121 research outputs found
European expert network on rare communicable diseases and other rare diseases linked to mobility and globalisation focused on ealth care provision (EURaDMoG): a feasibility study.
INTRODUCTION NlmCategory: BACKGROUND content: In the current mobility and globalization context, there is a growing need to identify potential changes on the pattern of diseases in the European Union (EU)/European Economic Area (EEA)
and provide accurate diagnosis and treatment for the population.
The pattern of rare communicable diseases that can affect people
returning to EU/EEA from travel abroad, visiting EU/EEA or
establishing in the EU/EEA is of special relevance. The
objective of this manuscript is to give an overview about the
EURaDMoG study and discuss the feasibility of establishing a
European network on rare communicable diseases and other rare
conditions linked to mobility and globalization. - Label:
METHODS NlmCategory: METHODS content: We undertook a three-steps
process where we first conducted a narrative review to estimate
the prevalence and incidence and to list rare communicable and
non-communicable diseases linked to mobility and globalization
in the EU/EEA; second, we organized an international
consultation workshop with experts in the diseases previously
selected; and finally, the feasibility study analysed how
successful a European expert network on rare diseases linked to
mobility and globalization focused on health care provision
would be, accounting for different operational and also
sustainability criteria. - Label: RESULTS NlmCategory: RESULTS
content: "First, considering the areas or topics that the
network should cover, it was concluded that communicable and
non-communicable rare diseases linked to mobility and
globalization should be differentiated. Second, since all
non-communicable rare diseases linked to mobility and
globalization identified are already covered by different
European Reference Networks (ERNs), there is no need for them to
be included in a new European network. Three scenarios were
considered for establishing a potential European network for
rare communicable diseases linked to Mobility and Globalisation
with a focus on Health Care provision: 1) To maintain the
current situation \"Status Quo\" scenario; 2) to create a
specific European expert network (EEN) on rare communicable
diseases linked to mobility and globalisation; 3) to develop a
new ERN on communicable rare diseases linked to mobility and
globalisation." - Label: CONCLUSIONS NlmCategory: CONCLUSIONS
content: Since the focus is the provision of health care, an ERN
could have the potential to better boost the quality of care
being facilitated by technological tools and online platforms
that permit the safe and ethically acceptable exchange of data.
However, this potential new network should not eclipse current
existing networks and they should be complementary
Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries
Strongyloidiasis is an intestinal parasitic infection becoming
increasingly important outside endemic areas, not only because
of the high prevalence found in migrant populations, but also
because immunosuppressed patients may suffer a potentially fatal
disseminated disease. The aim of these guidelines is to provide
evidence-based guidance for screening and treatment of
strongyloidiasis in non-endemic areas. A panel of experts
focused on three main clinical questions (who should be screened
and how, how to treat), and reviewed pertinent literature
available in international databases of medical literature and
in documents released by relevant organizations/societies. A
consensus of the experts' opinion was sought when specific
issues were not covered by evidence. In particular, six
systematic reviews were retrieved and constituted the main
support for this work. The evidence and consensus gathered led
to recommendations addressing various aspects of the main
questions. Grading of evidence and strength of recommendation
were attributed to assess the quality of supporting evidence.
The screening of individuals at risk of the infection should be
performed before they develop any clinical complication.
Moreover, in immunosuppressed patients, the screening should be
mandatory. The screening is based on a simple and widely
accessible technology and there is now a universally accepted
treatment with a high efficacy rate. Therefore, the screening
could be implemented as part of a screening program for migrants
although further cost-effectiveness studies are required to
better evaluate this strategy from a public health point of
view
Epidemiology and economic impact of bovine cysticercosis and taeniosis caused by Taenia saginata in northeastern Spain (Catalonia)
Background: In Catalonia (north-eastern Spain), Taenia saginata has been described in cattle but its occurrence in
humans is unclear. Moreover, whether cattle acquired the infection in Catalonia or outside Catalonia and its economic
impact have not been investigated. This study aimed to estimate the prevalence and spatial distribution of bovine
cysticercosis in Catalonia (2008–2015), and the burden from T. saginata upon the animal and human sectors in Catalonia
(2013–2015).
Methods: Data on cattle diagnosed with cysticercosis at meat inspection were collected and analysed. Cattle movement
history was used to identify the most likely place of bovine cysticercosis infection and to investigate its spatial distribution.
Data on taeniosis treatment (niclosamide and praziquantel) costs and their supply in Catalonia as well as data on patients
attending primary care with diagnosis of taeniosis were collected. The financial impact associated with T. saginata due to
carcasses condemned and frozen, meat inspection and human taeniosis was estimated.
Results: During 2008–2015, between 18 and 107 cattle were found positive for cysticercosis each year (prevalence at
slaughter of 0.010%). Movement history was available for 44% of the infected cattle and in 53% of them Catalonia was
identified as the place where the infection was acquired with highest probability. Two significant bovine cysticercosis
clusters were detected. The number of patients diagnosed with taeniosis in primary care during the period 2013–2016
was 41–63/year. The overall economic impact of T. saginata (2013–2015) amounted to 154,903 €/year
(95% CI: 113,075–196,762). Meat inspection accounted for 81.9% (95% CI: 75.8–86.2%) of the costs, followed by costs due
to carcass condemnation and freezing (9.4%; 95% CI: 6.9–12.8%), and taeniosis-associated costs (8.7%; 95% CI: 6.7–11.6%).
Costs due to freezing and condemnation of carcasses reached 19,442 €/year (95% CI: 17,528–21,391)
(509 €/lightly infected carcass and 1,140 €/heavily infected carcass). Taeniosis-associated costs were estimated
at 12,848.5 €/year (237 €/patient).
Conclusions: The public health risk of T. saginata in the area seems to be low. The economic impact due to T. saginata
was mainly attributed to meat inspection. The cost due to carcass condemnation and freezing was limited compared to
the revenue of the beef sector. Developing and implementing risk-based surveillance is needed to lower the costs of
meat inspection. Considering cattle movements might be useful in the development of such a strategy
Epidemiology of congenital Chagas disease 6 years after implementation of a public health surveillance system, Catalonia, 2010 to 2015
Chagas disease; Trypanosoma cruzi; CongenitalMalaltia de Chagas; Trypanosoma cruzi; CongènitEnfermedad de Chagas; Trypanosoma cruzi; CongénitoBackgroundChagas disease is endemic in Latin America and affects 8 million people worldwide. In 2010, Catalonia introduced systematic public health surveillance to detect and treat congenital Chagas disease.AimThe objective was to evaluate the health outcomes of the congenital Chagas disease screening programme during the first 6 years (2010-2015) after its introduction in Catalonia.MethodsIn a surveillance system, we screened pregnant women and newborns and other children of positive mothers, and treated Chagas-positive newborns and children. Diagnosis was confirmed for pregnant women and children with two positive serological tests and for newborns with microhaematocrit and/or PCR at birth or serology at age 9 months.ResultsFrom 2010 to 2015, the estimated screening coverage rate increased from 68.4% to 88.6%. In this period, 33,469 pregnant women were tested for Trypanosoma cruzi and 937 positive cases were diagnosed. The overall prevalence was 2.8 cases per 100 pregnancies per year (15.8 in Bolivian women). We followed 82.8% of newborns until serological testing at age 9-12 months and 28 were diagnosed with Chagas disease (congenital transmission rate: 4.17%). Of 518 siblings, 178 (34.3%) were tested and 14 (7.8%) were positive for T. cruzi. Having other children with Chagas disease and the heart clinical form of Chagas disease were maternal risk factors associated with congenital T. cruzi infection (p < 0.05).ConclusionThe increased screening coverage rate indicates consolidation of the programme in Catalonia. The rate of Chagas disease congenital transmission in Catalonia is in accordance with the range in non-endemic countries
Accuracy of parasitological and immunological tests for the screening of human schistosomiasis in immigrants and refugees from African countries: An approach with Latent Class Analysis
BACKGROUND: Schistosomiasis is a neglected infection affecting
millions of people, mostly living in sub-Saharan Africa.
Morbidity and mortality due to chronic infection are relevant,
although schistosomiasis is often clinically silent. Different
diagnostic tests have been implemented in order to improve
screening and diagnosis, that traditionally rely on
parasitological tests with low sensitivity. Aim of this study
was to evaluate the accuracy of different tests for the
screening of schistosomiasis in African migrants, in a non
endemic setting. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective
study was conducted on 373 patients screened at the Centre for
Tropical Diseases (CTD) in Negrar, Verona, Italy. Biological
samples were tested with: stool/urine microscopy, Circulating
Cathodic Antigen (CCA) dipstick test, ELISA, Western blot,
immune-chromatographic test (ICT). Test accuracy and predictive
values of the immunological tests were assessed primarily on the
basis of the results of microscopy (primary reference standard):
ICT and WB resulted the test with highest sensitivity (94% and
92%, respectively), with a high NPV (98%). CCA showed the
highest specificity (93%), but low sensitivity (48%). The
analysis was conducted also using a composite reference
standard, CRS (patients classified as infected in case of
positive microscopy and/or at least 2 concordant positive
immunological tests) and Latent Class Analysis (LCA). The latter
two models demonstrated excellent agreement (Cohen's kappa:
0.92) for the classification of the results. In fact, they both
confirmed ICT as the test with the highest sensitivity (96%) and
NPV (97%), moreover PPV was reasonably good (78% and 72%
according to CRS and LCA, respectively). ELISA resulted the most
specific immunological test (over 99%). The ICT appears to be a
suitable screening test, even when used alone. CONCLUSIONS: The
rapid test ICT was the most sensitive test, with the potential
of being used as a single screening test for African migrants
Cost-effectiveness of Different Strategies for Screening and Treatment of Strongyloides stercoralis in Migrants From Endemic Countries to the European Union
Background: The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. Methods: We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was ¿32 126.95/LYG. Results: The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. Conclusion: Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system
Intra-individual effects of food upon the pharmacokinetics of rifampicin and isoniazid
Background:
Poor response to TB therapy might be attributable to subtherapeutic levels in drug-compliant patients. Pharmacokinetic parameters can be affected by comorbidities or the interaction of drugs with food.
Objectives:
This study aimed to determine the effect of food intake upon pharmacokinetics of rifampicin and isoniazid in a Peruvian population with TB.
Methods:
Rifampicin and isoniazid levels were analysed at 2, 4 and 6 h after drug intake in both fasting and non-fasting states using LC-MS methods.
Results:
Sixty patients participated in the study. The median rifampicin Cmax and AUC0–6 were higher during fasting than non-fasting: 7.02 versus 6.59 mg/L (P = 0.054) and 28.64 versus 24.31 mg·h/L (P = 0.002). There was a statistically significant delay overall of non-fasting Tmax compared with the fasting state Tmax (P = 0.005). In the multivariate analysis, besides the effect of fasting, Cmax for females was 20% higher than for males (P = 0.03). Concerning isoniazid, there were significant differences in the Cmax during non-fasting (median = 3.51 mg/L) compared with fasting (4.54 mg/L). The isoniazid dose received had an effect upon the isoniazid levels (1.26, P = 0.038). In the multivariate analysis, isoniazid exposure during fasting was found to be 14% higher than during non-fasting (CI = 1.02–1.28, P < 0.001). Neither radiological extent of the disease nor consumption of food with drug intake nor pharmacokinetics of rifampicin or isoniazid was associated with a poorer treatment outcome.
Conclusions: Rifampicin in particular and isoniazid pharmacokinetics were significantly affected by the intake of the drug with food between and within individuals
Health policies to control Chagas disease transmission in European countries
Chagas disease (CD) is a highly prevalent parasitic disease in immigrants from Mexico, as well as all of Central and South America. The total number of infected people is estimated between eight and ten million [1], [2], of whom 30%-40% either have, or will, develop cardiopathy, gastrointestinal disease, or both [1]. Cardiac involvement is the main cause of death from this infection through arrhythmias and cardiomyopathy. Nifurtimox and benznidazole are the only available medicines with proven efficacy against Trypanosoma cruzi infection in acute, congenital infection and early chronic infection. Until recently the treatment of chronic disease, particularly of adult patients with indeterminate form, was controversial; but during the past decade there has been a trend to offer treatment to adult patients and those with early cardiomyopathy
Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis
Background Chagas disease is currently prevalent in European countries hosting large communities from Latin
America. Whether asymptomatic individuals at risk of Chagas disease living in Europe should be screened and
treated accordingly is unclear. We performed an economic evaluation of systematic Chagas disease screening of the
Latin American population attending primary care centres in Europe.
Methods We constructed a decision tree model that compared the test option (screening of asymptomatic individuals,
treatment, and follow-up of positive cases) with the no-test option (screening, treating, and follow-up of symptomatic
individuals). The decision tree included a Markov model with five states, related to the chronic stage of the disease:
indeterminate, cardiomyopathy, gastrointestinal, response to treatment, and death. The model started with a target
population of 100 000 individuals, of which 4·2% (95% CI 2·2–6·8) were estimated to be infected by Trypanosoma cruzi.
The primary outcome was the incremental cost-effectiveness ratio (ICER) between test and no-test options.
Deterministic and probabilistic analyses (Monte Carlo simulations) were performed.
Findings In the deterministic analysis, total costs referred to 100 000 individuals in the test and no-test option were
€30 903 406 and €6 597 403 respectively, with a difference of €24 306 003. The respective number of quality-adjusted
life-years (QALYs) gained in the test and no-test option were 61 820·82 and 57 354·42. The ICER was €5442. In the
probabilistic analysis, total costs for the test and no-test option were €32 163 649 (95% CI 31 263 705–33 063 593) and
€6 904 764 (6 703 258–7 106 270), respectively. The respective number of QALYs gained was 64 634·35 (95% CI
62 809·6–66 459·1) and 59 875·73 (58 191·18–61 560·28). The difference in QALYs gained between the test and no test
options was 4758·62 (95% CI 4618·42–4898·82). The incremental cost-effectiveness ratio (ICER) was €6840·75
(95% CI 2545–2759) per QALY gained for a treatment efficacy of 20% and €4243 per QALY gained for treatment
efficacy of 50%. Even with a reduction in Chagas disease prevalence to 0·05% and with large variations in all the
parameters, the test option would still be more cost-effective than the no-test option (less than €30000 per QALY).
Interpretation Screening for Chagas disease in asymptomatic Latin American adults living in Europe is a cost-effective
strategy. Findings of our model provide an important element to support the implementation of T cruzi screening
programmes at primary health centres in European countries hosting Latin American migrants
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