RESUMO
In October 2000, the Ministries of Health of the Dominican Republic and Haiti notified two cases of acute flaccid paralysis (AFP) in rural areas, one of them in a 9-month-old female, and the other in a 2-year-old female, respectively. Stool samples that were obtained from these cases, which occurred in July and August 2000, after a 9-year interruption of wild poliovirus circulation in the Western Hemisphere, revealed the presence of type 1 poliovirus. Genetic sequencing, which was later performed at the Centers for Disease Control and Prevention, in Atlanta, Georgia, United States of America, revealed an atypical descendant of the virus used in the manufacture of the oral polio vaccine (OPV), but with 3% genetic divergence with respect to the parent strain. Normally, viral isolates that derive from vaccine components show 99.5% genetic agreement with the parent strain; in wild polioviruses, on the other hand, this agreement is usually less than 82.0%. Thus, the 3% genetic divergence detected in this study suggests that, in areas with low vaccine coverage, the virus used in the vaccine remained in circulation for at least two years, during which it recovered the neurovirulence and communicability of wild poliovirus type 1. This report describes the characteristics and results of the active search for cases of AFP that was sparked by the detection of the two index cases. It also looks at the public health implications of this outbreak for the entire Region of the Americas.
Assuntos
Surtos de Doenças , Poliomielite/epidemiologia , Poliomielite/virologia , Vacina Antipólio Oral/efeitos adversos , Pré-Escolar , República Dominicana/epidemiologia , Feminino , Haiti/epidemiologia , Humanos , LactenteRESUMO
In 1996 and 1997, cyclosporiasis outbreaks in North America were linked to eating Guatemalan raspberries. We conducted a study in health-care facilities and among raspberry farm workers, as well as a case-control study, to assess risk factors for the disease in Guatemala. From April 6, 1997, to March 19, 1998, 126 (2.3%) of 5, 552 surveillance specimens tested positive for Cyclospora; prevalence peaked in June (6.7%). Infection was most common among children 1.5 to 9 years old and among persons with gastroenteritis. Among 182 raspberry farm workers and family members monitored from April 6 to May 29, six had Cyclospora infection. In the case-control analysis, 62 (91%) of 68 persons with Cyclospora infection reported drinking untreated water in the 2 weeks before illness, compared with 88 (73%) of 120 controls (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.4, 10.8 by univariate analysis). Other risk factors included water source, type of sewage drainage, ownership of chickens or other fowl, and contact with soil (among children younger than 2 years).
Assuntos
Coccidiose/epidemiologia , Surtos de Doenças , Eucoccidiida/isolamento & purificação , Parasitologia de Alimentos , Frutas/parasitologia , Enteropatias Parasitárias/epidemiologia , Vigilância da População , Adolescente , Agricultura , Animais , Estudos de Casos e Controles , Criança , Pré-Escolar , Coccidiose/etiologia , Guatemala/epidemiologia , Humanos , Lactente , Enteropatias Parasitárias/etiologia , Prevalência , Fatores de Risco , Estações do Ano , Abastecimento de ÁguaRESUMO
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
We examined the recent panorama of ADD related deaths in Mexico in an effort to assess the overall impact of control measures that may vary in space and time. We pay particular attention to mortality rates recorded between 1985-1995, that is, before and after the cholera emergency. The aim is to focus on the social groups at risk, using time series data represented in the form of images and produced by a geographic information system (GIS). We show the potential of such methods to define populations at risk and support the decision process.
Assuntos
Cólera/mortalidade , Diarreia/mortalidade , Características de Residência , Doença Aguda , Pré-Escolar , Diarreia/epidemiologia , Diarreia/prevenção & controle , Surtos de Doenças/prevenção & controle , Humanos , Lactente , Recém-Nascido , Funções Verossimilhança , Modelos Lineares , México/epidemiologia , PrevalênciaRESUMO
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.