RESUMO
Zika virus (ZIKV) infections occurred in epidemic form in the Americas in 2014-2016, with some of the earliest isolates in the region coming from Haiti. We isolated ZIKV from 20 children with acute undifferentiated febrile illness who were part of a cohort of children seen at a school clinic in the Gressier region of Haiti. The virus was also isolated from three pools of Aedes aegypti mosquitoes collected at the same location. On phylogenetic analysis, three distinct ZIKV clades were identified. Strains from all three clades were present in Haiti in 2014, making them among the earliest isolates identified in the Western Hemisphere. Strains from all three clades were also isolated in 2016, indicative of their persistence across the time period of the epidemic. Mosquito isolates were collected in 2016 and included representatives from two of the three clades; in one instance, ZIKV was isolated from a pool of male mosquitoes, suggestive of vertical transmission of the virus. The identification of multiple ZIKV clades in Haiti at the beginning of the epidemic suggests that Haiti served as a nidus for transmission within the Caribbean.
Assuntos
Aedes , Infecção por Zika virus , Zika virus , Animais , Criança , Haiti/epidemiologia , Humanos , Masculino , Mosquitos Vetores , Filogenia , Instituições AcadêmicasRESUMO
OBJECTIVE: To identify determinants of intended versus actual care-seeking behaviours in a pluralistic healthcare system that is reliant on both conventional and non-conventional providers and discover opportunities to catalyse improved healthcare access. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: In Haiti 568 households (incorporating 2900 members) with children less than 5 years of age were randomly sampled geographically with stratifications for population density. These households identified the healthcare providers they frequented. Among 140 providers, 65 were located and enrolled. OUTCOME MEASURES: Household questionnaires with standardised cases (intentions) were compared with self-recall of health events (behaviours). The connectedness of households and their providers was determined by network analysis. RESULTS: Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (adjusted OR (aOR)=3.17; 95% CI 1.99 to 5.05; p<0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95% CI 1.06 to 1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favoured non-conventional providers (McNemar's χ2 test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional. CONCLUSION: Addressing geographic barriers, possibly with technology solutions, should be prioritised to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.
Assuntos
Acessibilidade aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Catálise , Criança , Estudos Transversais , Haiti , HumanosRESUMO
This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
Assuntos
Agricultura , Diabetes Mellitus Tipo 2/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Estado Pré-Diabético/epidemiologia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 2/etiologia , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estado Pré-Diabético/etiologia , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVES: Acute Respiratory Infection (ARI) is the most common cause of childhood morbidity and mortality in developing countries, including Haiti. Our objective was to detect pathogens found in children with ARI in rural Haiti to help develop evidence-based guidelines for treatment and prevention. METHODS: Retrospective study of students with ARI at four schools in rural Haiti. Viral and/or bacterial pathogens were identified by qPCR in 177 nasal swabs collected from April 2013 through November 2015. RESULTS: Most common viruses detected were Rhinovirus (36%), Influenza A (16%) and Adenovirus (7%), and bacteria were Streptococcus pneumoniae (58%) and Staphylococcus aureus (28%). Compared to older children, children aged 3-5 years had more Influenza A (28% vs. 9%, p=0.002) and Adenovirus detected (14% vs. 3%, p=0.01). Similarly, S. pneumoniae was greatest in children 3-5 years old (71% 3-5yrs; 58% 6-15 years; 25% 16-20 years; p=0.008). Children 3-10 years old presented with fever more than children 11-20 years old (22% vs 7%; p=0.02) and were more often diagnosed with pneumonia (28% vs 4%, p<0.001). CONCLUSIONS: Younger children had increased fever, pneumonia, and detection of Influenza A and S. pneumoniae. These data support the need for influenza and pneumococcus vaccination in early childhood in Haiti.
Assuntos
Infecções Respiratórias/epidemiologia , Infecções Estafilocócicas/epidemiologia , Viroses/epidemiologia , Vírus/isolamento & purificação , Doença Aguda/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Haiti/epidemiologia , Humanos , Lactente , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/fisiologia , Viroses/virologia , Vírus/classificação , Vírus/genética , Adulto JovemRESUMO
Asymptomatic Plasmodium falciparum infection is responsible for maintaining malarial disease within human populations in low transmission countries such as Haiti. Investigating differential host immune responses to the parasite as a potential underlying mechanism could help provide insight into this highly complex phenomenon and possibly identify asymptomatic individuals. We performed a cross-sectional analysis of individuals who were diagnosed with malaria in Sud-Est, Haiti by comparing the cellular and humoral responses of both symptomatic and asymptomatic subjects. Plasma samples were analyzed with a P. falciparum protein microarray, which demonstrated serologic reactivity to 3,877 P. falciparum proteins of known serologic reactivity; however, no antigen-antibody reactions delineating asymptomatics from symptomatics were identified. In contrast, differences in cellular responses were observed. Flow cytometric analysis of patient peripheral blood mononuclear cells co-cultured with P. falciparum infected erythrocytes demonstrated a statistically significant increase in the proportion of T regulatory cells (CD4+ CD25+ CD127-), and increases in unique populations of both NKT-like cells (CD3+ CD8+ CD56+) and CD8mid T cells in asymptomatics compared to symptomatics. Also, CD38+/HLA-DR+ expression on γδ T cells, CD8mid (CD56-) T cells, and CD8mid CD56+ NKT-like cells decreased upon exposure to infected erythrocytes in both groups. Cytometric bead analysis of the co-culture supernatants demonstrated an upregulation of monocyte-activating chemokines/cytokines in asymptomatics, while immunomodulatory soluble factors were elevated in symptomatics. Principal component analysis of these expression values revealed a distinct clustering of individual responses within their respective phenotypic groups. This is the first comprehensive investigation of immune responses to P. falciparum in Haiti, and describes unique cell-mediated immune repertoires that delineate individuals into asymptomatic and symptomatic phenotypes. Future investigations using large scale biological data sets analyzing multiple components of adaptive immunity, could collectively define which cellular responses and molecular correlates of disease outcome are malaria region specific, and which are truly generalizable features of asymptomatic Plasmodium immunity, a research goal of critical priority.
Assuntos
Infecções Assintomáticas/epidemiologia , Malária Falciparum/imunologia , Plasmodium falciparum/imunologia , Proteínas de Protozoários/imunologia , Subpopulações de Linfócitos T/imunologia , Linfócitos T Reguladores/imunologia , Imunidade Adaptativa/imunologia , Adolescente , Adulto , Contagem de Linfócito CD4 , Linfócitos T CD8-Positivos/imunologia , Estudos Transversais , Eritrócitos/parasitologia , Feminino , Haiti/epidemiologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Inflamação/imunologia , Mediadores da Inflamação/metabolismo , Malária Falciparum/epidemiologia , Malária Falciparum/parasitologia , Masculino , Pessoa de Meia-Idade , Análise Serial de Proteínas , Adulto JovemRESUMO
BACKGROUND: Since 2001, Haiti's National Program for the Elimination of Lymphatic Filariasis (NPELF) has worked to reduce the transmission of lymphatic filariasis (LF) through annual mass drug administration (MDA) with diethylcarbamazine and albendazole. The NPELF reached full national coverage with MDA for LF in 2012, and by 2014, a total of 14 evaluation units (48 communes) had met WHO eligibility criteria to conduct LF transmission assessment surveys (TAS) to determine whether prevalence had been reduced to below a threshold, such that transmission is assumed to be no longer sustainable. Haiti is also endemic for malaria and many communities suffer a high burden of soil transmitted helminths (STH). Heeding the call from WHO for integration of neglected tropical diseases (NTD) activities, Haiti's NPELF worked with the national malaria control program (NMCP) and with partners to develop an integrated TAS (LF-STH-malaria) to include assessments for malaria and STH. METHODOLOGY/PRINCIPLE FINDINGS: The aim of this study was to evaluate the feasibility of using TAS surveys for LF as a platform to collect information about STH and malaria. Between November 2014 and June 2015, TAS were conducted in 14 evaluation units (EUs) including 1 TAS (LF-only), 1 TAS-STH-malaria, and 12 TAS-malaria, with a total of 16,655 children tested for LF, 14,795 tested for malaria, and 298 tested for STH. In all, 12 of the 14 EUs passed the LF TAS, allowing the program to stop MDA for LF in 44 communes. The EU where children were also tested for STH will require annual school-based treatment with albendazole to maintain reduced STH levels. Finally, only 12 of 14,795 children tested positive for malaria by RDT in 38 communes. CONCLUSIONS/SIGNIFICANCE: Haiti's 2014-2015 Integrated TAS surveys provide evidence of the feasibility of using the LF TAS as a platform for integration of assessments for STH and or malaria.
Assuntos
Filariose Linfática/transmissão , Helmintos/isolamento & purificação , Malária/transmissão , Solo/parasitologia , Animais , Criança , Filariose Linfática/epidemiologia , Filariose Linfática/parasitologia , Feminino , Haiti/epidemiologia , Helmintos/classificação , Helmintos/genética , Humanos , Malária/epidemiologia , Malária/parasitologia , MasculinoRESUMO
In October of 2010, an outbreak of cholera was confirmed in Haiti for the first time in more than a century. A single clone of toxigenic Vibrio cholerae O1 biotype El Tor serotype Ogawa strain was implicated as the cause. Five years after the onset of cholera, in October, 2015, we have discovered a major switch (ranging from 7 to 100%) from Ogawa serotype to Inaba serotype. Furthermore, using wbeT gene sequencing and comparative sequence analysis, we now demonstrate that, among 2013 and 2015 Inaba isolates, the wbeT gene, responsible for switching Ogawa to Inaba serotype, sustained a unique nucleotide mutation not found in isolates obtained from Haiti in 2012. Moreover, we show that, environmental Inaba isolates collected in 2015 have the identical mutations found in the 2015 clinical isolates. Our data indicate that toxigenic V. cholerae O1 serotype Ogawa can rapidly change its serotype to Inaba, and has the potential to cause disease in individuals who have acquired immunity against Ogawa serotype. Our findings highlight the importance of monitoring of toxigenic V. cholerae O1 and cholera in countries with established endemic disease.
Assuntos
Cólera/microbiologia , Vibrio cholerae O1/isolamento & purificação , Vibrio cholerae/isolamento & purificação , Cólera/diagnóstico , Cólera/epidemiologia , Microbiologia Ambiental , Haiti/epidemiologia , Humanos , Sorotipagem , Vibrio cholerae/classificação , Vibrio cholerae/genética , Vibrio cholerae O1/classificação , Vibrio cholerae O1/genéticaRESUMO
BACKGROUND: Public health measures are poised for transition from malaria control to malaria elimination on the island of Hispaniola. Assessment of the reservoir of asymptomatic infections from which acute malaria cases may derive is critical to plan and evaluate elimination efforts. Current field technology is ill suited for detecting sub-microscopic infections, thus highly sensitive survey methods capable of detecting virtually all infections are needed. In this study the prevalence of infection with Plasmodium falciparum was determined in patients seeking medical care primarily for non-febrile conditions in six departments in Haiti using a newly designed qRT-PCR-based assay. METHODS: Three different methods of parasite detection were compared to assess their utility in approximating the prevalence of P. falciparum infections in the population: malaria rapid diagnostic test (RDT) designed to detect histidine-rich protein 2 (HRP2), thick smear microscopy, and a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay based upon the small sub-unit ribosomal RNA. The limit of detection of the qRT-PCR assay utilized was 0.0003 parasite/µL of blood. Venous blood was obtained from a total of 563 subjects from six departments in Haiti, all of whom were seeking medical attention without complaints consistent with malaria. Each subject was questioned for knowledge and behaviour using demographic and epidemiological survey to identify risk factors for disease transmission. RESULTS: Among the 563 samples tested, ten and 16 were found positive for malaria by RDT and microscopy, respectively. Using the qRT-PCR test to assess the infection status of these subjects, an additional 92 were identified for a total of 108. Based upon the qRT-PCR assay results, a wide variation in prevalence of infection in asymptomatic subjects was seen between geographic locations ranging from 4-41%. The prevalence of infection was highest in the Grand Anse, Nord and Sud-Est Departments, and demographic data from questionnaires provide evidence for focal disease transmission. CONCLUSIONS: The qRT-PCR assay is sufficiently sensitive to identify an unexpectedly large number of asymptomatic, submicroscopic infections. Identifying and clearing these infections presents a significant challenge to both control and elimination efforts, but the qRT-PCR assay offers a reliable method to identify them.
Assuntos
Infecções Assintomáticas/epidemiologia , Testes Diagnósticos de Rotina/métodos , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , Plasmodium falciparum/isolamento & purificação , Adulto , Estudos Transversais , Feminino , Haiti/epidemiologia , Humanos , Imunoensaio , Microscopia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , População Rural , Adulto JovemRESUMO
Currently, there are only limited data available on rates of major diagnostic categories of illnesses among Haitian children. We have established a cohort of 1,245 students attending schools run by the Christianville Foundation in the Gressier/Leogane region of Haiti, for whom our group provides primary medical care. Among 1,357 clinic visits during the 2012-2013 academic year, the main disease categories (with rates per 1,000 child years of observation) included acute respiratory infection (ARI) (385.6 cases/1,000 child years of observation), gastrointestinal complaints (277.8 cases/1,000 child years), febrile illness (235.0 cases/1,000 child years), and skin infections (151.7 cases/1,000 child years). The most common diarrheal pathogen was enteroaggregative Escherichia coli (present in 17% of children with diarrhea); Vibrio cholerae O1 and norovirus were the next most common. Our data highlight the importance of better defining etiologies for ARI and febrile illnesses and continuing problems of diarrheal illness in this region, including mild cases of cholera, which would not have been diagnosed without laboratory screening.
Assuntos
Diarreia/epidemiologia , Gastroenterite/epidemiologia , Infecções Respiratórias/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Cólera/epidemiologia , Cólera/microbiologia , Estudos de Coortes , Diarreia/microbiologia , Escherichia coli/fisiologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Gastroenterite/microbiologia , Haiti/epidemiologia , Humanos , Masculino , Norovirus/fisiologia , Pacientes Ambulatoriais , Infecções Respiratórias/microbiologia , Instituições Acadêmicas , Estações do Ano , Dermatopatias Infecciosas/microbiologia , Estudantes , Vibrio cholerae O1/fisiologia , Adulto JovemRESUMO
An epidemic of cholera infections was documented in Haiti for the first time in more than 100 years during October 2010. Cases have continued to occur, raising the question of whether the microorganism has established environmental reservoirs in Haiti. We monitored 14 environmental sites near the towns of Gressier and Leogane during April 2012-March 2013. Toxigenic Vibrio cholerae O1 El Tor biotype strains were isolated from 3 (1.7%) of 179 water samples; nontoxigenic O1 V. cholerae was isolated from an additional 3 samples. All samples containing V. cholerae O1 also contained non-O1 V. cholerae. V. cholerae O1 was isolated only when water temperatures were ≥31°C. Our data substantiate the presence of toxigenic V. cholerae O1 in the aquatic environment in Haiti. These isolations may reflect establishment of long-term environmental reservoirs in Haiti, which may complicate eradication of cholera from this coastal country.
Assuntos
Reservatórios de Doenças/microbiologia , Monitoramento Ambiental , Vibrio cholerae O1/isolamento & purificação , Microbiologia da Água , Animais , Cólera/epidemiologia , Cólera/microbiologia , Geografia , Haiti/epidemiologia , Humanos , Incidência , Sorotipagem , Vibrio cholerae O1/classificação , Vibrio cholerae O1/genéticaRESUMO
In response to the recent cholera outbreak, a public health response targeted high-risk communities, including resource-poor communities in Port-au-Prince, Haiti. A survey covering knowledge and practices indicated that hygiene messages were received and induced behavior change, specifically related to water treatment practices. Self-reported household water treatment increased from 30.3% to 73.9%.