RESUMO
The emergence of epidemic cholera in post-earthquake Haiti portended a public health disaster of uncertain magnitude. In order to coordinate relief efforts in an environment with limited healthcare infrastructure and stretched resources, timely and realistic projections of the extent of the cholera outbreak were crucial. Projections were shared with Government and partner organizations beginning 5 days after the first reported case and were updated using progressively more advanced methods as more surveillance data became available. The first projection estimated that 105 000 cholera cases would occur in the first year. Subsequent projections using different methods estimated up to 652 000 cases and 163 000-247 000 hospitalizations during the first year. Current surveillance data show these projections to have provided reasonable approximations of the observed epidemic. Providing the real-time projections allowed Haitian ministries and external aid organizations to better plan and implement response measures during the evolving epidemic.
Assuntos
Cólera/epidemiologia , Epidemias/prevenção & controle , Cólera/prevenção & controle , Desastres , Terremotos , Epidemias/estatística & dados numéricos , Métodos Epidemiológicos , Haiti/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Modelos Teóricos , Vigilância da PopulaçãoRESUMO
Fresh produce increasingly is recognized as an important source of salmonellosis in the United States. In December 1999, the Centers for Disease Control and Prevention detected a nationwide increase in Salmonella serotype Newport (SN) infections that had occurred during the previous month. SN isolates recovered from patients in this cluster had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (which identified the outbreak strain), suggesting a common source. Seventy-eight patients from 13 states were infected with the outbreak strain. Fifteen patients were hospitalized; 2 died. Among 28 patients enrolled in the matched case-control study, 14 (50%) reported they ate mangoes in the 5 days before illness onset, compared with 4 (10%) of the control subjects during the same period (matched odds ratio, 21.6; 95% confidence interval, 3.53- infinity; P=.0001). Traceback of the implicated mangoes led to a single Brazilian farm, where we identified hot water treatment as a possible point of contamination; this is a relatively new process to prevent importation of an agricultural pest, the Mediterranean fruit fly. This is the first reported outbreak of salmonellosis implicating mangoes. PFGE was critical to the timely recognition of this nationwide outbreak. This outbreak highlights the potential global health impact of foodborne diseases and newly implemented food processes.
Assuntos
Surtos de Doenças , Mangifera/microbiologia , Infecções por Salmonella/epidemiologia , Salmonella enterica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções por Salmonella/microbiologia , Estados Unidos/epidemiologiaRESUMO
Lack of reliable data about street vendors, who are difficult to survey, has hampered efforts to improve the safety of street-vended food. A two-phase method for sampling vendors, surveying first in areas of concentrated vending activity identified by local authorities and second in randomly selected areas, was developed and implemented in two Guatemalan cities where street-vended food had been implicated in cholera transmission. In a 4-day survey in Escuintla, 59 vendors (42 from phase 1, 17 from phase 2) were interviewed. They demonstrated good knowledge of food safety and cholera but unsafe practices, implying that more effective, practical training was needed. In a 6-day survey in Guatemala City, 78 vendors (77 from phase 1, 1 from phase 2) were interviewed. Sixty-eight (87 %) vendors stored water, usually in wide-mouthed vessels prone to contamination; this led to a field test of a new system for safe water storage. Useful information for public health planning and intervention can be gathered rapidly with this new method for surveying street vendors.
Assuntos
Cólera/prevenção & controle , Métodos Epidemiológicos , Inspeção de Alimentos , Serviços de Alimentação/normas , Adolescente , Adulto , Idoso , Bebidas/normas , Cólera/epidemiologia , Feminino , Inspeção de Alimentos/métodos , Guatemala/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estudos de Amostragem , Inquéritos e Questionários , Abastecimento de Água/normasRESUMO
A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P = 0.002). Infants < 1 year old (P = 0.05) and children 5-14 years old (P = 0.01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P = 0.02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P < 0.0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.
Assuntos
Participação da Comunidade , Diarreia/prevenção & controle , Desinfetantes , Educação em Saúde/métodos , Purificação da Água/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Bolívia , Criança , Pré-Escolar , Diarreia/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Fatores de Risco , Microbiologia da ÁguaRESUMO
In 1992, an outbreak of chronic diarrhea occurred among passengers on a cruise ship visiting the Galapagos Islands, Ecuador. Passengers (548) were surveyed, and stool and biopsy specimens from a sample who reported chronic diarrhea were examined. On completed questionnaires, returned by 394 passengers (72%), 58 (15%) reported having chronic diarrhea associated with urgency (84%), weight loss (77%), fatigue (71%), and fecal incontinence (62%). Illness began 11 days (median) after boarding the ship and lasted 7 to >42 months. Macroscopic and histologic abnormalities of the colon were common, but extensive laboratory examination revealed no etiologic agent. No one responded to antimicrobial therapy. Patients were more likely than well passengers to have drunk the ship's unbottled water or ice before onset of illness and to have eaten raw sliced fruits and vegetables washed in unbottled water. Water handling and chlorination on the ship were deficient. Outbreaks of a similar illness, Brainerd diarrhea, have been reported in the United States. Although its etiology remains unknown, Brainerd diarrhea may also occur among travelers.
Assuntos
Diarreia/epidemiologia , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Diarreia/diagnóstico , Diarreia/etiologia , Surtos de Doenças , Equador/epidemiologia , Microbiologia Ambiental , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Frutas/microbiologia , Frutas/parasitologia , Frutas/virologia , Humanos , Navios , Viagem , Abastecimento de ÁguaRESUMO
In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.
Assuntos
Antibacterianos/farmacologia , Diarreia/microbiologia , Disenteria Bacilar/tratamento farmacológico , Shigella/efeitos dos fármacos , Shigella/isolamento & purificação , Animais , Antibacterianos/uso terapêutico , Bolívia , Campylobacter/isolamento & purificação , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Pré-Escolar , Diarreia/tratamento farmacológico , Diarreia/parasitologia , Resistência Microbiana a Medicamentos , Resistência a Múltiplos Medicamentos , Disenteria Amebiana/tratamento farmacológico , Disenteria Amebiana/parasitologia , Disenteria Bacilar/microbiologia , Empirismo , Entamoeba histolytica/isolamento & purificação , Fezes/parasitologia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Salmonella/isolamento & purificação , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/microbiologiaRESUMO
BACKGROUND: To assess the effectiveness of the cholera prevention activities of the Peruvian Ministry of Health, we conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the cholera epidemic in 1991. METHODS: We surveyed heads of 67 urban and 61 rural households to determine diarrhoea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding ten cholera prevention measures. RESULTS: Twenty-five per cent of 482 urban and 11% of 454 rural household members had diarrhoea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, and education through interpersonal communication was more prevalent in rural villages. Ninety-three per cent of rural and 67% of urban respondents believed they could prevent cholera. The mean numbers of correct responses to ten knowledge questions were 7.8 for urban and 8.2 for rural respondents. Practices lagged behind knowledge and attitudes (mean correct response to ten possible: urban 4.9, rural 4.6). Seventy-five per cent of respondents drank untreated water and 91% ate unwashed produce, both of which were identified as cholera risk factors in a concurrently conducted case-control study. CONCLUSIONS: The cholera prevention campaign successfully educated respondents, but did not cause many to adopt preventive behaviours. Direct interpersonal education by community-based personnel may enhance the likelihood of translating education into changes in health behaviours. Knowledge, attitudes, and practices surveys conducted with case-control studies during an epidemic can be an effective method of refining education/control programmes.
PIP: The authors conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the 1991 cholera epidemic to assess the effectiveness of the Peruvian Ministry of Health's cholera prevention activities. Diarrhea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding 10 cholera prevention measures were determined by surveying the heads of 67 urban and 61 rural households. 25% of 482 urban and 11% of 454 rural household members had diarrhea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, while education through interpersonal communication prevailed in rural villages. 93% of rural and 67% of urban respondents believed they could prevent cholera. Rural respondents were slightly more knowledgeable than urban respondents about cholera. Overall, however, practices did not reflect their knowledge and attitudes; 75% of respondents drank untreated water and 91% ate unwashed produce.
Assuntos
Cólera/prevenção & controle , Surtos de Doenças/prevenção & controle , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cólera/epidemiologia , Cólera/terapia , Feminino , Comportamentos Relacionados com a Saúde , Educação em Saúde/organização & administração , Humanos , Lactente , Masculino , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Peru/epidemiologia , Fatores de RiscoRESUMO
This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), and describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an October 1993 PAHO questionnaire. In all, 948429 cholera cases were reported to PAHO by affected Latin American countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993). The case-fatality rate over the three-year period, and also in 1993, was 0.8%. A general downward trend in the incidence of cholera was observed in most South American countries, while the incidence increased in most Central American countries. A good deal of variation was noted in the definitions used for reporting cholera cases, hospitalized cholera cases, and cholera-attributable deaths. Because of these variations, broad intercountry comparisons (including disease burden calculations and care quality assessments based on case-fatality rates) are difficult to make, and even reported trends within a single country need to be evaluated with care. The situation is likely to be complicated in the future by the arrival of V. cholerae O139 in Latin America, creating a need to distinguish between it and the prevailing O1 strain. For purposes of simplicity, wide acceptance, and broad dissemination of case data, the following definitions are recommended: Confirmed case of O1 cholera: laboratory-confirmed infection with toxigenic V. cholerae O1 in any person who has diarrhea. Confirmed case of O139 cholera: laboratory-confirmed infection with toxigenic V. cholerae O139 in any person who has diarrhea. Clinical case of cholera: acute watery diarrhea in a person over 5 years old who is seeking treatment. Death attributable to cholera: death within one week of the onset of diarrhea in a person with confirmed or clinically defined cholera. Hospitalized patient with cholera:a person who has confirmed or clinically defined cholera and who remains at least 12 hours in a health care facility for treatment of the disease.
Assuntos
Cólera/epidemiologia , América Central/epidemiologia , Cólera/microbiologia , Cólera/mortalidade , Notificação de Doenças , Métodos Epidemiológicos , Humanos , Incidência , México/epidemiologia , América do Sul/epidemiologia , Vibrio cholerae/classificação , Vibrio cholerae/isolamento & purificaçãoRESUMO
Epidemiologic investigations of the Latin America cholera epidemic have repeatedly implicated untreated drinking water and water touched by hands during storage as important vehicles for disease transmission. To prevent such transmission, we provided a new narrow-mouthed, plastic, water storage vessel and 5% calcium hypochlorite solution for home disinfection of stored water to a Bolivian Aymara Indian community at risk for cholera. We evaluated acceptance of this intervention and its effect on water quality. Each of 42 families in the study obtained water from a household well; fecal coliform bacteria were found in water from 39 (93%) of 42 wells and 33 (79%) of 42 usual water storage vessels. One group of families received the special vessels and chlorine (group A), a second received only the special vessels (group B), and a third served as a control group (group C). Water samples collected every three weeks from group A special vessels had lower geometric mean fecal coliform colony counts (P < 0.0001) and lower geometric mean Escherichia coli colony counts (P < 0.0001) than water from group B or C vessels. Adequate levels of free chlorine persisted in these vessels for at least 5 hr. The special vessels and chlorine solution were well accepted and continued to be used for at least six months. Use of the vessel and chlorine solution produced drinking water from nonpotable sources that met World Health Organization standards for microbiologic quality.
Assuntos
Cólera/prevenção & controle , Purificação da Água/métodos , Abastecimento de Água/normas , Adolescente , Adulto , Idoso , Bolívia , Compostos de Cálcio , Cólera/transmissão , Contagem de Colônia Microbiana , Coleta de Dados , Escherichia coli/crescimento & desenvolvimento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Fatores de TempoRESUMO
Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemala ranked third in the hemisphere in reported cases of cholera. We conducted a case-control study with two age-, sex-, and neighbourhood-matched controls per patient in periurban Guatemala City. Twenty-six patients hospitalized for cholera and 52 controls were enrolled. Seven (47%) of 15 stool cultures obtained after admission yielded toxigenic Vibrio cholerae O1. All seven were resistant to furazolidone, sulfisoxazole, and streptomycin, and differed substantially by pulsed-field gel electrophoresis from the Latin American epidemic strain dominant in the hemisphere since 1991. In univariate analysis, illness was associated with consumption of left-over rice (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 1.4-36), flavored ices (-helados') (OR = 3.6, CI = 1.1 - 12), and street-vended non-carbonated beverages (OR = 3.8, CI = 1.2-12) and food items (OR = 11.0, CI = 2.3-54). Street-vended food items remained significantly associated with illness in multivariate analysis (OR = 6.5, CI = 1.4-31). Illness was not associated with drinking municipal tap water. Maintaining water safety is important, but slowing the epidemic in Guatemala City and elsewhere may also require improvement in street vendor food handling and hygiene.