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A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

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A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

PLoS One. 2019;14(7):e0220102

Authors: Santaus TM, Li S, Saha L, Chen WH, Bhagat S, Stine OC, Geddes CD

Abstract
The ability for safe and rapid pathogenic sample transportation and subsequent detection is an increasing challenge throughout the world. Herein, we describe and use bead-beating, vortex, sonication, 903 protein saver cards, and Lyse-It methods, aiming to inactivate Gram-positive and -negative bacteria with subsequent genome DNA (quantitative Polymerase Chain Reaction) qPCR detection. The basic concepts behind the four chosen technologies is their versatility, cost, and ease of use in developed and underdeveloped countries. The four methods target the testing of bacterial resilience, cellular extraction from general and complex media and subsequent DNA extraction for qPCR detection and amplification. These results demonstrate that conventional high temperature heating, 903 protein saver cards, and Lyse-It are all viable options for inactivating bacterial growth for safe shipping. Additionally, Lyse-It was found to be particularly useful as this technology can inactivate bacteria, extract cells from 903 protein saver cards, lyse bacterial cells, and additionally keep genomic DNA viable for qPCR detection.

PMID: 31335892 [PubMed - in process]

Cholera in selected countries in Asia.

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Cholera in selected countries in Asia.

Vaccine. 2019 Jul 17;:

Authors: Lopez AL, Dutta S, Qadri F, Sovann L, Pandey BD, Bin Hamzah WM, Memon I, Iamsirithaworn S, Dang DA, Chowdhury F, Heng S, Kanungo S, Mogasale V, Sultan A, Ylade M

Abstract
INTRODUCTION: Although the current pandemic of cholera originated in Asia, reports of cholera cases and outbreaks in the region are sparse. To provide a sub-regional assessment of cholera in South and Southeast Asia, we collated published and unpublished data from existing surveillance systems from Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam.
METHODS: Data from existing country surveillance systems on diarrhea, acute watery diarrhea, suspected cholera and/or confirmed cholera in nine selected Asian countries (Bangladesh, Cambodia, India, Malaysia, Nepal, Pakistan, Philippines, Thailand and Vietnam) from 2011 to 2015 (or 2016, when available) were collated. We reviewed annual cholera reports from WHO and searched PubMed and/or ProMED to complement data, where information is not completely available.
RESULTS: From 2011 to 2016, confirmed cholera cases were identified in at least one year of the 5- or 6-year period in the countries included. Surveillance for cholera exists in most countries, but cases are not always reported. India reported the most number of confirmed cases with a mean of 5964 cases annually. The mean number of cases per year in the Philippines, Pakistan, Bangladesh, Malaysia, Nepal and Thailand were 760, 592, 285, 264, 148 and 88, respectively. Cambodia and Vietnam reported 51 and 3 confirmed cholera cases in 2011, with no subsequent reported cases.
DISCUSSION AND CONCLUSION: We present consolidated results of available surveillance in nine Asian countries and supplemented these with publication searches. There is paucity of readily accessible data on cholera in these countries. We highlight the continuing existence of the disease even in areas with improved sanitation and access to safe drinking water. Continued vigilance and improved surveillance in countries should be strongly encouraged.

PMID: 31326255 [PubMed - as supplied by publisher]

Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

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Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

J Public Health (Oxf). 2019 Jul 19;:

Authors: Mwenda V, Niyomwungere A, Oyugi E, Githuku J, Obonyo M, Gura Z

Abstract
BACKGROUND: Cholera globally affects 1.3-4.0 million people and causes 21 000-143 000 deaths annually. In June 2017, a cluster of diarrhoeal illness occurred among participants of an international scientific conference at a hotel in Nairobi, Kenya. Culture confirmed Vibrio cholerae, serotype Ogawa. We investigated to assess magnitude, identify likely exposures and suggest control measures.
METHODS: We carried out a retrospective cohort study utilizing a structured questionnaire administered by telephone, email and internet-based survey. We calculated food-specific attack rates, risk ratios and in a nested-case control analysis, performed logistic regression to identify exposures independently associated with the outbreak.
RESULTS: We interviewed 249 out of 456 conference attendees (response rate=54.6%). Mean age of respondents was 37.8 years, ±8.3 years, 131 (52.6%) were male. Of all the respondents, 137 (55.0%) were cases. Median incubation time was 35 (11-59) hours. Eating chicken (adjusted OR 2.49, 95% CI, 1.22-5.06) and having eaten lunch on Tuesday (adjusted OR 2.34, 95% CI 1.09-5.05) were independently associated with illness; drinking soda was protective (adjusted OR 0.17, 95% CI 0.07-0.42).
CONCLUSION: Point source outbreak, associated with chicken eaten at lunch on Tuesday 20th June 2017 occurred. We recommend better collaboration between the food and health sectors in food-borne outbreak investigations.

PMID: 31322662 [PubMed - as supplied by publisher]

A case of severe cholera imported from Bangladesh to Italy, 2017.

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A case of severe cholera imported from Bangladesh to Italy, 2017.

Travel Med Infect Dis. 2019 May - Jun;29:60-62

Authors: Ricaboni D, Bozzoni M, Riario Sforza GG, Rimoldi SG, Antinori S

PMID: 31055045 [PubMed - indexed for MEDLINE]

Climate change, cyclones and cholera - Implications for travel medicine and infectious diseases.

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Climate change, cyclones and cholera - Implications for travel medicine and infectious diseases.

Travel Med Infect Dis. 2019 May - Jun;29:6-7

Authors: Varo R, Rodó X, Bassat Q

PMID: 31029753 [PubMed - indexed for MEDLINE]

Micro-Space Complexity and Context in the Space-Time Variation in Enteric Disease Risk for Three Informal Settlements of Port au Prince, Haiti.

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Micro-Space Complexity and Context in the Space-Time Variation in Enteric Disease Risk for Three Informal Settlements of Port au Prince, Haiti.

Int J Environ Res Public Health. 2019 03 05;16(5):

Authors: Curtis A, Squires R, Rouzier V, Pape JW, Ajayakumar J, Bempah S, Taifur Alam M, Alam MM, Rashid MH, Ali A, Morris JG

Abstract
Diffusion of cholera and other diarrheal diseases in an informal settlement is a product of multiple behavioral, environmental and spatial risk factors. One of the most important components is the spatial interconnections among water points, drainage ditches, toilets and the intervening environment. This risk is also longitudinal and variable as water points fluctuate in relation to bacterial contamination. In this paper we consider part of this micro space complexity for three informal settlements in Port au Prince, Haiti. We expand on more typical epidemiological analysis of fecal coliforms at water points, drainage ditches and ocean sites by considering the importance of single point location fluctuation coupled with recording micro-space environmental conditions around each sample site. Results show that spatial variation in enteric disease risk occurs within neighborhoods, and that while certain trends are evident, the degree of individual site fluctuation should question the utility of both cross-sectional and more aggregate analysis. Various factors increase the counts of fecal coliform present, including the type of water point, how water was stored at that water point, and the proximity of the water point to local drainage. Some locations fluctuated considerably between being safe and unsafe on a monthly basis. Next steps to form a more comprehensive contextualized understanding of enteric disease risk in these environments should include the addition of behavioral factors and local insight.

PMID: 30841596 [PubMed - indexed for MEDLINE]

Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa.

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Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa.

Am J Trop Med Hyg. 2018 04;98(4):1021-1030

Authors: Nadri J, Sauvageot D, Njanpop-Lafourcade BM, Baltazar CS, Banla Kere A, Bwire G, Coulibaly D, Kacou N'Douba A, Kagirita A, Keita S, Koivogui L, Landoh DE, Langa JP, Miwanda BN, Mutombo Ndongala G, Mwakapeje ER, Mwambeta JL, Mengel MA, Gessner BD

Abstract
During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.

PMID: 29488455 [PubMed - indexed for MEDLINE]

Dengue fever in a municipality of West Bengal, India, 2015: An outbreak investigation.

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Dengue fever in a municipality of West Bengal, India, 2015: An outbreak investigation.

Indian J Public Health. 2017 Oct-Dec;61(4):239-242

Authors: Debnath F, Ponnaiah M, Acharya P

Abstract
BACKGROUND: In November 2015, death due to fever and increased number of fever cases were reported from Baranagar Municipality of North 24 Parganas district of West Bengal.
OBJECTIVES: The episode was investigated with the objective to (1) confirm the existence of an outbreak, (2) describe it in terms of time, place, and person, (3) determine the cause of outbreak, and (4) recommend control measures.
METHODS: Monthly incidence of dengue from 2012 to 2014 was calculated and compared with 2015 to confirm the outbreak. We used Integrated Disease Surveillance Programme definition and searched for suspect dengue cases going door-to-door in ward number one of Baranagar Municipality. Active case search was done in health facilities also. Information on date of onset, symptoms, sociodemographic, serological reports, and clinical outcome for suspected and confirmed dengue cases was collected. Blood specimens were collected for NS1 ELISA/monoclonal IgM antibody capture-ELISA test. Environmental and entomological surveys were done.
RESULTS: Six hundred and seventy-one dengue cases (Overall attack rate = 3/1000), two deaths (Case fatality = 3/1000) were reported during September 14, 2015, till December 12, 2015. Out of 34 wards, attack rate was highest in ward number 1 (0.7%) and was 3 per 1000 among females. All age groups were affected. Thirty-two percent required hospitalization. NS1 ELISA was positive for 612 cases. Out of interviewed 31 dengue cases, 94% had headache, 90% had myalgia, followed by arthralgia, rash, and retro-orbital pain. Only in ward number 1, house index was >5%.
CONCLUSION: We confirmed dengue outbreak. All age groups got affected. Deaths occurred in this outbreak. Potential breeding sources were present in ward number 1.

PMID: 29219127 [PubMed - indexed for MEDLINE]

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis.

Psychol Med. 2019 Jul 12;:1-13

Authors: Wu Y, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Boruff J, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Conwell Y, de Man-van Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki MD, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford MD, Sung S, Tan PLL, Turner A, van Weert HC, White J, Whooley MA, Winkley K, Yamada M, Benedetti A, Thombs BD

Abstract
BACKGROUND: Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
METHODS: We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
RESULTS: 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
CONCLUSIONS: PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

PMID: 31298180 [PubMed - as supplied by publisher]

Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa.

Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa.

AIDS Behav. 2019 Jul 11;:

Authors: Belus JM, Cholera R, Miller WC, Bassett J, Gaynes BN

Abstract
Psychiatric comorbidity, the presence of two or more psychiatric disorders, leads to worse HIV outcomes in the United States; this relationship has not been studied in sub-Saharan Africa. We conducted a preliminary study to describe the prevalence of psychiatric comorbidity (unipolar mood, anxiety, and trauma disorders) among 363 adults prior to HIV testing at Witkoppen Health and Welfare Centre, a primary care clinic in Johannesburg, South Africa. We also examined whether psychiatric comorbidity predicted subsequent linkage to HIV care 3 months later. Prevalence of psychiatric comorbidity prior to HIV testing was approximately 5.5%. In the final HIV-positive subsample (n = 76), psychiatric comorbidity of unipolar mood, anxiety, and trauma disorders did not predict linkage to care [adjusted relative risk = 1.01 (0.59, 1.71)] or number of follow-up appointments (adjusted relative risk = 0.86 (0.40, 1.82)]. A similar psychiatric profile emerged for HIV-positive and HIV-negative individuals before becoming aware of their HIV status. The psychiatric burden typically seen in HIV-positive individuals may manifest over time.

PMID: 31297682 [PubMed - as supplied by publisher]

Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria.

Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria.

Diagn Microbiol Infect Dis. 2019 May 30;:

Authors: Bankole OT, Ajayi IO

Abstract
This study assessed the capacity of public secondary facility-based laboratories in conducting diagnostic tests for selected epidemic-prone diseases in Oyo State, Nigeria. A descriptive cross-sectional study was conducted in 17 secondary facility-based laboratories in Oyo State. Capacity was assessed on a 100-point scale in which scores were rated low (≤49%), fair (50-79%) and good (≥80%). Diagnostic testing capacity for bacterial meningitis, cholera, and measles was "low" in all the laboratories. The reasons reported for laboratories not conducting diagnostic tests for the selected diseases included inadequate instruments, unavailable reagents, and clinicians' failure to request those diagnostic tests. Laboratory capacity to perform diagnostic tests for the selected diseases was low in Oyo State secondary hospitals. There is a need for the provision of modern instruments and reagents, as well as clinician laboratorian quality assurance programs, to improve diagnostic services relating to the selected diseases.

PMID: 31296359 [PubMed - as supplied by publisher]

Pathogen genomics: Genomics in the time of cholera.

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Pathogen genomics: Genomics in the time of cholera.

Nat Rev Genet. 2018 01;19(1):3

Authors: Perdigoto C

PMID: 29199282 [PubMed - indexed for MEDLINE]

Vaccines for enteric diseases.

Vaccines for enteric diseases.

Hum Vaccin Immunother. 2019;15(6):1205-1214

Authors: Cohen D, Muhsen K

PMID: 31291174 [PubMed - in process]

Safety of a bivalent, killed, whole-cell oral cholera vaccine in pregnant women in Bangladesh: evidence from a randomized placebo-controlled trial.

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Safety of a bivalent, killed, whole-cell oral cholera vaccine in pregnant women in Bangladesh: evidence from a randomized placebo-controlled trial.

BMC Infect Dis. 2019 May 15;19(1):422

Authors: Khan AI, Ali M, Lynch J, Kabir A, Excler JL, Khan MA, Islam MT, Akter A, Chowdhury F, Saha A, Khan IA, Desai SN, Kim DR, Saha NC, Singh AP, Clemens JD, Qadri F

Abstract
BACKGROUND: Cholera increases the risk of harmful effects on foetuses. We prospectively followed pregnant women unaware of their pregnancy status who received a study agent in a clinical trial evaluating the association between exposure to an oral cholera vaccine (OCV) and foetal survival.
METHODS: Study participants were selected from a randomized placebo-controlled trial conducted in Dhaka, Bangladesh. The vaccination campaign was conducted between January 10 and February 4, 2014. We enrolled women who were exposed to an OCV or placebo during pregnancy (Cohort 1) and women who were pregnant after the vaccination was completed (Cohort 2). Our primary endpoint was pregnancy loss (spontaneous miscarriage or stillbirth), and the secondary endpoints were preterm delivery and low birth weight. We employed a log-binomial regression to calculate the relative risk of having adverse outcomes among OCV recipients compared to that among placebo recipients.
RESULT: There were 231 OCV and 234 placebo recipients in Cohort 1 and 277 OCV and 299 placebo recipients in Cohort 2. In Cohort 1, the incidence of pregnancy loss was 113/1000 and 115/1000 among OCV and placebo recipients, respectively. The adjusted relative risk for pregnancy loss was 0.97 (95% CI: 0.58-1.61; p = 0.91) in Cohort 1. We did not observe any variation in the risk of pregnancy loss between the two cohorts. The risks for preterm delivery and low birth weight were not significantly different between the groups in both cohorts.
CONCLUSIONS: Our study provides additional evidence that exposure to an OCV during pregnancy does not increase the risk of pregnancy loss, preterm delivery, or low birth weight, suggesting that pregnant women in cholera-affected regions should not be excluded in a mass vaccination campaign.
TRIAL REGISTRATION: The study is registered at ( http://clinicaltrials.gov ). Identifier: NCT02027207 .

PMID: 31092224 [PubMed - indexed for MEDLINE]

Inland cholera in freshwater environs of north India.

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Inland cholera in freshwater environs of north India.

Vaccine. 2019 Jul 03;:

Authors: Taneja N, Mishra A, Batra N, Gupta P, Mahindroo J, Mohan B

Abstract
In the freshwater environment of north India, cholera appears seasonally in form of clusters as well as sporadically, accounting for a significant piece of the puzzle of cholera epidemiology. We describe a number of cholera outbreaks with an average attack rate of 96.5/1000 but an overall low case fatality (0.17). Clinical cholera cases coincided with high rainfall and elevated temperatures, whereas isolation of V. cholerae non-O1 non-O139 from water was dependent on temperature (p < 0.05) but was independent of rainfall and pH (p > 0.05). However, isolation from plankton samples correlated with increased temperature and pH (p < 0.05). A lag period of almost a month was observed between rising temperature and increased isolation of V. cholerae from the environment, which in succession was followed by an appearance of cholera cases in the community a month later. Our results suggested that the aquatic environment can harbor highly divergent V. cholerae strains and serve as a reservoir for multiple V. cholera virulence-associated genes that may be exchanged via mobile genetic elements. In agreement with PFGE, AFLP data also proved that the V. cholerae O1 population was not clonal but was closely related. Our investigation did not support the concept that seasonal cholera outbreaks occur by movement of a single clonal strain across the region, as the clinical isolates from the same years were clearly different, implying that continuous evolution of V. cholerae O1 strains occurs in the cholera endemic area. Interestingly, the viable but non-culturable (VBNC) V. cholerae O1 cells were demonstrated in 2.21% samples from natural water bodies in addition to 40.69% samples from cholera-affected areas respectively. This suggests that aquatic environs do harbor the pathogenic O1 strain, though the isolation of culturable V. cholerae O1 is a rare event in the presence of relatively abundant non-O1 non-O139 isolates.

PMID: 31279566 [PubMed - as supplied by publisher]

Surveillance and the global fight against cholera: Setting priorities and tracking progress.

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Surveillance and the global fight against cholera: Setting priorities and tracking progress.

Vaccine. 2019 Jun 29;:

Authors: Azman AS, Moore SM, Lessler J

PMID: 31266671 [PubMed - as supplied by publisher]

Ending cholera for all.

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Ending cholera for all.

Lancet Infect Dis. 2018 10;18(10):1047

Authors: The Lancet Infectious Diseases

PMID: 30303093 [PubMed - indexed for MEDLINE]

Comparative Analysis of Pasteurella multocida Isolates from Acute and Chronic Fowl Cholera Cases in Hungary During the Period 2005 Through 2010.

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Comparative Analysis of Pasteurella multocida Isolates from Acute and Chronic Fowl Cholera Cases in Hungary During the Period 2005 Through 2010.

Avian Dis. 2017 12;61(4):457-465

Authors: Sellyei B, Thuma Á, Volokhov D, Varga Z

Abstract
Fowl cholera (FC) is a highly contagious and economically important disease of poultry worldwide. This study was performed on 218 Pasteurella multocida isolates collected from separated breeding farms or backyards with acute and chronic FC cases in multiple localities across Hungary during the period 2005-2010. All isolates were characterized by a broad range of biochemical, serological, and molecular methods, as well as their antibiotic susceptibility to aminoglycosides (A), macrolides (M), penicillins (P), quinolones (Q), cephalosporins, sulphonamides (S), and tetracyclines (T) was determined. Fifty-two percent of all isolates belonged to a well-defined type that was highly virulent, caused acute FC, and had the same character: fermented L-arabinose, possessed capsule type A, identified as Heddleston serotype 1, and possessed allele type A of the ptfA fimbrial gene. This type was widely distributed among poultry in Hungary, especially in waterfowl flocks. Isolates collected from the chronic FC cases were more diverse: none of them fermented L-arabinose; they possessed capsule type A (76%), F (9%), or was non-typeable (15%) with different Heddleston serotypes, mainly 1, 3, 4, and 5, or 7 and 16; in addition, possessed allele type B of ptfA fimbrial gene. Only 26 isolates presented characters similar to any of the chronic FC cases but caused severe disease. The antibiotic susceptibility assay presented that 80% of all isolates were resistant to 1-5 of the studied antimicrobial agents. During the survey, after two years, there was a dramatic decline both in the number of the multi-drug resistance phenotypes and the prevalence of the highly virulent type of the isolates. In the next four years, multiresistant isolates were almost completely removed, whereas the number of isolates resistant to 1 or 2 drugs was constant. Reduced frequency of antibiotic multiresistant, mostly L-arabinose-fermenting isolates, has been observed since 2007. This reduction may be a consequence of the elimination of multiple waterfowl flocks in Hungary during avian influenza outbreaks, which possibly created a break in the "transmission chain" of pathogenic P. multocida isolates.

PMID: 29337626 [PubMed - indexed for MEDLINE]

Cholera prevention and control in refugee settings: Successes and continued challenges.

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Cholera prevention and control in refugee settings: Successes and continued challenges.

PLoS Negl Trop Dis. 2019 Jun;13(6):e0007347

Authors: Shannon K, Hast M, Azman AS, Legros D, McKay H, Lessler J

PMID: 31220084 [PubMed - in process]

Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015.

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Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015.

BMC Public Health. 2018 06 11;18(1):723

Authors: Curran KG, Wells E, Crowe SJ, Narra R, Oremo J, Boru W, Githuku J, Obonyo M, De Cock KM, Montgomery JM, Makayotto L, Langat D, Lowther SA, O'Reilly C, Gura Z, Kioko J

Abstract
BACKGROUND: From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response.
METHODS: Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns.
RESULTS: Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others.
CONCLUSIONS: The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.

PMID: 29890963 [PubMed - indexed for MEDLINE]

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