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Viral Diseases (Oral Presentation) a Pressing Need of Developing New Anti-T e174 14th International Congress on Infectious Diseases (ICID) Abstracts achieved important reductions in the incidence of Chagas in life. The availability of rapid diagnostic tools and dona- disease in many Latin American countries. However, this tions of several drugs from pharmaceutical companies, and approach has been ineffective in some geographic areas the reduced price of other essential antihelminthic drugs such as the Gran Chaco. As a result, the development of has catalysed the rapid expansion of chemotherapy-based effective new tools in these areas to prevent house rein- control programmes for NTDs. The main challenges to PTC festation by triatomine bugs is a high research priority. No in Africa include poor health service infrastructure in post less important is the need of innovative approaches includ- conflict countries and cost-effective approaches for inte- ing those generated from genomics to improve upon existing grating the individual vertical programmes targeting specific diagnostic tests and to develop new parasitological tests diseases. for the early diagnosis of congenital infection in the new- born and in immunocompromised patients, as well as for doi:10.1016/j.ijid.2010.02.1872 the assessment of treatment response (PCR; antigenemia, recombinant antigens,synthetic peptides etc.). There is also Viral diseases (Oral Presentation) a pressing need of developing new anti-T. cruzi agents with high activity in both the acute and chronic phases, and epi- 40.001 demiological methods that me may be used to estimate the Unusual clinical profile of Dengue Infection in patients prevalence of infection, subclinical disease and treatment attending a tertiary care teaching hospital in north India needs in endemic and non-endemic countries. J. Agarwal ∗, G. Kapoor, S. Srivastava, K.P.Singh, R. Kumar, doi:10.1016/j.ijid.2010.02.1871 A. Jain 39.004 C S M Medical University, Lucknow, Uttar pradesh, India Integrated control of neglected tropical diseases in Africa Background: Major outbreaks of dengue virus have been reported from many parts of North India including Luc- M.J. Bockarie know, at regular intervals since 1996. We have carried out a Centre for Neglected Tropical Diseases, Liverpool, United detailed investigation of the Dengue cases occurring in year Kingdom 2008. Methods: Clinically suspected patients attending Pedi- Neglected tropical diseases (NTD) are the ‘other dis- atrics and Medicine outpatient or inpatient Departments and eases’ of Millennium Development Goal 6 that have received referred to Microbiology Department for serological diagno- little attention from policy-makers and politicians who sis of dengue, were prospectively enrolled after obtaining over focus on HIV, tuberculosis and malaria. They include verbal consent. Detailed clinical history and examination many medically diverse diseases that are strongly associ- findings were recorded in a pre designed questionnaire from ated with poverty. NTDs include bacterial, viral, protozoan 398 such patients between Jan 2008 to Dec 2008. Dengue and helminth infections that have plagued humanity since specific antibodies were detected using commercial Mac- antiquity. Globally, over one billion people suffer from one ELISA kit (IVD, USA). Results of hematological and other or more NTDs and about 500,000 people die from them every investigations were noted from medical records. year. Results: Mean age of patients’ was10.25 ± 10.9 years and Neglected Tropical Diseases are widespread in Africa due, 328/398 were in pediatric age group (%12 yrs age). A total of in part, to the low socio-economic status of rural popula- 53.26% (212/398) patients were positive for dengue IgM and tions. Many countries are endemic with of 5 or more NTDs 93% of these were admitted patients. Male: Female ratio including schistosomiasis, soil-transmitted helminths (STH), was1.8:1 and ∼74% belonged to rural area. Overwhelming lymphatic filariasis, onchocerciasis and trachoma, as well majority (92%) of dengue cases were seen between July as zoonotic disease such as human African trypanosomiasis, to November, which are the post monsoon months in this rabies, tick borne relapsing fevers, echinococcus (hydatid), part of world. Frequent clinical features included fever taeniosis (cysticercosis), brucellosis and plague, with a large (100%) with mean duration of 14.07 ± 9.2 days, edema (50%), part of the population at risk of co-infection with 2 or more altered sensorium (39%), rash (31.84%). Mucosal bleeding, of these diseases. hepatomegaly and splenomegaly were present in 31.84%, Fortunately, control strategies as well as diagnostic tools 57.29% and 56.25% respectively. Thrombocytopenia (58.74%) and the availability of safe and effective drugs exist for the was common laboratory finding. Liver enzymes SGPT and NTDs responsible for the greatest burden in Africa: lym- SGOT were raised in 72.55% and 78.43% of positive cases, phatic filariasis, onchocerciasis, STH and schistosomiasis. respectively. Presentation varied between adults and pedi- The World Health Organization has developed a strategy, atric populations, while among adults, seizure (p=0.029), Preventive Chemotherapy and Transmission Control (PCT), skin rash (p=0.029), abdominal pain (p=0.005) and hemo- which is geared towards the implementation of large-scale concentration (PCV > 36; p=0.063) were significant findings; mass drug administration. The objective of PCT is to pro- however in children, headache (p=0.029), serum sodium vide national programmes with technical guidelines that and calcium levels (p=0.022 and p=.0006) were signif- emphasize a coordinated, cost-effective approach to the icantly raised. Logistic Regression analysis found serum implementation of national elimination and control activ- SGOT>40 U/L and presence of splenomegaly as independent ities where preventive chemotherapy is the main tool, i.e. predictors for dengue infection. Only 3 cases met the WHO regular anthelminthic drug administration to all people at criteria for dengue haemorrhagic fever (DHF), however clin- risk of morbidity due to helminthic diseases, starting early ically ∼20% of the dengue positive cases were labelled and 14th International Congress on Infectious Diseases (ICID) Abstracts e175 managed as DHF. Mortality rate amongst dengue IgM posi- Conclusion: This is one of the first recognized civil- tives was 6.02% (5/83). ian community outbreaks of HAdV-14 since the virus first Conclusion: The unusual clinical profile necessitates appeared in California in 2003. Demographic characteristics continuous sero surveillance and monitoring for changing and illness patterns in case-patients were similar to those clinical presentationof dengue infection. observed in other HAdV-14 outbreaks in Oregon and Wash- ington State in 2007, with disease mostly occurring in adult doi:10.1016/j.ijid.2010.02.1873 male smokers. In this setting, HAdV-14 appeared to have spread mostly among close contacts in the home or within 40.002 a certain social network whose members often reported An outbreak of pneumonia associated with emergent smoking or sharing smoking materials with other HAdV-14 human adenovirus serotype 14 - Southeast Alaska, 2008 case-patients. Lack of HAdV-14 infection in controls and their household contacts suggests wide-spread transmission D. Esposito 1,∗, T.J. Gardner 2, E. Schneider 1, L.J. did not occur, either previously or during this pneumonia Stockman 1, J. Tate 1, C.A. Panozzo 1, C.L. Robbins 1, outbreak. S.A. Jenkerson 2, L. Thomas 3, C.M. Watson 4, A. Curns 1, D.D. Erdman 1,X. Lu1, T. Cromeans 1, M. Westcott 5, doi:10.1016/j.ijid.2010.02.1874 C. Humphries 5, J. Ballantyne 5, G.E. Fischer 1, J.B. McLaughlin 2, G. Armstrong 1, L.J. Anderson 1 40.003 1 Centers for Disease Control and Prevention, Atlanta, GA, Uptake and impact of Rotavirus vaccines in US Children USA J. Cortes 1, D. Esposito 1, M. Cortese 2, D. Bartlett 2,J. 2 Alaska Department of Health and Social Services, Anchor- Tate 2, D. Payne 2, M. Patel 2, A. Curns 2, J. Gentsch 2,U. age, AK, USA ,∗ Parashar 1 3 Alicia Roberts Medical Center, Klawock, AK, USA 4 Craig Public Health Center, Craig, AK, USA 1 CDC, Atlanta, GA, USA 5 Alaska State Public Health Virology Laboratory, Fairbanks, 2 CDC, NCIRD, Atlanta, GA, USA AK, USA Background: In 2006 and 2008, two new vaccines were Background: In September 2008, an outbreak of pneumo- recommended for routine vaccination of US infants against nia associated with a rare human adenovirus (serotype-14 rotavirus. We assessed vaccine uptake and its impact on [HAdV-14]) occurred on a rural island in Southeast Alaska. rotavirus disease in US children. To determine risk factors for disease and household trans- Methods: To measure vaccine uptake, we examined data mission characteristics, we investigated pneumonia cases in from sentinel immunization information system (IIS) sites three affected island communities. in eight different US locations. Coverage with at least 1 Methods: Case-patients were island residents who pre- dose of rotavirus vaccine was measured at age 5 months, sented to one of two medical clinics with clinical or and compared with coverage of other established child- radiological evidence of pneumonia between September 1 hood vaccines, DTaP and pneumococcal vaccine, given at the and October 27, 2008. Controls from the community were same age. To measure vaccine impact, we examined data matched 1:1 to case-patients based on age, sex, and com- from 2000-2009 on laboratory detections of rotavirus from munity of residence. Case-patients, controls, and household a national network of ∼70 laboratories to assess trends and contacts were interviewed for information on demograph- timing of rotavirus activity. Data from a subset of 29 labo- ics, recent illnesses, medical history, ill contacts, and other ratories that consistently reported for ≥30 weeks for each possible exposures. Serum and respiratory specimens were season during 2000-2009 were used to measure national and also collected. Risk factors for pneumonia were determined regional changes in rotavirus test results. using exact multivariate conditional logistic regression.
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