Water, Sanitation, and Hygiene Interventions to Reduce Diarrhoea in Less Developed Countries: A Systematic Review and Meta-analysis

The authors developed a comprehensive research strategy designed to identify all peer-reviewed articles, in any language, that presented water, sanitation, or hygiene interventions. Out of 2,120 publications, ultimately 40 studies were judged to contain relevant evidence. Most of the studies confined their study groups to children aged under 5 or 6 years. The identified studies were done in a wide range of settings, in many countries, and over many years. All of the interventions studied were found to reduce significantly the risks of diarrheal illness. The results generally agree with those from previous reviews, but water quality interventions (point-of-use water treatment) were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus

Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract\ud \ud \ud \ud Background\ud \ud Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population.\ud The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil.\ud \ud \ud \ud Methods\ud \ud A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview.\ud \ud \ud \ud Results\ud \ud After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%).\ud \ud \ud \ud Conclusion\ud \ud We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil.\ud While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.Investigators by institution:Investigators by institution:Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).Financial Support:Financial Support:This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during doutoradosanduiche.This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during "doutorado-sanduiche.

Early prediction of median survival among a large AIDS surveillance cohort

<p>Abstract</p> <p>Background</p> <p>For individuals with AIDS, data exist relatively soon after diagnosis to allow estimation of "early" survival quantiles (<it>e.g.</it>, the 0.10, 0.15, 0.20 and 0.30 quantiles, etc.). Many years of additional observation must elapse before median survival, a summary measure of survival, can be estimated accurately. In this study, a new approach to predict AIDS median survival is presented and its accuracy tested using AIDS surveillance data.</p> <p>Methods</p> <p>The data consisted of 96,373 individuals who were reported to the HIV/AIDS Reporting System of the California Department of Health Services Office of AIDS as of December 31, 1996. We defined cohorts based on quarter year of diagnosis (<it>e.g.</it>, the "931" cohort consists of individuals diagnosed with AIDS in the first quarter of 1993). We used early quantiles (estimated using the Inverse Probability of Censoring Weighted estimator) of the survival distribution to estimate median survival by assuming a linear relationship between the earlier quantiles and median survival. From this model, median survival was predicted for cohorts for which a median could not be estimated empirically from the available data. This prediction was compared with the actual medians observed when using updated survival data reported at least five years later.</p> <p>Results</p> <p>Using the 0.15 quantile as the predictor and the data available as of December 31, 1996, we were able to predict the median survival of four cohorts (933, 934, 941, and 942) to be 34, 34, 31, and 29 months. Without this approach, there were insufficient data with which to make any estimate of median survival. The actual median survival of these four cohorts (using data as of December 31, 2001) was found to be 32, 40, 46, and 80 months, suggesting that the accuracy for this approach requires a minimum of three years to elapse from diagnosis to the time an accurate prediction can be made.</p> <p>Conclusion</p> <p>The results of this study suggest that early and accurate prediction of median survival time after AIDS diagnosis may be possible using early quantiles of the survival distribution. The methodology did not seem to work well during a period of significant change in survival as observed with highly active antiretroviral treatment, but results suggest that it may work well in a time of more gradual improvement in survival.</p

Endemic cryptosporidiosis and exposure to municipal tap water in persons with acquired immunodeficiency syndrome (AIDS): A case-control study

BACKGROUND: In persons with acquired immunodeficiency syndrome (AIDS), Cryptosporidium parvum causes a prolonged, severe diarrheal illness to which there is no effective treatment, and the risk of developing cryptosporidiosis from drinking tap water in non-outbreak settings remains uncertain. To test the hypothesis that drinking tap water was associated with developing cryptosporidiosis, we conducted a matched case-control study among persons with AIDS in San Francisco. METHODS: Among patients reported to the San Francisco AIDS Registry from May 1996 through September 1998, we compared patients who developed cryptosporidiosis to those who did not. Cases were individually matched to controls based on age, sex, race/ethnicity, CD4(+ )T lymphocyte count, date of CD4(+ )count, and date of case diagnosis. Population attributable fractions (PAFs) were calculated. RESULTS: The study consisted of 49 cases and 99 matched controls. In the multivariable analysis with adjustments for confounders, tap water consumption inside and outside the home at the highest exposure categories was associated with the occurrence of cryptosporidiosis (inside the home: odds ratio (OR), 6.76; 95% CI 1.37–33.5, and outside the home: OR 3.16; 95% CI 1.23–8.13). The PAF was 85%; that is, the proportion of cases of cryptosporidiosis in San Francisco AIDS patients attributable to tap water consumption could have been as high as 85%. CONCLUSIONS: Although the results from this observational study cannot be considered definitive, until there is more data, we recommend persons with AIDS, especially those with compromised immune systems, consider avoiding tap water

Effect of the one-child policy on influenza transmission in China: a stochastic transmission model

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The Association of Bay Area Health Officials: Advancing Public Health through Regional Networks

The Association of Bay Area Health Officials (ABAHO) is a regional network of 13 local health jurisdictions in the San Francisco Bay Area. Since the early 1980’s the ABAHO network has brought together representatives from Bay Area health departments to address issues ranging from the emergence of the HIV/AIDS epidemic to pandemic influenza preparedness. Utilizing both a health officials committee and a public health preparedness subcommittee, the ABAHO network leverages the expertise and resources of local health departments to advance regional public health and promote communication and collaboration among neighboring counties.

Conflicts of Interest during Contact Investigations: A Game-Theoretic Analysis

In this paper, we develop a simple mathematical model of contact investigations among a small group of individuals and apply game theory to explore conflicts of interest that may arise in the context of perceived costs of disclosure. Using analytic Kolmogorov equations, we determine whether or not it is possible for individual incentives to drive noncooperation, even though cooperation would yield a better group outcome. We found that if all individuals have a cost of disclosure, then the optimal individual decision is to simply not disclose each other. With further analysis of (1) completely offsetting the costs of disclosure and (2) partially offsetting the costs of disclosure, we found that all individuals disclose all contacts, resulting in a smaller basic reproductive number and an alignment of individual and group optimality. More data are needed to understand decision making during outbreak investigations and what the real and perceived costs are

Conflicts of Interest during Contact Investigations: A Game-Theoretic Analysis

The goal of contact tracing is to reduce the likelihood of transmission, particularly to individuals who are at greatest risk for developing complications of infection, as well as identifying individuals who are in need of medical treatment of other interventions. In this paper, we develop a simple mathematical model of contact investigations among a small group of individuals and apply game theory to explore conflicts of interest that may arise in the context of perceived costs of disclosure. Using analytic Kolmogorov equations, we determine whether or not it is possible for individual incentives to drive noncooperation, even though cooperation would yield a better group outcome. We found that if all individuals have a cost of disclosure, then the optimal individual decision is to simply not disclose each other. With further analysis of (1) completely offsetting the costs of disclosure and (2) partially offsetting the costs of disclosure, we found that all individuals disclose all contacts, resulting in a smaller basic reproductive number and an alignment of individual and group optimality. More data are needed to understand decision making during outbreak investigations and what the real and perceived costs are