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1998 Annual Report
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 | The advance of dengue type 3 into the wider Caribbean |
| The limited resumption of transmission of malaria in some of our countries previously free of this disease, and the awareness of the presence of diseases such as Chagas' disease within our region. |
In 1998 a pilot programme was initiated with community groups - mainly school children in collaboration with service clubs such as Kiwanis - for participation and for prevention of dengue in our communities. These activities included: · Environmental sanitation awareness and practices · Message preparation and utilisation for dengue prevention.
The process has started with enthusiasm, presenting an opportunity for behavioural change in the young which did not occur in the older population. From this model, it is proposed to extend the programme to other CMCs for the combined effort of: · Communities · Non-Governmental Organisations (NGOs) · Health Care Workers · Educational Groups
The impact of dengue infection (classical dengue fever, DHF and DHF-related deaths) on Community behaviour with respect to mosquito production was investigated in the East-West corridor area of Trinidad. The outcome is presented in the Laboratory section of this report. One of the main findings was that even serious illness (DHF) did not prevent householders from returning to mosquito production habits. Only death due to DHF in the family seemed to make a difference in behaviour.
A Sero-prevalence study of Chagas' disease was finalised in Guyana, Suriname and Trinidad & Tobago with small grant funding from the Tropical Disease Research (TDR) (WHO). Low frequencies of Chagas' disease were detected in high risk groups, but not in routine blood bank samples, (Table 1 below).
Antimicrobial Class and |
POSGH |
Private Lab1 |
Private Lab2 |
BVI |
Grand Bahamas |
QEH |
|---|---|---|---|---|---|---|
| Penicillins: Ampicillin |
74 (969/1306) |
72 (55/76) |
63 (25/40) |
71 (51/66) |
85 (297/351) |
51 (27/53) |
| Amoxycillin-clavulanate Piperacillin |
24 (314/1294) 27 (277/1010) |
32 ( 33/71) 0 (0/7) |
23 (9/40) NT |
NT 29 (11/38) |
59 (135/332) 33 ( 5/15) |
NT NT |
| Cephalosporins: Cephazolin/ Cephalothin |
45 (346/765) |
NT |
67 (9/28) |
50 (33/66) |
64 (101/284) |
49 (28/66) |
| Cefuroxime
Cefoxtin |
17 (182/1056) 19 (30/160) |
19 (9/47) NT |
8 (2/24) NT |
21 (14/66) NT |
43 (46/105) NT |
NT NT |
| Cefotaxime/ Ceftriaxone/ Ceftazdime |
9 (134/1432) |
16 ( 7/44) |
NT |
NT |
NT |
NT |
| AminoglycosideGentamicin | 10 (133/1353) |
8 ( 5/66) |
3 (1/32) |
7 (6/86) |
11 ( 42/386) |
10 (11/51) |
| Quinolones Nalidixic acid
Norfloxacin |
NT
NT |
38 (5/33) 7 (2/28) |
25 (10/40) 8 (3/40) |
NT
25 (22/88) |
NT
9 (23/261) |
NT
NT |
| Ciprofloxacin/ Oflaxacin |
7 ( 54/774) |
7 (2/27) |
8 |
47 (18/38) |
NT |
NT |
| Others: Furadantin |
22 (103/461) |
38 (5/13) |
35 (14/40) |
28 15/53 |
NT |
NT |
| Trimethoprim-sulphamethoxazole | 29 (373/1265) |
29 (20/68) |
29 (9/31) |
27 18/66 |
37 (143/386) |
47 (36/76) |
| NT = not tested | ||||||
Lymphatic Filariasis (LF) prevalence studies were carried out in Guyana (endemic), and in Trinidad (previously endemic) utilising a new circulating antigen tool. All Trinidad populations appeared to be negative (Table 2), suggesting a model for a certification programme for Caribbean countries, previously endemic for L.F. For countries such as Guyana (Table 3) with high LF prevalences, a country-wide elimination programme is recommended. CAREC and other partners such as CDC can assist the Ministry of Health by seeking funding to support such a programme.
In 1998, malaria continued to be endemic in countries, but autochthonous malaria also occurred in two (2) CMCs, previously free of the disease. CAREC worked with the MOH Bahamas on the surveillance and elimination of a small focus of P. falciparum malaria in February. A survey for chloroquine sensitivity in P. vivax in Guyana was executed by a team of US Navy scientists in collaboration with the Ministry of Health, PAHO and CAREC. The results are yet to be analysed.
A preliminary CL study was done in association with the MOH in Guyana (Table 4 ). The positive results showed that this disease needs to be assessed and control strategies put in place - especially in the interior where development work such as mining and eco-tourism is taking place.
During the year under review CAREC's Entomologist/Parasitologist visited and advised on the surveillance and control of a small malaria outbreak in Nassau, Bahamas. While some of the microscopy and serology from the fever and geographical surveys were done at CAREC, prompt intervention in country, for the control of Anopheles mosquitoes, prevented any further detectable spread of the disease. This intervention could be a model for other CMCs, now free of malaria, but at risk of re- introduction of the disease. There were two major hurricanes in the region in 1998. Georges in the Leeward Islands - particularly St. Kitts - and Mitch in Central America, affecting Belize. CAREC's Entomologist and an Epidemiologist visited, advised and participated in the vital post-hurricane efforts of mitigation of mosquitoborne diseases and nuisance biters such as the salt marsh mosquito, Aedes taeniorhynchus.
Messages in the form of posters were produced and disseminated in order to encourage community involvement in environmental sanitation to prevent the production of peri-domestic mosquitoes and the dengue epidemic. In addition to poster messages from the schools poster competition, CAREC mass-produced its own posters with support of funding from the Italian Government - through the office of the CPC - for distribution to all CMCs. It is proposed to have leaflets with anti-dengue messages on display in every home.
The Entomologist was invited by the Ministry of Agriculture, Trinidad and Tobago, to join a team of scientists to evaluate the epidemic and control strategies for the potentially disastrous pest, the Pink Hibiscus Mealy Bug - Maconellicoccus hirsutus. This pest was recently introduced to the Caribbean. Among other strategies, a Knowledge, Attitude and Practices (KAP) study was conducted throughout Trinidad and Tobago, to assess the community's response to the pest. Reports were presented to the Ministry of Agriculture. This was a case of direct technical support to a CMC - outside of our readily-recognised mandate, Public Health.
COUNTRY |
SOURCE |
NUMBER ASSAYED |
NO POSITIVE |
% |
|---|---|---|---|---|
| Suriname
Guyana
Trinidad & Tobago |
Blood Bank High Risk
Blood Bank High Risk2 Blood Bank High Risk3 |
500 100 2001 500 195 500 215 |
0 0 2 0 3 0 15 |
0 0 2.0 0 1.54 0 6.98
|
COMMUNITY |
NUMBER OF CHILDREN ASSAYED BY THE ICT |
NUMBER POSITIVE |
|---|---|---|
Blanchisseuse Matelot Grand Riviere |
69 38 32 |
0 0 0 |
GROUP SCREENED |
# POSITIVE/TOTAL |
% POSITIVE |
|---|---|---|
Patients Staff |
23/83 7/19 |
27.7 36.8 |
| COMMUNITY | NUMBER OF PERSONS SAMPLED |
NUMBER POSITIVE |
|---|---|---|
| Maraval Blanchisseuse1 Matelot Grand Riviere Freeport Couva Plesantville La Brea |
21 68 17 25 25 24 21 10 |
0 0 0 0 0 0 0 |
During 1998, emphasis was placed on capacity building, training, research, dissemination of new information and partnership with regional institutions and private sectors on emerging bacterial infections - tuberculosis, antibiotic resistance and non- typhoidal salmonellosis in the Caribbean. A strategy document on the development of reference laboratory services in the area of emerging bacterial and fungal infections at CAREC was drafted. This would form the basis for any future developments in Microbiology at CAREC.
| National TB programmes were reviewed in Turks and Caicos, British Virgin Islands, St.Vincent, Guyana, Suriname, Barbados and Belize. The need for a comprehensive TB programme consisting of surveillance, laboratory support, clinical management and contact tracing was advocated in these countries. |
| At a symposium conducted CCMRC Scientific meeting in Jamaica, it was agreed that it is
essential for the formation of an Informal Laboratory Information Network where results
would be shared among laboratory, development of a standardized TB manual for Level 1 and
2 laboratories by CAREC with input from the national TB laboratories and the
standardization of reporting format of TB data from CMCs in the Caribbean. The TB manual
for Level 1 Laboratories has been completed and will be distributed to all national
Laboratories in May, 99. |
| Quality Control of Sputum Microscopy has continued in all national laboratories |
| Development of a plan of action on TB prevention and control Programme in the Caribbean in collaboration with the Epidemiology Division. |
| The laboratory methods for antibiotic resistance were reviewed and surveillance system
for antibiotic resistance in sentinel laboratories in the Caribbean was proposed -
Trinidad (3), Barbados (1), British Virgin Islands (1), Grand Bahamas (1), St.Vincent (1)
and the Cayman Islands. (1). Initial discussion on the formation of an informal network to
study the antimicrobial resistance surveillance in the Caribbean is encouraging. Quality
control methods were implemented in all sentinel laboratories and feed back provided on a
periodic basis. An analysis of antibiotic resistance patterns was also conducted. The data
collected from the laboratories agreed to participate in this study is shown in Table(1). |
| Collaborative linkages were established with the pharmaceutical agencies and the
Caribbean Association of Medical Technologists for the continuous education on antibiotic
resistance surveillance methods in the Caribbean. Two symposia conducted on "
Antibiotic Resistance Surveillance in the Caribbean - Role of Medical Technologists"
in Trinidad, Nassau, the Bahamas sponsored by the Glaxo Wellcome, Caribbean Ltd. Another
seminar on " Role of Pharmaceutical companies in the promotion of rational use of
antibiotics" was conducted where antibiotic resistance data from Trinidad was
presented. |
| Information on the antibiotic resistance patterns was disseminated by making a
presentation to health professionals during the monthly Clinico- Pathological conference
in Port of Span Hospital. The title of the presentation was " Bugs, Drugs and
Eggs". |
| Two pilot research projects namely, "Knowledge, Practice and beliefs on antibiotic
use - A cross sectional Population survey in Trinidad and Tobago " and " The
Antibiotic Prescription Patterns in General Practice in Chaguanas, Central Trinidad "
were completed. These projects were initiated in collaboration with the UWI and the Bishop
Anstey High School, Trinidad. Data on these projects are being analysed |
| International collaboration is being explored on the development of an antibiotic
resistance surveillance programme. Project proposals on antibiotic resistance surveillance
are being developed for the funding. |
| Emerging non typhoidal salmonella infections in the Caribbean: S. Enteritidis and
S.Typhimurium Phage Type 104b are the two leading emerging non-typhoidal salmonella
species common in the Caribbean. A project on "The Molecular Epidemiology of
S.Enteritidis in three Caribbean countries- Trinidad and Tobago, Barbados and
Jamaica" is being conducted. This project is a collaborative effort of CAREC, UWI,
Ministries of Health and CDC, Atlanta, USA. The initial findings in Trinidad and Tobago
show that the incidence of S.Enteritidis increased from <1 per 100,000 in 1992 to 6.3
cases per 100,000 population in 1997. The descriptive epidemiological study suggested the
consumption of raw or undercooked eggs as a risk factor for infection in Trinidad.
S.Enteritidis was isolated from patients in family clusters, food and eggs. A case
-control study is also being conducted to determine the risk factors for the S.Enteritidis
infection in Trinidad. Molecular typing techniques will be used to determine the
relatedness of strains isolated from various sources. |
| The analysis of salmonella infections shows that the incidence of S.Enteritidis in
Barbados was 4.3 cases per100,000 in 1997 and has increased to 12 cases per 100,000 in
1998. An outbreak of S.Enteritidis occurred in July- August. |
| Retrospective analysis showed that poor egg handling practices by an employee working in
a tourist resort hotel was the cause of this outbreak. The Antibiotic resistant
S.Typhimurium continues to be the leading salmonella infection in Barbados. |
| The retrospective analysis of data from Jamaica also revealed that S.Enteritidis is not
an uncommon salmonella infection. A case control study will also be conducted in 1999 in
Jamaica and Barbados. |
| Although antibiotic resistant S.Enteritidis is uncommon in the Caribbean, an unusual isolate of extended spectrum beta-lactamase producing S.Enteritidis was isolated in a patient with Multiple Myeloma presented with septicemia in Trinidad. This phenomenon has been observed in other countries. Hence the need for surveillance of antibiotic resistant enteric pathogens is essential. |
Outstanding Performance Award from the Caribbean Association of Medical Technologists, TT Chapter.1998
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Caribbean Epidemiology Centre Page last modified 21 May, 1999 |
