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Trop. Med. Infect. Dis., Volume 2, Issue 2 (June 2017)

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Open AccessArticle
Clinical Manifestations and Outcomes of Rickettsia australis Infection: A 15-Year Retrospective Study of Hospitalized Patients
Trop. Med. Infect. Dis. 2017, 2(2), 19; https://doi.org/10.3390/tropicalmed2020019
Received: 15 May 2017 / Revised: 13 June 2017 / Accepted: 17 June 2017 / Published: 20 June 2017
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Abstract
Queensland tick typhus (QTT; Rickettsia australis) is an important cause of community-acquired acute febrile illness in eastern Australia. Cases of QTT were identified retrospectively from 2000 to 2015 at five sites in Northern Brisbane through a pathology database. Those included had a [...] Read more.
Queensland tick typhus (QTT; Rickettsia australis) is an important cause of community-acquired acute febrile illness in eastern Australia. Cases of QTT were identified retrospectively from 2000 to 2015 at five sites in Northern Brisbane through a pathology database. Those included had a fourfold rise in spotted fever group (SFG)-specific serology, a single SFG-specific serology ≥ 256 or SFG-specific serology ≥ 128 with a clinically consistent illness. Cases were excluded on the basis of clinical unlikelihood of QTT infection. Thirty-six cases were included. Fever was found in 34/36 (94%) patients. Rash occurred in 83% of patients with maculopapular being the dominant morphology (70%). Thrombocytopenia, lymphopenia, and raised transaminases were common and occurred in 58%, 69%, and 89% of patients, respectively. Thirty-one of 36 (86%) patients received antibiotic therapy (usually doxycycline) and the time to correct antibiotic (from admission) ranged from 3 to 120 h (mean 45.5 h). Four of 36 (11%) required intensive care unit (ICU) admission for severe sepsis and end-organ support. There were no deaths. QTT has a wide range of clinical and laboratory features. Early and appropriate antimicrobial therapy is important and may prevent severe disease. Further prospective studies are required to identify factors associated with severe infection and sepsis. Full article
(This article belongs to the Special Issue The Past and Present Threat of Rickettsial Diseases)
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Open AccessArticle
Trends in Strongyloides stercoralis Faecal Larvae Detections in the Northern Territory, Australia: 2002 to 2012
Trop. Med. Infect. Dis. 2017, 2(2), 18; https://doi.org/10.3390/tropicalmed2020018
Received: 19 April 2017 / Revised: 13 June 2017 / Accepted: 13 June 2017 / Published: 19 June 2017
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Abstract
Strongyloides stercoralis is a soil-transmitted helminth (STH) endemic to tropical and subtropical areas. We reviewed the temporal detection trends in patients with S. stercoralis larvae present in faecal samples, in Northern Territory (NT) Government Health facilities, between 2002 and 2012. This was a [...] Read more.
Strongyloides stercoralis is a soil-transmitted helminth (STH) endemic to tropical and subtropical areas. We reviewed the temporal detection trends in patients with S. stercoralis larvae present in faecal samples, in Northern Territory (NT) Government Health facilities, between 2002 and 2012. This was a retrospective observational study of consecutive patients with microbiologically confirmed detection of S. stercoralis in faeces. The presence of anaemia, eosinophilia, polyparasitism, and geographic and demographic data, were included in the assessment. S. stercoralis larvae were present in 389 of 22,892 faecal samples (1.7%) collected across the NT over 11 years, examined by microscopy after formol ethyl acetate concentration. 97.7% of detections were in Indigenous patients. Detections, by number, occurred in a biphasic age distribution. Detections per number of faecal samples collected, were highest in the 0–5 year age group. Anaemia was present in 44.8%, and eosinophilia in 49.9% of patients. Eosinophilia was present in 65.5% of the ≤5 age group, compared to 40.8% of >5 year age (p < 0.0001). Polyparasitism was present in 31.4% of patients. There was an overall downward trend in larvae detections from 2.64% to 0.99% detections/number of faecal samples year between 2002 and 2012, consistent with the trends observed for other local STHs. S. stercoralis remains an important NT-wide pathogen. Full article
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Open AccessArticle
Field Studies Evaluating Bait Acceptance and Handling by Dogs in Navajo Nation, USA
Trop. Med. Infect. Dis. 2017, 2(2), 17; https://doi.org/10.3390/tropicalmed2020017
Received: 26 April 2017 / Revised: 9 June 2017 / Accepted: 12 June 2017 / Published: 15 June 2017
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Abstract
Mass parenteral vaccination remains the cornerstone of dog rabies control. Oral rabies vaccination (ORV) could increase vaccination coverage where free-roaming dogs represent a sizeable segment of the population at risk. ORV’s success is dependent on the acceptance of baits that release an efficacious [...] Read more.
Mass parenteral vaccination remains the cornerstone of dog rabies control. Oral rabies vaccination (ORV) could increase vaccination coverage where free-roaming dogs represent a sizeable segment of the population at risk. ORV’s success is dependent on the acceptance of baits that release an efficacious vaccine into the oral cavity. A new egg-flavored bait was tested alongside boiled bovine intestine and a commercially available fishmeal bait using a hand-out model on the Navajo Nation, United States, during June 2016. A PVC capsule and biodegradable sachet were tested, and had no effect on bait acceptance. The intestine baits had the highest acceptance (91.9%; 95% confidence interval (CI), 83.9%–96.7%), but the fishmeal (81.1%; 95% CI, 71.5%–88.6%) and the egg-flavored baits (77.4%; 95% CI, 72.4%–81.8%) were also well accepted, suggesting that local bait preference studies may be warranted to enhance ORV’s success in other areas where canine rabies is being managed. Based on a dyed water marker, the delivery of a placebo vaccine was best in the intestine baits (75.4%; 95% CI, 63.5%–84.9%), followed by the egg-flavored (68.0%; 95% CI, 62.4%–73.2%) and fishmeal (54.3%; 95% CI, 42.9%–65.4%) baits. Acceptance was not influenced by the supervision or ownership, or sex, age, and body condition of the dogs. This study illustrates that a portion of a dog population may be orally vaccinated as a complement to parenteral vaccination to achieve the immune thresholds required to eliminate dog rabies. Full article
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Open AccessArticle
The Understanding of Ebola Virus Disease (EVD) Among Medical Practitioners of Karachi, Pakistan
Trop. Med. Infect. Dis. 2017, 2(2), 16; https://doi.org/10.3390/tropicalmed2020016
Received: 3 May 2017 / Revised: 8 June 2017 / Accepted: 12 June 2017 / Published: 14 June 2017
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Abstract
The World Health Organization (WHO) has acknowledged the large West African Ebola virus disease (EVD) outbreak to be a community health disaster of global concern, and the spread of disease demands a synchronized response. Medical practitioners have an increased risk of contracting the [...] Read more.
The World Health Organization (WHO) has acknowledged the large West African Ebola virus disease (EVD) outbreak to be a community health disaster of global concern, and the spread of disease demands a synchronized response. Medical practitioners have an increased risk of contracting the disease as compared to others as they are directly exposed to patients’ blood or fluids. This study evaluated the knowledge of medical practitioners in Karachi regarding EVD. It was descriptive and exploratory in nature and took place over a period of 4 months, i.e., August 2016 to November 2016. The respondents were randomly selected by convenience sampling and surveyed with a 20-item questionnaire. Overall, 403 questionnaires were included in the study and a response rate of 80.6% was achieved. The majority (56.3%) considered themselves to be somewhat knowledgeable; females had more knowledge as compared to male (p < 0.003). More than 80% knew about the 2014 Ebola outbreak in West Africa. Interestingly, the findings revealed that respondents’ knowledge about diagnosis and identification of EVD is good. Respondents considered EVD a severe disease and emphasized on the need for protective measures when contacting affected patients. Interventions should be tailored to focus on areas where respondents showed a lack of knowledge about the disease. Full article
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Open AccessArticle
Antenatal Practices Ineffective at Prevention of Plasmodium falciparum Malaria during Pregnancy in a Sub-Saharan Africa Region, Nigeria
Trop. Med. Infect. Dis. 2017, 2(2), 15; https://doi.org/10.3390/tropicalmed2020015
Received: 9 May 2017 / Revised: 8 June 2017 / Accepted: 9 June 2017 / Published: 12 June 2017
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Abstract
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision [...] Read more.
Pregnancy-associated malaria (PAM) is a major public health concern constituting a serious risk to the pregnant woman, her foetus, and newborn. Management of cases and prevention rely partly on effective and efficient antenatal services. This study examined the effectiveness of antenatal service provision in a major district hospital in sub-Saharan Africa at preventing PAM. A cross-sectional hospital based study design aided by questionnaire was used. Malaria diagnosis was by microscopy. Overall prevalence of PAM was 50.7% (38/75). Mean Plasmodium falciparum density was (112.89 ± standard error of mean, 22.90) × 103/µL red blood cell (RBC). P. falciparum prevalence was not significantly dependent on gravidity, parity, trimester, age, and BMI status of the women (p > 0.05). Difference in P. falciparum density per µL RBC in primigravidae (268.13 ± 58.23) × 103 vs. secundi- (92.14 ± 4.72) × 103 vs. multigravidae (65.22 ± 20.17) × 103; and in nulliparous (225.00 ± 48.25) × 103 vs. primiparous (26.25 ± 8.26) × 103 vs. multiparous (67.50 ± 20.97) × 103 was significant (p < 0.05). Majority of attendees were at 3rd trimester at time of first antenatal visit. Prevalence of malaria parasitaemia in the first-time (48.6%), and multiple-time (52.6%) antenatal attendees was not significantly different (χ2 = 0.119, p = 0.730). The higher prevalence of malaria among bed net owners (69.6% vs. 42.9%, χ2 = 2.575, p = 0.109, OR = 3.048 (95% CI 0.765–12.135)) and users (66.7% vs. 33.3%, χ2 = 2.517, p = 0.113, OR = 4.000 (95% CI 0.693–23.089)) at multiple antenatal visits vs. first timers was not significant. None of the pregnant women examined used malaria preventive chemotherapy. Antenatal services at the hospital were not effective at preventing PAM. Holistic reviews reflecting recommendations made here can be adopted for effective service delivery. Full article
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Open AccessArticle
Retrospective Cohort Study to Assess the Risk of Rabies in Biting Dogs, 2013–2015, Republic of Haiti
Trop. Med. Infect. Dis. 2017, 2(2), 14; https://doi.org/10.3390/tropicalmed2020014
Received: 29 April 2017 / Revised: 29 May 2017 / Accepted: 6 June 2017 / Published: 12 June 2017
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Abstract
Background: In canine rabies endemic countries the World Health Organization recommends post-exposure prophylaxis (PEP) be initiated immediately after exposure to an animal suspected to have rabies. Limited capacity in low and middle income countries to assess biting animals for rabies may result in [...] Read more.
Background: In canine rabies endemic countries the World Health Organization recommends post-exposure prophylaxis (PEP) be initiated immediately after exposure to an animal suspected to have rabies. Limited capacity in low and middle income countries to assess biting animals for rabies may result in the over prescription of rabies biologics. Few guidelines exist to determine the risk of whether a dog that has bitten someone is rabid. Given PEP cost and access limitations in many countries, accurate and timely assessment of dogs that have bitten people may reduce unwarranted PEP use and improve healthcare seeking behaviors. Methods: Haiti’s animal rabies surveillance program utilizes veterinary professionals to conduct rabies assessments on reported biting dogs and records characteristics of the dog, health outcomes, and laboratory results in a national database. Characteristics of rabid dogs were assessed through a retrospective cohort study of biting dogs investigated during the period from January 2013–December 2015. 1409 biting dogs were analyzed; 1361 dogs that were determined to not have rabies were compared to 48 laboratory-confirmed rabid dogs. Rate ratios, sensitivity, specificity, positive predictive values, negative predictive values, likelihood ratios, quarantine survival of biting dogs, and a risk matrix were developed. Findings: The assessor’s determination that the animal likely had rabies was the most significant predictive factor for a rabid dog (RR = 413.4, 95% CI 57.33–2985, Sn = 79.17, Sp = 91.92). Clinical factors significantly associated with rabid dogs included hypersalivation, paralysis, and lethargy (RR = 31.2, 19.7, 15.4, respectively). Rabid dogs were 23.2 times more likely to be found dead at the time of the investigation compared to case negative dogs (95% CI 14.0–38.6). Rabid dogs were also significantly more likely to lack a history of rabies vaccination or be unowned (RR = 10.3 95% CI 2.5–42.3 and RR = 4.5 95% CI 2.0–10.1, respectively). Rabid dogs were four times more likely to have bitten multiple people (RR = 4.0 95% CI 1.9–8.3). Most rabid dogs died or were killed before quarantine (75%) and all died by day 3 of quarantine, compared to <1% of quarantined case-negatives. The greatest risk of death was predicted to be for persons bitten on the head or neck from symptomatic dogs. Bites from dogs deemed healthy by veterinary assessors and which were available for quarantine presented less than a 0.05% risk of rabies death to the victim. Conclusions: Vaccination of all persons exposed to a suspected rabid dog is a highly effective approach to minimize human rabies deaths. However, this may place undue financial burden on bite victims that have had a low-risk exposure and over-prescription may contribute to regional supply shortages. The results here indicate that in a low-resource country such as Haiti, a well-trained veterinary assessor can provide an accurate risk assessment of biting dogs based on a standard case investigation protocol. In canine rabies endemic countries with limited access to PEP, or where PEP costs may cause undue burden on bite victims, structured risk assessments by trained professionals may be a reliable method of triaging PEP for bite victims. Evaluating rabies risk through a matrix of bite location and risk factor in the dog presents a clear delineation of high and low risk encounters and should be used to develop data-derived PEP recommendations. Full article
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Open AccessArticle
Cost and Relative Value of Road Kill Surveys for Enhanced Rabies Surveillance in Raccoon Rabies Management
Trop. Med. Infect. Dis. 2017, 2(2), 13; https://doi.org/10.3390/tropicalmed2020013
Received: 7 March 2017 / Revised: 8 May 2017 / Accepted: 10 May 2017 / Published: 23 May 2017
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Abstract
Oral rabies vaccination (ORV) requires knowledge of the spatial-temporal distribution of rabies virus variants targeted for control. Rabies-exposure based public health surveillance alone may not provide a sound basis for ORV decisions. The value and cost of road kill surveys was evaluated for [...] Read more.
Oral rabies vaccination (ORV) requires knowledge of the spatial-temporal distribution of rabies virus variants targeted for control. Rabies-exposure based public health surveillance alone may not provide a sound basis for ORV decisions. The value and cost of road kill surveys was evaluated for the late spring–early fall 2005–2007 as a part of enhanced rabies surveillance in northern New York, where raccoon rabies is enzootic and ORV has occurred since the late 1990s. Structured surveys were conducted to collect raccoons and other meso-carnivores for rabies testing at the New York State Rabies Laboratory. Of the 209 meso-carnivore heads collected and submitted for testing, 175 were testable by direct fluorescent antibody; none was rabid. Rabies was also not reported through public health surveillance in survey zones during 2005–2007. Overall, survey costs were $37,118 (2016 USD). Salaries and benefits accounted for 61% of costs, followed by fuel (22%), vehicle depreciation (14%), and sample shipping (3%). Mean daily distance driven was 303 ± 37 km and 381 ± 28 km for total road kills and raccoons, respectively. Costs/road kill collected and submitted was $176/all species and $224/raccoon. This study provides costs for planning road kill surveys and underscores the need to continually improve enhanced rabies surveillance approaches to support ORV decision making. Full article
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Open AccessArticle
“HIV Changed My Life Forever”: An Illustrative Case of a Sub-Saharan African Migrant Woman Living with HIV in Belgium
Trop. Med. Infect. Dis. 2017, 2(2), 12; https://doi.org/10.3390/tropicalmed2020012
Received: 5 April 2017 / Revised: 15 May 2017 / Accepted: 16 May 2017 / Published: 23 May 2017
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Abstract
Living with HIV and AIDS changes everything for people diagnosed with HIV and it can be the most difficult experience in life. Like most people who have chronic diseases, these individuals have to deal with living a normal and quality life. Globally, more [...] Read more.
Living with HIV and AIDS changes everything for people diagnosed with HIV and it can be the most difficult experience in life. Like most people who have chronic diseases, these individuals have to deal with living a normal and quality life. Globally, more women (51%) than men are HIV positive. The main aim of this paper was to describe a sub-Saharan African migrant woman’s lived experience, and also to use the individual’s story to raise questions about the larger context after a HIV diagnosis. A qualitative study consisting of a personal story of a HIV-infected sub-Saharan African living in Belgium was conducted. Data were analysed using thematic analysis. The main themes that emerged from the data included relational risks, personal transformation and the search for normality, anxiety, depression, fear of stigma, societal gender norms, and support. The participant reported that marriage was no guarantee of staying HIV-free, especially in a male-dominant culture. This case further illustrates that married and unmarried African women are often at high risk of HIV and also informs us how HIV could spread, not only because of cultural practices but also because of individual behaviour and responses to everyday life situations. The participant also emphasized that she is faced with physical and mental health problems that are typical of people living with HIV. The vulnerability of sub-Saharan African women to HIV infection and their precarious health-related environments wherever they happen to be is further elucidated by this case. Full article
Open AccessArticle
Orientation of Head Lice on Human Hosts, and Consequences for Transmission of Pediculosis: The Head Lice Movement Studies
Trop. Med. Infect. Dis. 2017, 2(2), 11; https://doi.org/10.3390/tropicalmed2020011
Received: 13 March 2017 / Revised: 11 May 2017 / Accepted: 15 May 2017 / Published: 22 May 2017
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Abstract
We performed head lice movement studies to elucidate factors influencing orientation and movement of head lice. Studies included observation of lice movements on hand and forearm at different positions of the upper limb; movements exposed to unshaved and shaved forearm; and movements with [...] Read more.
We performed head lice movement studies to elucidate factors influencing orientation and movement of head lice. Studies included observation of lice movements on hand and forearm at different positions of the upper limb; movements exposed to unshaved and shaved forearm; and movements with and without antennae. In 57 of 60 (95.0%) observations while holding the hand down, lice moved proximal, and 3 (5%) distal. While holding the hand up, 37/60 (61.7%) moved proximal, and 23 (38.3%) distal (p < 0.0001). On the unshaved limb, 29/30 (96.7%) moved proximal, with clockwise movements in 26/30 (86.7%). After shaving, 9/30 (30%) walked proximal and 18 (60%) distal, with 12/30 (40%) clockwise movements. After antennectomy, while holding the hand up, 16/25 (64%) lice did not move, 1 (4%) walked proximal, and 8 (32%) distal. While handing the hand down, 17/25 (68%) did not move, 5 (20%) walked proximal, and 3 (12%) distal. Transmission of head lice may not only occur by head-to-head contact, but also via head-to-body contact, with movement to the head against gravitational pull. Surface factors of hand and forearm may be important in orientation for lice, in addition to gravity. Movement of lice against gravity is not governed by organs in the antennae. Full article
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Open AccessPerspective
Childhood Rabies Deaths and the Rule of Rescue
Trop. Med. Infect. Dis. 2017, 2(2), 9; https://doi.org/10.3390/tropicalmed2020009
Received: 6 January 2017 / Revised: 7 April 2017 / Accepted: 11 April 2017 / Published: 17 April 2017
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Abstract
Every childhood rabies death is potentially preventable. The vaccine that prevents rabies disease has a formidable safety and efficacy track record. Rabies vaccination of dogs and timely pre-and post-exposure vaccine administration are life-saving and cost-effective, and yet nearly 60,000 people, mainly children, die [...] Read more.
Every childhood rabies death is potentially preventable. The vaccine that prevents rabies disease has a formidable safety and efficacy track record. Rabies vaccination of dogs and timely pre-and post-exposure vaccine administration are life-saving and cost-effective, and yet nearly 60,000 people, mainly children, die unnecessarily each year. Poor performance by many veterinary and public health systems, and neglect by complicit authorities is in stark contravention of the Convention on the Rights of the Child. The ethical principle of beneficence and the rule of rescue demand re-energised commitment to eradicating childhood rabies deaths. Full article
Open AccessArticle
Epidemiology and Characteristics of Rickettsia australis (Queensland Tick Typhus) Infection in Hospitalized Patients in North Brisbane, Australia
Trop. Med. Infect. Dis. 2017, 2(2), 10; https://doi.org/10.3390/tropicalmed2020010
Received: 22 March 2017 / Revised: 9 April 2017 / Accepted: 10 April 2017 / Published: 15 April 2017
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Abstract
Queensland Tick Typhus (QTT; Rickettsia australis) is a Spotted Fever Group (SFG) rickettsial infection endemic to Australia. It is an underreported and often unrecognized illness with poorly defined epidemiology. This article describes epidemiological features and the geographical distribution of QTT in hospitalized [...] Read more.
Queensland Tick Typhus (QTT; Rickettsia australis) is a Spotted Fever Group (SFG) rickettsial infection endemic to Australia. It is an underreported and often unrecognized illness with poorly defined epidemiology. This article describes epidemiological features and the geographical distribution of QTT in hospitalized patients. Cases of QTT were identified retrospectively from 2000–2015 at five sites in Northern Brisbane through a pathology database. Included cases had a four-fold rise in SFG-specific serology, a single SFG-specific serology ≥256 or an SFG-specific serology ≥128 with a clinically consistent illness. Of the fifty cases identified by serology, 36 were included. Age ranged from 3–72 years (with a mean of 39.5 years) with a male-to-female ratio of 1:1.1. Fifteen of 36 (42%) study participants had hobbies and/or occupations linked with the acquisition of the disease. Seventeen of 36 (47%) identified a tick bite in the days preceding presentation to hospital, and reported exposure to a known animal host was minimal (25%). QTT infection occurred throughout the year, with half reported between April and July. Recent ecological and sociocultural changes have redefined the epidemiology of this zoonotic illness, with areas of heightened infection identified. Heightened public health awareness is required to monitor QTT disease activity. Full article
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Open AccessArticle
Using Spatial Video to Analyze and Map the Water-Fetching Path in Challenging Environments: A Case Study of Dar es Salaam, Tanzania
Trop. Med. Infect. Dis. 2017, 2(2), 8; https://doi.org/10.3390/tropicalmed2020008
Received: 26 January 2017 / Revised: 11 March 2017 / Accepted: 4 April 2017 / Published: 11 April 2017
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Abstract
Access to clean drinking water remains a significant health problem in the developing world. Traditional definitions of water access oversimplify the geographic context of water availability, the burden of water collection, and challenges faced along the path, mainly due to a lack of [...] Read more.
Access to clean drinking water remains a significant health problem in the developing world. Traditional definitions of water access oversimplify the geographic context of water availability, the burden of water collection, and challenges faced along the path, mainly due to a lack of fine scale spatial data. This paper demonstrates how spatial video collected in three informal areas of Dar es Salaam, Tanzania, can be used to quantify aspects of the walk to water. These include impediments encountered along the path such as changes in elevation and proximity to traffic. All are mapped along with classic health-related environmental and social information, such as standing water, drains, and trash. The issue of GPS error was encountered due to the built environment that is typical of informal settlements. The spatial video allowed for the correction of the path to gain a more accurate estimate of time and distance for each walk. The resulting mapped health risks at this fine scale of detail reveal micro-geographies of concern. Spatial video is a useful tool for visualizing and analyzing the challenges of water collection. It also allows for data generated along the walk to become part of both a household and local area risk assessment. Full article
(This article belongs to the Special Issue Slum Health: Diseases of Neglected Populations)
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Open AccessArticle
Relative Performance and Predictive Values of Plasma and Dried Blood Spots with Filter Paper Sampling Techniques and Dilutions of the Lymphatic Filariasis Og4C3 Antigen ELISA for Samples from Myanmar
Trop. Med. Infect. Dis. 2017, 2(2), 7; https://doi.org/10.3390/tropicalmed2020007
Received: 11 February 2017 / Revised: 27 March 2017 / Accepted: 4 April 2017 / Published: 11 April 2017
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Abstract
Diagnostic testing of blood samples for parasite antigen Og4C3 is used to assess Wuchereria bancrofti in endemic populations. However, the Tropbio ELISA recommends that plasma and dried blood spots (DBS) prepared using filter paper be used at different dilutions, making it uncertain whether [...] Read more.
Diagnostic testing of blood samples for parasite antigen Og4C3 is used to assess Wuchereria bancrofti in endemic populations. However, the Tropbio ELISA recommends that plasma and dried blood spots (DBS) prepared using filter paper be used at different dilutions, making it uncertain whether these two methods and dilutions give similar results, especially at low levels of residual infection or resurgence during the post-program phase. We compared results obtained using samples of plasma and DBS taken simultaneously from 104 young adults in Myanmar in 2014, of whom 50 (48.1%) were positive for filariasis antigen by rapid antigen test. Results from DBS tests at recommended dilution were significantly lower than results from plasma tested at recommended dilution, with comparisons between plasma and DBS at unmatched dilutions yielding low sensitivity and negative predictive values of 60.0% and 70.6% respectively. While collection of capillary blood on DBS is cheaper and easier to perform than collecting plasma or serum, and does not need to be stored frozen, dilutions between different versions of the test must be reconciled or an adjustment factor applied. Full article
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Open AccessArticle
Concordance between Plasma and Filter Paper Sampling Techniques for the Lymphatic Filariasis Bm14 Antibody ELISA
Trop. Med. Infect. Dis. 2017, 2(2), 6; https://doi.org/10.3390/tropicalmed2020006
Received: 20 February 2017 / Revised: 27 March 2017 / Accepted: 4 April 2017 / Published: 7 April 2017
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Abstract
Diagnostic testing for the antibody Bm14 is used to assess the prevalence of bancroftian and brugian filariasis in endemic populations. Using dried blood spots (DBS) collected on filter paper is ideal in resource-poor settings, but concerns have been raised about the performance of [...] Read more.
Diagnostic testing for the antibody Bm14 is used to assess the prevalence of bancroftian and brugian filariasis in endemic populations. Using dried blood spots (DBS) collected on filter paper is ideal in resource-poor settings, but concerns have been raised about the performance of DBS samples compared to plasma or serum. In addition, two versions of the test have been used: the Bm14 CELISA (Cellabs Pty Ltd., Manly, Australia) or an in-house CDC version. Due to recent improvements in the CELISA, it is timely to validate the latest versions of the Bm14 ELISA for both plasma and DBS, especially in settings of residual infection with low antibody levels. We tested plasma and DBS samples taken simultaneously from 92 people in Myanmar, of whom 37 (40.2%) were positive in a rapid antigen test. Comparison of results from plasma and DBS samples demonstrated no significant difference in positive proportions using both the CELISA (46.7% and 44.6%) and CDC ELISA (50.0% and 47.8%). Quantitative antibody unit results from each sample type were also highly correlated, with coefficients >0.87. The results of this study demonstrate that DBS samples are a valid collection strategy and give equivalent results to plasma for Bm14 antibody ELISA testing by either test type. Full article
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Open AccessReview
Four Thousand Years of Concepts Relating to Rabies in Animals and Humans, Its Prevention and Its Cure
Trop. Med. Infect. Dis. 2017, 2(2), 5; https://doi.org/10.3390/tropicalmed2020005
Received: 20 February 2017 / Revised: 16 March 2017 / Accepted: 17 March 2017 / Published: 24 March 2017
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Abstract
The epitome of the One Health paradigm—and of its shortcomings—rabies has been known to humankind for at least 4000 years. We review the evolution through history of concepts leading to our current understanding of rabies in dogs and humans and its prevention, as [...] Read more.
The epitome of the One Health paradigm—and of its shortcomings—rabies has been known to humankind for at least 4000 years. We review the evolution through history of concepts leading to our current understanding of rabies in dogs and humans and its prevention, as transmitted by accessible and surviving written texts. The tools and concepts currently available to control rabies were developed at the end of the 19th Century, including the first live, attenuated vaccine ever developed for humans and the first post-exposure prophylaxis (PEP) regimen. No progress, however, has been made in etiological treatment, leaving clinicians who provide care to animals or patients with symptomatic rabies as powerless today as their colleagues in Mesopotamia, 40 centuries ago. Rabies remains to date the most lethal infectious disease known to humans. Widespread access to timely, effective, and affordable PEP in rural areas of developing countries is urgently needed. Full article
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