Sentinel surveillance systems with special focus on vector-borne diseases

In the past few decades, vector-borne diseases have been spreading into countries previously free of these agents. It is necessary for a surveillance method to be tailored to the biology of these agents in order to detect their incursion. Using a sentinel herd system, it is possible to target high-risk areas where occurrence is most probably due to vector presence. Since the 1970s, diseases such as Akabane, vesicular stomatitis and Bluetongue disease have successfully been monitored using cattle herds as sentinels in many countries such as Saudi Arabia, Australia, China, Indonesia, Sultanate of Oman and most recently in countries in Western Europe. This paper reviews the strengths and weaknesses of sentinel herd surveillance systems in general. In order to determine their efficacy, the following criteria were found to be essential: the choice of sentinel locations, sentinel animal, seasonality of sampling and diagnostic testing methods. We conclude that due to its ability to focus on a specific disease, sentinel herd systems have been successful in the early detection of the spread of a targeted agent. This review is used as a basis for recommendations for the development of future sentinel herd system

Estimating the temporal and spatial risk of bluetongue related to the incursion of infected vectors into Switzerland

<p>Abstract</p> <p>Background</p> <p>The design of veterinary and public health surveillance systems has been improved by the ability to combine Geographical Information Systems (GIS), mathematical models and up to date epidemiological knowledge. In Switzerland, an early warning system was developed for detecting the incursion of the bluetongue disease virus (BT) and to monitor the frequency of its vectors. Based on data generated by this surveillance system, GIS and transmission models were used in order to determine suitable seasonal vector habitat locations and risk periods for a larger and more targeted surveillance program.</p> <p>Results</p> <p>Combined thematic maps of temperature, humidity and altitude were created to visualize the association with <it>Culicoides </it>vector habitat locations. Additional monthly maps of estimated basic reproduction number transmission rates (R₀) were created in order to highlight areas of Switzerland prone to higher BT outbreaks in relation to both vector activity and transmission levels. The maps revealed several foci of higher risk areas, especially in northern parts of Switzerland, suitable for both vector presence and vector activity for 2006.</p> <p>Results showed a variation of R₀values comparing 2005 and 2006 yet suggested that Switzerland was at risk of an outbreak of BT, especially if the incursion arrived in a suitable vector activity period. Since the time of conducting these analyses, this suitability has proved to be the case with the recent outbreaks of BT in northern Switzerland.</p> <p>Conclusion</p> <p>Our results stress the importance of environmental factors and their effect on the dynamics of a vector-borne disease. In this case, results of this model were used as input parameters for creating a national targeted surveillance program tailored to both the spatial and the temporal aspect of the disease and its vectors. In this manner, financial and logistic resources can be used in an optimal way through seasonally and geographically adjusted surveillance efforts. This model can serve as a tool for other vector-borne diseases including human zoonotic vectors which are likely to spread into Europe.</p

Permanent tooth agenesis in non-syndromic Robin sequence and cleft palate: prevalence and patterns

Objectives: Partial tooth agenesis is frequently observed in Robin sequence. Tooth anomalies are increasingly considered as an extended phenotype of the cleft palate population. The study objective was to compare the prevalence and patterns of tooth agenesis in a group of patients with non-syndromic Robin sequence (ns-RS) and a group with non-syndromic cleft palate (ns-CP). Materials and methods: The panoramic radiographs of 115 ns-RS and 191 ns-CP patients were assessed for agenesis of the permanent dentition (excluding third molars) and the patterns recorded using the Tooth Agenesis Code. Results: Partial tooth agenesis was observed in 47.8% of ns-RS and 29.8% of ns-CP patients with a greater prevalence in the mandibula than in the maxilla, particularly in ns-RS. The teeth most frequently absent in both groups were the mandibular second premolars and maxillary lateral incisors. Tooth agenesis was bilateral in two-thirds of affected ns-RS patients and one-half of ns-CP patients. In ns-RS, bilateral agenesis of the mandibular second premolars was more frequently observed in female than that in male patients. Completely symmetrical patterns of hypodontia were found in around 45% of ns-RS patients with tooth agenesis compared to 35% in ns-CP. No association was found between the extent of the palatal cleft and the severity of hypodontia. Conclusion: Tooth agenesis is more prevalent in ns-RS than that in ns-CP, demonstrates a much greater predilection for the mandible in ns-RS, and bears no relation to the extent of the palatal cleft. Clinical relevance: When compared to ns-CP, additional developmental disturbances are likely involved in the etiology of tooth agenesis in ns-RS. Future research could help identify the underlying genetic traits and aid in classifying patients in those with and without expected tooth agenesis in order to facilitate orthodontic management strategies

Best practices for the diagnosis and evaluation of infants with robin sequence:a clinical consensus report

Importance: Robin sequence (RS) is a congenital condition characterized by micrognathia, glossoptosis, and upper airway obstruction. Currently, no consensus exists regarding the diagnosis and evaluation of children with RS. An international, multidisciplinary consensus group was formed to begin to overcome this limitation. Objective: To report a consensus-derived set of best practices for the diagnosis and evaluation of infants with RS as a starting point for defining standards and management. Evidence Review: Based on a literature review and expert opinion, a clinical consensus report was generated. Findings: Because RS can occur as an isolated condition or as part of a syndrome or multiple-anomaly disorder, the diagnostic process for each newborn may differ. Micrognathia is hypothesized as the initiating event, but the diagnosis of micrognathia is subjective. Glossoptosis and upper airway compromise complete the primary characteristics of RS. It can be difficult to judge the severity of tongue base airway obstruction, and the possibility of multilevel obstruction exists. The initial assessment of the clinical features and severity of respiratory distress is important and has practical implications. Signs of upper airway obstruction can be intermittent and are more likely to be present when the infant is asleep. Therefore, sleep studies are recommended. Feeding problems are common and may be exacerbated by the presence of a cleft palate. The clinical features and their severity can vary widely and ultimately dictate the required investigations and treatments. Conclusions and Relevance: Agreed-on recommendations for the initial evaluation of RS and clinical descriptors are provided in this consensus report. Researchers and clinicians will ideally use uniform definitions and comparable assessments. Prospective studies and the standard application of validated assessments are needed to build an evidence base guiding standards of care for infants and children with RS