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  • 1.
    Ahangari, Alebtekin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Research Centre for Generational, Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 12016In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, no 10, p. 1282-1292Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS: The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS: Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION: Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.

  • 2. Banks, S De Raedt
    et al.
    Orsborne, J
    Gezan, S A
    Kaur, H
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
    Lindsey, S W
    Logan, J G
    Permethrin-treated clothing as protection against the dengue vector, Aedes aegypti: extent and duration of protection2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 399-400Article in journal (Other academic)
    Abstract [en]

    Background: 3900 million people globally are at risk of dengue fever infection, with its distribution increasing rapidly over the past 50 years. Since the primary vector, Aedes aegypti, is exophilic and most active during the day, personal protection technologies, such as insecticide treated clothing, could provide significant protection from mosquito bites.

    Methods: World Health Organisation Pesticide Evaluation Scheme (WHOPES) cone and arm-in-cage assays were used to assess protection, knockdown and mortality against factory, home-dipped and microencapsulated permethrin-treated fabrics using Ae. aegypti mosquitoes. Factory-treated clothing was then analysed further to investigate the effects of insecticide resistance, clothing coverage, washing, Ultra-violet light and ironing.

    Results: Factory-treated clothing showed the greatest protective effect (1 h KD 96.5% and 24 h mortality 97.1%), landing protection (59% (95% CI = 49.2–66.9) and bite protection (100%). Landing and biting protection reduced significantly from 58.9% to 18.5% and 28.6% to 11.1% after 10 washes for simulated hand washing. Resistance to permethrin had no effect on the efficacy of the clothing, with coverage playing an important role. Full coverage provided the highest protection (79.4% landing protection, 100% biting protection). Free flight room assays showed no difference in landing protection between the two coverage types but bite protection was significantly greater (>90%) with full coverage. HPLC confirmed ironing reduced permethrin content after 1 week simulated use, with a 96.7% decrease after 3 months. UV exposure was shown to have no effect.

    Conclusion: Insecticide treated clothing can provide significant biting and landing protection, even in a resistant strain. However, our findings also suggest that clothing may provide only short-term protection due to the effect of washing and ironing, highlighting the need for improved clothing treatment techniques.

    Disclosure: Nothing to disclose.

  • 3.
    Byass, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Collinson, M A
    Tollman, S M
    Kahn, K
    Malaria mortality in a hypoendemic area of North-Eastern South Africa: population-based surveillance from 1992 to 2013 reveals an increasing malaria burden2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 128-128Article in journal (Other academic)
    Abstract [en]

    Introduction: Most of South Africa is malaria-free, but hypoendemic levels of transmission persist in lowveld areas in the north-east of the country, adjacent to Mozambique. Many families have links to relatives in Mozambique, where malaria transmission remains much higher, and cross-border travel is commonplace, although the Kruger National Park provides something of a depopulated buffer zone along the border. Malaria diagnosis and treatment is relatively easily available at public and private facilities in the endemic area.

    Methods: The Agincourt Health and Socio-Demographic Surveillance Site has monitored population health in a defined area within Mpumulanga Province, around 24.7°S, 31.2°E, since 1992. A circumscribed semi-rural area with a population ranging from approximately 60 000 in 1992 to 90 000 in 2013 was covered. All households were visited regularly to consistently record demographic and health data, including the documentation of deaths and their causes using verbal autopsy.

    Results: From 1992 to 2013 a total of 13 251 deaths were documented over 1.58 million person-years observed. Of that total mortality burden, 1.2% of deaths were ascribed to malaria. Half of the malaria deaths were among children aged under 15 years, with most of the remainder among working-age adults. Malaria deaths were strongly correlated with temperature and rainfall. The malaria mortality rate was over 50% higher during the last 5 years of the surveillance period, compared with earlier years. A huge HIV/AIDS epidemic that developed and receded in this population during the period of observation had no apparent effect on malaria mortality.

    Conclusions: This detailed longitudinal examination of malaria mortality showed that although malaria is a relatively minor cause of death in this population, it has become more common in recent years, and shows no sign of retreating despite rapid socioeconomic development. In addition to local relevance, these findings are important for understanding potential population burdens of hypoendemic malaria in other areas of sub-Saharan Africa as progress towards malaria control and elimination targets is realised.

  • 4.
    Edvardsson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Ntaganira, Joseph
    Åhman, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Semasaka Sengoma, Jean Paul
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali ,Rwanda.
    Small, Rhonda
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study2016In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, no 7, p. 895-906Article in journal (Refereed)
    Abstract [en]

    Objective To explore Rwandan physicians' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. Methods Physicians (n=19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively. Results Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women's main expectations of ultrasound. Although women's right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician protection'. Conclusions There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women's uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative.

  • 5. Filippi, Véronique
    et al.
    Goufodji, Sourou
    Sismanidis, Charalambos
    Kanhonou, Lydie
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ronsmans, Carine
    Alihonou, Eusèbe
    Patel, Vikram
    Effects of severe obstetric complications on women's health and infant mortality in Benin2010In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 15, no 6, p. 733-742Article in journal (Refereed)
    Abstract [en]

    Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group.

  • 6.
    Fottrell, Edward
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sartorius, Benn
    Huong, Dao Lan
    Van Minh, Hoang
    Fantahun, Mesganaw
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mortality measurement in transition: proof of principle for standardised multi-country comparisons2010In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 15, no 10, p. 1256-1265Article in journal (Refereed)
    Abstract [en]

    Given the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.

  • 7. Franco, L
    et al.
    Cnops, L
    Navascues, A
    Boillat, N
    Neumayr, A
    Norman, F
    Vanio, K
    Dudman, S
    Van Esbroeck, M
    Molero, F
    Hernandez, L
    Potente, A
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hatz, C
    Sanchez-Seco, M P
    Dengue in Africa: sustained and silent circulation of multiple serotypes and genotypes, detected in travelers from 2010 to 20142015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 107-108Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue is caused by 4 different related viruses, DENV 1 to 4, transmitted to humans via Aedes mosquitoes. The disease is endemic in more than 100 countries. In Africa, the estimated dengue burden is 15 million of clinical cases and about 48 millions of inapparent infections. However, dengue remains largely unrecognized in Africa. Due to the lack of laboratory confirmation, a febrile syndrome is frequently misdiagnosed as malarial infection. The circulation of different dengue serotypes is also poorly documented. However, some information is provided by reports of dengue infections in travellers returning from Africa. In the present study we attempt the identification of dengue serotypes and genotypes circulating in Africa from 2010 to 2014 detected in travellers returning to Europe.

    Methods: We collected samples from viraemic travellers returning from Africa who attended TropNet clinics in Europé from 2010 to 2014. Sequences of the Envelope gene were used to identify the serotype and genotype.

    Results: During the study period we identified 3 DENV serotypes circulating in Africa. DENV 1 strains were detected in East Africa in 2010 (Eritrea) and in 2012 (Kenia), whereas in Central Africa in 2013(Angola and DRC). Strains from East Africa were grouped within Asian genotype, close to virus isolated in previous years in Djibouti and Kenia; we found American /African genotype in Central Africa. Both genotypes have circulated in West Africa for many years. DENV 2 strains were detected in West Africa (Senegal) and in East Africa (Tanzania) in 2014. Dengue 2 from Tanzania belongs to cosmopolitan genotype, but form a distinct clade different from the old African group. However, DENV 2 from Senegal surprisingly fell into genotype America /Asia. To our knowledge this is the first time identified in Africa. Finally, DENV 3 was detected in 2010 in Mali and Burkina Faso and again in Burkina Faso in 2013. All DENV 3 belong to genotype III and form a cluster with the African strains identified since 2008.

    Conclusion: DENV 1 of both genotypes was identified previously in Africa indicating endemic transmission as well as with DENV 3. Meanwhile, a new DENV 2 appeared in Tanzania, introduced from South East Asia, and in Senegal from the Americas. These results confirm silent and sustained circulation of dengue in Africa and show the usefulness of travelers for sentinel surveillance to unmask the dengue problem in Africa.

    Disclosure: Nothing to disclose.

  • 8. Franco, L
    et al.
    Fernandez, M D
    Serre, N
    Martinez, M
    Sulleiro, E
    Neumayr, A
    Molero, F
    Schunk, M
    Guido, C
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hatz, C
    Sanchez-Seco, M P
    Dengue serotypes and genotypes circulating in recent years in the Caribbean and imported to Europe2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 104-105Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue viruses (DENV) are the most widespread arthropod-borne viruses endemic in the tropics and transmitted to humans through the bites of Aedes mosquitoes. Travelers can act as vectors to introduce DENV to uninfected areas or regions. Travelers can also serve as sentinels for ongoing outbreaks and dominating serotypes and genotypes in the source countries. We set out to describe the importation of dengue virus from the Caribbean via travelers to Europe.

    Methods: From 2011 to 2014, we collected samples from viraemic travelers returning from the Caribbean with confirmed dengue to 11 TropNet clinics in Europe that are participating in the DengueTools project. Sequences of the Envelope gene were used to identify serotype and genotype.

    Results: The main countries of importation were Barbados, Cuba, Dominican Republic, Guadeloupe, Haiti, Martinique, Netherlands Antilles and Puerto Rico. All 4 DENV serotypes were identified. DENV 1 strains were grouped within genotype V creating a new clade. All DENV 2 sequences clustered within a clade in the American/Asian genotype which was recently also identified in other Caribbean and Brazilian strains. DENV 3 strains were grouped within genotype III. All DENV 4 strains were phylogenetically grouped within a modern Caribbean basin clade in genotype II.

    Conclusions: Travelers provides unique insights into the global picture of circulating DENV strains. This study from the Caribbean region led to the identification of novel clades. Moreover, we were be able to detect dengue strains circulating in Cuba from 2011 to 2013, although officially no dengue was reported during that time period. Travelers serve as sentinels to provide timely information about current distribution of dengue serotypes and genotypes associated or not with outbreaks and track the spread of DENV strains in areas with scarce epidemiological information.

    Disclosure: Nothing to disclose.

  • 9.
    Godefay, Hagos
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Admasu, K
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    A national programme of freely-available ambulance transportation for women in labour halves maternal mortality in Ethiopia: an operational analysis from Tigray Region2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 72-72Article in journal (Other academic)
    Abstract [en]

    Introduction: One of the challenges for maternal health services across Africa is physically getting women to health facilities for delivery at the appropriate time. A lack of transportation has often been cited as a major obstacle. The Ethiopian Federal Ministry of Health implemented a national programme of freely available ambulance transportation in every District from 2012, and this operational analysis investigated the effects of the ambulance programme on maternal mortality.

    Methods: Maternal mortality was measured in a survey of six randomly selected districts in Tigray Region over a 1-year period in 2012/13. For the same time period, data from ambulance log books from the same six Districts were captured and ambulance trips associated with deliveries extracted. Data on month, distance to health facility and mobile network coverage at local area level were included.

    Results: The survey identified 51 maternal deaths and 19 179 live births, corresponding to an overall maternal mortality ratio (MMR) of 266 per 100 000 live births. Districts using ambulances for at least 25% of deliveries had an MMR of 116 per 100 000 compared with 407 per 100 000 elsewhere. Distance from home to facility, the availability of a mobile telephone network and utilisation of ambulances were all independently associated with maternal mortality. When all these factors competed in a multivariable model at local area level, only utilisation of ambulances persisted as a significant factor, with a maternal mortality rate ratio of 0.51. One maternal death was estimated to have been averted for every 5000 ambulance-kilometres driven.

    Conclusions: Freely available ambulance transport in Ethiopia was associated with significant reductions in maternal mortality, although this was a strategy requiring substantial investment. Similar results could probably be achieved elsewhere given sufficient investment in vehicles and operational infrastructure.

    Acknowledgements: The Tigray Regional Health Bureau funded this operational assessment, including the maternal mortality survey and capturing the ambulance data. A collaboration grant from the Swedish Research Council facilitated analysis.

    Disclosure: Hagos Godefay is the Head of Tigray Regional Bureau and Kesetebirhan Admasu is the Minister of Health, Federal Democratic Republic of Ethiopia.

  • 10. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Tesfaye, Fikru
    Lakew, Zufan
    Worku, Bogale
    Dewey, Michael
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Hughes, Marcus
    Tomlinson, Mark
    Patel, Vikram
    Prince, Martin
    Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P-MaMiE population-based cohort study2009In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 14, no 2, p. 156-166Article in journal (Refereed)
    Abstract [en]

    This study provides preliminary evidence of important public health consequences of poor maternal mental health in low-income countries but does not replicate the strong association with low birth weight found in South Asia.

  • 11. Hounton, Sennen
    et al.
    Sombié, Issiaka
    Meda, Nicolas
    Bassane, Brahima
    Byass, Peter
    Immpact, University of Aberdeen, Aberdeen, UK.
    Stanton, Cynthia
    De Brouwere, Vincent
    Methods for evaluating effectiveness and cost-effectiveness of a Skilled Care Initiative in rural Burkina Faso2008In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 13, no Suppl 1, p. 14-24Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the Skilled Care Initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. Methods: The evaluation used a quasi-experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near-miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre-tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy-related and perinatal mortality over the previous 5 years, and causes of pregnancy-related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost-effectiveness ratios. Results: A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out. Conclusions: A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand-held computers proved possible for direct data capture, even in this remote rural environment.

  • 12.
    Kahn, Kathleen
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Garenne, Michel
    Gear, John S S
    Validation and application of verbal autopsies in a rural area of South Africa2000In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 5, no 11, p. 824-831Article in journal (Refereed)
  • 13.
    Kahn, Kathleen
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Tollman, Stephen M
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Garenne, Michel
    Gear, John S S
    Who dies from what?: determining cause of death in South Africa's rural north-east1999In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 4, no 6, p. 433-441Article in journal (Refereed)
  • 14. Kamali, Anatoli
    et al.
    Kinsman, John
    Medical Research Council Programme on AIDS, Uganda.
    Nalweyiso, Norah
    Mitchell, Kirstin
    Kanyesigye, Edward
    Kengeya-Kayondo, Jane F
    Carpenter, Lucy M
    Nunn, Andrew
    Whitworth, James A G
    A community randomized controlled trial to investigate impact of improved STD management and behavioural interventions on HIV incidence in rural Masaka, Uganda: trial design, methods and baseline findings2002In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 7, no 12, p. 1053-1063Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe study design, methods and baseline findings of a behavioural intervention alone and in combination with improved management of sexually transmitted diseases (STDs) aimed at reducing HIV incidence and other STDs.

    DESIGN: A three-arm community randomized controlled trial (RCT) of 18 rural communities (approximately 96 000 adults) in SW Uganda. A standardized behavioural intervention was implemented in 12 communities (arms A and B) through community-based education, meetings and information leaflets. Six of these communities in addition received improved STD management through government and private health units (arm B). Arm C communities received routine government health services. Impact assessment was through three questionnaire and serological surveys of 750-1000 adults in each community at 18-24-month intervals. The primary outcome measure was HIV incidence and secondary measures were syphilis and herpes simplex virus type 2 incidence, prevalence of Neisseria gonorrhoea and Chlamydia trachomatis and sexual behaviour changes.

    RESULTS: Approximately 15 000 adults (72% of eligible population) were enrolled at baseline. HIV baseline prevalence rates were 9-10% in all arms and demographic and behavioural characteristics and STD prevalence were also similar. In intervention communities, there were 391 995 attendance at 81 502 activities (6.1 per target adult), 164 063 leaflets distributed (2.6 per person) and 1 586 270 condoms (16.5 condoms per adult). In the STD communities a total of 12 239 STD cases (65% women) were seen over a 5-year period (7.7 per 100 adults/year).

    CONCLUSION: This is the first community RCT of its type with a behavioural component. There is fair baseline comparability between study arms and process data suggest that interventions were adequately implemented.

  • 15. Kittayapong, P
    et al.
    Olarantmanee, P
    Maskao, P
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lohr, Wolfgang
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gubler, D
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    A school-based intervention trial using insecticide-treated school uniforms to reduce dengue infections in school-aged children2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 114-114Article in journal (Other academic)
    Abstract [en]

    Background: There is an urgent need to enhance our armamentarium to prevent dengue infections in children. Since dengue vectors (Aedes mosquitoes) are active mainly during the day, a potential target for control should be schools where children spend a considerable amount of their day. School uniforms are the cultural norm in most developing countries, worn throughout the day. We hypothesized that insecticide-treated school uniforms will  reduce the incidence of dengue infection in school-aged children. Our objective was to determine the impact of impregnated school uniforms on dengue incidence.

    Methods: A randomised controlled trial was conducted in 10 schools in eastern Thailand in 2012. Pre-fabricated school uniforms were commercially treated to ensure consistent high quality of insecticide impregnation with permethrin. The 1-h-knock-down effect and 24 h mortality of Aedes mosquitoes by the impregnated cloth was tested at baseline and then once per month using WHOPES cone test. Blood samples were taken at baseline and at the end of the school-term for the hemagglutination-inhibition assay to identify serologically confirmed dengue infections during the study period. Students were randomized into intervention schools (all students wearing impregnated uniforms) versus control schools (uniforms had the same appearance and odor, but were not impregnated).

    Results: A total of 1808 students in 10 schools were enrolled, mean age 10.07 years. Of these, 1651 had paired blood samples taken, which showed an incidence of new dengue infection of 3.3 % over the school term (5  months). There was no difference in the incidence of dengue infections in intervention versus control schools. Both the knock-down and mortality at baseline were close to 100%, but rapidly waned after only 8 washes to 20% e.g. after only 1 month of wearing the uniform.

    Conclusion: Although the results of mosquitoes’ knock-down and mortality of impregnated schools looked very promising, we did not see a protective effect of impregnated uniforms on reducing dengue infections in this school-based trial. The most likely reason for the apparent failure was the rapid waning efficacy of impregnation after washing. New technologies need to be developed to overcome rapid waning efficacy of impregnated clothing.

    Disclosure: This research was funded by the European Commission 7th Framework and was conducted by ‘DengueTools’ partners.

  • 16. Kittayapong, P
    et al.
    Ruangsri, B.
    Intasanta, V
    Phanomkate, N
    Subjalerndee, N
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Efficacy of permethrin-impregnated clothing on knock-down and mortality of dengue mosquito vectors2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 110-110Article in journal (Other academic)
    Abstract [en]

    Introduction: As vector control for dengue has proven to be elusive, additional methods to protect against dengue are urgently needed. We have previously shown that pre-fabricated clothing impregnated with permethrin in a proprietary manner had a close to 100% 1 h knock-down and 24 h-mortality effect on Aedes mosquito vectors. However, this effect rapidly declined with repeated washing. Here we investigated different impregnation techniques to assess the best method with the lowest waning efficacy after washing. Materials and methods School clothes were impregnated with permethrin by two different technologies: pad-dry-cure versus exhaustion. Impregnated products were tested for their efficacy using laboratory-reared Aedes mosquito vectors using WHOPES cone test, before and after 10 washes.

    Results: The 1 h knock down effect and 24 h mortality rate of school clothes treated by both technologies were both found to be 100%. However, the clothes treated by pad-dry-cure technology could stand frequent washing better than those treated by exhaustion technology. The decrease in efficacy of up to about 60% of the clothes treated by pad-dry-cure technology was observed after washing 8 times while those treated by exhaustion technology showed decrease in knock-down effect (67.27%) and mortality rate (74.29%) after washing only 4 times.

    Conclusion: The knock-down and 24 h mortality results look very promising to support impregnated clothing as a potential strategy to protect against day-biting Aedes mosquito vectors to prevent dengue infections. However, rapid waning efficacy of impregnated clothing after <10 washes suggests that impregnation techniques for sustainable effect are sub-optimal and hence such an approach is not recommended at this point in time. Either new impregnation technologies will need to be developed to overcome the waning efficacy after washing, or clothing such as aprons or vests will need to be employed. Since school aprons are hanged in classrooms after daily use without washing through out the school term, they could potentially have a prolonged impact of permethrin on mosquito vectors (in terms of knock-down and mortality) and eventually dengue transmission in school.

    This research was funded by the European Union 7th Frame- work Programme through ‘DengueTools’ and Mahidol University.

    Disclosure: Nothing to disclose

  • 17.
    Krishnan, Anand
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Srivastava, R
    Dwivedi, P
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pandav, CS
    Non-specific sex-differential effect of DTP vaccination may partially explain the excess girl child mortality in Ballabgarh, India.2013In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 18, no 11, p. 1329-1337Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that a gender differential exists in the effect on child mortality of BCG, DTP, measles vaccine as administered under programme conditions in Ballabgarh HDSS area.

    METHODS: All live births in 28 villages of Ballabgarh block in North India from 2006 to 2011 were followed until 31 December 2011 or 36 months of age whichever was earlier. The period of analysis was divided into four time periods based on eligibility for vaccines under the national immunisation schedule (BCG for tuberculosis, primary and booster doses of diphtheria-tetanus-pertussis and measles). Cox proportional hazards regression was used to assess the association between sex and risk of mortality by vaccination status using age as the timescale in survival analysis and adjusting for wealth index, access to health care, the presence of a health facility in the village, parental education, type of family, birth order of the child and year of birth.

    RESULTS: 702 deaths (332 boys and 370 girls) occurred among 12 142 children in the cohort in the 3 years of follow-up giving a cumulative mortality rate of 57.5 per 1000 live births with 35% excess girl child mortality. Age at vaccination for the four vaccines did not differ by sex. There was significant excess mortality among girls after immunisation with DTP, for both primary (HR 1.65; 95% CI:1.17-2.32) and DTPb (2.21; 1.24-3.93) vaccinations. No significant excess morality among girls was noted after exposure to BCG 1.06 (0.67-1.67) or measles 1.34 (0.85-2.12) vaccine.

    CONCLUSION: This study supports the contention that DTP vaccination is partially responsible for higher mortality among girls in this study population.

  • 18. Lemma, Hailemariam
    et al.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Desta, Alem
    Bosman, Andrea
    Costanzo, Gianfranco
    Toma, Luigi
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Marrast, Anne-Claire
    Ambachew, Yohannes
    Getachew, Asefaw
    Mulure, Nathan
    Morrone, Aldo
    Bianchi, Angela
    Barnabas, Gebre Ab
    Deploying artemether-lumefantrine with rapid testing in Ethiopian communities: impact on malaria morbidity, mortality and healthcare resources2010In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 15, no 2, p. 241-250Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia.

    Methods: Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year.

    Results: At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013).

    Conclusions: Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.

  • 19.
    Liu-Helmersson, Jing
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Quam, Mikkel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Science and Technology, Department of Molecular Biology (Faculty of Science and Technology).
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Ebi, K
    Massad, E
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Seasonality of dengue epidemic potential in Europe - based on vectorial capacity for Aedes mosquitoes2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 113-113Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue is a mosquito-borne viral infection that has become a major public health concern. About 390 million people are infected yearly. Increased global connectivity and population movement as well as climate change affect the global distribution of both dengue vectors and the virus, facilitating the spread of dengue to new geographic areas. Weather is an important factor determining mosquito behaviour and effectiveness of dengue virus transmission. Dengue epidemic potential depends on vectorial capacity of Aedes mosquitoes, which depend on climate, such as, temperature and diurnal temperature range. This study aims at identifying high-risk areas and high-risk time windows in Europe based on temperature, in order for timely vector surveillance and control.

    Methods: Relative vectorial capacity (rVc) was used to estimate dengue epidemic potential. Using historical and projected temperature data over two centuries (1901–2099) and temperature dependent vector parameters for Aedes vectors, rVc was calculated for 10 selected European cities from Stockholm in the North to Malaga in the South.

    Results: Compared to dengue endemic areas, rVc in Europe was lower and showed more prominent seasonality. The peak and width of the seasonal windows in rVc were generally higher in the South than the North. Currently, only South and Central-East Europe and the summer season corresponds to rVc that is over the threshold for possible dengue transmission. By the end of this century, in the best case scenario, all the Central and Southern European cities would be at risk for dengue transmission during the warmer months; in the worst case scenario, this risk would extend to Northern European to include Stockholm if dengue vectors were established and virus introduced.

    Conclusion: As travel and globalization become more frequent channels for dengue vector and virus introduction, Europe may face the reality of more frequent dengue outbreaks in their warmer months. Madeira's outbreak in 2012 underlines this concern. The future's high risk area and time window depend sensitively on climate scenarios. Therefore, it is important to emphasize climate change mitigation and enhance vector surveillance and control in Europe.

    Acknowledgement: This research was funded by the European Union 7th Framework Programme through 'DengueTools' (www.denguetools.net).

    Disclosure: Nothing to disclose.

  • 20. Massad, E
    et al.
    Lopez, L F
    Amaku, M
    Coutinho, F A B
    Quam, Mikkel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Burattini, M N
    Struchiner, C J
    Wilder-Smith, Annelies
    Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    The risk of infectious diseases introduction into non-infected countries by travelers visiting endemic countries2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 340-340Article in journal (Other academic)
    Abstract [en]

    This work is an attempt to estimate the risk of infections importation and exportation by travelers. In it we propose a model that takes into account the force of infection of the disease in the endemic country, which can either be a visited country (source of infection importation) or a country from where local residents export the infection when travel in the latent condition for disease-free countries. The model is deterministic but a preliminary stochastic formulation is presented in the appendix. It considers two countries: one is the host home-country and the other is the source country (with an endemic infectious disease). Susceptible individuals travel from their home-country to the endemic country and eventually return infected. The input of the model is the force of infection at the visited/source country which is assumed to be known and we assume that, in the case of disease importation, travelers are subject to the same risk of infection as local residents but do not contribute to it. In the case of disease exportation, the model calculates the probability that a latent individual travels from an endemic (or epidemic) country to a disease-free country. We exemplify the model with two distinct situation, namely, the risk of dengue importation from Thailand to Europe and the risk of Ebola exportation from Liberia to the USA.

    Disclosure: Nothing to disclose.

  • 21. Meda, Nicolas
    et al.
    Hounton, Sennen
    De Brouwere, Vincent
    Sombié, Issiaka
    Byass, Peter
    Immpact, University of Aberdeen, Scotland, UK.
    From evaluating a Skilled Care Initiative in rural Burkina Faso to policy implications for safe motherhood in Africa.2008In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 13, no Supplement 1, p. 68-72Article in journal (Refereed)
    Abstract [en]

    Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for safe motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating safe motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the safety of motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.

  • 22. Montenegro, C A
    et al.
    Louis, V R
    Kusumawathie, P
    Palihawadana, P
    Tozan, Y
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute of Public Health, Heidelberg University, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
    Tissera, H
    Entomological survey of dengue vector breeding sites in Colombo, Sri Lanka2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 409-410Article in journal (Other academic)
    Abstract [en]

    Introduction: In Sri Lanka, the number of dengue cases has steadily increased in recent years. Prevention through disease and vector surveillance is an important strategy in dengue control. The aim of the study was to assess Aedes mosquito breeding sites and the prevention practices of community members in one heavily urbanized area of Colombo.

    Methods: A cross-sectional entomological survey was conducted from April to June 2013 in 1469 premises located in a sub-district of Colombo Municipality. Types of breeding sites and infestation with larvae or pupae were recorded and a questionnaire was administered to occupants to assess knowledge and practises concerning dengue vector control.

    Results: The surveyed premises included 1341 households (91%), 99 work or public sites and 11 schools. 126 premises were positive for Aedes larvae or pupae. 12 672 potential breeding sites susceptible to host larvae or pupae were recorded, of which 21% contained water. Among these, 6% were positive for larvae and 13% for pupae. For schools the percentage rose to 40% and 67%, respectively. The main productive breeding sites were: discarded items, water tanks, ornamental plants, ponds and flowerpots, and non-specified containers. The majority was located on outdoor ground areas. Compared to households, the odds ratio for non-household premises of being infested with larvae was 2.29 (P = 0.005, 95% CI: 1.278–4.129) and with pupae 5.76 (P < 0.001, 95% CI: 2.660–12.497). Occupants of 82% of the premises reported using preventive measures. The main practices were coverage of containers and elimination of mosquito-breeding places. 45% of schools and 19% of households took no preventive measures. There was a significant correlation between the occurrence of preventative measures taken and the type of premise involved (P = 0.002).

    Conclusion: Residential buildings had the lowest relative number of potential breeding sites, and household members reported a high use of vector control measures. Schools and working sites, however, were identified as being at highest risk for productive breeding sites combined with shortcomings in preventive measures. Hence, this study suggests that while it is important to maintain vector control and prevention practices at the household level, schools and working sites should actively be targeted to better combat dengue.

    Acknowledgements: This research was funded by 'DengueTools' of the 7th Framework Programme of the European Community.

    Disclosure: Nothing to disclose.

  • 23. Murray, N.
    et al.
    Louis, V.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Jansarikij, S.
    Olanratmanee, P.
    Maskhao, P.
    Kittayapong, P.
    Innovative dengue prevention and control using permethrin-impregnated school uniforms: a mixed methods study on acceptability2013In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 18, no Special Issue, p. 52-53Article in journal (Other academic)
  • 24. Olanratmanee, P.
    et al.
    Jansarikij, S.
    Kittayapong, P.
    Maskhao, P.
    Louis, V. R.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Innovative dengue prevention and control using permethrin-impregnated school uniforms: purchasing decision based on background knowledge and experience2013In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 18, no Special Issue, p. 121-122Article in journal (Other academic)
  • 25. Olliaro, P.
    et al.
    Kroeger, A.
    Tozan, Y.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Developing and operationalizing national-level early warning and response systems (EWARS) for dengue and other Aedes-borne arboviral diseases2017In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 22, p. 51-51Article in journal (Other academic)
  • 26.
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Universitaetsklinikum Heidelberg, Germany; INDEPTH Network, Ghana; Gadjah Mada University, Indonesia; Universiteit Van Amsterdam, Netherlands; Harvard Centre for Population and Development Studies, USA.
    INDEPTH training and research centres of excellence (INTREC): building research capacity in social determinants of health in low- and middle-income countries2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 428-428Article in journal (Other academic)
    Abstract [en]

    The major causes of poor health are rooted in society. Achieving health equity requires a global action in support of building the limited evidence on health and its determinants from low- and middle-income countries (LMICs). This intentionally demands building capacity for mobilizing research in these countries. The INDEPTH Training and Research Centres of Excellence (INTREC), an EU FP7 project was established with the aim of undertaking capacity-building activities to facilitate research on the social determinants of health (SDH) in LMICs. Therefore, a six members' consortium initiated this coordination action project in Jan 2012, which is due to conclude in June 2015. INTREC activities covered recruiting a social scientist from each participating country of INDEPTH network, three from Africa (Tanzania, Ghana, South Africa) and four from Asia (Bangladesh, India, Vietnam, and Indonesia) who were trained to produce a standardized-format country needs assessment. These reports provided the basis for the subsequent development of the INTREC training curriculum, including five individual training blocks developed to cover qualitative and quantitative research methods. These were delivered sequentially in five educational blocks over a 12 month period during 2014. The first block was an online course of video lectures and assignments. The second block was a two-week methods workshop, held in both Indonesia (16 students) and Ghana (15 students). A one-week data analysis workshop held at Harvard University comprised the third block, translating research findings to policy and practice comprised Block 4 and the final block had the students share their papers on the course website. The main result of the INTREC action is the development of a conceptual framework detailing how to build a sustainable capacity for research on SDH in LMICs; currently being developed using documentation produced. Furthermore, a total of 31 young researchers are now trained in SDH, and they themselves constitute a network that is promising to develop into the future. The findings indicate a pressing need for mentors who are available to support young researchers in these countries. Also, such a research capacity development has the potential for identifying critical areas requiring policy attention; contributing to health equity in the future.

  • 27.
    Quam, Mikkel B
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Liu-Helmersson, Jing
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Massad, E
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Madeira's dengue outbreak in 2012: could it happen again in the near future?2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 408-409Article in journal (Other academic)
    Abstract [en]

    Introduction: A dengue outbreak in 2012 having 2000 + reported cases, followed vector introduction to the Portuguese island of Madeira in 2005. We describe contributing factors for the 2012 outbreak through modeling of temperature dependent vectorial capacity, meteorological observations of environmental factors pertinent to vector lifecycle, and dynamics of travellers arriving from dengue endemic areas. In combination with reported vector and human surveillance, the temporal onset of the 2012 outbreak and factors setting 2012 apart from other years were used to generate a predictive model for potential re- emergence of dengue in Madeira.

    Methods: Relative Vectorial capacity (rVC) was calculated with previously published methods for Madeira (Island) and Funchal (City) from 2005 to 2014 based on both remotely sensed satellite data and observation stations. We also estimated potentially imported dengue infections using previously published methods. Epidemiological features of the 2012 outbreak combined with generated data to inform a predictive model. Projected travel and seasonal weather forecasting inputs for the predictive model described the dengue importation-driven transmission likelihood for Madeira in 2015.

    Results: Longitudinal comparisons of available data were displayed simultaneously to show periods of greatest potential for dengue emergence in Madeira, historically. The modeled outputs especially during the months before the outbreak provide more precise quantification and visualization of the temporal coincidence, which may have primed Madeira for emergence of dengue in late summer 2012. When seasonal forecast information is applied to the historically informed model for spring and summer 2015, potential for local dengue

    transmission in Madeira was determined. Conclusions Local transmission of dengue in Madeira may re occur given the environmental envelope and continuous importation of the dengue virus via travelers, even with strengthened vector control efforts; however, the severity of the 2012 outbreak will hopefully remain the highest. Our results clearly display the coalescence of multiple factors necessary for initial emergence of a dengue epidemic in a naïve population. Descriptive modeling of a known outbreak can better inform the development of predictive modeling of dengue emergence in Madeira and other areas of Europe.

    Acknowledgment: European Union 7th Framework Programme through DengueTools (www.denguetools.net) funded this research.

    Disclosure: Nothing to disclose.

  • 28.
    Quam, Mikkel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sessions, O
    Liu-Helmersson, Jing
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Dissecting the origin of the 2014 dengue outbreak in Japan2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 408-408Article in journal (Other academic)
    Abstract [en]

    Introduction: Endemic in at least 100 countries, dengue is currently regarded as world's most important mosquito borne viral disease. While most of the disease burden is limited to areas with tropical and sub-tropical climates, evidence suggests that temperate areas may be increasingly at risk as the geographic distribution of relevant vectors expands. Japan, a country with a temperate climate, reported the first major dengue outbreak in 2014. We examined the factors that may have facilitated the dengue outbreak in Tokyo during 2014.

    Methods: Multiple sequence alignment of the dengue virus 1 (DENV1) sequence from the 2014 dengue outbreak in Tokyo was carried out using a fast Fourier transformation method in MAFFT v6.940b. We collected the Japan National Tourism Organization’s data on inbound travelers between January and September 2014 from dengue endemic countries in Asia to Japan. Daily observations of temperature (minimum, maximum, and mean) and precipitation were obtained from the MIDAS dataset for Tokyo. We calculated the relative vectorial capacity (rVc) for Aedes vectors to quantify the dengue epidemic potential based on temperature dependent parameters, by applying a modified Ross-McDonald model.

    Findings: Tourist arrivals into Japan in 2014 coincided by 70% with its warm summer months suitable for dengue transmission, The phylogenetic similarity of DENV-1 isolated from the 2014 outbreak in Japan with viruses from China, Indonesia, Singapore, and Vietnam renders any of these four countries a likely source of importation. Several conducive climate factors converged preceding and during the time of the dengue outbreak in Tokyo, August until October 2014. Climate conditions, in particular mean temperature and precipitation, were favorable for the amplification of Aedes vectors. Furthermore, the ability for the vector to transmit dengue, as measured by the relative vectorial capacity, was highest at the time of the 2014 outbreak.

    Conclusions: Taking into account the travel volume into Japan, China appears the most probable source of dengue virus introduction that triggered Tokyo's outbreak. Despite Japan's temperate climate, dengue epidemic potential already exists. Under scenarios of changing climate and increasing regional travel, Japan will likely face more dengue outbreaks in the future.

    Acknowledgements: The study was financially supported by the European Union's Seventh Framework Programme- DengueTools (www.denguetools.net).

    Disclosure: Nothing to disclose.

  • 29. Ramroth, Heribert
    et al.
    Lorenz, Eva
    Rankin, Johanna C.
    Fottrell, Edward
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ye, Maurice
    Neuhann, Florian
    Ssennono, Mark
    Sie, Ali
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Becher, Heiko
    Cause of death distribution with InterVA and physician coding in a rural area of Burkina Faso2012In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 17, no 7, p. 904-913Article in journal (Refereed)
    Abstract [en]

    Objectives To compare the cause of death distribution using the Physician Coded Verbal Autopsy approach versus the Interpreting Verbal Autopsy model, based on information from a French verbal autopsy questionnaire, in rural north-western Burkina Faso. Methods Data from 5649 verbal autopsy questionnaires reviewed by local physicians at the Nouna Health and Demographic Surveillance Site between 1998 and 2007 were considered for analyses. Information from VA interviews was extracted to create a set of standard indicators needed to run the Interpreting Verbal Autopsy model. Cause-specific mortality fractions were used to compare Physician Coded Verbal Autopsy and Interpreting Verbal Autopsy results. Results At the population level, 62.5% of causes of death using the Interpreting Verbal Autopsy model corresponded with those determined by two or three physicians. Although seven of the 10 main causes of death were present in both approaches, the comparison of percentages of single causes of death shows discrepancies, dominated by higher malaria rates found in the Physician Coded Verbal Autopsy approach. Conclusion Our results confirm that national mortality statistics, which are partly based on verbal autopsies, must be carefully interpreted. Difficulties in determining malaria as cause of death in holoendemic malaria regions might result in higher discrepancies than those in non-endemic areas. As neither Physician Coded Verbal Autopsy nor Interpreting Verbal Autopsy results represent a gold standard, uncertainty levels with either procedure are high.

  • 30. Ratanawong, P
    et al.
    Kittayapong, P
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
    Tozan, Y
    Louis, V R
    Exploring entomological factors associated with high dengue incidence in Thai schools2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 411-411Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue infection is a leading cause of child hospitalization in Thailand and schools may represent an important site of infection. Because high variations in the number of dengue cases were observed among schools, the aim of this study was to explore what entomological factors were associated with high dengue incidence in selected schools located in Chacheongsao Province, Thailand.

    Methods: Students from ten schools were enrolled; blood was taken at baseline (June 2012) and at the end of the school term (Nov. 2012). New dengue infections during this period were determined by dengue IgG conversion or a > 4-fold higher dengue IgG compared to baseline. Location of the homes and schools of infected students were mapped using GIS. Through monthly surveys from May 2013 to June 2014, potential breeding sites were identified, infestation with Aedes larvae and pupae recorded, and adult mosquitoes collected using portable aspirators. Logistic regression was used for statistical analysis.

    Results: A total of 1825 students were included in the study. They were distributed among 88 classrooms within the 10 schools. 55 confirmed dengue cases were detected in seven of the 10 schools. 67% of the cases occurred in 13 (15%) of the 88 classrooms, with at least 2 (and as many as 6) cases occurring per classroom. The remaining 18 cases were detected as single cases per classroom. No two cases occurred in the same households and eight cases occurred in households distant 100 meters or less from each other. There was no direct association between high and low incidence schools in relation to the number of breeding sites, mosquitoes, or mosquito control methods used. Of the 2399 potential breeding sites recorded, 484 (20%) were positive for Aedes larvae or pupae. Among the productive sites, the most common were water and cement tanks (30%) and car tires (9%). Mosquito control was used for 11% of breeding sites, with temephos (32%), fish (24%) and covers (30%) being the most common measures taken.

    Conclusion: The study provides information on the main breeding sites for larvae and pupae and the commonly used mosquito control methods around schools. Although there was no significant association found between entomological factors and dengue cases at school levels, the study suggests that transmission may be clustered at classroom level rather than at household level.

    Disclosure: This research was funded by the European Union 7th Framework Programme through 'DengueTools'.

  • 31.
    Rocklöv, Joacim
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Global dispersion patterns and outbreak risks of Dengue2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 36-37Article in journal (Other academic)
    Abstract [en]

    Dengue, a mosquito-borne viral disease, is rapidly becoming a global health threat due to climate change, globalisation, urbanisation, and population growth. The estimates of the global buren of disease of dengue has recently been updated to show much higher estimates than previous studies. The future burden is likely to expand due to human activities unless effective control measures are put in place. Dengue vectors take advantage of urbanisation, particularly urban heat islands and changes in environment and human populations densities. Global mobility is responsible for the global dispersion of dengue virus and vectors. The introduction of dengue to Europe is highly correlated to international flight network traffic flows. Further, climate change is associated with changes in seasonal weather patterns with potential subsequent impacts on the suitability and temporal and spatial distribution of vectors. Within this context of multiple factors that contribute to the increasing geographic range and intensity of transmission of dengue, prediction and early identification of outbreak risk areas are critically important. Understanding dengue occurrence and outbreaks is complex. We use disease data from international surveillance registers, and meteorological and climate data from online databases. Population and data on global mobility were obtained from IATA registers, and estimates of introduction to dengue in Europe are derived. We used mathematical and statistical methods to describe relationships, timing, and geographic areas of dengue risk in the past, present, and future using a formula for dengue relative vectorial capacity. Modeled global drivers of dengue can predict historic and current risk of dengue outbreaks, and future risk indices indicate further risk of expansion and prolonged transmission seasons in Europe. Information, like this, can guide preventive strategies and actions to control dengue. However, we also acknowledge data scarcity and difficulties in projecting future disease burdens of dengue given that the virus can change, vectors can adapt, and interventions such as vaccine development can radically alter the future disease burden.

    Disclosure Nothing to disclose.

  • 32. Tensou, Biruk
    et al.
    Araya, Tekebash
    Telake, Daniel S
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Berhane, Yemane
    Kebebew, Tolcha
    Sanders, Eduard J
    Reniers, Georges
    Evaluating the InterVA model for determining AIDS mortality from verbal autopsies in the adult population of Addis Ababa.2010In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 15, no 5, p. 547-553Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the performance of a verbal autopsy (VA) expert algorithm (the InterVA model) for diagnosing AIDS mortality against a reference standard from hospital records that include HIV serostatus information in Addis Ababa, Ethiopia. METHODS: Verbal autopsies were conducted for 193 individuals who visited a hospital under surveillance during terminal illness. Decedent admission diagnosis and HIV serostatus information are used to construct two reference standards (AIDS vs. other causes of death and TB/AIDS vs. other causes). The InterVA model is used to interpret the VA interviews; and the sensitivity, specificity and cause-specific mortality fractions are calculated as indicators of the diagnostic accuracy of the InterVA model. RESULTS: The sensitivity and specificity of the InterVA model for diagnosing AIDS are 0.82 (95% CI: 0.74-0.89) and 0.76 (95% CI: 0.64-0.86), respectively. The sensitivity and specificity for TB/AIDS are 0.91 (95% CI: 0.85-0.96) and 0.78 (95% CI: 0.63-0.89), respectively. The AIDS-specific mortality fraction estimated by the model is 61.7% (95% CI: 54-69%), which is close to 64.7% (95% CI: 57-72%) in the reference standard. The TB/AIDS mortality fraction estimated by the model is 73.6% (95% CI: 67-80%), compared to 74.1% (95% CI: 68-81%) in the reference standard. CONCLUSION: The InterVA model is an easy to use and cheap alternative to physician review for assessing AIDS mortality in populations without vital registration and medical certification of causes of death. The model seems to perform better when TB and AIDS are combined, but the sample is too small to statistically confirm that.

  • 33. Thalagala, N
    et al.
    Tiserra, H
    Palihawadana, P
    Amarasinghe, A
    Ambagahawita, A
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Shepard, D S
    Tozan, Y
    Costs of dengue hospitalization and public prevention and control activities in urban Sri Lanka2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 379-379Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue has become a major public health problem in Sri Lanka; however, the economic impact of the disease has not been studied in this setting. This study assessed the costs of dengue prevention and control activities and the direct medical costs of dengue hospitalizations in the Colombo District, the most affected district with the highest dengue caseloads in the country.

    Methods: The study was conducted in the epidemic year of 2012. Using information from the official databases of governmental agencies in charge of the dengue prevention and control activities in each administrative unit, we calculated the total financial costs of these activities and the average cost per capita. The direct medical costs of hospitalized dengue cases in the public health sector were derived using operational budgets and a sample of bed head tickets of adult and pediatric patients available from six secondary-level hospitals.

    Results: In 2012, the total financial cost of dengue prevention and control activities in the Colombo District was about $998 000, or $0.43 per capita. The mean direct medical costs to the public health care system per case of hospitalized dengue fever (DF) and dengue haemoraggic fever (DHF) were $221 and $316 for paediatric partients, respectively, and $203 and $272 for adult patients, respectively.

    Conclusion: These preliminary results highlight the high economic burden of dengue to the public health sector in the Colombo district in Sri Lanka during an epidemic year and contribute to the sparse literature on the economic burden of dengue in affected countries.

    Acknowledgements: This research was funded by ‘DengueTools’ of the 7th Framework Programme of the European Community.

    Disclosure: Nothing to disclose.

  • 34. Tissera, H
    et al.
    Gunasena, S
    da Silva, D
    Sessions, O
    Palihawadana, P
    Amarasinghe, A
    Muthukuda, C
    Botheju, C
    Leong, W -Y
    Lohr, Wolfgang
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
    Gubler, D
    Enhanced dengue sentinel surveillance in Sri Lanka2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 133-133Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue poses a significant socioeconomic and disease burden in Sri Lanka, where the geographic spread, incidence and severity of disease has been increasing since the first dengue hemorrhagic fever (DHF) epidemic occurred in 1989. Periodic epidemics have become progressively larger, peaking in 2012 with 44 456 cases. Passive surveillance was established nationwide more than a decade ago but dengue notifications have been based on clinical diagnosis, with infrequent laboratory confirmation. To obtain more accurate data on the disease burden, a laboratory-based enhanced sentinel surveillance system was established in Colombo Municipality, the area with the highest dengue incidence. Here we describe the study design and the results of the first 2 years (2012–2014).

    Methods: Three government hospitals and two outpatient clinics in Colombo District were selected for the sentinel surveillance. All patients presenting with undifferentiated fever were enrolled, if consent given, capped at a maximum of 60 patients per week. Acute blood samples were taken from all enrolled subjects and tested by dengue-specific PCR, and NS1, and IgM – ELISA at the time of first presentation. A sub-set of 536 samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping.

    Results: Between 1 April, 2012 and 31 March, 2014, 3127 patients were enrolled, 964 (30.9%) as outpatients and 2160 (69.1%) as inpatients. The mean age was 22.3 years (SD = 17.5) and the time of first presentation was at day 4 of illness. For inpatients, 1687 (78.1%) of all febrile cases had laboratory-confirmed dengue. For outpatients, the proportion of confirmed dengue was 237 (24.6%). The mean duration of hospitalization was 4.1 days (SD = 1.85). The proportion of DHF in lab-confirmed hospitalized dengue cases was 22.1% and 4 patients (0.21%) died. Serotypes 1 and 4 were the only viruses detected in this sample (serotype 1: 85%; serotype 4: 15%). The clinicians’ diagnosis for dengue at time of first presentation had a sensitivity of 92% and specificity of 23%.

    Conclusions: Dengue infection was responsible for a high proportion of febrile illnesses during 2012–2014, with serotypes 1 and 4 circulating. A significant proportion (22%) of hospitalized dengue cases developed DHF, but the case fatality rate was low. Clinicians’ judgment was associated with good sensitivity, but to enhance specificity it is important to add laboratory confirmation of dengue.

    Disclosure: This research was funded by the European Commission under the 7th Framework and conducted by DengueTools partners (www.denguetools.net).

  • 35. Tissera, H
    et al.
    Weeraman, J
    Amarasinghe, A
    Muthukuda, T
    Janaka, H
    Botheju, C
    Palihawadana, P
    Gubler, D
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessment of severity among adult dengue patients in Colombo district, Sri Lanka2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 416-416Article in journal (Other academic)
    Abstract [en]

    Introduction: Dengue is a major acute febrile illness in Sri Lanka and reported in epidemic proportions. From 2009 to 2013 an average of 35 000 cases were reported annually with over 60% above 15 years of age. Clinical case classification of dengue was originally based on paediatric patients. Here we assess severity of dengue illness among adults according to both WHO classical and TDR classifications.

    Methods: A study was conducted in 100 adult patients presenting to ID Hospital, Colombo with fever <7 days, in 2013. All were tested for dengue ELISA NS1/IgM and RT-PCR. Of them 88 were confirmed as having dengue, and were classified into two WHO classifications. Type of care received was categorized into three levels as:

    Category 1 – general ward,

    Category 2 – special dengue unit,

    Category 3 – intensive care unit.

    Results: According to classical classification, 47 (53.4%) were Dengue Fever (DF) patients. Of them 31and 16 received Category 1 and 2 care respectively. None received Category 3 care. 41 (46.6%) Dengue Haemorrhagic Fever (DHF) patients. Of them 14 received category 1 care while 25 and two received Category 2 and Category 3 care respectively. Classical classification and level of care sensitivity was 62.8% (CI 48–78) while specificity was 68.9% (CI 55–82). According to TDR classification 29 (32.9%) were Dengue patients without warning signs. Of them 22 and 07 received Category 1 and 2 level of care respectively and none went into category 3. 48 (55%) were Dengue with warning signs and 11 (13%) severe dengue patients. Of them 18 received Category 1 care while 39 and two received category 2 and category 3 care respectively. TDR classification and level of care sensitivity was 85.4% (CI 75–95) Specificity 55% (CI 39–70).

    Conclusions: WHO TDR classification captures more patients who need closer observation in Category 2 and three levels of care than classical classification. This may warrant additional hospital resources in developing country settings.

    Disclosure: This research was funded by the European Union 7th Framework Programme through 'DengueTools'.

  • 36. Uehara, A
    et al.
    Kamaraj, U S
    Tissera, H A
    Amarasinghe, A
    Palihawadana, P
    Gunasena, S
    Ong, X M
    Howe, S
    Desilva, A D
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gubler, D J
    Sessions, O M
    A hybridization-based enrichment strategy to increase the accuracy of next generation sequencing in phylogenetic analysis of dengue viruses in Sri Lanka2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 120-120Article in journal (Other academic)
    Abstract [en]

    Introduction: Sri Lanka has experienced confirmed dengue outbreaks since the 1960s although severe dengue disease (DHF/DSS) didn’t appear until 1989. Since then, cyclical outbreaks associated with severe disease have occurred throughout the island. The most recent epidemic began in 2009 with the apparent introduction of a new genotype of DENV-1. To better understand the mechanisms underlying the persistence of this ongoing epidemic, a longitudinal study was conducted in hospitals in the Colombo district from April 2012 to March 2014. In order to glean as much information as possible about the viral genetics from this large cohort, we developed a novel Next Generation Sequencing (NGS) platform that can function without any a priori knowledge of the target dengue genome.

    Methods: The principle problem encountered when employing NGS directly on patient samples is the high ratio of host to viral RNA. To compensate for this, we developed a hybridization-based enrichment strategy consisting of DENV-specific 120nt, biotinylated oligodeoxynucleotides to capture DENV genomic material from an NGS library prepared directly from patient sera.

    Results: The strategy developed here allowed us to enrich DENV genomic material over 5000 fold relative to unenriched material. Full genome data and phylogenetic analysis indicate that the DENV-1 are predominantly genotype 1 although a smaller number of genotype 5 isolates was also identified.

    Conclusion: The platform developed for this study has the inherent ability to capture all four serotypes of DENV and can significantly increase the virus to host RNA ratio. The principle driver of the current dengue epidemic in Sri Lanka is the same DENV-1 genotype that has been in circulation since 2009.

    This research was funded by the Singapore Infectious Disease Initiative (SIDI/2013/012) and the European Union 7th Framework Programme through ‘DengueTools’. (www.dengue-tools.net).

    Disclosure: Nothing to disclose.

  • 37.
    Wilder-Smith, Annelies
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    DengueTools: innovative strategies and tools for the prevention and control of dengue2015In: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 20, no Suppl. 1, p. 36-36Article in journal (Other academic)
    Abstract [en]

    With estimated 390 million infections annually and 2.5 billion people at risk, dengue is a major emerging disease threat and an escalating public health problem worldwide. Effective vector control remains elusive, and surveillance in dengue endemic countries remains suboptimal at best. We lack understanding of individual or combined roles of viral, entomological, ecological, environmental and climate factors that influence dengue transmission dynamics and their respective outbreak predictive capability and the most cost-effective approach for surveillance and early warning systems. To address those gaps we have set up a comprehensive, early warning, laboratory-based sentinel disease surveillance system in Sri Lanka that has predictive capability for epidemic dengue. Furthermore, children are the most vulnerable group for dengue. We desperately need simple, cost-effective and scalable control strategies to protect children from dengue. Our DengueTools consortium hypothesized that insecticide treated school uniforms may be a target for school-based intervention to reduce the incidence of dengue in school children. We will report on our preliminary results. Lastly, DengueTools examines gaps in understanding the risk of introduction of dengue to non-infected areas, including Europe. We currently have insufficient data on the magnitude and trends of importation and virus evolution over time and by geographic origin. We also only have a poor understanding of vector density, preferred breeding sites, and vectorial capacity of Aedes in temperate climates that are needed for predictive models under changing climate conditions. We will collect clinical and virological data in travellers returning to Europe from dengue endemic countries, explore the effectiveness of vector control programs against Aedes albopictus in Southern France, and develop predictive risk models and maps the the introduction and establishment of dengue in Europe under different future climate scenarios in Europe. DengueTools is a global consortium of 14 partners, funded by the European commission 7th framework. We have 12 work packages around 3 main research areas.

    Disclosure: Principal Investigator of DengueTools. No other conflict of interests since January 2011.

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