Integrated strategy for dengue prevention and control in the Region of the Americas]

During the last 22 years, the Region of the Americas has seen an upward trend in dengue incidence, with epidemics peaking ever higher and recurring every 3-5 years, almost regularly. A major factor in the spread of the disease has been the diminished capacity of national programs to respond with dengue prevention and control. This paper evaluates the Integrated Strategy for Dengue Prevention and Control-approved by the 44th Directing Council of the Pan American Health Organization in September 2003- and its preliminary results. The Integrated Strategy for Dengue is a management model designed to strengthen national programs, with a focus on reducing morbidity, mortality, and the societal and economic burdens produced by outbreaks and epidemics. Currently, 11 of the countries in the Region have developed a plan for or implemented a national strategy. In addition, a sub-Regional plan has been developed for Central America and the Dominican Republic. The Integrated Strategy for Dengue is expected to produce a qualitative leap forward in prevention and control through stronger partnerships among the State, its various ministries, and governing bodies, at all levels; private companies; and the range of community and civil groups. Once implemented, this strategy will reduce risk factors for dengue transmission, establish an integrated epidemiological surveillance system, decrease Aedes aegypti mosquito populations, prepare laboratories to better detect and identify the virus, optimize diagnosis and treatment, and, as a result, decrease the frequency, magnitude, and severity of dengue outbreaks and epidemics.     

Expanding control banding for workplace silica exposures throughout the Americas

Abstract

Background: Silicosis, a lung disease caused by inhaling respirable crystalline silica dust, is an occupational illness affecting millions of workers worldwide. The National Institute for Occupational Safety and Health (NIOSH) has partnered with the World Health Organization, the International Labour Organization, and multiple agencies in the Americas to implement the program “The Elimination of Silicosis in the Americas”.

Objectives: One component of this program is control banding, a qualitative risk assessment and management strategy that allows non-experts to use task-based hazard data and potential exposure information to determine appropriate controls.

Results: From 2005 to the present, NIOSH occupational health researchers have worked with experts in Chile, Peru, Colombia, and Brazil to assess, implement, and provide tools to evaluate the use of control banding methodology.     

Increase in imported dengue, Germany, 2001-2002

Dengue fever is a reportable disease in Germany. Surveillance data from 2001 and 2002 were analyzed and compared to travel patterns. Imported dengue fever increased strongly in this time. Most infections were acquired in Southeast Asia, specifically Thailand. The 2002 epidemic in Brazil was also reflected in these data.     

Travel-associated dengue infections--United States, 2001-2004

Dengue is a mosquito-transmitted, acute viral disease caused by any of the four dengue virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4). Dengue is endemic in most tropical and subtropical areas of the world and has occurred in U.S. residents returning from travel to such areas. CDC maintains a laboratory-based passive surveillance system for travel-associated dengue among U.S. residents. The system relies on voluntary reports submitted to state health departments by clinicians; patient specimens are then forwarded to CDC for diagnostic testing. This report summarizes information about travel-associated dengue cases among U.S. residents during 2001-2004. The risk for dengue infection among travelers can be reduced by use of repellents and by avoiding exposure to mosquitoes.     

Quality control of immunologic testing of blood in the Region of the Americas]

Assuring the best quality in transfusion medicine necessarily involves exercising exhaustive control over the entire system and developing protocols for procedures and techniques, the reagents and equipment used, personnel training, and so on. Additional guarantees can come from adequately organizing the work and perhaps automating processes in order to avoid errors. Another way to avoid errors in the laboratory is to register and continuously analyze the mistakes that do occur, since that makes it necessary to change procedures in order to avoid repeating them. External quality control programs (EQCP) make it possible to perform a periodic overall assessment of the suitability of techniques, reagents, and training of personnel in relation to the validity of the results obtained. By voluntarily participating in an EQCP, the blood center shows its commitment to the quality of care. In the Region of the Americas, the Pan American Health Organization's Immunohematology Quality Control Program has made it possible to objectively quantify the improvement attained in the formative level reached by participating blood banks in the four years the Program has been in operation.     

Laboratory surveillance of dengue in Argentina, 1995-2001

Local transmission of dengue fever virus in Argentina is increased by the presence of Aedes aegypti mosquitoes and dengue outbreaks in neighboring countries. From 1995 to 2001, a laboratory-based active surveillance program detected 922 dengue cases. Indigenous transmission involving dengue-1 and -2 serotypes was confirmed only in subtropical areas in northern Argentina.     

Reliability of the final dengue diagnosis in the epidemic occurring in Rio de Janeiro, Brazil, 2001-2002

This study analyzed the reliability of the final diagnosis in the 155,242 dengue reports during the 2001-2002 epidemic in the city of Rio de Janeiro, Brazil, using the official information system on communicable diseases (SINAN). The system allows the following options for the final diagnosis: classic dengue, dengue hemorrhagic fever, discarded, inconclusive, and unknown. We built a classification routine in Epi Info to compare the final diagnosis from SINAN with Ministry of Health criteria. According to the final diagnosis, the case breakdown was: 52.4% classic dengue; 0.6% dengue hemorrhagic fever; 0.9% discarded; 46% inconclusive and unknown. The revised diagnosis showed that 78% of classic dengue, 69% of dengue hemorrhagic fever, and 21.1% of discarded cases met the classification criteria. Although the reliability of the SINAN final diagnosis was generally satisfactory (kappa = 0.681; 95%CI: 0.685-0.677), it was worse for fatal cases (kappa = 0.152; 95%CI: 0.046-0.258). Considering the epidemic's magnitude, the final diagnosis of classic dengue and dengue hemorrhagic fever was satisfactory, but the high proportion of inconclusive or unknown cases and the poor quality of information for fatal cases limit the usefulness of SINAN in this context.     

Risk perception and strategies for mass communication on dengue in the Americas]

Dengue is clearly a very serious public health problem. In the Americas the number of dengue cases has been increasing since the 1960s, and outbreaks of the disease have been occurring more frequently. Furthermore, the density of infestation with the disease vector, the Aedes aegypti mosquito, is high in the Americas. The general strategy for preventing and controlling dengue and dengue hemorrhagic fever is based on promoting behavior changes that lead to incorporating the community in controlling the disease, particularly the vector. In order to achieve this, mass communication programs on dengue should have two primary aims: converting information into practice and encouraging the community to take over prevention and control measures. The new generation of programs should be designed based on the local sanitation structure (water distribution and waste disposal) as well as information on community organizations and the roles of different family members. Furthermore, the new programs should incorporate all the following ten components: epidemiological surveillance, intersectoral actions, community participation, managing the environment and basic services, patient care, case reporting, education, using insecticides and vector control, training, and preparing for emergencies. Communication should be aimed at modifying the behavior of individuals and the community by empowering them to carry out prevention and control measures.     

湛江市1996～2001年麻疹流行病学调查

目的　调查 1 996～ 2 0 0 1年湛江市麻疹的流行病学情况 ,了解加强免疫对麻疹疫情控制的效果。方法　麻疹加强免疫接种按《广东省 1 998年控制麻疹加强免疫活动实施计划》的方法进行。1 998年 9月中旬对全市范围内 4～ 7岁儿童进行一次麻疹疫苗加强接种 ;1 999年后凡年满 4岁的儿童均接受麻疹疫苗加强免疫接种 ;同时收集 1 996～ 2 0 0 1年各县 (市、区 )与麻疹发病有关的各种流行病学资料进行分析比较。结果　麻疹发病相对集中在 3～ 5月 ,1～ 6岁学龄前儿童为高发人群 ,县级市麻疹发病率比市区高。全市麻疹加强免疫接种前三年 (1 996～ 1 998年 )麻疹发病率为 4 86 / 1 0万 ;麻疹加强免疫接种后三年 (1 999～ 2 0 0 1年 )麻疹发病率为 2 6 8/ 1 0万 ,两者比较差异有显著性 (P <0 0 1 )。结论　麻疹疫苗加强免疫接种后麻疹的发病率明显下降 ,加强免疫对控制麻疹疫情有显著效果     

Quality of drinking water and diarrheal diseases in Cuba, 1996-1997]

A study was conducted in 1996 and 1997 in 31 Cuban cities having a population greater than 35,000, in order to determine if there was a relationship between drinking water quality and the frequency of acute diarrheal diseases (ADD). We used the level of disinfection (based on chlorine concentration) as well as the level of bacterial contamination (based on the presence of coliform bacteria) as water quality indicators, and the frequency of ADD was calculated on the basis of the number of visits (per 100,000 inhabitants) to individual family physicians and to physicians on call in hospitals and polyclinics that were prompted by ADD. Weekly determinations of chlorine concentrations and monthly measurements of bacterial contamination were performed by taking daily water samples at 2,045 key sites along the water distribution channels in the cities included in the study. In 1996 and 1997, the percentages of samples with good chlorination (residual chlorine > or = 0.3 mg/L) for the entire country were 72.4% and 74.8%, respectively, whereas the percentages of samples with little bacterial contamination (most probable number [MPN] of fecal coliform bacteria < or = 9.2/100 mL) were 87.0% and 76.5%, respectively. Logistic regression revealed, at the local level, an inverse correlation between each of these percentages and the number of medical consultations for ADD (per 100,000 inhabitants), although it was not statistically significant. These results allowed the authors to stratify the cities included in the study according to their different levels of risk for ADD: high risk (23 cities), moderate risk (8 cities), and low risk (0 cities).     

Lessons learned during dengue outbreaks in the United States, 2001-2011

Since 2001, three autochthonous dengue fever outbreaks have occurred in the United States: in Hawaii (2001); Brownsville, Texas (2005); and southern Florida (2009-2011). We sought to characterize and describe the response to these outbreaks from the perspectives of public health and vector control officials. By conducting a medical literature review through PubMed and news media searches through Google, we identified persons involved in managing each outbreak; 26 persons then participated in qualitative, semistructured interviews. After analyzing the 3 outbreaks, we found the following prominent themes in the response efforts: timely detection of illness; communication of up-to-date, correct information; and development of a rapid response that engages the community. We therefore recommend that public health authorities involve the clinical and laboratory community promptly, provide accurate information, and engage the local community in vector control and case identification and reporting.     

广东省2001-2006年登革热流行病学分析

目的分析广东省近年来登革热疫情特点及流行规律,为制定预防控制措施提供依据。方法收集广东省2001-2006年登革热疫情资料,用描述性流行病学方法分析其流行特征和流行因素。结果2001-2006年广东省共报告登革热本地病例2 897例,报告外地病例320例,年发病率在0.01/10万~1.77/10万之间。疫情涉及12个市,主要集中于广州(73.89%)、汕头(6.99%)、阳江(5.10%)、中山(4.78%)等市。3-12月均有病例报告,6-11月为流行期,8-10月为发病高峰期(占88.90%)。男女性别比例为1∶1.07;各年龄组均有发病,但发病数以15~54岁年龄组居多(占73.72%),发病率以20~44、60~69岁年龄人群居高;职业以家务及待业、农民、学生、工人和离退人员为主。每年均有国外输入病例报告,病例输入地主要以新加坡、印尼、柬埔寨等东南亚地区为主。51起本地暴发疫情中,除1起疫情为登革Ⅱ型病毒引起外,其余均为登革Ⅰ型病毒引起。结论广东省登革热仍为输入或输入引起的本地传播的传染病,珠江三角洲和粤东地区应为广东省登革热预防控制的重点地区。     

Heat-related deaths--Chicago,Illinois, 1996-2001, and United States, 1979-1999

Heat waves (i.e., >/=3 consecutive days of air temperatures >/=90 degrees F [>/=32.2 degrees C]) are meteorologic events that contribute significantly to heat-related deaths. Exposure to excessive heat can cause illness, injury, and death. This report describes four cases of heat-related deaths, as reported by the Office of the Medical Examiner, Cook County, Chicago, that occurred during 1996-2001; summarizes total heat-related deaths in Chicago during 1996-2001; and compares the number of heat-related deaths during the 1995 and 1999 Chicago heat waves. This report also summarizes trends in the United States during 1979-1999, describes risk factors associated with heat-related deaths and symptoms, and outlines preventive measures for heat-related illness, injury, and death. Persons at risk for heat-related death should reduce strenuous outdoor activities, drink water or nonalcoholic beverages frequently, and seek air conditioning.     

Assessing medical expenditures on 4 smoking-related diseases, 1996-2001

OBJECTIVE: To examine the current-period cost of treating 4 major smoking-related diseases: lung cancer, chronic obstructive pulmonary disease, ischemic heart disease, and cerebrovascular disease. METHODS: Analyses are based on the MarketScan database, a medical claims database from large employers. RESULTS: We found that total expenditures to treat ischemic heart disease were highest, followed by those to treat chronic obstructive pulmonary disease (COPD). When median expenditures per claim and disease severity were considered, lung cancer was the most expensive condition to treat and ischemic heart disease the least expensive. Median treatment expenditures increased as the severity of disease increased. CONCLUSION: Treating smoking-related diseases is costly in the current-period and over a lifetime.     

Effects of the El Ni?o-Southern Oscillation on dengue epidemics in Thailand, 1996-2005

Background  

Despite intensive vector control efforts, dengue epidemics continue to occur throughout Southeast Asia in multi-annual cycles. Weather is considered an important factor in these cycles, but the extent to which the El Ni?o-Southern Oscillation (ENSO) is a driving force behind dengue epidemics remains unclear.