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Identifying the most sensitive and specific sign and symptom combinations for cholera: results from an analysis of laboratory-based surveillance data from Haiti, 2012-2013.

Lucien MA, Schaad N, Steenland MW, Mintz ED, Emmanuel R, Freeman N, Boncy J, Adrien P, Joseph GA, Katz MA - Am. J. Trop. Med. Hyg. (2015)

Bottom Line: Since October 2010, over 700,000 cholera cases have been reported in Haiti.From April 2012 to May 2013, we tested 1,878 samples from hospitalized patients with acute watery diarrhea; 1,178 (62.7%) yielded Vibrio cholerae O1.When laboratory diagnostic testing is not immediately available, clinicians can evaluate signs and symptoms to more accurately identify cholera patients.

View Article: PubMed Central - PubMed

Affiliation: National Public Health Laboratory, Ministry of Public Health and Population, Port-au-Prince, Haiti; Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Foodborne, Water and Environmental Diseases, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Atlanta, Georgia; Directorate of Epidemiology, Laboratory and Research, Ministry of Public Health and Population, Port-au-Prince, Haiti; Centers for Disease Control and Prevention-Haiti, Port-au-Prince, Haiti lucienmentor@gmail.com.

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Laboratory-based sentinel surveillance sites, Haiti, 2012–2013.
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Figure 2: Laboratory-based sentinel surveillance sites, Haiti, 2012–2013.

Mentions: We used data from laboratory-based surveillance being conducted at selected four hospitals.5 The first two hospitals, Hôpital Universitaire De La Paix (HUP) and Hôpital Foyer Saint Camille (HSC), are located in the capital of Haiti, Port-au-Prince, in the west department. The third site, Hôpital Saint Nicolas (HSN) de Saint Marc, is in the Artibonite Department, and the fourth, Hôpital Saint Michel de Jacmel (SMJ), is in the southeast department (Figure 2). We chose these four hospitals because they all have associated CTFs, have relatively large facilities, and are located within a 3-hour drive from Laboratoire Nationale de Sante Publique (LNSP) in Port-au-Prince, making transport of specimens manageable. At each site, trained nurses used convenience sampling to collect stool specimens from up to 10 hospitalized patients per week with acute watery diarrhea defined as three or more episodes of acute watery diarrhea within 24 hours, with onset of symptoms within the past 7 days.5 Patients who had taken antibiotics either at home or in the health facility were excluded. Patients were selected from CTFs, pediatric wards, medicine wards, and emergency rooms. We also administered a questionnaire to patients to collect demographic and clinical information. Nurses determined a patient's clinical symptoms, including dehydration status, by a combination of chart review, questions, and physical exam. Dehydration status was defined according to WHO case definitions (http://whqlibdoc.who.int/publications/2005/9241593180.pdf). Moderate dehydration was defined as restless or irritable behavior, poor skin turgor, rapid pulse, and moderate increase in thirst. Severe dehydration was defined as a lethargic or comatose patient with a rapid and weak pulse, very poor skin turgor, and a major increase in thirst.


Identifying the most sensitive and specific sign and symptom combinations for cholera: results from an analysis of laboratory-based surveillance data from Haiti, 2012-2013.

Lucien MA, Schaad N, Steenland MW, Mintz ED, Emmanuel R, Freeman N, Boncy J, Adrien P, Joseph GA, Katz MA - Am. J. Trop. Med. Hyg. (2015)

Laboratory-based sentinel surveillance sites, Haiti, 2012–2013.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385769&req=5

Figure 2: Laboratory-based sentinel surveillance sites, Haiti, 2012–2013.
Mentions: We used data from laboratory-based surveillance being conducted at selected four hospitals.5 The first two hospitals, Hôpital Universitaire De La Paix (HUP) and Hôpital Foyer Saint Camille (HSC), are located in the capital of Haiti, Port-au-Prince, in the west department. The third site, Hôpital Saint Nicolas (HSN) de Saint Marc, is in the Artibonite Department, and the fourth, Hôpital Saint Michel de Jacmel (SMJ), is in the southeast department (Figure 2). We chose these four hospitals because they all have associated CTFs, have relatively large facilities, and are located within a 3-hour drive from Laboratoire Nationale de Sante Publique (LNSP) in Port-au-Prince, making transport of specimens manageable. At each site, trained nurses used convenience sampling to collect stool specimens from up to 10 hospitalized patients per week with acute watery diarrhea defined as three or more episodes of acute watery diarrhea within 24 hours, with onset of symptoms within the past 7 days.5 Patients who had taken antibiotics either at home or in the health facility were excluded. Patients were selected from CTFs, pediatric wards, medicine wards, and emergency rooms. We also administered a questionnaire to patients to collect demographic and clinical information. Nurses determined a patient's clinical symptoms, including dehydration status, by a combination of chart review, questions, and physical exam. Dehydration status was defined according to WHO case definitions (http://whqlibdoc.who.int/publications/2005/9241593180.pdf). Moderate dehydration was defined as restless or irritable behavior, poor skin turgor, rapid pulse, and moderate increase in thirst. Severe dehydration was defined as a lethargic or comatose patient with a rapid and weak pulse, very poor skin turgor, and a major increase in thirst.

Bottom Line: Since October 2010, over 700,000 cholera cases have been reported in Haiti.From April 2012 to May 2013, we tested 1,878 samples from hospitalized patients with acute watery diarrhea; 1,178 (62.7%) yielded Vibrio cholerae O1.When laboratory diagnostic testing is not immediately available, clinicians can evaluate signs and symptoms to more accurately identify cholera patients.

View Article: PubMed Central - PubMed

Affiliation: National Public Health Laboratory, Ministry of Public Health and Population, Port-au-Prince, Haiti; Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Foodborne, Water and Environmental Diseases, National Center for Emerging and Zoonotic Infections, Centers for Disease Control and Prevention, Atlanta, Georgia; Directorate of Epidemiology, Laboratory and Research, Ministry of Public Health and Population, Port-au-Prince, Haiti; Centers for Disease Control and Prevention-Haiti, Port-au-Prince, Haiti lucienmentor@gmail.com.

Show MeSH
Related in: MedlinePlus