Agueda Cabello

Seroprevalence of leptospirosis and associated factors in workers of the urban cleaning service of the Municipality of Asuncion, Paraguay

INTRODUCTION Leptospirosis is a serious infectious disease that has been linked to occupational activities such as farmers, sewer workers, garbage collectors, butchers and veterinarians. It is acquired through contact with major reservoirs like rodents, pets, or the environment contaminated by their urine. In Paraguay, there are no published reports on the seroprevalence of leptospirosis related to work activity. OBJECTIVE To determine the seroprevalence and factors associated with transmission of leptospirosis in urban sanitation workers. METHODOLOGY Descriptive transversal study. The study included workers from the Department of Urban Cleanliness of the City of Asuncion, who had completed at least one month on the job and who agreed to particípate in the study. Sampling was stratified and proportional to the number of workers. After informed consent was obtained, participants were surveyed and a blood sample was taken for detection of Leptospira IgG antibodies by ELISA. RESULTS Leptospirosis seroprevalence was 8.6% (29/339), all positive cases were male and prevalence was statistically higher in workers of the collection area than in those of other work areas. CONCLUSION We found a lower than expected seroprevalence. However, conditions observed at work and at home are conducive to transmission of infection. We recommend the improvement of prevention strategies and health promotion in this population.

Chickenpox outbreak originated in a military school in a community in Paraguay

Introduction : Chickenpox is an infectious disease of worldwide distribution, caused by primary infection of varicella zoster virus (VZV), is characteristic of childhood. Man is the only known reservoir. In tropical climates, the pattern is not so obvious, the virus circulates less frequently and the disease are acquired at later ages. In May 2013, following the notification of four cases of chickenpox to the Directorate General of Health Surveillance in a military school, research was conducted. Objective : To confirm the outbreak and to propose recommendations for prevention and control. Materials and Methods : cross sectional descriptive study. Were conducted Active retrospective search according to the following definition: a person from the Military School (MS) who presented with skin lesions, fever or sore throat between epidemiological weeks 14 and 21. Suspected cases was interviewed using a semi-structured questionnaire. Results : In addition to the four cases already reported, we identified 12-suspected cases more, but they were discarded later. The cases were all males aged 20-24 years old, with no history of varicella, one required hospitalization and antiviral treatment, four had skin lesions, three had fever and one had sore throat. Conclusion : The outbreak was confirmed in a closed institution, which originated in a community of Quiindy district. All cases were temporally related to the first case found in the community. The preventive measure for cadets (students) was the home insulation so that contagion was prevented in other students of MS. Immunization against chickenpox outbreaks recommended, intensify surveillance in health services so that the system is sensitive enough to respond in a more timely manner to such events and home insulation both in closed populations as well in the community.

Casos de intoxicación aguda por plaguicidas en la colonia Puerto Pirapó, Itapúa, Paraguay, febrero de 2014

In Paraguay, pesticides are the causative agent in 13.7% of poisonings, especially organophosphorus compounds. Such poisoning produces the inhibition of acetylcholinesterase generating three possible clinical conditions: acute poisoning, intermediate syndrome or late neurotoxicity. We present 15 cases of acute poisoning, ten women and five men from a rural community between 5 and 67 years of age, whose symptoms began after using water contaminated by pesticides from the community network. The most common symptoms were nausea and vomiting, followed by abdominal pain, headache, fever, itching, red eyes and sweating. Five patients underwent blood tests for blood count, renal and liver function and serum cholinesterase, with results within the reference values; just one patient had high liver enzymes.In two samples from the community water supply network the active compound detected was profenophos. It is essential to train primary health care personnel to identify cases of acute pesticide poisoning in a timely manner to provide appropriate treatment, especially in rural areas. Additionally, it is necessary that responsible institutions monitor compliance with environmental regulations in these areas to avoid such incidents.

Seroprevalencia de la infección por dengue en un distrito del Chaco Paraguayo: Estudio poblacional

BACKGROUND Dengue is an infection of great global importance with different clinical presentations. OBJECTIVE To establish the seroprevalence of infection by the dengue virus in a district of the Paraguayan Chaco. MATERIAL AND METHODS Cross-sectional study in 418 inhabitants of three villages in the district of Villa Hayes, Paraguay, using a probabilistic household sampling, a questionnaire and blood sampling. Antibodies were determined by the ELISA capture IgG anti dengue method and factors associated with seroprevalence were evaluated. RESULTS The overall seroprevalence for dengue virus infection was 24,2% (CI95%: 20,2%-28,6%); 34% (n: 142) of respondents reported history of dengue in the previous 10-year period. Of the 276 people (66%) who reported no history of dengue infection, 37 (13%) tested positive, which points out asymptomatic individuals. The main factors associated with infection were: males with significantly higher prevalence than women (31%); to be over 60 years of age (44%), be residents of Villa Hayes (31,1%). No association with educational level or monthly income of the participants, nor housing condition, drinking water source or type of bathroom were observed. The larval infestation rate was 0,51%. CONCLUSIONS The relatively low seroprevalence of infection by the dengue virus is consistent with the small size of the district and highlights the potential risk of infection in future epidemics.

Exploring the Implementation of e-Health Practices in a Low Income Country

In low income countries like Paraguay, broad segments of the population have only limited access to health services and lack sufficient human and financial resources as well as infrastructure for an appropriate health service delivery. At the same time, access to information and communication technologies (ICTs) varies across countries and population groups.

P1-104 Community syndromic surveillance system using information and communication technology in Paraguay

The objective of syndromic surveillance is to identify illness clusters early and to mobilise a rapid response, thereby reducing morbidity and mortality. Objective To describe the system named Bonis, which uses Information and Communication Technology to prevent, warn, monitor and control the spread of febrile syndromes and influenza like illness (ILI) at the community level. Methods Bonis has a kernel free software application; Asterisk, a phone center with VoIP service, PHP as Script language and Mysql as data base management. The system was implemented in a primary healthcare. Results The developed system has the ability to record, classify, and prioritise automatically through the Interactive Voice Response the suspected cases. It has been programmed in a PHP language script AGI to improve the functionality of the Asterisk, in a way that during the user call to report a possible case, the system feeds a database, through the manager module based in a web application developed in PHP. The system, to which the users access from a mobile or fixed telephone, automatically receives the call with 9 questions on signs and symptoms. The system is working since May 2010 and records the phone calls correctly; follow-ups of these patients are performed by the teams within a period of 24 h. Conclusion The developed system is allowing the community to notify and register events that require surveillance, and the community health agents is prioritising visits to those homes from where fever cases are reported for sooner and more appropriate interventions.

P1-72 Stratification of area of risk for dengue in metropolitan area of Paraguay

Dengue constitutes a severe public health problem worldwide, especially in most tropical countries where environmental conditions favour the development and proliferation of Aedes aegypti. Objective To identify priority areas of risk in various areas creating a numerical scale designated as low, moderate or high risk. Methodology A retrospective descriptive study was done of historical accumulated cases during the years 2006–2007, 2008–2009, 2009–2010. The capital city and surrounding districts were selected for the study and the following indicators were calculated: the mean incidence rates of the three epidemic periods; the general house larval infestation rate by district before the SE 14-2010 (peak of the last epidemic); and the historical movement of different serotypes in each district. Results Nine districts met the condition of population density. The average incidence rates of the three periods makes Asuncion first with 636.60 and Luque last with 167.69 per 100 000 inhabitants. The house larval infestation rate is in all districts of the metropolitan area >1%. The highest is 18.46% in Fernando de la Mora and the lowest 4.94% in Mariano Roque Alonso (MRA). The history of viral circulation shows that in the metropolitan area three serotypes, DEN 1, DEN 2, and DEN 3 have circulated. In the nine Metropolitan districts, four are at moderate risk and five are at high risk. Conclusion This epidemiological risk scale for dengue fever may be useful for the allocation of resources in a more rational way and address the actions with a risk approach.