Dengue and Dengue Haemorrhagic Fever in French Polynesia-Current Situation

All four dengue virus serotypes have occurred in French Polynesia. The first epidemic of dengue on Tahiti island of known serotype (dengue 1) occurred in 1944 as part of the Pacific-wide spread of the disease during World War II. The next outbreak of dengue took place in 1964 and was the result of the introduction of dengue 3 virus. With the increase in air travel by humans, dengue has occurred as successive epidemics, especially between 1969 and 1979 with each epidemic involving a different serotype. Each time, the epidemic serotype replaced the unique endemic serotype that had been transmitted during the preceeding interepidemic period: dengue type 3 in 1969, dengue 2 in 1971, dengue 1 in 1975-1976 and dengue 4 in 1979. With the exception of the dengue 2 epidemic, during which severe haemorrhagic cases and several deaths were observed on Tahiti on 1971, cases of dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) were not common. Following a long inter-epidemic period involving a low transmission of dengue 4, two back-to-back epidemics of dengue 1 and dengue 3 took place during 1988-1989. Of great interest was the occurrence of DHF/DSS in the latter epidemic (11 fatalities) while mildness characterized the former. Surveillance of both epidemics involved clinically and laboratory-based systems. Public health control measures were instituted. These viruses were throughoutly spread in the Pacific region with varying degrees of disease severity. Molecular epidemiology studies provided new information on geographic distribution, origin, evolution and strain variation among dengue viruses

Global tuberculosis targets and milestones set for 2016-2035: definition and rationale.

BACKGROUND: Global tuberculosis (TB) targets were set as part of the World Health Organization's End TB Strategy (2016-2035) and the Sustainable Development Goals (2016-2030). OBJECTIVE: To define and explain the rationale for these targets. DESIGN: Scenarios for plausible reductions in TB deaths and cases were developed using empirical evidence from best-performing countries and modelling of the scale-up of under-used interventions and hypothetical TB vaccines. Results were discussed at consultations in 2012 and 2013. A final proposal was presented to the World Health Assembly in 2014 and unanimously endorsed by all Member States. RESULTS: The 2030 targets are a 90% reduction in TB deaths and 80% reduction in TB incidence compared with 2015 levels. The 2035 targets are for reductions of 95% and 90%, respectively. A third target-that no TB-affected households experience catastrophic costs due to the disease by 2020-was also agreed. CONCLUSION: The global TB targets and milestones set for the period 2016-2035 are ambitious. Achieving them requires concerted action on several fronts, but two things are fundamental: 1) progress towards universal health coverage to ensure that everyone with TB can access high-quality treatment; and 2) substantial investment in research and development for new tools to prevent TB disease among the approximately 1.7 billion people infected

Monitorização de centrais solares fotovoltaicas por IoT

Esta dissertação tem por objetivo estudar os princípios, métodos, tecnologias, e equipamento atuais para sistemas de monitorização de centrais solares fotovoltaicas à distância por IoT. Efetuar a análise de soluções de sistemas de monitorização de centrais solares fotovoltaicos, resultados de estudos e desenvolvimentos da comunidade científica, e da norma ISO 61724:2017. São analisados diversos tipos de sensores, sistemas de medição e princípios de funcionamento, assim como outros componentes do sistema de monitorização, com avaliação da incerteza de medição, quando aplicável, associados à monitorização de centrais solares fotovoltaicas por IoT. Implementação prática de um sistema de monitorização por IoT a um pequeno grupo de painéis fotovoltaicos existente no Instituto Politécnico de Setúbal, recorrendo a opções, equipamentos e soluções, de custo reduzido, mas cujos princípios de funcionamento podem ser transportados e representativos de implementação em soluções mais complexas, de maior dimensão, superior exatidão e precisão na monitorização. Recurso a sensores com saída analógica, utilização de placas microcontroladores com ADC integrado, da marca Arduino, e comunicação sem fios através da comunicação do tipo LoRa. Arquivo, análise, e visualização de dados de monitorização através de uma base de dados localizada na internet para ser acessível em qualquer ponto com ligação à internet. Com transmissão sem fios através da banda ISM-Industrial Scientific and Medical, os dados das medições dos sensores relevantes do conjunto de painéis fotovoltaicos, foram transmitidos para uma antena recetora a uma distância, sensivelmente, de 700 m sem obstáculos na linha de vista, e a 120 m dentro do edifício do campus do IPS. No sistema de receção, após verificação da integridade dos dados, estes eram enviados para uma base de dados localizada na internet, onde foi criado um painel de controlo, que permitiu a monitorização das medições em qualquer ponto com ligação à internet. Análise e conclusões dos resultados obtidos e propostas de melhoria do sistema implementado.This dissertation aims to study the principles, methods, technologies, and current equipment for IoT monitoring systems of solar photovoltaic power plants. Analysis of solar photovoltaic power plant monitoring systems, based on scientific developments carried out by community studies, and study of ISO 61724:2017- Photovoltaic system performance monitoring. Analysis of different types of sensors, measurement systems and operating principles, as well as other components of monitoring system, with evaluation of the measurement uncertainty, when applicable, associated to IoT monitoring of solar photovoltaic plants. Practical implementation of an IoT monitoring system to a small group of photovoltaic panels located in the Polytechnic Institute of Setúbal, using options, equipment’s, and low-cost solutions, but whose operating principles can be transported and representative for implementation to monitor more complex solutions, bigger dimension, with greater accuracy and precision. Use of sensors with analogue output connected to microcontroller boards with integrated ADC, Arduino brand, and wireless communication through LoRa communication. Archive, analysis, and visualization of monitoring data through a database located on the internet to be accessible from any point with internet connection. With wireless transmission over the ISM-Industrial Scientific and Medical band, measurement data from the relevant sensors of the photovoltaic panels were transmitted to a receiver antenna at a distance of approximately 700m in free space, and 120m inside of building of the IPS campus. In the receiving antenna, after checking data integrity, it was sent to a database located on the internet, where a control panel was created, which allowed monitoring of the measurements from any point with internet connection. Analysis and conclusions of the results obtained and proposals for improving the implemented system

Implementing the Global Plan to Stop TB, 2011–2015 – Optimizing Allocations and the Global Fund’s Contribution: A Scenario Projections Study

CITATION: Korenromp, E. L. et al. 2012. Implementing the Global Plan to Stop TB, 2011-2015 - optimizing allocations and the Global Fund's contributions : a scenario projections study. PLoS ONE, 7(6): e38816, doi:10.1371/journal.pone.0038816.The original publication is available at http://journals.plos.org/plosoneBackground: The Global Plan to Stop TB estimates funding required in low- and middle-income countries to achieve TB control targets set by the Stop TB Partnership within the context of the Millennium Development Goals. We estimate the contribution and impact of Global Fund investments under various scenarios of allocations across interventions and regions. Methodology/Principal Findings: Using Global Plan assumptions on expected cases and mortality, we estimate treatment costs and mortality impact for diagnosis and treatment for drug-sensitive and multidrug-resistant TB (MDR-TB), including antiretroviral treatment (ART) during DOTS for HIV-co-infected patients, for four country groups, overall and for the Global Fund investments. In 2015, China and India account for 24% of funding need, Eastern Europe and Central Asia (EECA) for 33%, sub-Saharan Africa (SSA) for 20%, and other low- and middle-income countries for 24%. Scale-up of MDR-TB treatment, especially in EECA, drives an increasing global TB funding need – an essential investment to contain the mortality burden associated with MDR-TB and future disease costs. Funding needs rise fastest in SSA, reflecting increasing coverage need of improved TB/HIV management, which saves most lives per dollar spent in the short term. The Global Fund is expected to finance 8–12% of Global Plan implementation costs annually. Lives saved through Global Fund TB support within the available funding envelope could increase 37% if allocations shifted from current regional demand patterns to a prioritized scale-up of improved TB/HIV treatment and secondly DOTS, both mainly in Africa − with EECA region, which has disproportionately high per-patient costs, funded from alternative resources. Conclusions/Significance: These findings, alongside country funding gaps, domestic funding and implementation capacity and equity considerations, should inform strategies and policies for international donors, national governments and disease control programs to implement a more optimal investment approach focusing on highest-impact populations and interventions.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038816Publisher's versio

End TB strategy: the need to reduce risk inequalities

Background Diseases occur in populations whose individuals differ in essential characteristics, such as exposure to the causative agent, susceptibility given exposure, and infectiousness upon infection in the case of infectious diseases. Discussion Concepts developed in demography more than 30 years ago assert that variability between individuals affects substantially the estimation of overall population risk from disease incidence data. Methods that ignore individual heterogeneity tend to underestimate overall risk and lead to overoptimistic expectations for control. Concerned that this phenomenon is frequently overlooked in epidemiology, here we feature its significance for interpreting global data on human tuberculosis and predicting the impact of control measures. Summary We show that population-wide interventions have the greatest impact in populations where all individuals face an equal risk. Lowering variability in risk has great potential to increase the impact of interventions. Reducing inequality, therefore, empowers health interventions, which in turn improves health, further reducing inequality, in a virtuous circle

The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era

Summary Tuberculosis is the number one cause of death from infectious disease globally and drug-resistant forms of the disease are a major risk to global health security. On the occasion of World Tuberculosis Day (March 24, 2018), we provide an up-to-date review of the status of the tuberculosis epidemic, recommended diagnostics, drug treatments and vaccines, progress in delivery of care and prevention, progress in research and development, and actions needed to accelerate progress. This Review is presented in the context of the UN Sustainable Development Goals and WHO's End TB Strategy, which share the aim of ending the global tuberculosis epidemic. In 2016, globally there were an estimated 10·4 million new cases of tuberculosis, and 600 000 new cases with resistance to rifampicin (the most powerful first-line drug). All countries and age groups are affected by tuberculosis, but most cases (90%) in 2016 were in adults, and almost two-thirds were accounted for by seven countries: India, Indonesia, China, Philippines, Pakistan, South Africa, and Nigeria. The sex ratio (male to female) was 1·9 and 10% of patients with newly diagnosed tuberculosis were also HIV-positive. There were 1·7 million deaths from tuberculosis in 2016, including 0·4 million deaths among people co-infected with HIV (officially classified as deaths caused by HIV/AIDS). Progress in care and prevention means that the global mortality rate (deaths per 100 000 people per year) is decreasing by 3·4% per year and incidence (new cases per 100 000 people per year) is decreasing by 1·9% per year. From 2000 to 2016, the annual global number of tuberculosis deaths decreased by 24% and the mortality rate declined by 37%. Worldwide, an estimated 53 million deaths were averted through successful treatment. Nonetheless, major gaps in care and prevention remain. For example, the 6·3 million new cases of tuberculosis reported globally in 2016 represented only 61% of the estimated incidence; only one in five of the estimated number of people with drug-resistant tuberculosis was enrolled in treatment. Pipelines for new diagnostics, drugs, and vaccines are progressing, but slowly. Actions needed to accelerate progress towards global milestones and targets for reductions in the burden of tuberculosis disease set for 2020, 2025, 2030, and 2035 include closing coverage gaps in testing, reporting of cases, and overall access to health care, especially in countries that account for the largest share of the global gap; multisectoral efforts to reduce prevalence of major risk factors for infection and disease; and increased investment in research and development

The impact of social protection and poverty elimination on global tuberculosis incidence: a statistical modelling analysis of Sustainable Development Goal 1.

BACKGROUND: The End TB Strategy and the Sustainable Development Goals (SDGs) are intimately linked by their common targets and approaches. SDG 1 aims to end extreme poverty and expand social protection coverage by 2030. Achievement of SDG 1 is likely to affect the tuberculosis epidemic through a range of pathways. We estimate the reduction in global tuberculosis incidence that could be obtained by reaching SDG 1. METHODS: We developed a conceptual framework linking key indicators of SDG 1 progress to tuberculosis incidence via well described risk factor pathways and populated it with data from the SDG data repository and the WHO tuberculosis database for 192 countries. Correlations and mediation analyses informed the strength of the association between the SDG 1 subtargets and tuberculosis incidence, resulting in a simplified framework for modelling. The simplified framework linked key indicators for SDG 1 directly to tuberculosis incidence. We applied an exponential decay model based on linear associations between SDG 1 indicators and tuberculosis incidence to estimate tuberculosis incidence in 2035. FINDINGS: Ending extreme poverty resulted in a reduction in global incidence of tuberculosis of 33·4% (95% credible interval 15·5-44·5) by 2035 and expanding social protection coverage resulted in a reduction in incidence of 76·1% (45·2-89·9) by 2035; both pathways together resulted in a reduction in incidence of 84·3% (54·7-94·9). INTERPRETATION: Full achievement of SDG 1 could have a substantial effect on the global burden of tuberculosis. Cross-sectoral approaches that promote poverty reduction and social protection expansion will be crucial complements to health interventions, accelerating progress towards the End TB targets. FUNDING: World Health Organization

The global burden of tuberculosis mortality in children: a mathematical modelling study

Background: Tuberculosis (TB) in children is increasingly recognised as an important component of the global TB burden, with an estimated 1 million cases in 2015. Although younger children are vulnerable to severe forms of TB disease, no age-disaggregated estimates of paediatric TB mortality exist, and TB has never appeared in official estimates of under-five child mortality. Methods: We estimated deaths in children aged <5 and 5 to <15 for 217 countries and territories using a case-fatality-based approach. We used paediatric TB notifications data, HIV and antiretroviral treatment estimates to disaggregate the World Health Organization (WHO) paediatric TB incidence estimates by age, HIV and treatment status. Systematic review evidence on corresponding case fatality ratios was then applied. Findings: We estimated that 239,000 (95% uncertainty interval [UI] 194,000 - 298,000) children aged <15 died due to TB globally in 2015; around 80% of these deaths - 191,000 (95%UI: 132,000 - 257,000) - were in children <5 years old. Over 70% of deaths occurred in the WHO South-East Asia and Africa regions. We estimated around 20% of paediatric TB deaths globally were in children with HIV infections, with this proportion nearer 30% in the WHO Africa region. Over 96% of all TB deaths occurred in children not receiving TB treatment. Interpretation: Tuberculosis is a top ten cause of death in children and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden. Funding: UNITAID, NIH, NIH