isolation, polymerase chain reaction (PCR), plaque-reduction neutralization (PRNT) or anti-dengue IgM and IgG antibody. RESULTS: Thirty-two (97%) of the 33 program participants responded; 21 of the 32 (66%) provided at least one serum sample for study. The median age was 17 years; 20 (62%) were women. Of 32 respondents, 22 (69%) met the clinical case definition for dengue: 15 of them (68%) had a positive IgM antibody response and 7 did not submit a serum sample. Dengue 1 virus (DEN-1) was identified by PCR in one case and all 11 positive PRNT results. No asymptomatic infections were identified. No respondent used effective mosquito repellent, and only 2 (6%) used bednets. CONCLUSIONS: A DEN-1 outbreak with a high attack rate (69%) occurred in a group of young short-term community aid workers. There were no asymptomatic infections documented. Participants' rare use of bednets or effective mosquito repellent highlights the importance of providing travelers to tropical areas with information about dengue fever and the recommended precautions to protect against infection.
Assuntos
Dengue/epidemiologia , Surtos de Doenças , Viagem , Adolescente , Anticorpos Antivirais/sangue , Dengue/diagnóstico , Vírus da Dengue/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase , Socorro em Desastres , Estudos Retrospectivos , Fatores de Risco , Índias Ocidentais/epidemiologiaRESUMO
The evolution in physical condition, life expectancy at birth, and access to preventive and curative services rapidly improved the quality of life of Puerto Ricans in the twentieth century. The population quadrupled to almost 4 million inhabitants and the crude mortality rate fell from 38 per thousand in 1900 to 7.7 per thousand in 1997, with its most dramatic change (18.6 to 6.7) occurring from 1941 to 1960. The great promoters of health were the general increase in socioeconomic level, improvements in infrastructure, and vaccines; its great scourges were infectious diseases (from hookworm to AIDS) and social dislocations, such as the war of 1917 (accompanied by epidemics and hunger) or the present war between illicit drug distributors. This article summarizes the events in the century related to health and its political and economic contexts, the developments in public health structures and health care, professional education, volunteer organizations, campaigns against infectious diseases, chronic causes of mortality, and environmental problems. Bringing the capacity to defend public health to the level of sophistication available for clinical care is one of the vital challenges of the twenty-first century for Puerto Rico.
Assuntos
Atenção à Saúde/história , Nível de Saúde , Educação Médica/história , Governo , Reforma dos Serviços de Saúde/história , História do Século XX , Humanos , Expectativa de Vida , Porto RicoRESUMO
Capture-recapture estimations compare the results of 2 or more independent surveillance systems for the same event, and by measuring the degree of overlap between them, provide an estimate of the total number of events, and therefore the completeness of ascertainment in each system. The Puerto Rico Department of Health and the Dengue Branch of the Centers for Disease Control and Prevention (CDC) monitor dengue activity in Puerto Rico through 2 distinct surveillance systems: diagnostic specimens from patients with suspected dengue and infection control nurses' reports on patients hospitalized for suspected dengue. The patient listings from these systems were used in a 2-sample, capture-recapture calculation to estimate the total number of persons with suspected dengue hospitalized from 1991 to 1995. The laboratory positivity rate for suspected dengue cases who submitted appropriately timed serum samples in those years ranged from 72.1% to 81.2%. The laboratory-based (diagnostic sample) surveillance system (routinely used to monitor hospitalizations for suspected dengue) detected an average of 1,197 hospitalized cases during non-epidemic years, and 4,329 cases during the epidemic year of 1994. The detection rate of this system averaged 42% of the numbers derived by the capture-recapture method. In non-epidemic years, an estimated average of 2,791 patients (range = 1,553-3,481) was estimated to have been hospitalized with a clinical diagnosis of dengue, compared with 9,479 during 1994. These results demonstrate the under-detection inherent in passive surveillance systems for hospitalized cases of suspected dengue, and illustrate the value of capture-recapture techniques to better estimate the true incidence of hospitalizations for this disease.