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Journal Description

iproc (iproceedings) is a peer-review and publishing platform for conference papers, abstracts, posters, and presentations. JMIR Publications partners with leading conferences such as Medicine 2.0 or the Connected Health Conference to provide peer-review and editing services, and/or to publish proceedings, posters, or abstracts. If you are a conference organizer or conference chair running a leading medical or technology conference, and wish to outsource the submission and peer-reviewing process, or are interested in hosting a virtual poster show or wish to publish electronic proceedings, or if you are looking for a permanent and open dissemination venue for presentations at your conference, please contact us to discuss partnership options. Starting in 2017, we will also accept individual submissions from researchers who wish to disseminate their poster presented at a major peer-reviewed conference.

 

 

Recent Articles:

  • Enforcement of Functionality and Effectiveness of Event-Based Surveillance System (EBS), Egypt, April-September 2017

    Abstract:

    Background: To meet the requirements of International Health Regulations 2005 (IHR), initiation of EBS is essential to complement the Indicator Based Surveillance (IBS) and to boost early detection of potential Public health threats. In November 2015, the Ministry of Health (MoH) launched the EBS at the central level. The hot line in emergency room and active browsing for electronic media are the main sources of information. Objective: To enhance early detection and rapid response to potential public health threats and to improve the performance of the EBS team. Methods: At the end of June 2017, the reporting form, database and the standard Operating Procedures (SOPs) of EBS were updated. EBS team received training for the system updates. Data from April to September was investigated for the source of information, signal filtration, verification, and timeliness of response. For the events that are routinely reported by IBS, early detection was checked for both systems. The results were compared three months before and after the training. Results: Out of 762 raw signals, 199 events were detected, from which 65% (130/199) events after June. Proportion of events captured by electronic media, health care workers and community were 75% (150/199), 20% (40/199) and 5% (9/199) respectively. Filtration of signals varied significantly from 14 % to 51% (P value < 0.0001). Verification improved from 78% to 86 % (P value= 0.154). Positive Predictive Value (PPV) significantly differed from 80% to 93% (P value = 0.012). Rapid response within 24 hours significantly improved from 53% to 88% (P value < 0.0001). Capability of EBS to capture events Preceding IBS improved from 27% (9/33) to 38% (32/85) (P value= 0.288). Conclusions: Increase EBS capacity for early detection of potential public health threats. Marked improvement of EBS team performance. Raise community awareness, expand the sources of information and shift to electronic database are highly recommended.

  • Assessment of Water, Sanitation and Hygiene (WASH) within Healthcare Facilities in Selected Eastern Mediterranean Countries

    Abstract:

    Background: Inadequate drinking water, sanitation, and hygiene (WASH) in health care facilities impacts the health, particularly in low and middle-income countries. There is limited knowledge on the status of WASH in such settings. Objective: The primary objective of this study was to assess WASH conditions in health care facilities in four EM countries; Jordan, Morocco, Lebanon, and Pakistan. Methods: This study was based on secondary data analysis of the regional study on WASH services in health facilities. Separate samples of health care facilities were selected from Jordan (19 hospitals), Morocco (8 hospitals), Lebanon (14 hospitals), and Pakistan (8 hospitals) and were assessed using the WHO/CEHA tool WSH in the health facilities assessment tool. The assessment tool consisted of items to assess the WSH services availability, adequacy, and functionality. Results: All health care facilities (100%) in Jordan and Morocco, 71.4% of hospitals in Lebanon and none of the hospitals in Pakistan had a safe water source. Overall, all hospitals in Jordan, Morocco, and Lebanon and 71.4 % of hospitals in Pakistan had improved and gender separated toilets in inpatients settings (One per 20 users). About 84.2% of hospitals in Jordan, none in Morocco, 28.6% in Lebanon, and all hospitals in Pakistan had sufficient improved and gender separated toilets in outpatients setting. Overall, 84.2% of hospitals had sufficient and functioning handwashing basins with soap and water and 79.0% of hospitals had sufficient showers. The majority of hospitals in the selected countries have a policy for the safe management of healthcare waste but inadequate training program on healthcare waste. Conclusions: WASH services are not well implemented in health care facilities of the selected countries. The countries have to develop and implement a monitoring system for WASH services or at least support inclusion of WASH services in routine monitoring of health care services.

  • An Outbreak of Brucellosis in Cattle dairy farm, District Okara, Pakistan - January 2017

    Authors List:

    Abstract:

    Background: Brucellosis is prevalent in livestock causing huge economic losses due to loss of production. On January 4, 2017, six abortions at third trimester of gestation were reported from a cattle dairy farm at Renalakhurd, District Okara. Objective: An Outbreak investigation was initiated to assess the magnitude, identify risk factors and recommend control measures. Methods: A case-control study was conducted. A case was defined as adult cow in the affected dairy farm aborting at third trimester, without fever, from 18th December 2016 to 7th January 2017. Age-matched controls were selected from the same farm (1:4). Semen doses used for insemination, were tested by molecular and culturing technique. Serological testing was done through RBPT and i-ELISA. Frequencies were calculated, odd ratios determined calculated at 95% confidence interval with p value less than 0.05. Results: A total of 49 pregnant cows were identified and 16 of them had aborted at 3rd trimester. The age ranged from 5-7 year (median=5 year). For the 16 cases attack rate was 33% for aborting cows, 24% for close contact cows. The aborting cows were more likely to have brucellosis (OR 35, 95% CI 7-175, P=0.00) as compared to non-aborting cows and close contact cows were more likely to have brucellosis (OR 5, 95% CI 1.4-16, P=0.017) as compared to cows from other sheds. A total of 18.4% (23/125) farm cattle were found infected with brucellosis on serological testing. Brucellae were not detected in semen doses. Index case was a newly added (2 month before) exotic cow that was not screened by RBPT neither quarantined. Conclusions: Infected exotic cow was the most probable cause of the outbreak. Healthy animals got infection by licking aborted fetus or vaginal secretions of aborting cow. Vaccination of eligible calves using strain19, culling of confirmed cases, isolation of pregnant cows, screening & quarantine of newly purchased animals was recommended.

  • Outbreak of Brucellosis Among Workers of Cattle Dairy Farm at Renala Khurd- District Okara, Pakistan, January 2017

    Abstract:

    Background: Brucellosis is endemic in Pakistan and poses a great challenge owing to nonspecific clinical manifestations. On 7th January 2017 three workers of cattle dairy farm at Renala Khurd reported to have intermittent fever. Objective: A team was sent on 8th January 2017 to estimate magnitude of outbreak, evaluate risk factors and recommend control measures. Methods: A case was defined as prolonged intermittent fever, profuse night sweats and headache in a worker of cattle dairy farm at Renala Khurd from 7th to 21st January 2017. Cases and controls were matched by age and locality (1:4). Epidemiological information was recorded on a questionnaire. Serological testing was conducted using Rose Bengal plate test & iELISA. Frequencies were calculated, odd ratios determined at 95% confidence interval with p value less than 0.05. Results: A total of 9 cases were identified and mean age was 30 year (range 24-42 years). Overall attack rate was 29% and attack rate in cattle attendant was 47%. Among cases 78% (7/9) were involved in milking, feeding, cleaning, 44% (4/9) were habitual consumers of raw milk while 22% (2/9) were drivers and watchmen. Persons consuming contaminated raw milk (OR: 10; 95% CI: 1.4-70.2; P=.024) and workers having direct contact with animals (OR: 8.3; 95% CL: 1.4-49; P=.01) were more likely to have brucellosis. Apart from intermittent fever, night sweats (88%), headache (88%), fatigue (44%) and backache (11%) were the most frequent symptoms. All 9 cases were positive for brucella antibodies. Conclusions: The most probable cause of this outbreak was consumption of unprocessed contaminated milk and contact with secretions/excretions of infected animals. Monthly screening of workers, for a period of six months was recommended. Human cases were referred for medical treatment and Department of Health was notified.

  • Prevalence and Antimicrobial Susceptibility Patterns of Salmonella Enteritidis and Salmonella Typhimurium Isolates from Commercial Poultry in Punjab, Pakistan

    Abstract:

    Background: Non-typhoid salmonella infections are one of the leading food borne infections worldwide. Similarly, ever increasing antimicrobial resistance has become a major problem to animal as well as human health worldwide. Poultry being the single largest animal protein source in Pakistan is one of the major suspects for both these public health concerns. Objective: This study was aimed to determine the prevalence of Salmonella Enteritidis and Salmonella Typhimurium in commercial poultry flocks of Punjab and to evaluate their antimicrobial susceptibility patterns. Methods: Specimens were collected from morbid or dead birds suspected for salmonella infection on the basis of clinical signs or post-mortem lesions brought to five poultry diagnostic laboratories in Punjab between 2014 and 2017. The samples were then processed for bacterial isolation and molecular confirmation through PCR. The isolates were then subjected to antibiotic sensitivity test using disc diffusion method. The susceptibility was determined using CLSI guidelines for antimicrobial susceptibility testing. The frequencies and percentages were calculated using Epi info. Results: A total of 28150 samples were processed, among them 1.04% (294/28150) were positive. 89.5% (263/294) of the isolates were Salmonella Enteritidis while 10.5% (31/294) were Salmonella Typhimurium. The isolates were most sensitive to Ciprofloxacin and least to doxycycline with 96% (273/294) and 56% (166/294) response rates respectively. 7.8% (23/294) of the isolates were found to be resistant to three or more antibiotics. For other drugs the sensitivity percentages were Gentamicin 86% (254/294), Enrofloxacin 82% (241/294), Amoxicillin 77% (227/294), Norfloxacin 74% (219/294), Colistin 71% (208/294) and Neomycin 67% (197/294). Conclusions: Salmonella isolates were found more sensitive to Ciprofloxacin, followed by Gentamicin, Enrofloxacin and Amoxicillin while the isolates were least sensitive to Doxycycline.

  • Outbreak of Cutaneous Anthrax in Kalukhali Upazilla, Rajbari District, Bangladesh 2017

    Abstract:

    Background: Anthrax is endemic and human infection has been identified in 15 of 64 districts of Bangladesh. Outbreak are associated with exposure to infected animals during droughts, floods or soil disturbances. On September 6, 2017 the civil surgeon of Rajbari District, reported six people with anthrax like lesions with exposure to one sick cow. Objective: We investigated to determine cause of outbreak, describe the epidemiological and clinical features of cases, and to control the outbreak. Methods: We selected cutaneous anthrax cases among the people presented with painless skin lesion including papular, vesicular and depressed black eschar living in Kalukhali, Rajbarj from 27th August to 09th September 2017. Human cases exposure with sick cow identified by contract tracing. We interviewed the suspected cases for clinical symptoms and types of exposure. We collected skin swabs from 5 humans and meat from the slaughtered sick cow and tested these samples by RT-PCR. Results: We found 11 cases from community by contract tracing and 6 cases from medical record. Most (71%) cases were male; median age of cases was 30 years. Among the cases, five females cleaned meat, nine males butchered the animal, and three males carried the meat. Most (59%) cutaneous lesions were found on hands. The cattle became sick after eating of Kolmi shak (water spinach) from a nearby flooded area. Cutaneous symptoms developed in 1 to 9 days (median 5 days). Bacillus anthacis was positive by PCR in one cattle meat sample and one human swab sample. Conclusions: This was the first reported anthrax outbreak in the Rajbari district. To control this outbreak, all the cattle in the village were vaccinated and an awareness program to avoid slaughtering of sick cattle was conducted. To prevent future outbreaks, anthrax vaccination of ruminants should be conducted yearly, and priority should be given in the flood affected district.

  • Descriptive Analysis of Suspected Crimean-Congo Haemorrhagic Fever (CCHF) Cases in Isolation Ward of Public Sector Hospital, Quetta from March-August 2017

    Abstract:

    Background: CCHF cases from Balochistan and Afghanistan are referred to isolation ward in Quetta. CCHF is endemic to Balochistan but still there is no established surveillance system in province and no tick bite reporting system. The main objective was to determine the means of transmission and the epidemiologic characteristics of disease. Objective: Describe the Epidemiology of CCHF and analyze the situation of health facility. Methods: A descriptive study was carried out in the CCHF isolation ward in Quetta from March-August 2017. Using standardized case definition, all patients admitted in Isolation ward with clinical evidence of CCHF were included in the study. After taking informed consent, data was collected on demographic factors, history of animal contact, tick bite history, co morbidity, laboratory results and treatment outcome. Means and percentages were calculated. Results: During the study period, 51 suspected CCHF patients were admitted in Isolation ward, 38 (74.5%) males were affected. Mean age of the cases was 30 years (range 02-75years). Most affected 16 (31%) age group was 21-30 years. Forty-eight (94%) cases had history of animal contact and 44 (86%) with tick bite. Majority of cases 42 (82%) were reported from May -August. 30 patients in study were tested by PCR, 16 (53.3%) were positive, out of which 5 (31%) expired. It is only isolation ward in whole province with 2 doctors, 2 nurses & 1 paramedic. Proper Personal protective equipment was not available. No Laboratory was available for immediate investigations. Conclusions: Given the overall results important risk factors for CCHF are history of tick bite, high-risk occupations and having contact with livestock. Public health measures should focus on preventing tick bites, increasing awareness of CCHF signs and symptoms, adopting hospital infection control practices, timely investigation & treatment to reduce mortality. Government should set up isolation units in all Major hospitals with proper surveillance system in Province.

  • Outbreak Investigation of Malaria in Usta Mohammad, District Jaffarabad

    Authors List:

    Abstract:

    Background: On 7 August 2017, District Health office received information about 2 deaths due to high grade fever at Usta Mohammad. 7 similar cases were also reported from same village. Objective: Descriptive followed by Case Control study was conducted to investigate outbreak and to assess risk factors Methods: Descriptive followed by Case Control study was conducted to investigate outbreak and to assess risk factors. Case was defined any person resident of Usta Mohammad, regardless of age and sex, having fever with chills with August 7th August to 26th September 2017. Review of hospital records and active case finding was done through house to house survey. Matched for Age and sex controls were taken from locality with a ratio of 1:2 and interviewed. Blood samples were taken for microscopy and rapid diagnostic tests. Data were analyzed using EpiI nfo version 7.0. Results: 180 cases identified with mean age of 22.5 years (range: 01-60). Males were 59%. Age group 1-20 years was most affected (n=59). All cases were confirmed on microscopy and 90% (n=162) were positive on rapid test. Plasmodium falciparum was positive in 35% (n=64) while rest were positive for Plasmodium vivax. Attack rate was 31.4%. Case fatality was 12%. Spot map shows clustering around a stagnant Pond water. Epi curve shows sudden outburst of cases on 23th of September 2017. statistical associations was found between disease occurrence and following risk factors; Stagnant water pond (OR 48.23, 95% CI 4.43-31.27; P<0.05), non-usage of repellents (OR 5.3, 95%CI:2.67-13.52; P<0.05), absence of window screens (OR 11.2, 95% CI 5.44-41.12; P<0.05), absence of insecticide spray (OR 4.22, 95% CI 6.76-183.72; P<0.05) and waste dump near houses (OR 7.2, 95% CI 4.91-33.41; P<0.05). Conclusions: Stagnant Pond water was major mosquito breeding site and probable cause of outbreak. Mass awareness, Residual sprays, pond treatment by larvicidal, provision of bed nets and prophylaxis with chloroquine were able to control the outbreak.

  • Surveillance and Molecular Epidemiology of Avian Influenza H9N2 Viruses Circulating in Pakistan

    Authors List:

    Abstract:

    Background: Avian influenza H9N2 is highly endemic in commercial and backyard poultry in Pakistan. Its widespread circulation and high mutation rates provide a possibility of novel reassorted viruses hence posing a serious public health threat. Objective: This study was aimed to isolate and evaluate the AI H9N2 viruses circulating in poultry as well as aquatic birds in Pakistan between 2014 and 2017. Methods: Specimens were collected from morbid or dead birds suspected for AI H9N2 on the basis of clinical signs or post-mortem lesions brought to five poultry diagnostic laboratories in Punjab. The samples were subjected for virus isolation. The isolates then were confirmed for H and N type using PCR. Six isolates were subjected to phylogenetic analysis of Haemagglutinin gene. The results were compared with isolate reported previously from Pakistan and other regional countries for homology. Results: 129,622 samples from 7481 poultry flocks were processed, 5.3% (399/7481) were positive for AIV H9N2. Sequence analysis showed that it had homology of 84-93% with different regional strains. Changes were seen at 24 different sites and at cleavage site at K148R and I151R in comparison to previous Pakistani isolates. Six possible glycosylation sites were observed. Neighbor joining phylogenetic tree confirmed its 93.4% homology with the isolate of Iran. The isolates were the same clade as other regional isolates and have common ancestors. Conclusions: The prevailing H9N2 viruses in Pakistan have certain markers and elements in the HA gene that may improve its avian to human transmission. Continuous surveillance of influenza A viruses is necessary to monitor their antigenic determinants. Protocols for the AI surveillance have officially been notified by Department of Livestock & Dairy Development Department, Punjab as a result of these findings.

  • Prevalence of Brucellosis in Sindh Pakistan

    Abstract:

    Background: Brucellosis is a bacterial disease caused by genus brucella. Bovine brucellosis affects cattle, sheep & goats, camels, equines, dogs and may also infects other animals. The disease in animals is characterized by abortion in last trimester and reproductive failure. All ages of cattle are susceptible, and infection can last for many years. Infected males develop epididymitis, orchitis and testicular abscesses. In humans, brucellosis can be caused by B. abortus, B. melitensis, B.suis (biovars 1-4) and rarely B. canis. The major losses caused by brucellosis are; decreased milk production, weight loss, calf mortality, infertility and lameness. Objective: To identify the animals infected with brucellosis in selected districts and to develop disease control and mitigation measures of brucellosis. Methods: The present study was aimed to determine the prevalence of brucellosis in cattle with reproductive disorders, randomly selected cattle, cross breed cattle and small ruminants (sheep and goat) in eight districts of Sindh by Milk Ring Test (MRT), Rose Bengal Plate Test (RBPT) and Indirect ELISA. Results: A total of 4559 animals with reproductive disorders (4225 female and 334 male) were screened. The prevalence was found 25.16% in female cattle while 27.84% in male cattle. A total of 6390 randomly selected animals (6248 female and 142 male) were screened. The prevalence was found to be 10.57% in female cattle while 21.12% in male cattle. The 1002 samples were screened from cross breed cattle, the prevalence was 25.54%. A total of 1639 samples were screened from sheep and goat. The prevalence was found to be 14.46%. Conclusions: It was concluded from the present study that brucellosis is endemic in Sindh, therefore the prevention of brucellosis with vaccination is best policy for the control of the disease.

  • Investigation of Malaria Outbreak in Aswan, Egypt, 2014

    Abstract:

    Background: On May 26th 2014, new malaria cases were reported from Aswan in upper Egypt to the ministry of health and population (MOHP) through the national surveillance system(NEDSS), with no history of travel to a malaria-endemic country. MOHP interfered with a rapid response team(RRT) to investigate and contain any suspected outbreak. Efforts were concentrated on active-case finding, laboratory testing, entomological surveillance, proper treatment of patients and health education Objective: To investigate and contain any suspected outbreak. Methods: Field investigation in the affected village and its surrounding 15 villages. started on May 28th,2014 after confirmation of the first case. The RRT used a standardized case definition and distributed it to all hospitals and health unites in Aswan. Cases were diagnosed clinically, and laboratory confirmed. Active case finding was done. Investigation continued till June 19th till no additional cases were reported. Results: A total of 319 suspected cases at Edfu Fever Hospital; about 14,696 samples examined during active case-finding; where 4 samples proved positive and were transferred to Edfu Fever Hospital to receive proper treatment. A total of 22 cases were confirmed for malaria, all were caused by P. vivax. The median age of patients was 19 (range 6-90 years), with male: female ratio 1:1. No complications or deaths were reported. All cases were discharged after full recovery and after performing 4 blood films all of which are negative for plasmodia. The first onset of symptoms occurred on May 20th 2014 and the final case revealed symptoms on the 15th of June 2014. Conclusions: The Egyptian MoHP succeeded in early detection and rapid containment of a new focus of re-emerged malaria cases at a village in Upper Egypt through intensive malaria control procedures. Malaria Surveillance should be continued and reinforced for early detection of future outbreaks

  • Descriptive Analysis of Malaria Surveillance System Data, Yemen, 2011-2015

    Authors List:

    Abstract:

    Background: Malaria remains one of the most serious health problems in Yemen where 68% of population is living in malaria risk areas. An Integrated Malaria Surveillance System (IMSS) was introduced in 2009 to improve reporting. Objective: To describe the epidemiology of malaria and identify groups at risk. Methods: Data for 2011-2015 was obtained from the National Malaria Control Program (NMCP). According to the NMCP Guidelines, confirmed malaria case is defined as a case that is positive by microscopy or rapid test. We calculated incidence rate (IR) by age group, sex, type of plasmodium, seasonality and population at risk using projections from the 2014 Central Statistical Organization data. Results: Although the overall malaria IR dropped from 11/1000 in 2011 to 5 in 2015, the IR among < 5 children increased from 8 to 15/1000 and the percentage of confirmed cases increased from 0.64% to 0.83%. Among pregnant women, the IR increased from 4/1000 in 2011 to 6 in 2014 but decreased to 2 in 2015. Two thirds of malaria cases were reported among males and from the coastal governorates. Plasmodium Falciparum accounted for 99% of cases. Conclusions: Despite IR dropped from 2011 to 2015, such drop might not reflect improvement in control and prevention measures, but could reflects underreporting due to political instability, war situation and poor access to health facilities. Proper targeting especially of coastal areas by insecticide treated bed nets and indoor residual spraying is necessary. Strengthening of surveillance system for high-risk groups i.e. <5 children and pregnant women is recommended. A qualitative research should investigate reasons behind the predominance of malaria among males. Further IMSS evaluation is recommended.

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