A. Troupin

B. Londono – Renteria

C. Grippin

C. Mores

E. Cloherty

J. Cardenas

M. Bear-Johnson

T. Colpitts

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Anna l s o f G l o b a l He a l t h 129Background: In order to reduce mortality among HIV/AIDS pa-tients, it is imperative to understand the cause of mortality in theseindividuals. In this study, we reviewed clinical characteristics andoutcome of HIV/AIDS inpatients in a tertiary hospital setting inEthiopia in 2008.Methods: Retrospective medical chart review was done for HIV-infected patients admitted to the All Africa Leprosy, Tuberculosis andRehabilitation training (ALERT) Centre, a tertiary referral hospital inAddis Ababa, Ethiopia from January 1 to December 31 in 2008.Basic information (sex, age etc), HIV profile (CD4 count, WHOstage, ART regimen etc), presenting symptoms, diagnosis, and out-comes were obtained, and the data were analyzed. Ethical approvalwas obtained from the Albert Einstein College of Medicine, ALERTCentre and the Ethiopian National Review Board.Findings: A total of 290HIV positive patients admitted to the ALERTCentre in 2008were included in this study.Out of the total patients, 187of them had been onARTprior to admission (the ART group), and 103of them were not on ART (the non-ART group). The mean CD4 countwas 142.9 cell/mm3 for theART group and101.6 cell/mm3 for thenon-ART group (p¼0.002). The distribution of WHO stage was similarbetween the ART and non-ART groups; more than 90% of patients inboth groups were either WHO stage III or IV. For overall patients,bacterial pneumonia (27.9%), all-extrapulmonary TB (26.9%), pulmo-nary TB (26.0%) and bacterial sepsis (18.6%) were the most commondiagnosis. About 70% of TB diagnoses and more than 90% of CNSdiagnoses were made empirically. Themortality was 36.4% for the ARTgroup and 59.2% for the non-ART group (p¼0.000). The highestmortality was associated with final diagnoses of bacterial sepsis (61.4%)followed by CNS diagnoses (58.1%), pulmonary TB (53.7%), bacterialpneumonia (52.7%) and all-extrapulmonary TB (51.2%). About 60%ofthe ART group showed improvement during the admission; only 35%of the non-ART group showed improvement (p¼0.000).Interpretation: The non-ART group was associated with higherinpatient mortality than the ART group. Nevertheless, both groupshad extremely high death rate with the overall mortality rate of 44.5%.The majority of patients presented at advanced stage of HIV disease,and the majority of the diagnoses were made empirically. In addition,more than half of the patients were diagnosed as co-infected with TB.Better diagnostic tools and treatment options will likely improve theoutcome of HIV patients in Ethiopia. Of paramount importance isthe implementation of the June 2013 WHO guideline to enrollpeople on ART with the CD4 count less than 500 cell/mm3 beforetheir immune system is severely immunocompromised.Funding: NIH sponsored Einstein Center For Aids Research.Abstract #: 02CD012Effect of fluoride varnish on early childhood caries inimmunization clinics of roatan, HondurasE. Lee1, W. Yang2, C. Tsai3, E. Tran2, B. Chaffee2, L. Zhan2; 1Uni-versity of California, San Francisco, Menlo Park, CA/US, 2University ofCalifornia, San Francisco, CA/US, 3University of California SanFrancisco, San Marcos, CA/USBackground: Early childhood caries (ECC) is a common chronicinfectious disease worldwide with a higher burden in lower incomecountries. Fluoride varnish (FV) can effectively prevent ECC, butaccess is often limited. Early childhood vaccination programs areoften well established in developing countries and the incorporationof FV into immunization facilities can play a significant role inimproving early childhood oral health. The aim of this study was toassess the feasibility and utility of incorporating FV application invaccination clinics to prevent ECC in Roatán, Honduras.Methods: In a pilot observational study, 183 children aged 6-72months were recruited from two Roatán public vaccination clinics.Some of these children had previously received FV with their regularlyscheduled vaccination as part of a recent ad hoc oral health program.Study participant’s demographics, diet, oral health habits, FV exposure,height, weight, and health information were collected via provider in-terviews, medical chart reviews, and physical exams. Caries scores wererecorded using modified ICDAS. Data were analyzed using SPSS 17.0.Findings: Of the 178 (97%) children who were vaccinated, only 34(19%) received FV. Caries prevalence increased with the age. Chil-dren who received FV had significantly lower dmft (meanSE:2.450.09 for FV vs. 5.350.08 for non-FV, Mann-Whitney, P <0.001) and lower caries prevalence (45% for FV vs. 69% for non-FV,Chi Square, P < 0.01). Parent education, frequent soda and juiceintake, and frequent snacking were positively associated with ECCwhile daily intake of milk was inversely associated with ECC.Interpretation: Children who received FV in vaccination clinics inRoatán, Honduras had significantly less ECC compared to childrenwho did not receive FV. However, the percentage of children whoreceived FV was low compared to vaccination coverage. Education onhealthy diet and the expanded use of FV in vaccination clinics canhelp reduce ECC in young children of Roatán, Honduras.Funding: The study was supported by Global Healing, GlobalResearch Award Health from School of Dentistry (University ofCalifornia, San Francisco) and Kwan Scholarship for Global Health(University of California, San Francisco).Abstract #: 02CD013The impact of immunity against mosquito salivaryproteins on dengue transmissionB. Londono e Renteria1, J. Cardenas2, M. Bear-Johnson1, E. Cloherty1,A. Troupin1, C. Grippin1, C. Mores3, T. Colpitts1; 1Tulane University,SPHTM, New Orleans, LA/US, 2Los Patios Hospital, Los Patios, CO,3LSU, Baton Rouge, LA/USBackground: Dengue is a mosquito-transmitted disease of the tropicsand subtropics caused by dengue virus (DENV). In endemic areas, thisdisease has become the leading cause of childhood morbidity andmortality. In South America, DENV is primarily maintained betweenhumans and Ae. aegypti and Ae. albopictus. While the majority ofDENV infections result in little or no disease, a small proportion ofinfections progress to the severe forms, hemorrhagic fever or shocksyndrome. There is no specific therapeutic agent available againstdengue virus, and vaccine development has been continually hamperedby safety issues. An important and relatively unexplored area in DENVresearch is the role of arthropod vector factors in DENV infection anddisease outcome. During feeding, the mosquito deposits salivary pro-teins (mSP) in human skin to facilitate bloodmeal intake. These mSPstimulate immune responses, which may lead to antibody productionand modulation of cellular and cytokine function, which in turn canhave a strong effect on viral infectivity. We propose that, in endemicsettings, after repeated exposure of mosquito bites hosts develop animmune response against mosquito salivary proteins that can modulateor even block dengue viral infectivity. Here, we evaluated the antibodylevels in human patients against specific mosquito salivary proteins thatwere found to be downregulated during mosquito DENV infection.Methods: After informed consentwas voluntary given, a serum samplewas obtained from 80 febrile patients with probable dengue diagnosisfrom Los Patios Hospital in Norte de Santander Colombia and 10controls living in the same area. DENV infection was detected by qRT-PCR. ELISA test was performed to evaluate the level of antibodiesagainst Aegyptin, ADA and C-Type Lectin proteins from Ae. aegypti.130 Commun i c a b l e D i s e a s e sPurified anti-mSP antibodies were incubated with each protein in thepresence of DENV to measure blocking activity of such antibodies.Findings: In febrile subjects,antibody levels against C-type Lectine werehigher in control subjects (n¼23) than in febrile (n¼34) and DENV-infected (n¼48) participants (p¼0.0422). In contrast, antibodies againstAegyptin were significantly higher in DENV-infected (viremic) patients(p¼0.0266). Interestingly, we found that antibodies against ADA werenot significantly different among groups (p¼0.3769). In vitro testingshowed a decrease of DENV infectivity in Vero cells exposed to mSP ifthey had been preincubated with antibodies (p¼0.0361)Interpretation: In the field, humans are exposed predominantly touninfected mosquito saliva via mosquito bites. In the mosquito vec-tor, DENV infection alters the expressionof salivary proteins.Chronic exposure to either normal or modified saliva proteins inducean immune response that may protect or predispose people toexcessive viremia and severe symptoms during DENV infection.Funding: Grants NIH/NIAID K22AI103067-01 and NIH/NGMSU01GM097661.Abstract #: 02CD014An evaluation of children’s personal health practices andschool performance in a public primary school in Kisoro,UgandaH. Mamillapalli1, K. Dieckhaus2; 1University of Connecticut HealthCenter, Cheshire, CT/US, 2University of Connecticut Health Center,Farmington, CT/USProgram/Project Purpose: The right to health is listed in theUniversal Declaration of Human Rights as a right to which all humanbeings are entitled. Unfortunately, this right has failed to be realizedin much of the developing world due to poor knowledge of citizensregarding health and hygiene, as well as a lack of adequate resourcesand facilities. This has ultimately led to the spread of communicablediseases and continues to plague much of the African continent.1According to the World Health Organization (WHO), in 2008, thepercent of deaths due to communicable diseases was 8% in developedcountries compared to 68% in developing parts of the world.2 In thesame year in Uganda, the WHO reported the percent of deathsresulting from communicable diseases, such as lower-respiratory in-fections and diarrheal diseases, to be 76%.3 Children in particularbear a disproportionate amount of the disease burden due to inade-quate sanitation and insufficient hygiene leading to school absen-teeism and in severe cases, death .4, 5 Past studies among school-agedchildren in Colombia, Ethiopia, and Kenya have shown that despitean awareness of the importance of hygiene, very few children actuallypractice an adequate amount of sanitation.Structure/Method/Design: This study employed the KAP (Knowl-edge, Attitudes, and Practice) model at Katarara Primary School, agovernment funded school located in Kisoro, Uganda, to evaluatehygiene practices, student background, and school attendance andperformance in 119 students using a survey instrument. Studentsfrom grades 4 through 6 were recruited using an informed consentprocess with the help of a local translator. The survey was adminis-tered orally with the help of the translator.Outcomes & Evaluation: Although no association was found be-tween health practices and school performance, a surprising percent(100%) of students were aware of the health consequences of unhygienicbehavior. This knowledge of the students attests to the strong healtheducation program at Katarara. However, the students did not have anopportunity to employ their knowledge to perform safe health practicesdue to limited facilities at the poorly funded government school.Going Forward: The second part of this project was to inform aninterventional and education program on safe and effective handwashing techniques. Hand washing stations supplied with soap andwater were built on school grounds in an attempt for students toemploy their health knowledge to effective health practices. A followup study on the effectiveness of the intervention in improving hy-gienic practices as well as a study comparing these results to the healthknowledge and practices of students in schools across the countrywould better inform a public health initiative in Uganda in reducingthe spread of communicable diseases.Funding: This project was funded by the University of ConnecticutHealth Center.Abstract #: 02CD015Effectiveness of provider initiated HIV testing andcounseling in children in CameroonC. Mosimah, B. Spears, N. Khalil, M.N. Dohn; Wright State University,Dayton, OH/USBackground: In 2011 in Cameroon, only 13.8% of children eligiblefor antiretroviral therapy (ART) actually received it. Barriers to chil-dren receiving ART include delayed diagnosis and parents refusingHIV testing for their children. Provider initiated HIV testing andcounseling (PICT) refers to HIV testing and counseling routinelyrecommended by health care providers to persons attending healthcare facilities as a standard component of HIV care. PICT helps inearly identification of HIV-infected children, facilitates follow-up careand prevention measures that will ensure that children remain un-infected and healthy. The PICT approach also aids in early initiationof ART in infected children and parents. To date, no study has beenconducted at a regional or national level in the pediatric populationwith regards to HIV testing using the PICT approach. The purposewas to evaluate HIV testing rates after PICT.Methods: A descriptive cross-sectional pilot study of 5 monthduration (September 2012 to January 2013) was conducted in theRegional Hospital Limbe. The Regional Hospital Limbe is a majorreferral hospital providing healthcare in the Southwest Region ofCameroon. Its pediatric unit records an average of 550 admissionsper year. All hospitalized children aged 2 months to 15 years withinthe study period were recruited. Authorization to conduct study wasobtained from the regional delegation of health and the administra-tive authorities of the hospital. After acquiring parental/legal guardianinformed consent (written and/or verbal), blood samples from chil-dren and their parents were tested using an HIV rapid test followingthe national algorithm. For infantsFindings: The participants were 128 hospitalized children. Themean (SD) age of the children was 57( 48) months. Of the 128children, 52% were female. Children were accompanied by theirmothers (70%), fathers (20%), and grandparents/aunts (11%). Of the128 children, 17 (13%) had previously been tested for HIV, 4 ofwhom were HIV positive. In the current study, parents accepted HIVtesting for 110 of the remaining 111 children, of whom 5 were HIVpositive. One of 15 mothers tested was HIV positive.Interpretation: Parents and caretakers of hospitalized children nearlyuniversally accepted the recommendation to test their children for HIV,andwere willing to be tested themselves. This study identified 5 additionalchildren with HIV infection, more than doubling the number of childrenwith diagnosed HIV infection in this group. This study showed a higheracceptance ofHIV testing compared to previous reports, possibly related tocompetent, on-site PICT. In contrast to other studies in this area, a smallsample size and shorter duration of follow-up are major limitations.Given

The impact of immunity against mosquito salivary proteins on dengue transmission

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The impact of immunity against mosquito salivary proteins on dengue transmission

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