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Distribution of Subsidized Insecticide-treated Bed Nets through a Community Health Committee in Boboye Health District, Niger

Daisuke Nonaka ; Abani Maazou ; Shigeo Yamagata ; Issofou Oumarou ; Takako Uchida ; Honoré JG Yacouba ; Jun Kobayashi ; Tsutomu Takeuchi ; Tetsuya Mizoue

Tropical Medicine and Health.2012;40(4):125-131. doi:10.2149/tmh.2012-06

In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system.

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A Surveillance Model for Human Avian Influenza with a Comprehensive Surveillance System for Local-Priority Communicable Diseases in South Sulawesi, Indonesia

Shigeki Hanafusa ; Andi Muhadir ; Hari Santoso ; Kohtaroh Tanaka ; Muhammad Anwar ; Erwan Tri Sulistyo ; Masahiko Hachiya

Tropical Medicine and Health.2012;40(4):141-147. doi:10.2149/tmh.2012-10

The government of Indonesia and the Japan International Cooperation Agency launched a three-year project (2008–2011) to strengthen the surveillance of human avian influenza cases through a comprehensive surveillance system of local-priority communicable diseases in South Sulawesi Province. Based on findings from preliminary and baseline surveys, the project developed a technical protocol for surveillance and response activities in local settings, consistent with national guidelines. District surveillance officers (DSOs) and rapid-response-team members underwent training to improve surveillance and response skills. A network-based early warning and response system for weekly reports and a short message service (SMS) gateway for outbreak reports, both encompassing more than 20 probable outbreak diseases, were introduced to support existing paper-based systems. Two further strategies were implemented to optimize project outputs: a simulation exercise and a DSO-centered model. As a result, the timeliness of weekly reports improved from 33% in 2009 to 82% in 2011. In 2011, 65 outbreaks were reported using the SMS, with 64 subsequent paper-based reports. All suspected human avian influenza outbreaks up to September 2011 were reported in the stipulated format. A crosscutting approach using human avian influenza as the core disease for coordinating surveillance activities improved the overall surveillance system for communicable diseases.

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Phylogeography of Human T-lymphotropic Virus Type 1 (HTLV-1) Lineages Endemic to Japan

Masashi Otani ; Katsuyuki Eguchi ; Tatsuki Ichikawa ; Kohei Takenaka Takano ; Toshiki Watanabe ; Kazunari Yamaguchi ; Kazuhiko Nakao ; Taro Yamamoto

Tropical Medicine and Health.2012;40(4):117-124. doi:10.2149/tmh.2012-15

We conducted phylogenetic analyses and an estimation of coalescence times for East Asian strains of HTLV-1. Phylogenetic analyses showed that the following three lineages exist in Japan: “JPN”, primarily comprising Japanese isolates; “EAS”, comprising Japanese and two Chinese isolates, of which one originated from Chengdu and the other from Fujian; and “GLB1”, comprising isolates from various locations worldwide, including a few Japanese isolates. It was estimated that the JPN and EAS lineages originated as independent lineages approximately 3,900 and 6,000 years ago, respectively. Based on archaeological findings, the “Out of Sunda” hypothesis was recently proposed to clarify the source of the Jomon (early neolithic) cultures of Japan. According to this hypothesis, it is suggested that the arrival of neolithic people in Japan began approximately 10,000 years ago, with a second wave of immigrants arriving between 6,000 and 4,000 years ago, peaking at around 4,000 years ago. Estimated coalescence times of the EAS and JPN lineages place the origins of these lineages within this 6,000–4,000 year period, suggesting that HTLV-1 was introduced to Japan by neolithic immigrants, not Paleo-Mongoloids. Moreover, our data suggest that the other minor lineage, GLB1, may have been introduced to Japan by Africans accompanying European traders several centuries ago, during or after “The Age of Discovery.” Thus, the results of this study greatly increase our understanding of the origins and current distribution of HTLV-1 lineages in Japan and provide further insights into the ethno-epidemiology of HTLV-1.

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Visceral Leishmaniasis Eradication is a Reality: Data from a Community-based Active Surveillance in Bangladesh

Farhana Ferdousi ; Mohammad S. Alam ; Mohammad S. Hossain ; Enbo Ma ; Makoto Itoh ; Dinesh Mondal ; Rashidul Haque ; Yukiko Wagatsuma

Tropical Medicine and Health.2012;40(4):133-139. doi:10.2149/tmh.2012-25

More than 20 million people in Bangladesh are considered at risk of developing visceral leishmaniasis (VL). A community-based active surveillance was conducted in eight randomly selected villages in a highly endemic area of Bangladesh from 2006 to 2008. A total of 6,761 individuals living in 1,550 mud-walled houses were included in the active surveillance. Rapid rK39 dipstick tests were conducted throughout the study period to facilitate the case diagnosis. Individuals with previous or current clinical leishmaniasis were identified on the basis of the case definition of the VL elimination program. Untreated cases of suspected VL were referred to the hospital for treatment. Socioeconomic and environmental information including bed net use was also collected. In 2006, the annual incidence of clinical leishmaniasis in the study area was 141.9 cases per 10,000 population, which was significantly increased by the following year owing to community-based active surveillance for case detection and reporting. However, early case detection and early referral for treatment led to a significant decrease in incidence in 2008. This study suggests that community-based active surveillance using a simple diagnostic tool might play a role in achieving the goal of the VL elimination program.

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Retinal involvement of Paracoccioidomycosis: A Case Report

Thais Z. Igami ; Francisco Solano ; Rony C. Preti ; Carla Pagliari ; Walter Y. Takahashi ; Richard Y. Hida

Tropical Medicine and Health.2012;40(4):149-153. doi:10.2149/tmh.2012-27

Purpose: to describe the clinicopathologic features and treatment of a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement. Design: retrospective interventional case report. Participant: A 36-year-old young man with visual impairment in left eye with anterior uveitis and presence of whitish perimacular choroidal nodule, multiple underlying whitish spots and mid-periphery exudative retinal detachment. A primary extensive work-up for systemic infectious, autoimmune, neoplasic or inflammatory conditions was performed and high-resolution computer tomography scan demonstrated asymmetric parietal thickening of the trachea and bilateral diffuse multiple lobular opacities. Pulmonary bronchoscopy/biopsy of larynx, trachea and bronchial tube were also performed. Histopathological evaluation showed characteristic of Paracoccidioidomycosis. Intervention: Patient was treated with oral sulphadiazine (1.5 g/day). Main Outcome Measures: Anterior uveitis, retinal examination, histopathological evaluation and primary clinical outcome were observed during systemic treatment. Results: After 3 months of irregular treatment, choroidal lesions decreased in size forming atrophic scars and fibrotic spots; however visual acuity did not show any improvement. Conclusion: We report a rare case of systemic paracoccidioidomycosis with choroidal and retinal involvement treated with oral sulphadiazine.

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Characterization of the Population Demographics and the MSP-1 Block 2 Allele Gene Frequencies of P. falciparum Infected Individuals in Davao, Philippines

Denise Mirano-Bascos ; Pilarita Tongol-Rivera ; Elena A. Villacorte ; Aleyla D. Escueta ; Shin-ichiro Kawazu ; Shigeyuki Kano

Tropical Medicine and Health.2013;41(1):1-6. doi:10.2149/tmh.2012-01

Plasmodium falciparum is one of the causative agents of malaria in humans. This parasite causes the most severe forms of the disease. In order to combat the disease, it is important to have knowledge about the parasite and its interaction with its host. In this study, we profiled 74 patients admitted to hospital in Tagum, Davao, Philippines who were confirmed to be infected with P. falciparum. We correlated the age, sex and parasite load with malaria severity and show that among these, only sex is correlated with disease severity in this population. In addition, we profiled the MSP-1 block 2 allele distribution in the population and found that the most abundant allele form was K1, followed by MAD20. The RO33 allele form was the rarest allele in this population.

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Continued Circulation of G12P[6] Rotaviruses Over 28 Months in Nepal: Successive Replacement of Predominant Strains

Punita Gauchan ; Toyoko Nakagomi ; Jeevan B. Sherchand ; Michiyo Yokoo ; Basu Dev Pandey ; Nigel A. Cunliffe ; Osamu Nakagomi

Tropical Medicine and Health.2013;41(1):7-12. doi:10.2149/tmh.2012-28

Rotavirus A causes severe diarrhoea in infants and young children worldwide. The migration pattern (electropherotype) of the double-stranded RNA genome upon polyacrylamide gel electrophoresis has been used to define “strains” in molecular epidemiology. In temperate countries, distinct electropherotypes (strains) appear after the annual, off-seasonal interruption of rotavirus circulation. In Nepal, rotavirus circulated year-round and an uncommon genotype G12P[6] predominated and persisted, providing a unique opportunity to examine whether the same electropherotype (the same strain) persisted or new electropherotypes (new strains) emerged successively under the same G12P[6] predominance. A total of 147 G12P[6] rotaviruses, collected from diarrhoeal children in Nepal between 2007 and 2010, were classified into 15 distinct electropherotypes (strains). Of these, three electropherotypes (strains), LP1, LP24, and LP27, accounted for 10%, 32% and 38% of the G12P[6] rotaviruses, respectively. Each of the three major strains successively appeared, dominated, and disappeared. This study provided new evidence for the hypothesis that rotavirus constantly changes its strains to predominate in the local population even under conditions where a single genotype predominates and persists. Such dynamic strain replacement, the constant takeover of one predominant strain by another, fitter strain, is probably gives a competitive edge to the survival of rotavirus in nature.

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Evidence for Genetic Reassortment between Human Rotaviruses by Full Genome Sequencing of G3P[4] and G2P[4] Strains Co-circulating in India

T. N. Hoa Tran ; Toyoko Nakagomi ; Osamu Nakagomi

Tropical Medicine and Health.2013;41(1):13-20. doi:10.2149/tmh.2012-29

Rotavirus A causes severe diarrhoea in infants and young children worldwide. Many unusual combinations of G and P genotypes have been observed in rotaviruses circulating in developing countries. Mixed infection of a single individual with more than one strain is a mechanism by which genetic reassortants are formed with unusual G and P combinations. However, few studies have provided direct evidence for the formation of such unusual strains as a result of co-infection of co-circulating strains. Here, we used full-genome sequencing to re-analyze a G3P[4] strain (107E1B) and a G2P[4] strain (116E3D) detected in India in 1993 and showed that 107E1B had virtually an identical nucleotide sequence with 116E3D, except the VP7 gene. Phylogenetic analysis revealed that the 107E1B VP7 gene was of typical human rotavirus origin, with a 99.3% nucleotide sequence identity with another Indian G3 VP7 gene. Thus, this study provided robust evidence for the formation of the G3P[4] strain through genetic reassortment in which a G2P[4] strain with a typical DS-1 genogroup background acquired the VP7 gene from a co-circulating G3 human rotavirus strain. This study established a basis on which to facilitate full genome sequence analysis of an increasing number of G3P[4] strains in China and elsewhere in the world.

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Seroepidemiological Study of Chagas Disease in the Southern Amazon Region of Ecuador

Angel G. Guevara ; Richard D. Atherton ; Michael A. Wauters ; Yosselin Vicuña ; Marcos Nelson ; Jose Prado ; Hirotomo Kato ; Manuel H. Calvopiña ; Yoshihisa Hashiguchi

Tropical Medicine and Health.2013;41(1):21-25. doi:10.2149/tmh.2012-31

To determine the extent of Trypanosoma cruzi infection and/or transmission in the southern Amazon region of Ecuador, three indigenous communities in the provinces of Pastaza and Morona Santiago were serosurveyed. Chagatest^TM, Immunocomb^®II and immunofluorescent (IF) assays were used. Among the 385 inhabitants examined, nine (2.34%) were seropositive for T. cruzi infection. Of the nine positive sera, four (44.4%) fall in the 10–19, one each in the 20–29, 30–39 and 40–49, and two in the 50–59 age groups. These results suggested the possible existence of an autochthonous active T. cruzi transmission in the region and provide the first serological evidence for T. cruzi infection in the southern province of Morona Santiago bordering Peru. Further studies are needed in these Amazonian provinces to ascertain the spread of T. cruzi infection in the area.

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The NUITM-KEMRI P3 Laboratory in Kenya: Establishment, Features, Operation and Maintenance

Shingo Inoue ; Ernest Wandera ; Gabriel Miringu ; Martin Bundi ; Chika Narita ; Salame Ashur ; Allan Kwallah ; Amina Galata ; Mwajuma Abubakar ; Sora Suka ; Shah Mohamed ; Mohamed Karama ; Masahiro Horio ; Masaaki Shimada ; Yoshio Ichinose

Tropical Medicine and Health.2013;41(1):27-37. doi:10.2149/tmh.2013-01

A biocontainment facility is a core component in any research setting due to the services it renders towards comprehensive biosafety observance. The NUITM-KEMRI P3 facility was set up in 2007 and has been actively in use since 2010 by researchers from this and other institutions. A number of hazardous agents have been handled in the laboratory among them MDR-TB and yellow fever viruses. The laboratory has the general physical and operational features of a P3 laboratory in addition to a number of unique features, among them the water-air filtration system, the eco-mode operation feature and automation of the pressure system that make the facility more efficient. It is equipped with biosafety and emergency response equipments alongside common laboratory equipments, maintained regularly using daily, monthly and yearly routines. Security and safety is strictly observed within the facility, enhanced by restricted entry, strict documentation and use of safety symbols. Training is also engrained within the operation of the laboratory and is undertaken and evaluated annually. Though the laboratory is in the process of obtaining accreditation, it is fully certified courtesy of the manufactures’ and constructed within specified standards.

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