PLoS currents最新文献

{"title":"A Nosocomial Outbreak of Clinical Sepsis in a Neonatal Care Unit (NCU) in Port-Au-Prince Haiti, July 2014 - September 2015.","authors":"Annick Lenglet,&nbsp;Olumide Faniyan,&nbsp;Joost Hopman","doi":"10.1371/currents.outbreaks.58723332ec0de952adefd9a9b6905932","DOIUrl":"https://doi.org/10.1371/currents.outbreaks.58723332ec0de952adefd9a9b6905932","url":null,"abstract":"<p><strong>Introduction: </strong>Between July 2014 and September 2015, a neonatal care unit (NCU) in Port Au Prince, Haiti, experienced an outbreak of sepsis, most probably due to nosocomial transmission of Extended Beta Lactamase (ESBL) producing gram negative bacteria, included Klebsiella pneumoniae.</p><p><strong>Methods: </strong>We describe the epidemiological and microbiological activities performed as part of the outbreak investigation and the control measures implemented throughout this period.</p><p><strong>Results: </strong>During the study period 257 cases of sepsis were reported, of which 191 died. The case fatality decreased from 100% in July 2014 to 24% in September 2015 and could be attributed to an improvement in clinical management and strengthened infection prevention and control measures. Risk factors identified to be associated with having late onset sepsis (sepsis onset >48 hours after birth)(n=205/257, 79. included: all categories of birthweight lower than <2500g (p=<0.0001) and all categories of gestational age younger than 36 weeks (p=0.0002). Microbiological investigations confirmed that out of 32 isolates (N=55; 58%) that were positive for gram negative bacteria, 27 (89%) were due to K. pneumoniae and most of these were from single MLST type (ST37).</p><p><strong>Discussion: </strong>This outbreak highlighted the importance of epidemiological and microbiological surveillance during an outbreak of sepsis in a NCU in a low resource setting, including regular point prevalence surveys.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35992595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of a Case of Ebola Virus Disease on Emergency Department Visits in Metropolitan Dallas-Fort Worth, TX, July, 2013-July, 2015: An Interrupted Time Series Analysis.","authors":"Noelle-Angelique M Molinari,&nbsp;Tanya Telfair LeBlanc,&nbsp;William Stephens","doi":"10.1371/currents.outbreaks.e62bdea371ef5454d56f71fe217aead0","DOIUrl":"https://doi.org/10.1371/currents.outbreaks.e62bdea371ef5454d56f71fe217aead0","url":null,"abstract":"<p><strong>Background: </strong>The first Ebola virus disease (EVD) case in the United States (US) was confirmed September 30, 2014 in a man 45 years old. This event created considerable media attention and there was fear of an EVD outbreak in the US.</p><p><strong>Methods: </strong>This study examined whether emergency department (ED) visits changed in metropolitan Dallas-Fort Worth--, Texas (DFW) after this EVD case was confirmed. Using Texas Health Services Region 2/3 syndromic surveillance data and focusing on DFW, interrupted time series analyses were conducted using segmented regression models with autoregressive errors for overall ED visits and rates of several chief complaints, including fever with gastrointestinal distress (FGI). Date of fatal case confirmation was the \"event.\"</p><p><strong>Results: </strong>Results indicated the event was highly significant for ED visits overall (P<0.05) and for the rate of FGI visits (P<0.0001). An immediate increase in total ED visits of 1,023 visits per day (95% CI: 797.0, 1,252.8) was observed, equivalent to 11.8% (95% CI: 9.2%, 14.4%) increase ED visits overall. Visits and the rate of FGI visits in DFW increased significantly immediately after confirmation of the EVD case and remained elevated for several months even adjusting for seasonality both within symptom specific chief complaints as well as overall.</p><p><strong>Conclusions: </strong>These results have implications for ED surge capacity as well as for public health messaging in the wake of a public health emergency.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collective Statement Regarding Patient Access to Approved Therapies from the Center Directors of Parent Project Muscular Dystrophy's Certified Duchenne Care Centers.","authors":"Cristian Ionita, Kathi Kinnett, Katherine Mathews","doi":"10.1371/currents.md.4a12c57a46a24603cb3d36d7fe0668b6","DOIUrl":"10.1371/currents.md.4a12c57a46a24603cb3d36d7fe0668b6","url":null,"abstract":"<p><p>The dystrophinopathies (Duchenne [DMD] and Becker muscular dystrophy) are progressive diseases that until recently had no specific treatments. New FDA pathways to drug approval in rare diseases have resulted in a dramatic increase in the number of treatment trials for DMD and recently, two approved drugs. Health insurance policies for DMD products have been constructed with limited input from neuromuscular specialists directly involved in patient care and without patient input. These policies often reflect a lack of understanding of the disease, clinical population or the treatment. To ensure that policy determinations reflect best clinical practice, we recommend insurers work with neuromuscular specialists with expertise in care for patients with dystrophinopathy, as well as patients and families, and prominent advocacy organizations, such as Parent Project Muscular Dystrophy, in developing policies.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of the Zika Virus Outbreak in the Cabo Verde Islands, West Africa.","authors":"José Lourenço, Maria de Lourdes Monteiro, Tomás Valdez, Júlio Monteiro Rodrigues, Oliver Pybus, Nuno Rodrigues Faria","doi":"10.1371/currents.outbreaks.19433b1e4d007451c691f138e1e67e8c","DOIUrl":"10.1371/currents.outbreaks.19433b1e4d007451c691f138e1e67e8c","url":null,"abstract":"<p><strong>Introduction: </strong>The Zika virus (ZIKV) outbreak in the island nation of Cabo Verde was of unprecedented magnitude in Africa and the first to be associated with microcephaly in the continent.</p><p><strong>Methods: </strong>Using a simple mathematical framework we present a first epidemiological assessment of attack and observation rates from 7,580 ZIKV notified cases and 18 microcephaly reports between July 2015 and May 2016.</p><p><strong>Results: </strong>In line with observations from the Americas and elsewhere, the single-wave Cabo Verdean ZIKV epidemic was characterized by a basic reproductive number of 1.85 (95% CI, 1.5 - 2.2), with overall the attack rate of 51.1% (range 42.1 - 61.1) and observation rate of 2.7% (range 2.29 - 3.33).</p><p><strong>Conclusion: </strong>Current herd-immunity may not be sufficient to prevent future small-to-medium epidemics in Cabo Verde. Together with a small observation rate, these results highlight the need for rapid and integrated epidemiological, molecular and genomic surveillance to tackle forthcoming outbreaks of ZIKV and other arboviruses.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35992594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community's Emergency Preparedness for Flood Hazards in Dire-dawa Town, Ethiopia: A Qualitative Study.","authors":"Luche Tadesse Ejeta","doi":"10.1371/currents.dis.3843ad9fc823c8c853970148b350750c","DOIUrl":"https://doi.org/10.1371/currents.dis.3843ad9fc823c8c853970148b350750c","url":null,"abstract":"<p><strong>Background: </strong>Emergency preparedness at all levels (individuals and communities) is the corner stone of effective response to the increasing trends of global disasters due to man-made and natural hazards. It is determined by different factors, including (among others) past direct and indirect exposures to hazards. This study was carried out in Dire Dawa town, Ethiopia, which in the past experienced frequent flooding events, yet dearth of information exists about preparedness in the area.  The aim of the study was to assess the levels of emergency preparedness for flood hazards at households and communities levels.</p><p><strong>Methods: </strong>The study was conducted in a qualitative approach and was conducted in Dire Dawa town, which has been divided into nine administrative-units called Kebeles. Two focus group discussions were held in two of these units (Kebele-05 and 06), each focus group comprising twelve people (all above 18 years of age), and in total 24 people (13 females and 11 males) took part in the study. Open ended questions were used that could guide the discussions, and the discussions were audio-taped and transcribed. The results were translated from local language to English and qualitatively presented.</p><p><strong>Results: </strong>The findings of focus group discussions showed that the local government in collaboration with the federal government built the flood protection dams in areas where flood hazards have been thought to be repeatedly wreaking havoc, specifically after the flood disaster of the year 2006. In addition, in Kebele-05, where one Non-Governmental Organization (NGO) was operating on flood hazards prevention and mitigation program, some non-structural emergency preparedness measures were undertaken by the communities. These non-structural measures (the major ones) entailed: establishment of committees recruited from residents and training them to raise awareness among communities on emergency preparedness; some residents made changes to their own houses (retrofitted) and put sandbags around their houses to temporarily protect the flooding; establishment of communication channels between communities to alarm each other in the event of flood disaster; and reforestation of the already deforested mountainous areas surrounding the town. However, concerns were raised by study participants about strengths of the constructed flood protection dams. Furthermore, the non-structural emergency preparedness measures identified by this study were not comprehensive; for example, residents were not trained in first aid, first aid kits were not provided, there was no linkage being established between communities and health facilities so as to provide emergency medical care to victims in the event of flood disaster.</p><p><strong>Discussion: </strong>The findings of this study concur with some of the previous quantitative studies' results in that the past direct and indirect disaster experiences invoke prepar","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35955296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Laboratory Profile of Zika and Dengue Infected Patients: Lessons Learned From the Co-circulation of Dengue, Zika and Chikungunya in Brazil.","authors":"Elzinandes Leal Azeredo,&nbsp;Flavia Barreto Dos Santos,&nbsp;Luciana Santos Barbosa,&nbsp;Thiara Manuele Alves Souza,&nbsp;Jessica Badolato-Corrêa,&nbsp;Juan Camilo Sánchez-Arcila,&nbsp;Priscila Conrado Guerra Nunes,&nbsp;Luzia Maria de-Oliveira-Pinto,&nbsp;Ana Maria de Filippis,&nbsp;Márcia Dal Fabbro,&nbsp;Izilyanne Hoscher Romanholi,&nbsp;Rivaldo Venancio da Cunha","doi":"10.1371/currents.outbreaks.0bf6aeb4d30824de63c4d5d745b217f5","DOIUrl":"https://doi.org/10.1371/currents.outbreaks.0bf6aeb4d30824de63c4d5d745b217f5","url":null,"abstract":"Background: The current triple epidemic caused by dengue, zika and chikungunya constitutes a serious health problem in Brazil. The aim of this study was to investigate acute samples (up to the 7 days of symptoms) from patients presenting acute fever syndrome suspected as arboviral infection and characterize the clinical and laboratorial profile during the co-circulation of dengue, zika and chikungunya in Campo Grande, Mato Grosso do Sul (MS), midwest region of Brazil. Methods: All suspected cases (n=134) were tested by using serological and molecular diagnostic tests including DENV, ZIKV and CHIKV RT-PCR, Dengue nonstructural protein 1 (NS1) antigen capture ELISA, anti- DENV IgM ELISA and anti-CHIKV IgM ELISA. In addition, clinical, hematological and biochemical parameters of infected patients were analyzed. Results: It was observed that 79.1% of the blood samples were confirmed for ZIKV and/or DENV infection Of those, 38.0% patients were DENV monoinfected, 26.8% were ZIKV monoinfected and 13.4% were DENV/ZIKV co-infected. Seven patients presented Chikungunya IgM antibodies indicating a previous CHIKV infection. Common symptoms included fever, rash, arthralgia, myalgia, prostration, headache and conjunctivitis. Statistical analysis showed that pruritus and edema were associated with ZIKV infection while prostration and vomiting were more associated with dengue. Additionally, total protein and ALT levels were significantly different in DENV patients compared to ZIKV ones. Some DENV infected patients as well as co-infected needed hospitalization and venous hydration. Otherwise, most ZIKV infected patients presented mild clinical course. Among the pregnant women studied (n=11), three were ZIKV monoinfected while four were DENV monoinfected and two were DENV-1/ZIKV coinfected. In general, normal birth outcomes were observed except for the death due to respiratory insufficiency of one baby born to a mother coinfected with DENV-1/ZIKV. Conclusions: Herein, we provide evidence of the co-circulation of DENV, ZIKV and CHIKV infections in the Campo Grande, MS, Brazil, with a high frequency of DENV-1/ZIKV coinfection. Laboratorial diagnosis poses a challenge where those arboviruses are endemic and differential diagnosis proved to imperative for cases characterization. The knowledge about disease severity during arbovirus coinfections is still scarce and there are several issues emphasizing the importance of adequate management of patients at risk areas.","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35954083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humanitarian Needs in Government Controlled Areas of Syria.","authors":"Shannon Doocy,&nbsp;Emily Lyles","doi":"10.1371/currents.dis.f510b7b5f473a260a215744b4b85c38b","DOIUrl":"https://doi.org/10.1371/currents.dis.f510b7b5f473a260a215744b4b85c38b","url":null,"abstract":"<p><strong>Background: </strong>Five years of conflict in Syria have led to 13.5 million people in need of humanitarian assistance and 6.6 million internally displaced people. Humanitarian needs are ever-increasing as an inability to maintain humanitarian corridors and ceasefires continue. In light of the protracted nature of the conflict, immense needs, and dearth of large-scale data, we undertook this assessment to inform humanitarian response.</p><p><strong>Methods: </strong>A survey of accessible areas, which were largely urban and government controlled, was undertaken from April - June 2016 to identify unmet needs and assistance priorities. A cluster design with probability sampling was used to attain a final sample of 2,405 households from ten of fourteen governorates; 31 of 65 (47.7%) districts were included that are home to 38.1% of people in need (PiN).</p><p><strong>Results: </strong>Overall 45% of households received assistance in the preceding month; receipt of aid was lowest in al-Hasakeh (17%). Shelter was a concern, with 48% of households having shelter need(s); the unmet shelter needs were highest in the West Coast, Rif Damascus and al-Hasakeh.  Food security was a major concern where 64% had unmet food needs and 65% at least one indicator of concern; food insecurity was most severe in Rif Damascus and the West Coast. Water was also a concern with 36% of households reporting inconsistent access and 48% no access to water for several day periods; water needs were highest in Aleppo.</p><p><strong>Discussion: </strong>This assessment included accessible populations in predominantly urban and government controlled areas, which are likely to have better access to services and fewer needs than populations in rural locations or areas not controlled by the government.  The humanitarian situation in inaccessible and non-government controlled areas is likely to be considerably worse, thus findings should not be generalized. An expanded humanitarian response is desperately needed for Syrians to better endure the conflict.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35977885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.","authors":"Alan de Lima Pereira,&nbsp;Rosamund Southgate,&nbsp;Hikmet Ahmed,&nbsp;Penelope O'Connor,&nbsp;Vanessa Cramond,&nbsp;Annick Lenglet","doi":"10.1371/currents.dis.bb5f22928e631dff9a80377309381feb","DOIUrl":"https://doi.org/10.1371/currents.dis.bb5f22928e631dff9a80377309381feb","url":null,"abstract":"<p><strong>Introduction: </strong>In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015.</p><p><strong>Methods: </strong>We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years.</p><p><strong>Results: </strong>The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months.</p><p><strong>Discussion: </strong>As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high.</p><p><strong>Conclusion: </strong>We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35889645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rio's Mountainous Region (\"Região Serrana\") 2011 Landslides: Impact on Public Mental Health System.","authors":"Marcelo Dell'Aringa,&nbsp;Otavio Ranzani,&nbsp;Joost Bierens,&nbsp;Virginia Murray","doi":"10.1371/currents.dis.156b98022b9421098142a4b31879d866","DOIUrl":"https://doi.org/10.1371/currents.dis.156b98022b9421098142a4b31879d866","url":null,"abstract":"<p><p>INTRODUCTION In January 2011 landslides and floods followed heavy rain in the Mountainous Region of Rio de Janeiro State (\"Região Serrana\"), in southeastern Brazil. These events led to the largest disaster registered in Brazilian recent history. Few studies addressed the impacts of this disaster on public health, and we found none addressing the impact on mental health. This study reviewed the consequences of the 2011 disaster in the \"Região Serrana\", by comparing the demand for public mental health assistance data from time periods before and after the even  METHODS  We performed an ecologic study, analysing the aggregate data from \"Região Serrana\" during the period two years before and after the disaster, exporting data from the Brazilian open access public health database. The primary outcome was defined as Mental Health Care Demand, and for that we calculated the number of mental health care visits per month, the proportion of visits due to mental health care and the monthly absolute number of mental health care visits per CAPS - \"Centro de Atenção Psicossocial\" (Psychosocial Care Centre). For secondary outcomes we evaluated the total number of deaths by any reason, and the total number of hospitalizations. The other health administrative regions of Rio de Janeiro state were used as control group.  RESULTS  We observed that there was an important increase in the rate of visits due to mental health in the six months after the landslides, from 13,875 to 17,690, reaching its maximum one year after the event totalizing 21,980 visits (Dec 2011). It was also observed that the proportion of visits due to mental health disorders increased after the event in the \"Região Serrana\", as well as the number of mental health care visits per CAPS.   DISCUSSION  In conclusion, we observed that the 2011 Landslides in \"Região Serrana\" led to a sustained higher burden to public mental health care. There was an increase in the demand for mental health visits, and the ratio of visits per CAPS was higher during most part of the studied period after the event, even with the region having more CAPS than before.</p>","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35982149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Review of Francisella Tularensis: A Case Study in the Complications of Dual Diagnoses.","authors":"Ralph Anthony Stidham, David B Freeman, Robert L von Tersch, Peter J Sullivan, Samantha D Tostenson","doi":"10.1371/currents.outbreaks.8eb0b55f377abc2d250314bbb8fc9d6d","DOIUrl":"10.1371/currents.outbreaks.8eb0b55f377abc2d250314bbb8fc9d6d","url":null,"abstract":"Introduction: Tularemia is a rare but potentially fatal disease that develops in numerous wild and domestic animals, including lagomorphs, rodents, cats, and humans. Francisella tularensis bacterium, the causative agent of tularemia, was identified by veterinary personnel at Fort Riley, Kansas during a routine post-mortum evaluation of a domestic feline. However, before formal diagnosis was confirmed, the sample was sent and prepared for rabies testing at the Department of Defense (DoD) U.S. Army Public Health Command Central (PHC-C), Food Analysis and Diagnostic Laboratory (FADL). This case report provides insight on how veterinarian staff and laboratory personnel can clinically manage esoteric, unexplained, or post-mortum examinations. The epidemiologic characteristics of tularemia, F. tularensis as an organism of military interest, potential laboratory management of F. tularensis, and clinical findings on a case of feline tularemia are discussed. It further raises questions as to whether or not dead animals should be treated as sentinels and be pre-screened for select agents, especially in instances of dual diagnoses. Methods: A necropsy was performed on the cat by the Fort Riley veterinarian, DNA extraction and PCR analyses were conducted by FADL microbiologists, histology and immunohistology analyses were conducted by the Kansas State Veterinary Diagnostic Laboratory, and feline tissue and blood were sent to the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) for confirmatory testing and strain identification of tularemia. Results: Tularemia was identified in the spleen of the cat by the Fort Riley veterinarian and during the histological sampling of the spleen by the Kansas State Veterinary Diagnostic Laboratory. A specific subsequent real-time polymerase chain reaction (RT-PCR) in vitro diagnostic detection of target DNA sequences of F. tularensis was conducted by the FADL microbiologists using a Joint Biological Agent Identification and Diagnostic System (JBAIDS) Tularemia Detection Kit to detect a presumptive qualitative result to detect tularemia in feline and blood samples. USAMRIID also performed RT-PCR and identified genomic DNA from F. tularensis Type A, (SPL15.013.02), thus confirming the FADL’s initial presumptive result of F. tularensis. USAMRIID attempted to culture F. tularensis from three samples (swab, feline tissue, and transfer pipette tip), but no growth consistent with F. tularensis was observed on the cysteine heart agar with sheep blood and antibiotics (CHAB) and chocolate (CHOC) plates. Discussions: Our case study of a dual diagnosis of presumptive F. tularensis and possible rabies exposure transmission from a pet cat to its owner provides insight on how veterinarian staff and laboratory personnel can clinically manage esoteric, unexplained, or post-mortum examinations. Our case study also demonstrates the obligation for cooperation between animal health, human health, and public health professio","PeriodicalId":74464,"journal":{"name":"PLoS currents","volume":"10 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35791986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}