Taenia solium Cysticercosis Hotspots Surrounding Tapeworm Carriers: Clustering on Human Seroprevalence but Not on Seizures

Cysticercosis is a parasitic disease caused by the tapeworm Taenia solium, common in areas with limited sanitation or with migration from these populations. The adult parasite is hosted in the human intestine and releases large numbers of eggs with the feces. Human beings sometimes ingest eggs due to poor hygiene, and then eggs sometimes lodge on the brain and after a few years can cause intense headaches and seizures. During a study in seven rural communities in Peru, individuals exposed to T. solium eggs were often tightly clustered at the homes or immediate surrounding of the carriers of the adult parasite. However, no aggregation of cases of seizures was found near carriers. It appears that seizures do not cluster around carriers because several years pass between exposure to T. solium eggs and the onset of seizures. During these years the adult parasite has probably died or people had moved within or even outside their communities. Therefore, only a partial understanding of the epidemiology of cysticercosis is gained by studying seizures cases

Influenza-Like Illness Sentinel Surveillance in Peru

BACKGROUND: Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant source of morbidity and mortality worldwide. Despite the public health importance, little is known about the etiology of these acute respiratory illnesses in many regions of South America. In 2006, the Peruvian Ministry of Health (MoH) and the US Naval Medical Research Center Detachment (NMRCD) initiated a collaboration to characterize the viral agents associated with ILI and to describe the clinical and epidemiological presentation of the affected population. METHODOLOGY/PRINCIPAL FINDINGS: Patients with ILI (fever > or =38 degrees C and cough or sore throat) were evaluated in clinics and hospitals in 13 Peruvian cities representative of the four main regions of the country. Nasal and oropharyngeal swabs, as well as epidemiological and demographic data, were collected from each patient. During the two years of this study (June 2006 through May 2008), a total of 6,835 patients, with a median age of 13 years, were recruited from 31 clinics and hospitals; 6,308 were enrolled by regular passive surveillance and 527 were enrolled as part of outbreak investigations. At least one respiratory virus was isolated from the specimens of 2,688 (42.6%) patients, with etiologies varying by age and geographical region. Overall the most common viral agents isolated were influenza A virus (25.1%), influenza B virus (9.7%), parainfluenza viruses 1, 2, and 3, (HPIV-1,-2,-3; 3.2%), herpes simplex virus (HSV; 2.6%), and adenoviruses (1.8%). Genetic analyses of influenza virus isolates demonstrated that three lineages of influenza A H1N1, one lineage of influenza A H3N2, and two lineages of influenza B were circulating in Peru during the course of this study. CONCLUSIONS: To our knowledge this is the most comprehensive study to date of the etiologic agents associated with ILI in Peru. These results demonstrate that a wide range of respiratory pathogens are circulating in Peru and this fact needs to be considered by clinicians when treating patients reporting with ILI. Furthermore, these data have implications for influenza vaccine design and implementation in South America

Association between carcinogenic HPV and selected STIs and risk behaviors in HIV positive men who have sex with men in Lima, Peru

Thesis (Master's)--University of Washington, 2013Background: HIV infection in Peru is concentrated among MSM, and over the last 25 years, rates of anal cancer due to HPV have increased in this population. Currently, fifteen types of HPV types have been described as high-risk types for cancer. Other STIs such as HTLV-1/-2, syphilis, gonorrhea or chlamydia, may have an impact on HPV transmission in HIV positive MSM. The aim of this study was to assess for an association between the presence of carcinogenic types of HPV and infection with selected STI's in HIV positive individuals. Methods: Adult HIV-positive MSM were invited to participate. Participants were asked to complete a questionnaire (assessing demographic data and medical health history), give a 15 ml blood sample (for HTLV and syphilis testing), provide a urine sample (for detection of Chlamydia trachomaties and Neisseria gonorrhoeae) and undergo a rectal examination with swabbing (for HPV diagnosis by PCR). Results: All participants (152) considered themselves either "gay" (75.7%) or bisexual (24.3%); 50.9% reported having a versatile role in bed; another 27.8% considered their role mainly insertive or mainly receptive, meaning a degree of versatile behavior. The mean time from HIV diagnosis to enrollment was 4.4 years (SD 3.9 years); 78.3% were receiving HAART at the time of enrollment. Their mean CD4 cell count was 437.4 cells/mm3 (SD 193.5). Eighty participants (52.6%) had one or more STIs signs in the six months prior to the study. PCR assessment of HPV showed147 participants (96.7%) had at least one type of HPV; 90.5% of those had one or more carcinogenic types of HPV; most prevalent types were 6, 16, and 58. Four participants (2.6%) had chlamydia and 1 (0.7%) gonorrhea. The prevalence of confirmed syphilis was 26.3%. Factors associated with presence of carcinogenic types of HPV were ever having receptive anal intercourse (OR=10.17; 95% C.I. 2.12 - 52.61), having a versatile (OR=5.91; 95% C.I.1.36 - 25.63) or exclusively receptive role in bed (OR= 9.50; 95% C.I. 1.07 - 84.09). Conclusion: Given the high prevalence of carcinogenic types of HPV, different strategies are needed to improve compliance towards safer sex in this population, including male adolescent HPV vaccination

Individual and partnership factors associated with anticipated versus actual partner notification following STI diagnosis among men who have sex with men and/or with transgender women in Lima, Peru.

OBJECTIVES:A detailed understanding of intentions and practices related to partner notification (PN) following STI diagnosis can improve control strategies. We assessed participant-level and partner-level factors guiding notification behaviour among men who have sex with men and/or with transgender women (MSM-TW) in Lima, Peru, including discordances between anticipated and actual notification. METHODS:Men newly diagnosed with gonorrhoea, chlamydia and/or syphilis between 2012 and 2014 reported recent partners' characteristics, anticipated PN practices, and actual PN outcomes following diagnosis. Generalised estimating equation Poisson regression analyses assessed factors guiding PN outcomes. RESULTS:Participants (n=150) predominantly identified as homosexual (70%) and moderno (versatile sexual role, 55%); 55% of partners (n=402) were casual. Among all sexual partners, 35% were notified of the STI diagnosis, though only 51% of predicted PN occurred and 26% of actual notifications were unanticipated. 47% of participants notified no partners, while 24% notified all partners. PN was more common with stable versus casual (adjusted prevalence ratio (aPR), 95% CI: 0.53, 0.39 to 0.73) or commercial (aPR, 95% CI: 0.38, 0.12 to 1.21) partners, and among participants who perceived PN as normative among their peers (aPR, 95% CI: 1.96, 1.37 to 2.82). A trend towards greater notification following condom-protected intercourse was observed (aPR, 95% CI: 1.33, 0.98 to 1.81). PN frequency did not differ by type of STI diagnosed.Anticipated notification predicted actual notification (aPR, 95% CI: 1.67, 1.19 to 2.33) only imperfectly: 81 (54%) participants' PN practices did not match their anticipated behaviour. Successful notification despite anticipated silence (40 participants, 63 partners) was associated with stable partnerships and a normative perception of PN. Non-notification despite intention (43 participants, 73 partners) frequently occurred among participants reporting exclusively oral sex with the partner or with partners identified as activo (insertive role). CONCLUSIONS:Anticipated notification imperfectly reflects actual PN behaviour. Future interventions to improve PN among MSM-TW in Peru need to acknowledge partnership contexts

Temporal distribution by month and epidemiological week (EW) of influenza A and B confirmed cases, Peru 2006–2008.

<p>Temporal distribution by month and epidemiological week (EW) of influenza A and B confirmed cases, Peru 2006–2008.</p

Phylogenetic tree based on the partial hemagglutinin (HA) sequence of influenza B viruses.

<p>Numbers indicate bootstrap values. The legend indicates the geographical origin of the strains: southern highland (brown), coastal (red), jungle (green) and central (blue) regions. Arrows indicate the recommended vaccine strain for the Southern Hemisphere for each year of the study period.</p

Viral etiology of ILI in Peru distributed by age and geographic region, June 2006–May 2008.

<p>Viral etiology of ILI in Peru distributed by age and geographic region, June 2006–May 2008.</p

Phylogenetic tree based on the partial hemagglutinin (HA) sequence of influenza A H1N1 viruses.

<p>Numbers indicate bootstrap values. The legend indicates the geographical origin of the strains: southern highlands (brown), coastal (red), jungle (green) and central (blue) regions. Arrows indicate the recommended vaccine strain for the Southern Hemisphere for each year of the study period.</p