RECENT HIV INFECTION SURVEILLANCE IN ROUTINE HIV TESTING IN NAIROBI, KENYA: A FEASIBILITY STUDY.

BACKGROUND:Serological tests can distinguish recent (in the prior 12 months) from long-term HIV infection. Integrating recency testing into routine HIV testing services (HTS) can provide important information on transmission clusters and prioritize clients for partner testing. This study assessed the feasibility and utility of integrating HIV recency into routine testing. METHODS:We conducted a multi-method study at fourteen facilities in Kenya, and key informant interviews with healthcare providers. We abstracted clinical record data, collected specimens, tested specimens for recent infection, returned results to participants, and conducted a follow-up survey for those recently infected. RESULTS:From March to October 2018, we enrolled 532 clients who were diagnosed HIV positive for the first time. Of these, 46 (8.6%) were recently infected. Women aged 15- 24 years had 2.9 (95% CI, 1.46-5.78) times higher adjusted odds of recent infection compared to 15-24-year-old men and those tested within the past 12 months having 2.55 (95% CI .38-4.70) times higher adjusted odds compared to those tested ?12 months previously. Fourteen of seventeen providers interviewed found the integration of receny testing into routine HTS services acceptable and feasible. Among clients who completed the follow up interview, majority (92%) felt that the recency results were useful. CONCLUSIONS:Integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level

Relationship between the population incidence of febrile convulsions in young children in Sydney, Australia and seasonal epidemics of influenza and respiratory syncytial virus, 2003-2010: a time series analysis

<p>Abstract</p> <p>Background</p> <p>In 2010, intense focus was brought to bear on febrile convulsions in Australian children particularly in relation to influenza vaccination. Febrile convulsions are relatively common in infants and can lead to hospital admission and severe outcomes. We aimed to examine the relationships between the population incidence of febrile convulsions and influenza and respiratory syncytial virus (RSV) seasonal epidemics in children less than six years of age in Sydney Australia using routinely collected syndromic surveillance data and to assess the feasibility of using this data to predict increases in population rates of febrile convulsions.</p> <p>Methods</p> <p>Using two readily available sources of routinely collected administrative data; the NSW Emergency Department (ED) patient management database (1 January 2003 - 30 April 2010) and the Ambulance NSW dispatch database (1 July 2006 - 30 April 2010), we used semi-parametric generalized additive models (GAM) to determine the association between the population incidence rate of ED presentations and urgent ambulance dispatches for 'convulsions', and the population incidence rate of ED presentations for 'influenza-like illness' (ILI) and 'bronchiolitis' - proxy measures of influenza and RSV circulation, respectively.</p> <p>Results</p> <p>During the study period, when the weekly all-age population incidence of ED presentations for ILI increased by 1/100,000, the 0 to 6 year-old population incidence of ED presentations for convulsions increased by 6.7/100,000 (P < 0.0001) and that of ambulance calls for convulsions increased by 3.2/100,000 (P < 0.0001). The increase in convulsions occurred one week earlier relative to the ED increase in ILI. The relationship was weaker during the epidemic of pandemic (H1N1) 2009 influenza virus.</p> <p>When the 0 to 3 year-old population incidence of ED presentations for bronchiolitis increased by 1/100,000, the 0 to 6 year-old population incidence of ED presentations for convulsions increased by 0.01/100,000 (P < 0.01). We did not find a meaningful and statistically significant association between bronchiolitis and ambulance calls for convulsions.</p> <p>Conclusions</p> <p>Influenza seasonal epidemics are associated with a substantial and statistically significant increase in the population incidence of hospital attendances and ambulance dispatches for reported febrile convulsions in young children. Monitoring syndromic ED and ambulance data facilitates rapid surveillance of reported febrile convulsions at a population level.</p

Sickness behaviour pushed too far – the basis of the syndrome seen in severe protozoal, bacterial and viral diseases and post-trauma

Certain distinctive components of the severe systemic inflammatory syndrome are now well-recognized to be common to malaria, sepsis, viral infections, and post-trauma illness. While their connection with cytokines has been appreciated for some time, the constellation of changes that comprise the syndrome has simply been accepted as an empirical observation, with no theory to explain why they should coexist. New data on the effects of the main pro-inflammatory cytokines on the genetic control of sickness behaviour can be extended to provide a rationale for why this syndrome contains many of its accustomed components, such as reversible encephalopathy, gene silencing, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia. It is thus proposed that the pattern of pathology that comprises much of the systemic inflammatory syndrome occurs when one of the usually advantageous roles of pro-inflammatory cytokines – generating sickness behaviour by moderately repressing genes (Dbp, Tef, Hlf, Per1, Per2 and Per3, and the nuclear receptor Rev-erbα) that control circadian rhythm – becomes excessive. Although reversible encephalopathy and gene silencing are severe events with potentially fatal consequences, they can be viewed as having survival advantages through lowering energy demand. In contrast, dyserythropoiesis, seizures, coagulopathy, hypoalbuminaemia and hypertriglyceridaemia may best be viewed as unfortunate consequences of extreme repression of these same genetic controls when the pro-inflammatory cytokines that cause sickness behaviour are produced excessively. As well as casting a new light on the previously unrationalized coexistence of these aspects of systemic inflammatory diseases, this concept is consistent with the case for a primary role for inflammatory cytokines in their pathogenesis across this range of diseases

Comparative Efficacy of Albenzazole, Levamisole, Rafoxanide and Ivermectin Against Naturally Acquired Gastrointestinal Nematodes in Goats

A study of the efficacy of 4 antihelmintics was carried out using a faecal egg count reduction test (FECRT) in 105 goats on breeding farm at Ol'Magogo, Naivasha, Kenya. The goats were randomly assigned to 7 groups; received 5.0 mg kg body weight albendazole (ABZ), 15 mg kg levamisole (LEV) 15 mg kg rafoxanide (RAD) orally as 2 doses 24 hours apart and 0.2mg kg Ivermectin (ivm) once orally. Other groups received albendazole and levamisole (ABZ + RAF) at the same doses and schedules as before. Faecal egg counts were measured at treatment (day 0), at 10 and 14 days afterwards. Decreasing efficacies, s measured by 3 different formulae were recorded at day 14 for IVM, ABZ and ABZ +LEV (>96%), LEV

Natural Concurrent Infections with Black Spot Disease and Multiple Bacteriosis in Farmed Nile Tilapia in Central Kenya

Nile tilapia (Oreochromis niloticus) is the most cultured and available fish for Kenyan consumers, and therefore, any tilapine disease deprives them the valuable source of protein. Nile tilapia farm was diagnosed with severe concurrent black spot disease and multiple bacteriosis using gross lesions and parasitological, histopathology, and standard bacteriological procedures. A total of 25 fish were sampled and inspected, and all of them had raised, macroscopic 1 mm-sized black spot lesions. The mean intensity of black spots per fish was 728 with an abundance of 2–1740 metacercariae cysts per fish. A high intensity of black spot infestation was observed in the fins (43.9%), skin and underlying muscles (18.3%), and gills (18%). In addition, histopathological data confirmed presence of a metacercaria of Neascus spp. as the aetiological agent of black spot disease. Furthermore, a thick fibrous capsule around the metacercaria, black pigment melanomacrophages, and moderate muscle atrophy were observed. The most prevalent bacteria isolated were Aeromonas, Enterobacter cloacae, Klebsiella pneumoniae, and Micrococcus luteus. Physicochemical parameters of pond water were temperature (28.2°C), dissolved oxygen (4.2 mgl−1), pH (8.5), ammonia free nitrogen (15.8 mgl−1), alkalinity (112 mgl−1), hardness (68 mgl−1), nitrites (0.058 mgl−1), nitrates (58 mgl−1), and phosphates (0.046 mgl−1). However, the levels of nitrates, nitrites, alkalinity, and ammonia free nitrogen exceeded the recommended limits. In conclusion, these findings suggest that coinfections by these organisms coupled by water quality-related stress can be associated with low-grade mortality observed in postfingerling tilapia as well as reduced growth. The authors recommended immediate destocking, thorough disinfection, and control of piscivorous birds. Moreover, attention ought to be geared towards prevention of parasitic infestations in fish so as to minimize fish deaths related to secondary bacteriosis. Further experimental studies should be carried out to elucidate the relationship of these pathogens

Effect of phenobarbital on seizure frequency and mortality in childhood cerebral malaria: a randomised, controlled intervention study.

BACKGROUND: Seizures commonly complicate cerebral malaria and are associated with an increased risk of death and neurological sequelae. We undertook a randomised study to assess the efficacy of intramuscular phenobarbital in preventing seizures in childhood cerebral malaria. METHODS: Children with cerebral malaria admitted to one hospital in Kilifi, Kenya, were randomly assigned a single intramuscular dose of phenobarbital (20 mg/kg) or identical placebo. Clinical tolerance was assessed at the start of the trial, with particular reference to respiratory depression and hypotension. Seizures were timed and recorded, and treated in a standard way. Plasma phenobarbital concentrations were measured. Analyses were by intention to treat. FINDINGS: 440 children with cerebral malaria were admitted to the hospital; 100 were not recruited to the study. Of the remaining 340, 170 received phenobarbital and 170 placebo. The drug was adequately absorbed and well tolerated. Seizure frequency was significantly lower in the phenobarbital group than in the placebo group (18 [11%] vs 46 [27%] children had three or more seizures of any duration; odds ratio 0.32 [95% CI 0.18-0.58]) but mortality was doubled (30 [18%] vs 14 [8%] deaths; 2.39 [1.28-4.64]). The frequency of respiratory arrest was higher in the phenobarbital group than in the placebo group, and mortality was greatly increased in children who received phenobarbital plus three or more doses of diazepam (odds ratio 31.7 [1.2-814]). INTERPRETATION: In children with cerebral malaria, phenobarbital 20 mg/kg provides highly effective seizure prophylaxis but is associated with an unacceptable increase in mortality. Use of this dose cannot, therefore, be recommended