Showing papers by "Gustavo Kourí published in 2009"

Intersectoral coordination, community empowerment and dengue prevention: six years of controlled interventions in Playa Municipality, Havana, Cuba

Abstract: OBJECTIVE To document the process, outcome and effectiveness of a community-based intervention for dengue control. METHODS The primary intervention, focused on strengthening intersectoral coordination, was initiated by researchers in January 2000 in a pilot area in Playa municipality, Havana. In August 2002 health authorities extended the intervention to neighbouring areas, one of which was selected for evaluation. In August 2003 a complementary strategy, focused on community empowerment, was initiated in half of the pilot area. In our control area, routine dengue activities continued throughout the study period. Longitudinal process assessment was carried out using document analysis, interviews and group discussions. Random population surveys in 1999, 2002 and 2005 assessed levels of participation and behavioural changes. Entomological surveillance data from 1999 to 2005 were used to determine effectiveness. RESULTS Mean scores for participation in the pilot area were 1.6, 3.4 and 4.4 at baseline, and 2 years after initiating intersectoral coordination and intersectoral coordination plus community empowerment interventions, respectively. While in the control area little behavioural change was observed over time, changes were considerable in the pilot and extension areas, with 80% of households involved in the community empowerment intervention showed adequate behavioural patterns. The pilot and extension areas attained comparable entomological effectiveness with significantly lower Breteau indices (BIs) than the control area. The pilot (sub-) area with the community empowerment intervention reached BIs below 0.1 that continued to be significantly lower than the one in the control area until the end of the study. CONCLUSION The study showed a trend in the levels and quality of participation, behavioural change and effectiveness of Aedes control from the routine activities only over an intervention with intersectoral coordination to one that combined intersectoral coordination and community empowerment approach.

Dengue: where are we today?

Abstract: Dengue is considered the main arthropod-borne viral disease of humans. In the last few years, an increasing number of reports of mild and severe cases have been reported. The growing dengue incidence observed in recent years has been accompanied by reports of new observations, findings and global initiatives with an improvement in our understanding of this phenomenon. The epidemiology and new clinical classification of dengue, advances in the diagnostic and pathogenesis knowledge, and vaccine development as well as control methods including new global initiatives are summarised here.

Dual infection with dengue virus 3 and human immunodeficiency virus 1 in Havana, Cuba.

Abstract: Although dengue virus (DEN) endemic regions overlap with human immunodeficiency virus 1 (HIV) high incidence areas, little has been documented on HIV and DEN mixed infection. Here we report DEN/HIV concurrent infections recorded during the DEN-3 epidemic in 2001-2002 in Havana. Serologic-confirmed DEN is described in two HIV-infected subjects with dengue fever symptoms. Although patients had dengue disease, the CD4+ cells remained within normal levels and no accelerated progression of HIV disease was observed. To our knowledge, DEN cases caused by DEN-3 in HIV-infected individuals have not been reported previously. Further research is needed to diagnose this likely underreported mixed viral infection in DEN endemic areas.

New evidence of the development of dengue hemorrhagic fever during the dengue 3 epidemic in Cuba

Abstract: For the first time this paper defines some of the factors involved in the development of dengue hemorrhagic fever during the dengue-3 epidemic in Cuba. The secondary infection is confirmed to be the most important risk factor in that epidemic, after 24 years of the primary infection with dengue-1, in contrast to the infection sequence dengue- 2/dengue-3 that showed no relationship. Tertiary infection was also related to the development of dengue hemorrhagic fever. The neutralizing antibody titers were different for strains of dengue-3 of the same genotype in a panel of sera of late convalescent patients with both clinical epidemic conditions. Viremia was longer in the primary than in secondary infection; the first neutralizing antibodies were not detected during acute phase, while in the secondary infection the neutralizing antibodies were detected after the fifth day, coinciding with the decline of the viremia. In general, neutralizing antibodies reached lower levels in dengue fever patients, compared to those who developed dengue hemorrhagic fever