RESUMO
Current WHO guidelines for onchocerciasis elimination provide requirements for stopping mass drug administration of ivermectin and the verification of elimination of transmission. These guidelines also recommend post-elimination surveillance (PES) based on entomological surveys. Serological markers in humans could complement entomological PES once the longevity of anti-OV-16 antibody responses is better understood. In 2014-2015 we evaluated ELISA anti-OV-16 IgG4 antibody persistence among previously seropositive people from the central endemic zone of Guatemala. The country stopped all onchocerciasis program interventions in 2012 and was verified by WHO as having eliminated transmission of onchocerciasis in 2016. A total of 246 participants with prior OV-16 ELISA results from 2003, 2006, 2007, or 2009 were enrolled in a follow-up study. Of these, 77 people were previously OV-16 seropositive and 169 were previously seronegative. By 2014 and 2015, 56 (72.7%) previously seropositive individuals had sero-reverted, whereas all previous negatives remained seronegative. The progression of antibody responses over time was estimated using a mixed-effects linear regression model, using data from seropositive participants who had sero-reverted. The temporal variation showed a mean activity unit decay of 0.20 per year (95% credible interval [CrI]: 0.17, 0.23), corresponding to an estimated antibody response half-life of 3.3 years (95% CrI: 2.7, 4.1). These findings indicate that the majority of seropositive people will sero-revert over time.
Assuntos
Anticorpos Anti-Helmínticos , Imunoglobulina G , Oncocercose , Humanos , Guatemala/epidemiologia , Oncocercose/epidemiologia , Oncocercose/transmissão , Oncocercose/imunologia , Oncocercose/prevenção & controle , Imunoglobulina G/sangue , Masculino , Feminino , Adulto , Anticorpos Anti-Helmínticos/sangue , Pessoa de Meia-Idade , Ivermectina/uso terapêutico , Ivermectina/administração & dosagem , Erradicação de Doenças/métodos , Doenças Endêmicas/prevenção & controle , Animais , Onchocerca volvulus/imunologia , Adulto Jovem , Adolescente , Ensaio de Imunoadsorção Enzimática , Administração Massiva de MedicamentosRESUMO
BACKGROUND: Vector-borne transmission of Trypanosoma cruzi is seen exclusively in the Americas where an estimated 8 million people are infected with the parasite. Significant research in southern Peru has been conducted to understand T. cruzi infection and vector control, however, much less is known about the burden of infection and epidemiology in northern Peru. METHODOLOGY: A cross-sectional study was conducted to estimate the seroprevalence of T. cruzi infection in humans (n=611) and domestic animals [dogs (n=106) and guinea pigs (n=206)] in communities of Cutervo Province, Peru. Sampling and diagnostic strategies differed according to species. An entomological household study (n=208) was conducted to identify the triatomine burden and species composition, as well as the prevalence of T. cruzi in vectors. Electrocardiograms (EKG) were performed on a subset of participants (n=90 T. cruzi infected participants and 170 age and sex-matched controls). The seroprevalence of T. cruzi among humans, dogs, and guinea pigs was 14.9% (95% CI: 12.2-18.0%), 19.8% (95% CI: 12.7-28.7%) and 3.3% (95% CI: 1.4-6.9%) respectively. In one community, the prevalence of T. cruzi infection was 17.2% (95% CI: 9.6-24.7%) among participants < 15 years, suggesting recent transmission. Increasing age, positive triatomines in a participant's house, and ownership of a T. cruzi positive guinea pig were independent correlates of T. cruzi infection. Only one species of triatomine was found, Panstrongylus lignarius, formerly P. herreri. Approximately forty percent (39.9%, 95% CI: 33.2-46.9%) of surveyed households were infested with this vector and 14.9% (95% CI: 10.4-20.5%) had at least one triatomine positive for T. cruzi. The cardiac abnormality of right bundle branch block was rare, but only identified in seropositive individuals. CONCLUSIONS: Our research documents a substantial prevalence of T. cruzi infection in Cutervo and highlights a need for greater attention and vector control efforts in northern Peru.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Animais , Animais Domésticos , Doença de Chagas/parasitologia , Criança , Pré-Escolar , Estudos Transversais , Cães , Eletrocardiografia , Feminino , Cobaias , Humanos , Insetos Vetores/parasitologia , Masculino , Pessoa de Meia-Idade , Panstrongylus/parasitologia , Peru/epidemiologia , População Rural , Estudos Soroepidemiológicos , Trypanosoma cruzi/isolamento & purificação , Adulto JovemRESUMO
Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Missões Médicas , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Etários , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Coinfecção , Feminino , Nível de Saúde , Humanos , Lactente , Enteropatias Parasitárias/epidemiologia , Malária/epidemiologia , Masculino , Doenças Parasitárias/epidemiologia , Peru/epidemiologia , Rios , População Rural/estatística & dados numéricosRESUMO
BACKGROUND: The recent avian influenza epidemic in Asia and the H1N1 pandemic demonstrated that influenza A viruses pose a threat to global public health. The animal origins of the viruses confirmed the potential for interspecies transmission. Swine are hypothesized to be prime "mixing vessels" due to the dual receptivity of their trachea to human and avian strains. Additionally, avian and human influenza viruses have previously been isolated in swine. Therefore, understanding interspecies contact on smallholder swine farms and its potential role in the transmission of pathogens such as influenza virus is very important. METHODS: This qualitative study aimed to determine swine-associated interspecies contacts in two coastal areas of Peru. Direct observations were conducted at both small-scale confined and low-investment swine farms (n = 36) and in open areas where swine freely range during the day (n = 4). Interviews were also conducted with key stakeholders in swine farming. RESULTS: In both locations, the intermingling of swine and domestic birds was common. An unexpected contact with avian species was that swine were fed poultry mortality in 6/20 of the farms in Chancay. Human-swine contacts were common, with a higher frequency on the confined farms. Mixed farming of swine with chickens or ducks was observed in 36% of all farms. Human-avian interactions were less frequent overall. Use of adequate biosecurity and hygiene practices by farmers was suboptimal at both locations. CONCLUSIONS: Close human-animal interaction, frequent interspecies contacts and suboptimal biosecurity and hygiene practices pose significant risks of interspecies influenza virus transmission. Farmers in small-scale swine production systems constitute a high-risk population and need to be recognized as key in preventing interspecies pathogen transfer. A two-pronged prevention approach, which offers educational activities for swine farmers about sound hygiene and biosecurity practices and guidelines and education for poultry farmers about alternative approaches for processing poultry mortality, is recommended. Virological and serological surveillance for influenza viruses will also be critical for these human and animal populations.
Assuntos
Criação de Animais Domésticos/métodos , Vírus da Influenza A/crescimento & desenvolvimento , Vírus da Influenza A/genética , Recombinação Genética , Zoonoses/transmissão , Animais , Aves , Humanos , Peru , Medição de Risco , SuínosRESUMO
We molecularly characterized samples with Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system for diarrhea in Santa Rosa, Guatemala. The DNA sequence analysis determined the presence of Giardia assemblages A (N = 7) and B (N = 12) and, Cryptosporidium hominis (N = 2) and Cryptosporidium parvum (N = 2), suggestive of different transmission cycles. All 41 samples with soil-transmitted helminths did not have the ß-tubulin mutation described for benzimidazole resistance, suggesting potential usefulness in mass drug administration campaigns.
Assuntos
Cryptosporidium/genética , Giardia/genética , Helmintos/genética , Adolescente , Adulto , Idoso , Animais , Anti-Helmínticos/uso terapêutico , Ascaríase/tratamento farmacológico , Ascaríase/parasitologia , Ascaris lumbricoides/genética , Criança , Pré-Escolar , Criptosporidiose/tratamento farmacológico , Criptosporidiose/parasitologia , Cryptosporidium/fisiologia , Cryptosporidium parvum/genética , Cryptosporidium parvum/fisiologia , Resistência a Medicamentos/genética , Giardia/fisiologia , Giardíase/tratamento farmacológico , Giardíase/parasitologia , Guatemala , Helmintos/fisiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Solo/parasitologia , Tricuríase/tratamento farmacológico , Tricuríase/parasitologia , Trichuris/genética , Trichuris/fisiologia , Adulto JovemRESUMO
The association of wealth and infections with Giardia, Cryptosporidium, Cyclospora, and microsporidia were examined in a longitudinal cohort conducted in Peru from 2001 to 2006. Data from 492 participants were daily clinical manifestations, weekly copro-parasitological diagnosis, and housing characteristics and assets owned (48 variables), and these data were used to construct a global wealth index using principal component analysis. Data were analyzed using continuous and categorical (wealth tertiles) models. Participant's mean age was 3.43 years (range = 0-12 years), with average follow-up of 993 days. Univariate and multivariate analyses identified significant associations between wealth and infections with Giardia and microsporidia. Participants with greater wealth indexes were associated with protection against Giardia (P < 0.001) and persistent Giardia infections (> 14 days). For microsporidia, greater wealth was protective (P = 0.066 continuous and P = 0.042 by tertiles). Contrarily, infections with Cryptosporidium and Cyclospora were independent of wealth. Thus, subtle differences in wealth may affect the frequency of specific parasitic infections within low-income communities.
Assuntos
Enteropatias Parasitárias/economia , Enteropatias Parasitárias/epidemiologia , Pobreza/estatística & dados numéricos , Fatores Etários , Criança , Pré-Escolar , Criptosporidiose/economia , Criptosporidiose/epidemiologia , Ciclosporíase/economia , Ciclosporíase/epidemiologia , Diarreia/epidemiologia , Diarreia/parasitologia , Feminino , Giardíase/economia , Giardíase/epidemiologia , Humanos , Incidência , Lactente , Estudos Longitudinais , Masculino , Análise Multivariada , Razão de Chances , Peru/epidemiologia , Pobreza/economia , Análise de Componente Principal , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: Diarrhoeal illness is a major public health problem for children worldwide, particularly among developing countries, and is a proxy condition for severe dehydration. It has been hypothesized that severe dehydration in the first 6 months of life could be associated with increased blood pressure later in life. This study aimed to explore whether frequency of diarrhoea is associated with elevated blood pressure in children in a setting with a high incidence of diarrhoeal disease. METHODS: The present study is a cross-sectional study of blood pressure among children from a longitudinal child diarrhoeal disease cohort in Lima, Peru. From 2001 to 2006, daily diarrhoeal surveillance was made. Children were revisited in 2006 and blood pressure was measured. Diarrhoeal exposures were evaluated in terms of total number of diarrhoea days, number of episodes of diarrhoea, persistent diarrhoeal episodes and by the quartiles of daily incidence and episode incidence of diarrhoea. RESULTS: The overall incidence of diarrhoeal episodes at age under 1 year was 4.35 (95% confidence interval: 3.79-4.98) and under 5 years was 2.80 (95% confidence interval: 2.69-2.92). No association was observed between the total number of diarrhoeal days, diarrhoeal episodes or diarrhoeal incidence rates with childhood blood pressure. There was weak evidence that hospital admission due to severe dehydration in the first year of life showed a gradient towards an increase in both, systolic and diastolic blood pressure. CONCLUSION: In the first study to date to examine the association in a setting with a high incidence of diarrhoeal disease, diarrhoeal frequency did not show an association with increased blood pressure. Our observations of elevated levels of blood pressure among those admitted into hospitals in the first year of life are in line with the original hypothesis of dehydration in early infancy and high blood pressure. However, the effect of episodes of severe dehydration on later blood pressure remains uncertain.
Assuntos
Pressão Sanguínea , Diarreia Infantil/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Desidratação/complicações , Diarreia Infantil/complicações , Feminino , Humanos , Hipertensão/etiologia , Lactente , Peru/epidemiologiaRESUMO
To determine whether clinical manifestations are associated with genotypes or subtypes of Cryptosporidium spp., we studied a 4-year longitudinal birth cohort of 533 children in Peru. A total of 156 infection episodes were found in 109 children. Data from first infections showed that C. hominis was associated with diarrhea, nausea, vomiting, general malaise, and increased oocyst shedding intensity and duration. In contrast, C. parvum, C. meleagridis, C. canis, and C. felis were associated with diarrhea only. C. hominis subtype families were identified (Ia, Ib, Id, and Ie); all were associated with diarrhea. Ib was also associated with nausea, vomiting, and general malaise. All C. parvum specimens belonged to subtype family IIc. Analysis of risk factors did not show associations with specific Cryptosporidium spp. genotypes or subtypes. These findings strongly suggest that Cryptosporidium spp. and subtypes are linked to different clinical manifestations in children.
Assuntos
Criptosporidiose/epidemiologia , Criptosporidiose/parasitologia , Cryptosporidium/isolamento & purificação , Animais , Pré-Escolar , Estudos de Coortes , Cryptosporidium/classificação , Cryptosporidium/genética , Cryptosporidium parvum/genética , Cryptosporidium parvum/isolamento & purificação , Fezes/parasitologia , Feminino , Genótipo , Humanos , Lactente , Estudos Longitudinais , Masculino , Peru/epidemiologia , Fatores de RiscoRESUMO
In a longitudinal cohort diarrhea study, a girl living in Lima, Peru, and her brother and dog were diagnosed with Cryptosporidium canis infections during the same period. Both children had transient diarrhea, but the dog was asymptomatic. This is the first report of possible transmission of cryptosporidiosis between humans and dogs.
Assuntos
Criptosporidiose/transmissão , Cryptosporidium/classificação , Doenças do Cão/transmissão , Zoonoses , Animais , Pré-Escolar , Criptosporidiose/parasitologia , Cryptosporidium/genética , Cryptosporidium/isolamento & purificação , Doenças do Cão/parasitologia , Cães , Características da Família , Fezes/parasitologia , Feminino , Humanos , Masculino , Peru , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de RestriçãoRESUMO
Cryptosporidium parasites from a cross-sectional study conducted in two national hospitals in Lima, Peru were genetically characterized to determine the diversity of Cryptosporidium spp. in HIV-positive people. A total of 2,672 patients participated in this study and provided 13,937 specimens. Cryptosporidium oocysts were detected by microscopy in 354 (13.3%) of the patients. Analysis of 951 Cryptosporidium-positive specimens from 300 patients using a small subunit rRNA-based PCR-RFLP tool identified 6 genotypes; Cryptosporidium hominis was the species most frequently detected (67.5%), followed by C. meleagridis (12.6%) and C. parvum (11.3%). Cryptosporidium canis (4.0%), C. felis (3.3%), and Cryptosporidium pig genotype (0.5%) were also found. These findings indicate that C. hominis is the predominant species in Peruvian HIV-positive persons, and that zoonotic Cryptosporidium spp. account for about 30% of cryptosporidiosis in these patients.