378 was administered to new TB patients, older than 15 years, who had 1252 received at least one month of TB treatment and given consent. Data was collected through informal discussions with TB coordinators and facility EVALUATION OF HOUSEHOLD LEVEL INTERVENTIONS heads, desk top review of patient records and intervies with TB patients DURING A LARGE, URBAN TYPHOID FEVER OUTBREAK - to assess direct costs prior to being diagnosed and direct and indirect cost HARARE, ZIMBABWE 2011-2012 of current treatment. Of the 159 patients interviewed, 64% were in the 1 2 1 three lower socio economic quintiles with monthly income less than US$ Maho Imanishi , Patience Kweza , Rachel B. Slayton , Wellington 3 4 5 3 42.55. Health system delay was estimated at 1.4 weeks with males taking Mushayi , Tanaka Urayai , Odrie Ziro , Monica Chizororo , 5 3 6 6 longer to seek care than females. DOTS patients paid a mean total direct Ajay Paul , Susan M. Laver , Clement Duri , Stanley Mungofa , 6 7 7 cost of US$ 0.50 for each visit and spent of 58 minutes per DOTS visit. The Prosper Chonzi , Panganai Dhliwayo , Peter H. Kilmarx , Portia 8 1 9 mean number of days spent in the hospital was 22.7 days and direct cost Manangazira , Eric D. Mintz , Daniele S. Lantagne of hospitalization was US$ 48.32. Whilst 48.3% of the patients borrowed, 1Centers for Disease Control and Prevention, Atlanta, GA, United States, 37.7% sold assets to cope with paying for their ill health. Reduction 2National Institute of Communicable Diseases, Johannesburg, South Africa, of monthly household and patients income due to TB was 44.5% and 3United Nations Children’s Fund – Collaborating Centre for Operational 82.6% respectively. Sixty-one percent of the TB patients lost their jobs, Research and Evaluation, Harare, Zimbabwe, 4Population Services 11% got separated from their spouse/family and stopped attending public International – Zimbabwe, Harare, Zimbabwe, 5German Agro Action – functions. Through this study, the NTP has identified constraints faced Zimbabwe, Harare, Zimbabwe, 6Harare City Health Department, Harare, by TB patients and their families that have an effect on case finding and Zimbabwe, 7Centers for Disease Control and Prevention - Zimbabwe, treatment adherence. We recommend that TB patients and their families Harare, Zimbabwe, 8Ministry of Health and Child Welfare, Harare, should benefit from social protection packages that will ease the financial Zimbabwe, 9Harvard University, Boston, MA, United States burden. Employers should not hesitate to take back workers who have Between October 2011 and March 2012, ~2,750 suspected cases of been diagnosed and treated with TB. typhoid fever in two high-density suburbs of Harare (Dzivaresekwa and Kuwadzana) were reported to the Harare City Health Department 1251 (HCHD). To prevent outbreak spread, HCHD and non-governmental organizations conducted door-to-door health and hygiene education and CLINICAL OUTCOMES ASSOCIATED WITH ROUTINE USE OF distributed point-of-use water treatment (PoUWT) products beginning INTERFERON-γ RELEASE ASSAYS IN A CENTRAL LONDON TB in October 2011. To evaluate the effectiveness of these interventions, SERVICE we conducted cross-sectional household surveys in these two affected Dami Collier, Andy Taylor, Steve Morris-Jones suburbs in March 2012, including free chlorine residual (FCR) testing in stored drinking water. Reported intervention coverage was high, with 351 Hospital of Tropical Disease, London, United Kingdom (77%) of 458 randomly selected households having received both typhoid Interferon-γ release assay (IGRA) has been shown to have higher specificity fever prevention information and at least one PoUWT product. Of 368 than tuberculin skin testing (TST) for screening for latent TB and is households that received at least one of the three types of chlorine tablets recommended by the National Institute for Clinical Excellence (NICE). The distributed, 326 (89%) reported ever using them, 160 (43%) reported aim of this study is to review the indications for and analyse the results using them daily, and 98 (27%) had stored water that was treated and of IGRA testing in our central London BCG vaccine positive population. had FCR ≥0.2mg/L when tested. Only 169 (55%) of 310 household We analysed routinely collected clinical and demographic data on patients respondents who had chlorine tablets on the day of the survey knew the referred for IGRA testing to a TB service at a large London teaching correct volume of water to treat with their tablets. In univariate analysis, hospital from September 2007 to January 2012. Reasons for referral respondents who had higher income, were older, had received PoUWT for screening included contacts of active TB, pre-monoclonal antibody products or typhoid fever prevention information, and who reported therapy, recent migrants and occupational health. Quantiferon Gold household water treatment before the outbreak were more likely, and InTube was used. We used the London TB registrar to identify patients that respondents who reported boreholes as the primary source of drinking were diagnosed with active TB either by bacteriological or clinical evidence water were less likely, to report water treatment during the outbreak or on from November 2007 to February 2012. We determined the sensitivity and the day of the survey, and to have treated stored water with FCR ≥0.2mg/L specificity of IGRA for diagnosing active TB and screening for latent TB. (p < 0.05). The findings highlight: 1) relatively low uptake of PoUWT after We used univariate linear regression to assess the incremental impact of free distribution (consistent with other research); 2) the need to improve IGRA result on having a diagnosis of active TB. 961 IGRAs were performed coordination of NGO response activities through consistent PoUWT on 917 patients. 51% were male with a median age of 30 years (IQR 19- product choices and communication about product use; and, 3) the need 40). There were 46 (4.8%) indeterminate, 703 (73.2%) negative and 212 to emphasize treating drinking water from all sources daily to control and (22%) positive results. Indeterminate results were more prevalent amongst prevent typhoid fever and other waterborne disease outbreaks. immunosuppressed than immunocompetent patients 66.7% (24/36) vs. 33.3% (12/36). 46 cases of active tuberculosis were identified from the 1253 London tuberculosis register, 15 of which had a negative IGRA result. The sensitivity and specificity of IGRA for diagnosing active TB were 67% and EFFECTS OF ENVIRONMENT ON HUMAN CYTOKINE 79% respectively. We found a direct correlation between a positive IGRA RESPONSES: ROLE OF URBAN VERSUS RURAL RESIDENCE test result and active TB diagnosis (p 0.00 coefficient 1.343). The sensitivity 1 2 2 and specificity of IGRA for latent TB screening were 55% and 89% Philip J. Cooper , Leila D. Amorim , Camila A. Figueiredo , 2 3 4 4 respectively. We found an overrepresentation of indeterminate results Renata Esquivel , Fernanda Tupiza , Silvia Erazo , Yisela Oviedo , 4 4 2 amongst immunosuppressed patients. IGRA was used in addition or other Maritza Vaca , Martha E. Chico , Mauricio L. Barreto conventional diagnostic modalities for the diagnosis of active TB, which 1Liverpool School of Tropical Medicine, Liverpool, United Kingdom, is outside the scope of the NICE guidelines. Although the use of IGRA for 2Universidade Federal da Bahia, Salvador, Brazil, 3Hospital de Los Valles, this purpose is approved by the US Food and Drug Administration, caution Quito, Ecuador, 4Laboratorio de Investigaciones FEPIS, Quininde, Ecuador should be exercised due to its low sensitivity for diagnosing active TB. Environment may have a key role in the development of the immune However the usefulness of IGRA in screening for latent TB was conferred system in childhood and may explain the low prevalence of allergic and by its high specificity in our setting. autoimmune diseases in the rural tropics. To investigate the effects of urban versus rural residence on the immune response, we recruited 440 school children living in either in rural communities in the Province of Esmeraldas or in the city of Esmeraldas. We collected data on www.astmh.org 379 environmental exposures by questionnaire and on intestinal parasites by 1255 examination of stool samples. Whole blood was stimulated with mitogen, parasite antigen and aeroallergens. IFN-γ, IL-5, IL-10, IL-13, and IL-17 FARM WORKER HYGIENE AND HAND SANITATION IN were measured in supernatants. Overall, urban children had mothers MEXICO ASSOCIATED WITH CONTAMINATION OF FRESH with greater educational levels, were more likely to have access to piped PRODUCE water (urban 98.7 % vs. rural 1.9%) and were more likely to use latrines 1 1 1 or water closets for defecation (urban 94.8% vs. rural 54.7%). Rural Laura K. Wright , Elizabeth A. Adam , Gaelle J. Gourmelon , 1 1 children were more likely to be infected with geohelminths (urban 73.5% Faith E. Bartz , Anna M. Fabiszewski de Aceituno , Norma L. 2 2 3 1 vs. rural 20.9%). The frequencies of children with .. DDDdetectable levels Heredia , J. Santos Garcia , Lee-Ann Jaykus , Juan S. Leon of cytokines were similar in urban and rural samples except for IL-10 that 1Emory University, Atlanta, GA, United States, 2Universidad Autonoma de was significantly more frequent in the urban population when measured Nuevo Leon, Monterrey, Mexico, 3North Carolina State University, Raleigh, as spontaneous production (adjusted OR 2.56, 95% CI 1.05-6.24) and NC, United States after stimulation with Ascaris (adj. OR 2.5, 95% CI 1.09-5.79) and house Produce-related foodborne disease outbreaks lead to economic losses, dust mite (adj. 2.24, 95% CI 1.07-4.70) antigens. Our data do not illness, and death, making produce-contamination an important public provide support for a major role for place of residence or geohelminth health concern. In this study we investigated the pathways of produce infections as a major determinant of the cytokine response in childhood.