Tungiasis is a neglected parasitic skin disease caused by penetration of female sand fleas into the epidermis. The ectoparasitosis is widespread in resource-poor communities in South America, the Caribbean and sub-Saharan Africa. To identify risk factors for the presence of sand fleas and severe infestation in an endemic community, we examined the entire population of a traditional fishing village for the presence of embedded sand fleas and determined the number and type of lesions. Demographic, behavioural and environmental characteristics of the population were assessed using a structured questionnaire. Multivariable analysis showed that both occurrence of tungiasis and heavy infestation were significantly related to poor housing conditions (odds ratio [OR]=4.7, 95% CI 1.4-15.8), lack of health education (OR=4.1, 95% CI 2.0-8.6) and presence of animals on the compound (OR=1.9, 95% CI 1.1-3.4). Contrary to common belief, a protective effect of frequent use of closed footwear could not be demonstrated. Based on the population attributable fractions calculated for the major risk factors identified, we conclude that several low-cost interventions would have a considerable impact on the occurrence of tungiasis and heavy infestation.

Gripenet has been monitoring the activity of influenza-like-illness (ILI) with the aid of volunteers via the internet in the Netherlands and Belgium since 2003 and in Portugal since 2005. In contrast with the traditional system of sentinel networks of mainly primary care physicians coordinated by the European Influenza Surveillance Scheme (EISS), Gripenet obtains its data directly from the population. Any resident of the three countries can participate in Gripenet by completing an application form on the appropriate websites (http://www.gripenet.pt), which contains various medical, geographic and behavioural questions. Participants report weekly on the website any symptoms they have experienced since their last visit. ILI incidence is determined on the basis of a uniform case definition.In the 2006/2007 season, 19,623 persons participated in Gripenet in the Netherlands, 7,025 in Belgium and 3,118 in Portugal. The rise, peak and decline of ILI activity occurred at similar times according to Gripenet and EISS. However, ILI attack rates in the Netherlands (6.6%), Belgium (6.1%) and Portugal (5.6%) were remarkably more similar in Gripenet than in EISS (0.8%, 3.9%, and 0.6% respectively).Monitoring ILI activity with the direct participation of volunteers provides similar incidence curves compared to the traditional system coordinated by EISS. Whereas EISS provides an established system whose data is validated by virology tests, Gripenet is a fast and flexible monitoring system whose uniformity allows for direct comparison of ILI rates between countries. A current objective of Gripenet is to engage more European countries.

Tungiasis is hyperendemic in many poor communities in Brazil and is associated with considerable morbidity. In order to understand the factors that determine the distribution of this ectoparasitosis in a rural community, an epidemiological study was carried out in a traditional fishing village in Ceará State, north-eastern Brazil. Based on active case detection and voluntary participation, 91% of the population (belonging to 95% of all families) was examined. Embedded fleas were looked for over all parts of the body, counted, and the lesions were staged. The overall prevalence of infestation was 51.3% (95% CI: 47.0-55.5). More males than females were infested (54.8% vs 48.3%); however, this difference was not statistically significant. Age-specific prevalence rates followed an S-shaped curve with peaks in children aged 5-9 years and people elder than 60 years. The parasite burden was high (range 1-145 lesions; arithmetic mean: 8.9) and particularly elevated in males, children <15 years and the elderly. The distribution of the parasite burden was uneven within the population with the majority of the lesions in a few individuals: the 23 subjects (8% of all infested) with severe infestation (>30 lesions) accounted for 1,366 of the 2,493 lesions (54.8%) documented. The study shows that tungiasis is a highly prevalent ectoparasitosis in this deprived community with a peculiar distribution of prevalence and parasite burden.

No abstract

One-third of the world population (approximately 2 billion individuals) is currently infected with Mycobacterium tuberculosis, the vast majority harboring a latent infection. As the risk of reactivation is around 10% in a lifetime, it follows that 200 million of these will eventually develop active pulmonary disease. Only therapeutic or post-exposure interventions can tame this vast reservoir of infection. Treatment of latent infections can reduce the risk of reactivation, and there is accumulating evidence that combination with postexposure vaccines can reduce the risk of reinfection. Here we develop mathematical models to explore the potential of these postexposure interventions to control tuberculosis on a global scale. Intensive programs targeting recent infections appear generally effective, but the benefit is potentially greater in intermediate prevalence scenarios. Extending these strategies to longer-term persistent infections appears more beneficial where prevalence is low. Finally, we consider that susceptibility to reinfection is altered by therapy, and explore its epidemiological consequences. When we assume that therapy reduces susceptibility to subsequent reinfection, catastrophic dynamics are observed. Thus, a bipolar outcome is obtained, where either small or large reductions in prevalence levels result, depending on the rate of detection and treatment of latent infections. By contrast, increased susceptibility after therapy may induce an increase in disease prevalence and does not lead to catastrophic dynamics. These potential outcomes are silent unless a widespread intervention is implemented. r

A country-wide sentinel surveillance system was initiated in Germany after

With an annual incidence between 8 and 15 per 100,000 population in the period from 2009 to 2013, Slovenia has one of the highest notified incidences of tick-borne encephalitis (TBE) in Europe. TBE vaccination coverage remains at about 7.3%. To inform vaccination policy, we used surveillance data from 2009 to 2013 to calculate the overall and age- and sex-specific mean annual TBE incidence. We estimated disability-adjusted life years (DALYs) with 95% uncertainty intervals (UI), using the Burden of Communicable Diseases in Europe approach from the European Centre for Disease Prevention and Control. The mean annual incidence was 11.6 per 100,000 population, peaking in older age groups (50–74 years: 18.5/100,000) while relatively lower among children (5–14 years: 10.2/100,000). We estimated an overall 10.95 DALYs per 100,000 population per year (95% UI: 10.25-11.65). In contrast to the TBE incidence, the disease burden in children aged 5–14 years was higher than in adults aged 50–74 years: 17.31 (95% UI: 14.58–20.08) and 11.58 (95% UI: 10.25–12.91) DALYs per 100,000 stratum-specific population, respectively. In a limited resource setting where prioritisation of TBE vaccination strategies is required, vaccination programmes targeting children may have a higher impact on disease burden.

Compared to stool examinations using DFA, upper endoscopy is less sensitive for the diagnosis of giardiasis. In patients with negative stool examinations, lower endoscopy yields relevant diagnoses more often than upper endoscopy.