Global & Disaster Medicine

Archive for the ‘Diarrhea’ Category

Oral Ondansetron Administration to Dehydrated Children in Pakistan: Latest research

Oral Ondansetron Administration to Dehydrated Children in Pakistan: A Randomized Clinical Trial

  Stephen B. Freedman, Sajid B. Soofi, Andrew R. Willan, Sarah
  Williamson-Urquhart, Emaduddin Siddiqui, Jianling Xie, Fady Dawoud and
  Zulfiqar A. Bhutta
  Pediatrics 2019; 144:e20192161
“A total of 918 dehydrated Pakistani children with
gastroenteritis-associated vomiting received oral ondansetron or placebo;
children administered ondansetron were less likely to vomit and receive
intravenous rehydration.”

More than half of the 330,000 childhood deaths attributable to diarrhea in 2015 took place in just 55 out of 782 African states, provinces, or regions.

NEJM

Document:  Diarrhea

“Diarrheal diseases are the third leading cause of disease and death in children younger than 5 years of age in Africa and were responsible for an estimated 30 million cases of severe diarrhea (95% credible interval, 27 million to 33 million) and 330,000 deaths (95% credible interval, 270,000 to 380,000) in 2015…….”

 

 


Diarrhea in 195 countries

Lancet

“…..In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073–2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894–504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138–155 133) and among all ages (228 047 deaths, 183 526–292 737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2–85·0), 72·1% (34·0–91·4), and 56·4% (49·3–62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521–2170) could avert one death from diarrhoea……”


CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.

CDC

Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)
CDCHAN-00408

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.

 

Background
Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.

 

Recommendations

These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.

 

For More Information


Globally, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years

The Lancet

Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015

Troeger, Christopher et al.
The Lancet Infectious Diseases

Evidence before this study

This manuscript builds on previous GBD publications with updated data and methods. Diarrhoeal diseases are a leading cause of morbidity and mortality, especially in children younger than 5 years, and the global burden has been estimated by several groups, including the Maternal and Child Health Epidemiology Estimation group and the Global Burden of Disease Study (GBD) 2013. Diarrhoea mortality has declined substantially since 1990, but morbidity has not declined as rapidly. Diarrhoeal mortality attributable to aetiologies has mainly been based on categorical attribution from non-molecular diagnostic methods with low overall attribution.

Added value of this study

This study provides a comprehensive assessment of diarrhoea burden based on the findings of GBD 2015, including new and more robust evidence on the mortality, morbidity, and risk factors associated with diarrhoea and 13 aetiologies and is the first cause-specific description of diarrhoea from the GBD group. Moreover, it introduces molecular diagnostic case definitions for diarrhoeal aetiologies. In addition to descriptions of trends in morbidity and mortality, this analysis uses a Socio-demographic Index to relate changes in diarrhoea burden to demographic transitions and assesses the effect of changing population characteristics and risk factor exposure to decompose trends in diarrhoea mortality.

Implications of all the available evidence

This study provides a detailed picture of the decreasing diarrhoeal burden over time and 13 aetiologies across all geographies while relating these trends to changes in risk factor exposure. This work allows for an in-depth understanding of national health challenges and areas for intervention. The findings will have great implications for strategies and programmes to address the burden of diarrhoea at the global, country, and local level.

 


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