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[Molecular epidemiology of rabies epizootics in Colombia, 1994-2002: evidence of human and canine rabies associated with chiroptera].

Three urban rabies outbreaks have been reported in Colombia during the last two decades, one of which is ongoing in the Caribbean region (northern Colombia). The earlier outbreaks occurred almost simultaneously in Arauca (eastern Colombia) and in the Central region, ending in 1997. Phylogenetic relationships among rabies viruses isolated from the three areas were based on a comparison of cDNA fragments coding for the endodomain of protein G and a fragment of L protein obtained by RT-PCR. The sequenced amplicons which included the G-L intergenic region contained 902 base pairs. Phylogenetic analysis showed three distinct groups of viruses. Colombian genetic variant I viruses were isolated only from Arauca and the Central region, but are now apparently extinct. Colombian genetic variant II viruses were isolated in the Caribbean region and are still being transmitted in that area. The third group of bat rabies variants were isolated from two insectivorous bats, three domestic dogs and a human. This associates bat rabies virus with rabies in Colombian dogs and humans, and indicates bats to be a rabies reservoir of public health significance.

Amino Acid Sequence↗

Decentralization and equity of resource allocation: evidence from Colombia and Chile.

OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. METHODS: The "decision space" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization--the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes.

Chile↗

[New findings on the geographic distribution of the verrucarum group (Diptera: Psychodidae) in Colombia].

The incrimination of sand flies belonging to verrucarum species group in the leishmaniasis transmission underscores the need for a detailed information on the geographical distribution of these species. The current listing adds 34 new records that extend significantly the knowledge of the geographical distribution of the verrucarum group in Colombia. The most important new records pertain to Lutzomyia spinicrassa in the tropical dry forest of the Atlantic coast, Lutzomyia ovallesi in the Orinoco and Amazon River watersheds regions of Colombia, and the sympatric occurrence of Lutzomyia spinicrassa and Lutzomyia quasitownsendi in the eastern chain of the Andes mountains. Additionally, the municipal and altitudinal distributions are compiled for 19 new species recorded for Colombia. The series townsendi of the verrucarum group generally restricted to premontane and lower montane zones based on distribution data on Lutzomyia longiflocosa, L. quasitownsendi, Lutzomyia sauroida, L. spinicrassa, Lutzomyia torvida, Lutzomyia townsendi and Lutzomyia youngi. The series verrucarum is distributed from the tropical lowland to the montane zones, and includes species with wide geographical range (Lutzomyia evansi, Lutzomyia columbiana, L. ovallesi, Lutzomyia nuneztovari, Lutzomyia nevesi), and species of highly endemic distribution (Lutzomyia andina, Lutzomyia disiuncta, Lutzomyia moralesi, Lutzomyia antioquiensis). Members of the series pia (Lutzomyia pia, Lutzomyia limafalcaoae) and the series serrana (Lutzomyia serrana) occur from the tropical lowlands to the lower montane zones. The altitudinal divergences may be intrinsically tied to speciation process, especially as it relates to the climatic and geologic events that have affected the flora and fauna of the Andean region.

Animals↗

The decentralization of the health system in Colombia and Brazil and its impact on leprosy control.

Decentralization policies are an integrated component of health sector reform in an increasing number of countries. The ability of such policies to improve the health system's quality and efficiency is backed up by limited scientific evidence. This study intends to evaluate the impact of decentralization on a specialized field of disease control (leprosy control) in Colombia and Brazil. It analyses the respective juridical base, epidemiological indicators and local publications. Furthermore, 39 semi-structured interviews with key informants were conducted. In both countries, the devolution of technical responsibility and financial resources to the municipalities was the implemented form of decentralization. Access to preventive and curative health care and the community participation in decision-making improved clearly only in Brazil. The decentralization to private providers in Colombia had dubious effects on service quality in general and still more on public health. The flow of finances (including finance collection through state-owned taxes instead of insurance companies) seemed to be better controlled in Brazil. Leprosy control in Brazil took advantage of the decentralization process; in Colombia, it came close to a collapse.

Brazil↗

[Molecular evolution and geographic origins of type 1 human lymphotrophic virus in Colombia detected by RFLP polymorphism].

The human T-lymphotropic virus type I (HTLV-I) infection is a public health problem in many endemic areas of Colombia. The subtyping of HTLV-I was based on the analysis of restriction fragment length polymorphisms (RFLP) in 3'LTR proviral DNA. From 31 HTLV-I isolates collected throughout Colombia, a RFLP analysis in a 737 bp 3'LTR fragment was performed. Fifty-eight percent (18/31) were identified as the Cosmopolitan subtype a, 19.4% (6/31) in the West African subtype b, 12.9% (4/31) in the Cosmopolitan subtype b and 9.6% (3/31) in the West African subtype c. The phylogenetic analysis of 3'LTR nucleotide sequences indicated that all the isolates in the current study were in the subgroup B or Japanese, in contrast with the highly divergent isolates from native Amerindians grouped in subgroup a or Transcontinental. The supported hypothesis was that of a post-Columbus introduction of virus represented in the African-American communities of the Colombian South Pacific. Some viral isolates from Colombian native Amerindians exhibited a nucleotide variation compatible with a Paleolithic introduction of the virus. The genetic diversity of HTLV-I in Colombia is complex and probably represents several independent introductions of lymphotropic virus.

Base Sequence↗

[Trends of tuberculosis related mortality and hospital discharges before and after the implementation of the health sector reform, Colombia, 1985-1999].

We describe the changes that have been presented in the tendencies of mortality and hospital discharges by tuberculosis (TB) between 1985-1999, period before and during the implementation of the Health Sector Reform (HSR) in Colombia. For it, we carried out an exploratory descriptive study with analysis of time series of hospital discharges and mortality rates of TB in Colombia. It was found that although starting from 1991 the Series approach stabilized, their tendencies showed a significant descent diminishing both in 30% between 1985 and 1990. The steady trend registered from 1991 to 1999, could be explained by deterioration of the primary care during this period, also due to other complex social processes occurred in Colombia during this decade, which barred the continuing the descent trend in hospital discharges and mortality due to TB previously registered. Due to the study design limitations we cannot establish causal relationships between these trends and the health sector reform in the country; we recommend the improvement the health sector performance about public health problems such as TB in order to avoid unnecessary hospitalizations and deaths due to causes responsive to health sector interventions.

Colombia↗

Impact of climate variability in the occurrence of leishmaniasis in northeastern Colombia.

Previous studies have shown that variation in the distribution of vectors associated to the transmission of Leishmania species may be related to climatic changes. However, the potential implications of these ecological changes in human health need to be further defined in various endemic populations where leishmaniasis carries a substantial burden of disease such as in Northeastern Colombia. Herein, we report the impact of El Niño Southern Oscillation climatic fluctuations during 1985-2002 in the occurrence of cases of leishmaniasis in two northeastern provinces of Colombia. During this period, we identified that during El Niño, cases of leishmaniasis increased, whereas during La Niña phases, leishmaniasis cases decreased. This preliminary data show how climatic changes influence the occurrence of leishmaniasis in northeastern Colombia and contributes to the growing body of evidence that shows that the incidence of vector-borne diseases is associated with annual changes in weather conditions.

Animals↗

[First serological evidence of Hantavirus infection in rodents in Colombia].

OBJECTIVE: Determining Hantavirus infection prevalence in rodents in the C6rdoba department, Colombia. METHODS: Rodents were captured using Sherman live-capture traps (8 x 9 x 23 cm; Sherman Traps, Inc., Tallahassee, FL) in peridomestic areas of Córdoba. Hantavirus IgG antibodies were detected by ELISA using Sin Nombre virus (SNV) recombinant nucleocapsid antigen (CDC, Atlanta, Georgia, USA). RESULTS: 336 rodents were captured in 11 townships in the Córdoba department (Murinae: 249; Sigmodontinae: 68; Heteromyidae: 17; Echimyidae: 2; 8.5% overall trap success) during 79 nights of trapping between January 2003 and November 2004. Hantavirus antibody seroprevalence was 2.1% (7 out of 336 captures). Prevalence by genus varied between 5.9% (1 out of 17 Heteromys) to 50% (1 out of 2 Proechimys). CONCLUSIONS: SNV-reactive antibody prevalence in rodents in Córdoba, Colombia, indicated that at least one hantavirus is endemic in rodents in northern Colombia and is frequently transmitted to rural residents.

Animals↗

[Characterization by pulsed-field gel electrophoresis of Salmonella typhimurium isolates recovered in the acute diarrheal disease surveillance program in Colombia, 1997-2004].

INTRODUCTION: In Colombia Salmonella Typhimurium is the second most frequently isolated Salmonella serotype (after S. Enteritidis) from human clinical samples. This serotype represents 28.2% (n=468) of the 1659 Salmonella isolates recovered by the Instituto Nacional de Salud (INS) Acute Diarrheal Diseases Surveillance Program from 1997 to 2004. Previously, little was known about the molecular attributes of these strains and commonality of genetic subtypes among S. Typhimurium isolated from humans in Colombia. OBJECTIVE: The purpose of this study was to characterize S. Typhimurium isolates circulating in Colombia using pulsed-field gel electrophoresis in order to establish genetic profiles and determine their potential relatedness. MATERIALS AND METHODS: 468 S. Typhimurium isolates were submitted to INS by 14 Public Health Laboratories from January 1997 to December 2004. The pulsed-field gel electrophoresis was performed using restriction enzyme Xbal according to the PulseNet standard protocol (CDC, Atlanta). Restriction pattern analysis and cluster definition were performed using Molecular Analyst Fingerprinting II software. RESULTS: 180 distinct electrophoretic patterns were obtained. Pattern COINJPX.X01.0062 was the most common (21.3% of the 473 isolates, n=101), followed by COINJPX.X01.0001 (8.4%, n=40), COINJPX.X01.0058 (3%, n=13), COINJPX.X01.0003 (2.5%, n=12), COINJPX.X01.0066 (2.3%, n=11), and COINJPX.X01.0108 (1.4%, n=6). COINJPX.X01.0001, was the most prevalent pattern among S. Typhimurium isolated in Bogotá from 1997-2002, but appeared to be replaced both in Bogotá and nationally by COINJPX.X01.0062 in 2003-2004. Cluster analysis demonstrated three distinct groups with 53% and 82% similarity indicating heterogeneity within the serotype. CONCLUSIONS: The study provides important electrophoretic pattern baseline data, which will be useful for prospective real-time comparison of profiles of future isolates. Cluster detection using this method will facilitate outbreak detection and will enhance our ability to find common sources for seemingly unrelated infections.

Acute Disease↗

Infectivity of two strains of Plasmodium vivax to Anopheles albitarsis mosquitoes from Colombia.

Anopheles albitarsis obtained from Villavicencio, Colombia, were colonized in the laboratory using force-mating techniques. Laboratory reared mosquitoes were allowed to feed on Aotus monkeys infected with the Salvador II or the Rio Meta strains of Plasmodium vivax from El Salvador and Colombia, respectively. In comparison with other species, the An. albitarsis were less susceptible than Anopheles freeborni, Anopheles culicifacies and strains of Anopheles albimanus from El Salvador, Panama and Colombia and more susceptible than a strain of An. albimanus from Haiti.

Animals↗

Epidemiology of endemic goitre in western Colombia.

This paper reports on recent epidemiological observations in western Colombia, which further demonstrate the presence of naturally-occurring goitrogens contaminating water supplies in areas where goitre persists despite prolonged and continuous iodine supplementation. 'Prospective' and 'cross-sectional' studies in 41 localities where the populations have been on a uniform and adequate iodine supplementation for the last 10-20 years indicate that, in the endemia of western Colombia, environmental factors other than nutritional iodine deficiency are responsible for differences in goitre prevalence. Further epidemiological studies to determine the causal factors for the persistence of the endemia established a correlation between the sources of drinking water and goitre prevalence rates. Organic compounds containing sulfur with marked thionamide-like antithyroid activity were isolated from water supplying endemic goitre districts, and results are presented supporting the hypothesis that sedimentary rocks rich in organic matter are the main source of water-borne goitrogens. Bacteriological investigations showed that the presence of Klebsiella pneumoniae in drinking water and bacterial concentration were related significantly with goitre prevalence only in the presence of other variables, particularly the presence of sedimentary rocks. In the light of these epidemiological observations and experimental studies it may be concluded that, at present, endemic goitre in western Colombia is not due to nutritional iodine deficiency, but that water supplies are contaminated with sulfur-bearing organic compounds with thionamide-like antithyroid activity most probably deriving from sedimentary rocks rich in organic matter and that these compounds are the main factor underlying the endemia.

Adolescent↗

Prostitution, HIV, and cervical neoplasia: a survey in Spain and Colombia.

The prevalence of cervical intraepithelial neoplasia (CIN) and the association of CIN with prostitution was examined in Oviedo, a region in Spain with low incidence of cervical cancer, and in Cali, Colombia, where the incidence of cervical cancer is 6-10 times higher. In Oviedo, the study included 758 prostitutes attending a sexually transmitted diseases clinic and 1203 nonprostitutes attending a family-planning clinic. In Cali, 775 prostitutes and 1795 nonprostitutes attending health centers were included. Seropositivity to common sexually transmitted agents was investigated in Spanish prostitutes. No significant difference was found in the prevalence of CIN between Oviedo and Cali in both prostitutes (2.5 versus 1.8%) and nonprostitutes (1.2 versus 1.1%). Prostitutes had a 2-fold increased risk of CIN as compared to nonprostitutes; in Spain, the prevalence odds ratio (POR) was 2.3 and the 95% confidence interval (CI) was 1.1-4.5, and, in Colombia, POR was 1.8 and the 95% CI was 0.9-3.5. Among prostitutes in Oviedo, human immunodeficiency virus (HIV) prevalence was 4.9% and HIV-positive prostitutes showed a high risk of CIN as compared to HIV-negative prostitutes (POR, 12.7; 95% CI, 3.9-40.9); 76% of HIV-positive prostitutes were i.v. drug users and showed an increased seroprevalence of other sexually transmitted diseases. HIV-negative prostitutes did not show any increased risk of CIN (POR, 1.2; 95% CI, 0.5-2.8). These results show that among nonprostitutes the prevalence of CIN was not statistically different between the two cities in Spain and Colombia; prostitutes were at moderate increased risk compared to nonprostitutes in both cities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Violence and health in Colombia].

In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Columbians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some, but not enough, important answers. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. This it not merely an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.

Colombia↗

Acquired multidrug-resistant tuberculosis--Buenaventura, Colombia, 1998.

In 1996, the incidence of tuberculosis (TB) in Colombia was 26.5 per 100,000 population, and mortality was 3.4 per 100,000; in comparison, the incidence in Buenaventura, a port town on the Pacific coast, was 90.5 per 100,000, and mortality was 9.4 per 100,000. The prevalence of multidrug-resistant tuberculosis (MDR-TB) (i.e., Mycobacterium tuberculosis isolates resistant to at least isoniazid [INH] and rifampin [RIF]) was not known because susceptibility testing is not performed routinely, and data on drug resistance for the country have not been collected systematically. During October-November 1997, at the request of the Secretary of Health in Cali, Colombia, the International Center for Training and Medical Investigation in Cali performed sputum cultures for M. tuberculosis and drug-susceptibility testing on isolates from 18 (75%) of 24 TB patients in Buenaventura who were known to be clinically unresponsive to standard TB treatment. MDR-TB was identified in 12 (67%) of these patients, four of whom subsequently died. In March 1998, the International Center for Training and Medical Investigation and the Secretary of Health of Colombia invited CDC to participate in an investigation of these patients with MDR-TB. This report summarizes the findings of this investigation, which indicated that inconsistencies in treatment may have contributed to this outbreak, and provides recommendations for the prevention and control of MDR-TB in Buenaventura.

Adult↗

Dissemination of Streptococcus pneumoniae clone Colombia(5)-19 in Latin America.

Streptococcus pneumoniae serotype 5 is the third most common capsular type causing invasive diseases in children younger than 5 years in Latin America. Preliminary data on Colombian serotype 5 isolates indicated a common clonal origin associated with resistance to tetracycline (TET) and chloramphenicol (CHL). We studied 172 S. pneumoniae serotype 5 invasive isolates from Argentina, Brazil, Colombia, Guatemala, Mexico, and Uruguay and confirmed the presence of the Colombia(5)-19 clone throughout Latin America. Fifteen subtypes of a pulsed-field gel electrophoresis pattern and 4 electrophoretic types (ET) were obtained. Most of the isolates from different geographical regions belonged to pattern A (34.3%), subtype A5 (41.9%), and ET1 (91.1%). The A pattern (n = 59) was resistant to TET and had variable resistance to CHL; it was present in Brazil (10.2%), Colombia (78%), Guatemala (8.5%), and Mexico (3.4%). Subtype A5 with variable susceptibility to TET and sensitive to CHL was found in Argentina (29.2%), Mexico (8.3%), and Uruguay (62.5%). Subtypes A1-A4, A7-A8, and A9-A11 (closely related to A) also shared ET1, while subtype A6 was assigned to ET1, ET2, and ET3. Eleven subtypes (n = 21) were found to be specific for one country each. In summary, the S. pneumoniae serotype 5 isolates from Latin American are genetically closely related but show different patterns of antibiotic resistance, probably as a result of horizontal transfer.

Anti-Bacterial Agents↗

Serological response to HPV16 in CIN-III and cervical cancer patients. Case-control studies in Spain and Colombia.

This study evaluates the association of antibodies against HPV-16-derived peptides with cervical cancer and estimates the sensitivity and specificity of the serological assays in relation to HPV DNA detection in cervical cells by PCR. Study subjects were derived from 4 case-control studies carried out in Spain and Colombia. Sera from 544 cases of CIN III and invasive cancer and of 543 age-matched controls were tested for antibodies to 5 peptides derived from E2, E7 (3 partially overlapping frames of HPV 16 denoted E7/ 1, E7/2, E7/3) and L2 open reading frames of HPV 16. HPV DNA was detected using a L1-PCR based method. Among cancer controls, antibody response to E2 and E7/1, E7/2, E7/3 was higher in Colombia (22.5%,7.2%,11.7%,12.6% respectively) than in Spain (17.1 %, 4.7%, 5.9%, 5.9%). E7 antibodies were related to stage, particularly in CIN III vs. invasive stages and less markedly within invasive stages. Detection of antibodies to the E7/1 was associated to CIN III (OR = 1.8). The risk of invasive cervical cancer was increased among those with antibodies to E2 (OR = 2.2), to E7/1 (OR = 4.2), to E7/2 (OR = 4.3), and to E7/3 (OR = 2.5). Presence of antibodies to all the 3 E7 peptides increased the risk of CIN III (OR = 5.6) and that of invasive cancer (OR = 17.5). High levels of antibodies to E7/1 or E7/2 or E7/3 increased the risk of invasive cervical cancer (OR for high levels of antibodies vs. negatives to E7/1 OR = 22.6; E7/2 OR = 7.5, E7/3 OR = 3.4). In the present analysis, antibodies to L2 were not associated with either CIN III or cervical cancer. Serological markers of HPV 16 detected less than half of the HPV-16-DNA-positive cases. It is concluded that antibodies to E2 and particularly E7 antigens are strongly associated with cervical cancer. Antibodies to E7 seem to be a moderate marker of tumor burden.

Adult↗

Kaposi's sarcoma in Colombia.

Seventy-nine cases of Kaposi's sarcoma (KS), which correspond to one of every 1,000 malignant tumors, were reviewed at the National Institute of Cancer (NIC), Bogotá, Colombia, from 1935 to 1985. Seventy-four percent of the patients were older than 65 years of age. The male to female ratio was 8:1. In all cases, plaques and nodules first appeared in the lower limbs; they were symmetrical in 47% of the cases and ulcerated in 25%. No generalized or epidemic forms were seen. Esophageal squamous cell carcinoma concurrent with KS was observed in one case. KS developed several years after treatment for follicular lymphoma and chronic lymphocytic leukemia in two patients. An angiosarcomatous variant and one fibrosarcomatous change were seen. Ten cases studied for factor VIII expression through the peroxidase-antiperoxidase (PAP) technique were all reactive. We conclude that in Colombia before 1985, KS behaved as a chronic multicentric Stage I disease without a tendency to associate simultaneously with malignant conditions.

Adult↗

Quantifying remaining forested habitat within the historic distribution of the cotton-top tamarin (Saguinus oedipus) in Colombia: Implications for long-term conservation.

Landsat Thematic Mapper (TM) data were used to classify forested areas within the historic distribution of the endangered cotton-top tamarin (Saguinus oedipus) in Colombia. This species continues to be threatened by habitat destruction, and we observed a 31% decrease of the forested habitat within the tamarins' historic distribution in 1990-2000. It is estimated that since the establishment of some protected areas for cotton-top tamarins and other native Colombian wildlife (Parque Nacional Natural Paramillo, Santuario de Fauna y Flora Los Colorados, and Reserva Forestal de Montes de Maria), almost 43% of the original forested area has been lost. Given that the human population of Colombia increases annually by 1.6% [Patel, 2002], it is important to target specific areas for tamarin protection while creating mitigation strategies to compensate for economic growth. The results of this study provide valuable information to assist in the long-term development of effective conservation strategies for this endangered primate.

Animals↗