Exploring spatial patterns and hotspots of diarrhea in Chiang Mai, Thailand

<p>Abstract</p> <p>Background</p> <p>Diarrhea is a major public health problem in Thailand. The Ministry of Public Health, Thailand, has been trying to monitor and control this disease for many years. The methodology and the results from this study could be useful for public health officers to develop a system to monitor and prevent diarrhea outbreaks.</p> <p>Methods</p> <p>The objective of this study was to analyse the epidemic outbreak patterns of diarrhea in Chiang Mai province, Northern Thailand, in terms of their geographical distributions and hotspot identification. The data of patients with diarrhea at village level and the 2001–2006 population censuses were collected to achieve the objective. Spatial analysis, using geographic information systems (GIS) and other methods, was used to uncover the hidden phenomena from the data. In the data analysis section, spatial statistics such as quadrant analysis (QA), nearest neighbour analysis (NNA), and spatial autocorrelation analysis (SAA), were used to identify the spatial patterns of diarrhea in Chiang Mai province. In addition, local indicators of spatial association (LISA) and kernel density (KD) estimation were used to detect diarrhea hotspots using data at village level.</p> <p>Results</p> <p>The hotspot maps produced by the LISA and KD techniques showed spatial trend patterns of diarrhea diffusion. Villages in the middle and northern regions revealed higher incidences. Also, the spatial patterns of diarrhea during the years 2001 and 2006 were found to represent spatially clustered patterns, both at global and local scales.</p> <p>Conclusion</p> <p>Spatial analysis methods in GIS revealed the spatial patterns and hotspots of diarrhea in Chiang Mai province from the year 2001 to 2006. To implement specific and geographically appropriate public health risk-reduction programs, the use of such spatial analysis tools may become an integral component in the epidemiologic description, analysis, and risk assessment of diarrhea.</p

Determination of Leptospira borgpetersenii serovar Javanica and Leptospira interrogans serovar Bataviae as the persistent Leptospira serovars circulating in the urban rat populations in peninsular Malaysia

Background: Leptospirosis is an emerging infectious disease of global significance, and is endemic in tropical countries, including Malaysia. Over the last decade, a dramatic increase of human cases was reported; however, information on the primary vector, the rat, and the Leptospira serovars circulating among the rat population is limited. Therefore, the present study was undertaken to isolate Leptospira and characterise the serovars circulating in the urban rat populations from selected main cities in Peninsular Malaysia. Methods: Rat trappings were carried out between October 2011 to February 2014 in five urban cities which were chosen as study sites to represent different geographical locations in Peninsular Malaysia. Microscopic agglutination test (MAT) and PCR were carried out to identify the Leptospiral serogroup and determine the pathogenic status of the isolates, respectively while pulsed-field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD)-PCR were used to characterize the isolates. Results: Three rat species were identified from the three hundred and fifty seven rats captured with Rattus rattus, being the dominant rat species (285, 80 %) followed by Rattus norgevicus (53, 15 %) and Rattus exulans (19, 5 %). Only 39 samples (11.0 %) were positive by culture and further confirmed as pathogenic Leptospira by PCR. Significant associations were shown between host infection with locality, season, host-age and species. Based on MAT, two serogroups were identified in the population namely; L. borgpetersenii serogroup Javanica (n = 16) and L. interrogans serogroup Bataviae (n = 23). Pulsed-field gel electrophoresis (PFGE) distinguished the two serovars in the urban rat populations: L. borgpetersenii serovar Javanica (41 %), and L. interrogans serovar Bataviae (59 %). RAPD-PCR yielded 14 distinct patterns and was found to be more discriminative than PFGE. Conclusions: This study confirms two Leptospira serovars circulating among the urban rats population in Peninsular Malaysia namely; L. borgpetersenii serovar Javanica and L. interrogans serovars Bataviae. Despite the low number of isolates obtained from the rat population, this study suggests that rodent control programs and disease surveillance may help to reduce the possible risk of disease transmission

Platform for automatic patient quality assurance via Monte Carlo simulations in proton therapy

For radiation therapy, it is crucial to ensure that the delivered dose matches the planned dose. Errors in the dose calculations done in the treatment planning system (TPS), treatment delivery errors, other software bugs or data corruption during transfer might lead to significant differences between predicted and delivered doses. As such, patient specific quality assurance (QA) of dose distributions, through experimental validation of individual fields, is necessary. These measurement based approaches, however, are performed with 2D detectors, with limited resolution and in a water phantom. Moreover, they are work intensive and often impose a bottleneck to treatment efficiency. In this work, we investigated the potential to replace measurement-based approach with a simulation-based patient specific QA using a Monte Carlo (MC) code as independent dose calculation engine in combination with treatment log files. Our developed QA platform is composed of a web interface, servers and computation scripts, and is capable to autonomously launch simulations, identify and report dosimetric inconsistencies. To validate the beam model of independent MC engine, in-water simulations of mono-energetic layers and 30 SOBP-type dose distributions were performed. Average Gamma passing ratio 99 ± 0.5% for criteria 2%/2 mm was observed. To demonstrate feasibility of the proposed approach, 10 clinical cases such as head and neck, intracranial indications and craniospinal axis, were retrospectively evaluated via the QA platform. The results obtained via QA platform were compared to QA results obtained by measurement-based approach. This comparison demonstrated consistency between the methods, while the proposed approach significantly reduced in-room time required for QA procedures

Rift Valley Fever Virus Seroprevalence in Human Rural Populations of Gabon

Rift Valley fever (RVF) is a disease transmitted by a mosquito bite (Aedes). Humans can also be infected through direct contact with blood (aerosols) or tissues (placenta, stillborn) of infected animals. Although severe clinical cases can be observed, infection with RVF virus (RVFV) in humans in most cases causes a febrile illness without serious symptoms. In small ruminants RVFV mainly causes abortion and neonatal death. RVFV distribution has been poorly investigated in Central Africa. We conducted a large scale serological survey of RVF antibodies in rural populations in Gabon, involving 4,323 individuals from 212 randomly selected villages. The results showed an overall RVFV prevalence of 3.3%, with values of 2.9% in the forested zones, 2.2% in savannas and 8.3% in the lakes region. These findings strongly suggest for the first time the wide circulation of Rift valley fever virus in Gabon and the possible existence of a sylvan cycle of RVF virus in this country. The serological higher prevalence in the lake region suggests that this region is likely to have particular ecological conditions, especially mosquito vector species, favoring the circulation of this virus. In Gabon, human cases of RVF may occur but are either misdiagnosed or not reported

Contrasting Spatial Distribution and Risk Factors for Past Infection with Scrub Typhus and Murine Typhus in Vientiane City, Lao PDR

Scrub typhus and murine typhus are neglected but important treatable causes of fever, morbidity and mortality in South-East Asia. Epidemiological data suggests that scrub typhus would be more common in rural areas and murine typhus in urban areas but there are very few comparative data from places where both diseases occur, as is the case in Vientiane, the capital of the Lao PDR. We therefore determined the frequency of IgG antibody seropositivity against scrub typhus and murine typhus, as indices of prior exposure to these pathogens, in a randomly selected population of 2,002 adults living in different neighbourhoods in Vientiane. The overall prevalence of IgG against these two pathogens was ∼20%. However, within the city, the spatial distribution of IgG against these two diseases was radically different - past exposure to murine typhus being more frequent in urbanized areas while past exposure to scrub typhus more frequent in outlying areas. This study underscores the importance of ecological characteristics in improving the understanding of both scrub typhus and murine typhus transmission and epidemiology

Spatial pattern detection of tuberculosis : a case study of Si Sa Ket province, Thailand

This retrospective population-based study was conducted to analyze spatial patterns of tuberculosis (TB) incidence in Si Sa Ket province, Thailand. TB notification data from 2004 to 2008 collected from TB clinics throughout the province was used along with population data to reveal a descriptive epidemiology of TB incidences. Global clustering patterns of the occurrence were assessed by using global spatial autocorrelation techniques. Additionally, local spatial pattern detection was performed by using local spatial autocorrelation and spatial scan statistic methods. The findings indicated clusters of the disease occurred in the study area. More specifically, significantly high-rate clusters were mostly detected in Mueang Si Sa Ket and Khukhan districts, which are located in the northwestern part of the province, while significantly low-rate clusters were persistent in Kantharalak and Benchalak districts, which are located at the southeastern area