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Abstract. Malaria remains the most important parasitic cause of mortality in humans. Its presentation is thought to vary according to the intensity of Plasmodium falciparum transmission. However, detailed descriptions of presenting features and risk factors for death are only available from moderate transmission settings. Such descriptions help to improve case management and identify priority research areas. Standardized systematic procedures were used to collect clinical and laboratory data on 6,624 children admitted to hospital over a 1-year period in an intensely malarious part of Tanzania. Frequencies of signs and symptoms were calculated and their association with a fatal outcome was assessed using multivariate logistic regression. There were 72 deaths among 2,432 malaria cases (case fatality rate [CFR] ϭ 3.0%); 44% of the cases and 54% of the deaths were in individuals less than 1 year of age. There was no association between level of parasitemia and CFR. Increased risk of dying was independently found in all children with hypoglycemia (odds ratio [OR] ϭ 6.7, 95% confidence interval [CI] ϭ 3.9-11.7), in children 1-7 months of age with tachypnea (OR ϭ 8.8, 95% CI ϭ 2.6-30.5) and dehydration (OR ϭ 5.0, 95% CI ϭ 1.9-14.2), and in children 8 months to 4 years of age with chest indrawing (OR ϭ 4.7, 95% CI ϭ 2.0-11.2) and inability to localize a painful stimulus (OR ϭ 6.9, 95% CI ϭ 2.9-16.5). Children in the bottom quartile of weight-for-age were more likely to die (OR ϭ 2.1, 95% CI ϭ 1.3-3.5). Eight percent of the malaria cases had severe anemia (packed cell volume Ͻ 15%) but 24% received a blood transfusion. The epidemiology of malaria disease may be more complex than previously thought. Improved case management in a wide variety of health facilities may result from adequate identification and treatment of dehydration and hypoglycemia. Transfusion-requiring anemia is a major problem and sustainable, effective preventive measures are urgently needed.More than half of the world's population lives in areas endemic for Plasmodium falciparum malaria, resulting in more than 400 million clinical cases and between one and three million deaths every year. 1 Young children living in sub-Saharan Africa carry the largest part of this burden. 2 Although the epidemiology of P. falciparum infection has been well described in a variety of settings, the description of malaria as a life-threatening disease is less complete. Such descriptions can improve case management by identifying children at highest risk of dying; focusing scarce resources on such patients may reduce case fatality rates. Furthermore, these studies provide valuable insights into underlying pathophysiologic processes.Common manifestations of severe malaria in children include cerebral malaria and severe anemia. The relative importance of each presentation is thought to vary according to the intensity of transmission, with severe anemia being increasingly important as transmission intensity increases and cerebral malaria more common at lower transmission inten...

Purpose To estimate the incidence of herpes zoster (HZ) and rates of post-zoster pain in both the total study population and separately in patients with selected conditions/treatments associated with altered immune function.MethodsThe health administrative claims databases for commercially insured, Medicare, and Medicaid populations, together accounting for approximately 51 million insured individuals, were analyzed between 2005 and 2009 in a retrospective cohort study. Incidence of HZ episodes per 1,000 person-years (PY) was estimated in all study populations as well as within nine potentially immune-altering conditions. Among patients with HZ, the 6-month rate of persistent post-zoster pain was estimated.ResultsAnalysis of 90.2 million PY at risk revealed that the incidence of HZ in the total study population was 4.82/1,000 PY. The incidence of HZ was highest among patients with bone marrow or stem cell transplant (43.03 %) followed by solid organ transplant, human immunodeficiency virus infection, and systemic lupus erythematosus [95 % confidence interval (CI) 15.19–17.41 %]. HZ incidence rates were higher among persons on immunosuppressants/chemotherapy than among non-users. In the total study population, HZ incidence increased with age (18–49 years: 3.37/1,000 PY; 65+ years: 8.43/1,000 PY; P < 0.01) and female gender (incidence ratio vs. male 1.39, 95 % CI 1.38–1.40 %). The 6-month rate of persistent post-zoster pain was 4.29 % (95 % CI 4.22–4.36 %), which was higher in patients with the selected conditions.ConclusionsDespite providing a relatively small fraction of overall HZ cases, persons with immune function-altering conditions make a large contribution to the societal healthcare burden because they have a higher risk of developing HZ and persistent post-zoster pain. These risk factors should be considered in HZ prevention efforts.