Background Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the evolution of cholera and assess the relationship between the implementation of the ‘coup de poing’ strategy during the patron saint festivities and the incidence of cholera in the three communes of Cabaret, Carrefour, and Croix-des-Bouquets in Haiti in 2017. Methods An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and 2 weeks later was weighted against patronal festivities and weekly precipitation rates. Results In total, 3633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density, the implementation of the ‘coup de poing’ strategy during the patron saint festivities was associated with a significant reduction in cholera incidence of 57.23% [PR = 0.4277 (97.5% CI: 0.2798–0.6193), p = 0.0000244]. The implementation of the strategy was associated with a reduction in cholera incidence of 25.41% 1 week following patronal festivities. Conclusion This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the implementation of the ‘coup de poing’ strategy during patronal festivities and a reduction in cholera incidence. The findings imply that the multi-partner ‘coup de poing’ strategy may have contributed to the reduced cholera incidence following patron saint festivities and in Ouest department in Haiti in 2017.

ObjectiveTo examine environmental and human factors that affect the spatial and temporal dynamism of malaria in DRC’s South‐Kivu province.MethodsIn a cross‐sectional study conducted between 1 January 2010 and 31 December 2015, spatial distribution was determined through thematic maps of malaria attack rate. SatScan ™ software and Monte Carlo test were used to identify spatial risk clusters. Temporal evolutions were analysed using the Cleveland algorithm. Generalized Additive Models for Location Scale and Shape and negative binomial regression were used to assess the independent human and environmental factors associated with incident malaria.ResultsThe cumulative annual incidence of malaria increased from 10 968/100 000 in 2013 to 15 501/100 000 in 2015 (P for trend ˂0.001); malaria lethality increased from 0.1% in 2013 to 0.3% in 2015 (P for trend = 0.62). Between 2010 and 2015, 18 of 34 health zones consistently reported the highest attack rates, which ranged from 25 000 to 50 000/100 000. Four risk clusters areas were identified, with relative risk (RR) of 1.2 to 3.0, from which malaria was reported continuously during each year. Factors significantly associated with malaria cases were agro‐pisciculture practices (Incidence Risk Ratio [IRR]: 1.96; 95% CI: 1.23–3.13) and the presence of a lake in the health zone (IRR: 2.48, 95% CI: 1.51–4.42).ConclusionsMalaria control in this setting must be intensified in peri‐lacustrine areas and those in which the population is intensively engaged in standing water‐associated activities.

Introduction Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the evolution of cholera and assess the relationship between the implementation of the ‘coup de poing’ strategy during the patron saint festivities and the incidence of cholera in the three communes of Cabaret, Carrefour, and Croix-des-Bouquets in Haiti in 2017. Materials/Methods An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and two weeks later was weighted against patronal festivities and weekly precipitation rates. Results In total, 3 633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density, the implementation of the ‘coup de poing’ strategy during the patron saint festivities was associated with a significant reduction in cholera incidence of 57.23% [PR=0.4277 (97.5% CI: 0.2798-0.6193), p=0.0000244]. The implementation of the strategy was associated with a reduction in cholera incidence of 25.41% one week following patronal festivities. Conclusion This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the implementation of the ‘coup de poing’ strategy during patronal festivities and a reduction in cholera incidence. The findings imply that the multi-partner ‘coup de poing’ strategy may have contributed to the reduced cholera incidence following patron saint festivities and in Ouest department in Haiti 2017.

Background: We are currently witnessing the global emergence of multi-drug resistant (MDR) Gram-negative rods (GNR) in neutropenic patients with oncohematologic diseases.The aim of this study was to analyze the episodes of bacteremia caused by MDR-GNR in febrile neutropenic patients (FNP).Methods & Materials: We prospectively enrolled Gram negative rods bacteriemia occurring in admitted FNP from 01/01/2008-10/31/2017. Clinical and microbiological data were collected. MDR-GNR were defined as resistant to at least three classes of antibiotics: aminoglycosides, third-and fourth-generation cephalosporins, quinolones, carbapenems and/or betalactams with beta-lactamase inhibitors. MDR P. aeruginosa was defined as resistant to at least piperacillin, ciprofloxacin, ceftazidime and carbapenems. Univariate analysis was performed, considering statistically significant a p-value ≤0.05.Results: Throughout the study period, 635 episodes of febrile neutropenia were registered. Bacteriemia occurred in 57% (362/635) of episodes (in 194 patients). The median age of patients with bacteriemia was 40.9 years with a male predominance (56.6%). Associated disease: acute myeloid leukemia 47%, acute lymphoid leukemia 29%, other 24%. Disease in induction phase: 35.1%; consolidation: 21%; relapsed 17.1%. Median time from hospital admission to the development of bacteremia: 16 days. Previous antibiotic treatment: 54.8%. Quinolone prophylaxis was performed in 33.4% (applied from the start of the study to May 2010). GNR were isolated in 240 of 397 pathogens(60.45%) corresponding 53.75% (129/240) to MDR-GNR. Bacteriemia developing after 48 hours of admission was caused by MDR-GNR in 90.7% of cases. Mechanisms of resistance: ESBLs 53/129(41%), AMPc 8/129(6.2%), OXA beta-lactamases 8/129(8%), MBL carbapenemases 3/129(2.3%), KPC carbapenemases 6/129(4.6%), other 51/129(39.6%). Breakthrough bacteremia was caused by MDR-GNR in 69/362 cases (19%). Empirical treatment (ET) was inappropriate in 50/240 GNR isolates, 41 were MDR-GNR. Lethality was 19.9% (72/362) among episodes of bacteriemia. Univariate analysis: bacteriemia after 48 hours of admission(p < 0.001), breakthrough bacteremia(p < 0.001) and inappropriate ET(p < 0.001) were significantly associated to MDR-GNR bacteremia. Conclusion:The majority of bacteremia was due to MDR-GNR and the presentation was predominantly late. The isolation of MDR-GNR was significantly associated to bacteremia after 48 hours admission, breakthrough bacteriemia and inappropriate ET. MDR-GNR coverage should be considered when choosing an ET.

Introduction Religious pilgrimages are among the anthropogenic factors known to be associated with the transmission of diarrheal diseases, such as cholera. This ecological study aimed to describe the epidemiology of cholera in three communes in Haiti (Cabaret, Carrefour and Croix-des- Bouquets) in 2017 and assess the spatiotemporal influence of patron saint festivities on cholera incidence in communal sections.Materials/Methods An epidemiological curve was produced to illustrate the evolution of cholera at the communal level. Generalized linear models assuming a Poisson distribution were used to weight the annual cholera incidence of communal sections against variables such as the number of patronal festivities, population density and annual precipitation rates. The number of cases in the week of the festivity as well as one and two weeks later was weighted against patronal festivities and weekly precipitation rates.Results In total, 3 633 suspected cholera cases were continuously reported in three communes in Haiti (Cabaret, Carrefour, Croix-des-bouquets) during the 52-epidemiological week period in 2017. After controlling for rainfall and population density at the communal sections, the patronal festivities significantly reduced the annual incidence of cholera by 57.23%. The probability of occurrence of cholera cases one week after patronal festivities decreased by 25.41%.Conclusion This study showed a continuous presence of cholera in three communes in Haiti in 2017 and an association between the occurrence of patronal festivities in communal sections and a reduced probability of subsequent outbreaks. Although further assessments are necessary, these findings suggest an impactful prevention and response strategy around the festivities in 2017.