Delimitation of lymphatic filariasis transmission risk areas: a geo-environmental approach

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) depends upon Mass Drug Administration (MDA) to interrupt transmission. Therefore, delimitation of transmission risk areas is an important step, and hence we attempted to define a geo-environmental risk model (GERM) for determining the areas of potential transmission of lymphatic filariasis. METHODS: A range of geo-environmental variables has been selected, and customized on GIS platform to develop GERM for identifying the areas of filariasis transmission in terms of "risk" and "non-risk". The model was validated through a 'ground truth study' following standard procedure using GIS tools for sampling and Immuno-chromotographic Test (ICT) for screening the individuals. RESULTS: A map for filariasis transmission was created and stratified into different spatial entities, "risk' and "non-risk", depending on Filariasis Transmission Risk Index (FTRI). The model estimation corroborated well with the ground (observed) data. CONCLUSION: The geo-environmental risk model developed on GIS platform is useful for spatial delimitation purpose on a macro scale

Detection of Cryptosporidium, Giardia, fecal indicator bacteria, and total bacteria in commercial jar water in Kathmandu Valley, Nepal

Introduction: Jar water is a convenient and common source of drinking water in the Kathmandu Valley. However, studies including detailed microbial analyses of this source of potable water are lacking. In this study, jar water samples were examined for the occurrence of Cryptosporidium, Giardia, fecal indicator bacteria, and total bacteria. Methods: Thirty different brands of jars were collected in September 2014. Escherichia coli and total coliforms w ere determined using a Colilert reagent. Ten of the 30 brands w ere selected to test for Cryptosporidium, Giardia, and total bacteria. Bacterial DNA extraction from water samples w as performed using the Cica Geneus DNA Extraction Kit, follow ed by quantitative polymerase chain reaction (qPCR) targeting the 16S rRNA gene of bacterial DNA. Protozoan detection was accomplished by concentrating the samples using the electronegative membrane vortex method, followed by immunomagnetic separation and fluorescent staining. Results: E. coli w as detected in 10% of the samples, with a maximum concentration of 2 most probable number (MPN)/100 mL, whereas total coliforms were detected in 97% of the samples, with a maximum and mean concentration of 7.3 × 10 2 and 3.8 × 10 1 MPN/100 mL, respectively. Total coliforms concentrations in 40% of the samples ranged from 10 2 to 10 3 MPN/100 mL. Cryptosporidium and Giardia w ere not detected in any of the tested samples. Concentrations of total bacteria in the samples ranged from 10 4 to 10 6 cells/100 mL. Conclusions: Ninety-seven percent of the jar water brands were unsuitable for drinking without proper treatment based on the guideline values of the National Drinking Water Quality Standards (NDW Q S) of Nepal. There is no guideline value for total bacteria in NDW Q S however, high concentrations can be indicative of poor control on regrowth of bacteria and recontamination or inefficient water treatment methods.Malla B, Ghaju Shrestha R, Bhandari D, Tandukar S, Shrestha S, Yoshinaga H, Inoue D, Sei K, Nishida K, Tanaka Y, Sherchand JB, Haramoto

Dry and liquid formulations of IBT-V02, a novel multi-component toxoid vaccine, are effective against Staphylococcus aureus isolates from low-to-middle income countries

Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs) in the U.S. as well as more serious invasive diseases, including bacteremia, sepsis, endocarditis, surgical site infections, osteomyelitis, and pneumonia. These infections are exacerbated by the emergence of antibiotic-resistant clinical isolates such as methicillin-resistant S. aureus (MRSA), highlighting the need for alternatives to antibiotics to treat bacterial infections. We have previously developed a multi-component toxoid vaccine (IBT-V02) in a liquid formulation with efficacy against multiple strains of Staphylococcus aureus prevalent in the industrialized world. However, liquid vaccine formulations are not compatible with the paucity of cold chain storage infrastructure in many low-to-middle income countries (LMICs). Furthermore, whether our IBT-V02 vaccine formulations are protective against S. aureus isolates from LMICs is unknown. To overcome these limitations, we developed lyophilized and spray freeze-dried formulations of IBT-V02 vaccine and demonstrated that both formulations had comparable biophysical attributes as the liquid formulation, including similar levels of toxin neutralizing antibodies and protective efficacy against MRSA infections in murine and rabbit models. To enhance the relevancy of our findings, we then performed a multi-dimensional screen of 83 S. aureus clinical isolates from LMICs (e.g., Democratic Republic of Congo, Palestine, and Cambodia) to rationally down-select strains to test in our in vivo models based on broad expression of IBT-V02 targets (i.e., pore-forming toxins and superantigens). IBT-V02 polyclonal antisera effectively neutralized toxins produced by the S. aureus clinical isolates from LMICs. Notably, the lyophilized IBT-V02 formulation exhibited significant in vivo efficacy in various preclinical infection models against the S. aureus clinical isolates from LMICs, which was comparable to our liquid formulation. Collectively, our findings suggested that lyophilization is an effective alternative to liquid vaccine formulations of our IBT-V02 vaccine against S. aureus infections, which has important implications for protection from S. aureus isolates from LMICs

Epidemiology and Determinants of Vitamin D Deficiency in Eastern Nepal: A Community-Based, Cross-Sectional Study

Objective. To estimate the prevalence of vitamin D deficiency in the eastern part of Nepal and identify the sociodemographic factors associated with it. Methods. A descriptive cross-sectional study was carried out among 324 participants between the ages 18 and 65 years from the Sunsari and Morang districts of Nepal. A semi-structured questionnaire helped obtain sociodemographic data followed by anthropometric measurements and blood sampling. 25(OH)D level was measured by chemiluminescence immunoassay (CLIA) via a fully automated Maglumi 1000 analyzer (SNIBE Co., Ltd., China). Serum 25(OH)D was classified as deficient, insufficient, and sufficient (<20 ng/ml, 20–29 ng/ml, and 30–100 ng/ml, respectively). The chi-square test was used to analyze the sociodemographic variables followed by a post hoc analysis. Significant variables were subjected to multivariate logistic regression. Result. 181(55.9%) of the study population had vitamin D deficiency. There was significant association between vitamin D status and time of maximum sun exposure (chi square test = 11.1, p=0.02), duration of sun exposure (chi-square test = 15.1, p=0.004), type of meat intake (Fisher’s exact test is 16.4, p=0.01), frequency of fish intake (Fisher’s exact test is 19.3, p=0.001), and frequency of dairy intake (chi-square test=11.2, p=0.02). In multivariate regression, consumption of dairy products ≥3/week had lower OR (95% CI) (0.3(0.1–0.8) p:0.02) and weekly fish consumption had lower OR (95% CI) (0.06(0.008–0.6) p:0.01) for vitamin D deficiency. Conclusion. The prevalence of vitamin D deficiency was relatively high in eastern Nepal. This highlights the need to create public awareness regarding the importance of bare skin sun exposure, nutritional sources of vitamin D, and the need to implement food fortification policies by the government

Epidemiology and determinants of vitamin D deficiency in Eastern Nepal: a community-based, cross-sectional study

AbstractObjectiveTo estimate the prevalence of vitamin D deficiency in the Eastern the part of Nepal and identify the sociodemographic factors associated with it.MethodsA descriptive cross-sectional study was carried out among 324 participants between the ages of 18 to 65 years from the Sunsari and Morang districts of Nepal. A semi-structured questionnaire helped obtain sociodemographic data followed by anthropometric measurements and blood sampling. 25(OH)D level was measured by Chemiluminescence immunoassay (CLIA) via a fully automated Maglumi 1000 analyzer (SNIBE Co, Ltd, China). Serum 25(OH)D was classified as deficient, insufficient, and sufficient (&lt;20 ng/ml, 20-29 ng/ml, and 30–100 ng/ml respectively). The Chi-square test was used to analyze the sociodemographic variables followed by a post-hoc analysis. Significant variables were subject to multivariate logistic regression.Result181(55.9%) of the study population had vitamin D deficiency. There was significant association between vitamin D status and time of maximum sun exposure (Chi-sq = 11.1, p=0.02), duration of sun exposure (Chi-sq = 15.1, p=0.004), type of meat intake (Fischer’s exact test is 16.4, p=0.01), frequency of fish intake (Fischer’s exact test is 19.3, p=0.001), frequency of dairy intake (Chi-sq=11.2, p=0.02). In multivariate regression, consumption of dairy products ≥3/week had lower OR (95% CI) [0.3(0.1-0.8) p:0.02] and weekly fish consumption had lower OR (95% CI) [0.06(0.008-0.6) p: 0.01] for vitamin D deficiency.ConclusionThe prevalence of vitamin D deficiency was relatively high in eastern Nepal. This highlights the need to create public awareness regarding the importance of bare skin sun exposure and other sources of vitamin D as well as the need to implement food fortification policies by the government.</jats:sec

Health-Seeking Behaviors and Self-Care Practices of People with Filarial Lymphoedema in Nepal: A Qualitative Study

Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices