A Triage System For The Early Detection Of Chronic Cough Among TB Suspects Attending A Hospital In Banda Aceh, Indonesia

Background and Aims: One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with TB. In the hospital, people with symptoms compatible with TB have an opportunity to get proper diagnosis and treatment. Yet this opportunity is often missed. We hypothesize that a respiratory triage system recommended by WHO for prevention of the spread of respiratory infection at the outpatient department, can be improved to enhance early detection of TB. With this hypothesis an inter- vention study was conducted at Zainal Abidin Hospital. The objective of this intervention study was to compare the proportion of patients with cough >2 weeks, offered sputum test and TB case detection rate before versus after a respiratory triage system introduced. Methods: Before-and-after interventional study. Intervention; training of health personnel and setting up a respiratory triage system, to detect patients with >2 weeks cough and offering sputum test for acid-fast bacilli. Data from “exit poll” and central laboratory were compared before vs after the triage set up. Results: After the intervention, sampled patients who visited the hospital were more likely to be asked on >2 weeks cough (85.3% vs17.9%). In the whole samples (99.2% vs 64.7%) among them have >2 weeks cough patients. For TB detection, the changes were 39 positive results from 220 AFB tests of 61,871 outpatients to 55 positive from 365 AFB tests among 53,056 outpatients. The rates of sputum testing and TB case detection increased from 3.5 to 6.8 per 1,000 (OR=1.9, 95% CI=1.6-2.3) and 6.3 to 10.4 per 10,000 (OR=1.7, 95% CI=1.1-2.6) respectively. Conclusions: Respiratory triage can significantly increase TB detection rate

Variation of health-related quality of life assessed by caregivers and patients affected by severe childhood infections.

BACKGROUND: The agreement between self-reported and proxy measures of health status in ill children is not well established. This study aimed to quantify the variation in health-related quality of life (HRQOL) derived from young patients and their carers using different instruments. METHODS: A hospital-based cross-sectional survey was conducted between August 2010 and March 2011. Children with meningitis, bacteremia, pneumonia, acute otitis media, hearing loss, chronic lung disease, epilepsy, mild mental retardation, severe mental retardation, and mental retardation combined with epilepsy, aged between five to 14 years in seven tertiary hospitals were selected for participation in this study. The Health Utilities Index Mark 2 (HUI2), and Mark 3 (HUI3), and the EuroQoL Descriptive System (EQ-5D) and Visual Analogue Scale (EQ-VAS) were applied to both paediatric patients (self-assessment) and caregivers (proxy-assessment). RESULTS: The EQ-5D scores were lowest for acute conditions such as meningitis, bacteremia, and pneumonia, whereas the HUI3 scores were lowest for most chronic conditions such as hearing loss and severe mental retardation. Comparing patient and proxy scores (n = 74), the EQ-5D exhibited high correlation (r = 0.77) while in the HUI2 and HUI3 patient and caregiver scores were moderately correlated (r = 0.58 and 0.67 respectively). The mean difference between self and proxy-assessment using the HUI2, HUI3, EQ-5D and EQ-VAS scores were 0.03, 0.05, -0.03 and -0.02, respectively. In hearing-impaired and chronic lung patients the self-rated HRQOL differed significantly from their caregivers. CONCLUSIONS: The use of caregivers as proxies for measuring HRQOL in young patients affected by pneumococcal infection and its sequelae should be employed with caution. Given the high correlation between instruments, each of the HRQOL instruments appears acceptable apart from the EQ-VAS which exhibited low correlation with the others

Maintaining Vaccine Delivery Following the Introduction of the Rotavirus and Pneumococcal Vaccines in Thailand

Although the substantial burdens of rotavirus and pneumococcal disease have motivated many countries to consider introducing the rotavirus vaccine (RV) and heptavalent pneumococcal conjugate vaccine (PCV-7) to their National Immunization Programs (EPIs), these new vaccines could affect the countries' vaccine supply chains (i.e., the series of steps required to get a vaccine from their manufacturers to patients). We developed detailed computational models of the Trang Province, Thailand, vaccine supply chain to simulate introducing various RV and PCV-7 vaccine presentations and their combinations. Our results showed that the volumes of these new vaccines in addition to current routine vaccines could meet and even exceed (1) the refrigerator space at the provincial district and sub-district levels and (2) the transport cold space at district and sub-district levels preventing other vaccines from being available to patients who arrive to be immunized. Besides the smallest RV presentation (17.1 cm3/dose), all other vaccine introduction scenarios required added storage capacity at the provincial level (range: 20 L–1151 L per month) for the three largest formulations, and district level (range: 1 L–124 L per month) across all introduction scenarios. Similarly, with the exception of the two smallest RV presentation (17.1 cm3/dose), added transport capacity was required at both district and sub-district levels. Added transport capacity required across introduction scenarios from the provincial to district levels ranged from 1 L–187 L, and district to sub-district levels ranged from 1 L–13 L per shipment. Finally, only the smallest RV vaccine presentation (17.1 cm3/dose) had no appreciable effect on vaccine availability at sub-districts. All other RV and PCV-7 vaccines were too large for the current supply chain to handle without modifications such as increasing storage or transport capacity. Introducing these new vaccines to Thailand could have dynamic effects on the availability of all vaccines that may not be initially apparent to decision-makers

A Population-Based Acute Meningitis and Encephalitis Syndromes Surveillance in Guangxi, China, May 2007-June 2012.

Acute meningitis and encephalitis (AME) are common diseases with the main pathogens being viruses and bacteria. As specific treatments are different, it is important to develop clinical prediction rules to distinguish aseptic from bacterial or fungal infection. In this study we evaluated the incidence rates, seasonal variety and the main etiologic agents of AME, and identified factors that could be used to predict the etiologic agents.A population-based AME syndrome surveillance system was set up in Guigang City, Guangxi, involving 12 hospitals serving the study communities. All patients meeting the case definition were investigated. Blood and/or cerebrospinal fluid were tested for bacterial pathogens using culture or RT-PCR and serological tests for viruses using enzyme-linked immunosorbent assays. Laboratory testing variables were grouped using factor analysis. Multinomial logistic regression was used to predict the etiology of AME.From May 2007 to June 2012, the annual incidence rate of AME syndrome, and disease specifically caused by Japanese encephalitis (JE), other viruses, bacteria and fungi were 12.55, 0.58, 4.57, 0.45 and 0.14 per 100,000 population, respectively. The top three identified viral etiologic agents were enterovirus, mumps virus, and JE virus, and for bacteria/fungi were Streptococcus sp., Cryptococcus neoformans and Staphylococcus sp. The incidence of JE and other viruses affected younger populations and peaked from April to August. Alteration of consciousness and leukocytosis were more likely to be caused by JE, bacteria and fungi whereas CSF inflammation was associated with bacterial/fungal infection.With limited predictive validity of symptoms and signs and routine laboratory tests, specific tests for JE virus, mumps virus and enteroviruses are required to evaluate the immunization impact and plan for further intervention. CSF bacterial culture cannot be omitted in guiding clinical decisions regarding patient treatment

General characteristics of acute meningitis and encephalitis (AME) cases, Japanese encephalitis (JE), other viral encephalitis, fungi, and bacterial meningitis in Guigang City, Guangxi, May 2007- June 2012.

<p>General characteristics of acute meningitis and encephalitis (AME) cases, Japanese encephalitis (JE), other viral encephalitis, fungi, and bacterial meningitis in Guigang City, Guangxi, May 2007- June 2012.</p

Final multinomial logistic regression model predicting AME.

<p>Negative cases (n = 176) are the reference group.</p

Comparison of clinical features of negative group, Japanese encephalitis, other viral encephalitis and bacterial meningitis in Guigang City, Guangxi, May 2007- June 2012.

<p>Comparison of clinical features of negative group, Japanese encephalitis, other viral encephalitis and bacterial meningitis in Guigang City, Guangxi, May 2007- June 2012.</p

Monthly distribution of acute meningitis and encephalitis (AME) cases, Japanese encephalitis (JE) and other viruses in Guigang City, Guangxi, May 2007—June 2012.

<p>*Only those cases with negative JE IgM results and onset between May 2007 and December 2008 were tested for other viruses.</p

Final logistic regression model by using factor scores^*.

<p>Final logistic regression model by using factor scores^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144366#t007fn001" target="_blank">*</a>}.</p

Frequency of acute meningitis and encephalitis pathogens in Guigang City, Guangxi, May 2007- June 2012^*.

<p>Frequency of acute meningitis and encephalitis pathogens in Guigang City, Guangxi, May 2007- June 2012^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0144366#t002fn001" target="_blank">*</a>}.</p