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Article ; Online: Assessing critical gaps in COVID-19 testing capacity

Irene Torres / Rachel Sippy / Fernando Sacoto

BMC Public Health, Vol 21, Iss 1, Pp 1-

the case of delayed results in Ecuador

2021 Volume 8

Abstract: Abstract Background Testing is crucial for COVID-19 response and management, however, WHO’s preparedness index omits estimations of actual testing capabilities, which influence the ability to contain, mitigate and clinically manage infectious diseases. ... ...

Abstract	Abstract Background Testing is crucial for COVID-19 response and management, however, WHO’s preparedness index omits estimations of actual testing capabilities, which influence the ability to contain, mitigate and clinically manage infectious diseases. With one of the highest excess death rates globally, Ecuador had a comparatively low number of confirmed COVID-19 cases, which may have been influenced by limited availability of data for decision-making due to low laboratory capacity. Methods We examine de-identified data on 55,063 individuals with suspected COVID-19 between February 27 and April 30, 2020 included in the RT-PCR testing database collected by the Ministry of Health. Processing times and rates per province, and the number of pending tests, were tallied cumulatively. We assessed the relationship between sample shipping, laboratory capacity and case completion using a negative binomial generalized linear model. Results The national average time for case completion was 3 days; 12.1% of samples took ≥10 days to complete; the national average daily backlog was 29.1 tests per 100,000 people. Only 8 out of 24 provinces had authorized COVID-19 processing laboratories but not all processed samples. There was an association between samples coming from outside the processing laboratory province, the number of other samples present at the laboratory during processing, and the amount of time needed to process a sample. Samples from another province took 1.29 times as long to process, on average. The percentage of pending results on April 30 was 67.1%. Conclusion A centralized RT-PCR testing system contributes to critical delays in processing, which may mask a case burden higher than reported, impeding timely awareness, and adequate clinical care and vaccination strategies and subsequent monitoring. Although Ecuador adapted or authorized existing facilities to address limitations in laboratory capacity for COVID-19, this study highlights the need to estimate and augment laboratory capabilities for improved decision making and policies on diagnostic guidelines and availability. Support is needed to procure the necessary human and physical resources at all phases of diagnostic testing, including transportation of samples and supplies, and information management. Strengthening emergency preparedness enables a clear understanding of COVID-19 disparities within and across the country.
Keywords	Covid-19 ; Testing ; Health policy ; Inequality ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Endemic and Emerging Arboviruses of Mosquitoes in Ecuador

Rachel Sippy / Cat Lippi / Anna Stewart / Sadie Ryan

Práctica Familiar Rural, Vol 5, Iss

2020 Volume 2

Abstract: Arboviruses are arthropod-borne viruses that include many viruses of public health concern found in Ecuador. Dengue virus, yellow fever virus and Zika virus are in the Flaviridae family (1), while chikungunya virus and Mayaro virus are in the Togaviridae ...

Abstract	Arboviruses are arthropod-borne viruses that include many viruses of public health concern found in Ecuador. Dengue virus, yellow fever virus and Zika virus are in the Flaviridae family (1), while chikungunya virus and Mayaro virus are in the Togaviridae family (1). Yellow fever has circulated throughout the tropics since at least the17th century, with the first recorded outbreak in Latin America in 1647 (2), with the virus being identified in 1927 (3). Dengue virus is also a long-time source of global outbreaks and was identified in 1943 (4). Dengue has four virus serotypes (DENV 1-4), allowing for repeated infection of individuals. Chikungunya, Zika and Mayaro were identified as causes of febrile disease more recently: the Zika virus was isolated from a monkey in 1947 in Uganda (5), chikungunya virus during an outbreak in south-eastern Africa in 1952 (1), and Mayaro virus from a patient in Trinidad in 1954 (6). Chikungunya has four genotypes: East/Central/South African, Western African, Indian Ocean and Asian (1), while Zika has two genetics lineages: Asian and African (7). Ecuador is susceptible to introductions of arboviruses transmitted by several mosquito vectors that are either well established or recently introduced and has thus experienced multiple and repeated introductions of these diseases. Of these, at present, only yellow fever has a widely available and licensed vaccine.
Keywords	Arboviruses ; Endemic and Emerging ; Ecuador ; Public aspects of medicine ; RA1-1270
Language	Spanish
Publishing date	2020-07-01T00:00:00Z
Publisher	Fundación Salud y Desarrollo Andino, Saludesa Ecuador
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Aedes albopictus en América del Sur y su relación con la distribución, y mantenimiento de enfermedades

Rachel Sippy / Fernando Moreira

Práctica Familiar Rural, Vol 1, Iss

2016 Volume 3

Abstract: Introducción: Ae. aegypti y Ae. albopictus son los vectores responsables de la transmisión de arbovirus en América Central y América del Sur. Objetivo: ERevisar los principales aspectos acerca de los vectores de arbovirus (Dengue, Chikungunya, y Zika), ... ...

Abstract	Introducción: Ae. aegypti y Ae. albopictus son los vectores responsables de la transmisión de arbovirus en América Central y América del Sur. Objetivo: ERevisar los principales aspectos acerca de los vectores de arbovirus (Dengue, Chikungunya, y Zika), su llegada al continente, y los métodos de control de los dos vectores. Metodología: Se realizó una revisión de bibliografía utilizando los términos: vector, arbovirus, central america, south america. Resultados: 21 estudios fueron revisados. Existen diferencias importantes entre las dos especies de mosquitos con relación a los tres arbovirus de mayor impacto en la salud pública de la región: Dengue, Chikungunya, y Zika. Dengue se transmite en las Américas desde hace 35 años a través de Ae. aegypti. En cambio, Ae. albopictus llegó recién a Brasil en 1986 y América Central en 1988 por medio de mercancías, específicamente con el transporte de neumáticos usados. Ha habido un éxito limitado en el control de la transmisión de los arbovirus por parte de los dos vectores con la introducción de la bacteria Wolbachia Conclusiones: Se requieren más estudios para profundizar la relación entre vectores y los arbovirus para mejorar estrategias de control de transmisión de estas enfermedades cuyo impacto en la salud pública sigue creciendo.
Keywords	vector ; arbovirus ; américa central ; américa del sur ; Public aspects of medicine ; RA1-1270
Language	Spanish
Publishing date	2016-11-01T00:00:00Z
Publisher	Fundación Salud y Desarrollo Andino, Saludesa Ecuador
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A national analysis of risk for potential chronic kidney disease of unknown etiology in Ecuador

Rachel Sippy / Martín Lotto / Abigail Bideaux / Irene Torres / Sriram Narsipur / Ramya Bhargava / Anna Stewart

Práctica Familiar Rural, Vol 5, Iss

2020 Volume 2

Abstract: An increase of chronic kidney disease (CKD) has affected many tropical countries but with an atypical presentation. This illness, known as Chronic Kidney Disease of Unknown Etiology (CKDu), presents in younger adults without the typical comorbidities for ...

Abstract	An increase of chronic kidney disease (CKD) has affected many tropical countries but with an atypical presentation. This illness, known as Chronic Kidney Disease of Unknown Etiology (CKDu), presents in younger adults without the typical comorbidities for CKD, often among those working in agricultural production. The cause of disease is unknown but temperature, heat stress, or dehydration are thought to contribute to the development of this condition. There is no information on whether anyone in Ecuador is affected by this illness. We describe CKD rates in Ecuador and hypothesize that CKD is impacted by temperature and the agricultural industry in Ecuador. Using publicly available data from the Instituto Nacional de Estadísticas y Censos from the years 2010—2015, we describe the rate of CKD among adults aged 20—45 in each province, as well as the agricultural industry across Ecuador. We combined this information with land surface temperature and used a Poisson mixed effects model to assess the relationship between mean temperature, maximum temperature and agricultural industry with CKD rates among adults aged 20—49 in each province. We found that the CKD rate is increasing in this age group over 2010—2015 (p=0.017), and in 2015, CKD rates were highest in Pastaza. Our spatial analysis found that both mean temperature and proportion of population in agriculture were positively associated with CKD rate by province in 2014 and 2015. This preliminary analysis shows that temperature and agricultural industry are associated with CKD rates among adults aged 20—49. While this association does not definitively show the presence of CKDu, it provides evidence to support further investigation of this illness in Ecuador.
Keywords	chronic kidney disease ; agricultural workers ; tropical zones ; Public aspects of medicine ; RA1-1270
Subject code	630
Language	Spanish
Publishing date	2020-07-01T00:00:00Z
Publisher	Fundación Salud y Desarrollo Andino, Saludesa Ecuador
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Increasing arbovirus risk in Chile and neighboring countries in the Southern Cone of South America

Elizabet L. Estallo / Rachel Sippy / Michael A. Robert / Salvador Ayala / Carlos J. Barboza Pizard / Pastor E. Pérez-Estigarribia / Anna M. Stewart-Ibarra

The Lancet Regional Health. Americas, Vol 23, Iss , Pp 100542- (2023)

2023

Keywords	Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Chronic kidney disease in Ecuador

Irene Torres / Rachel Sippy / Kevin Louis Bardosh / Ramya Bhargava / Martín Lotto-Batista / Abigail E Bideaux / Ramon Garcia-Trabanino / Amelia Goldsmith / Sriram S Narsipur / Anna M Stewart-Ibarra

PLoS ONE, Vol 17, Iss 3, p e

An epidemiological and health system analysis of an emerging public health crisis.

2022 Volume 0265395

Abstract: The absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of CKD along with increasing diabetes, hypertension and population age. From 2012, ...

Abstract	The absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of CKD along with increasing diabetes, hypertension and population age. From 2012, augmented funding for renal replacement therapy expanded dialysis clinics and patient coverage. We conducted 73 in-depth sociological interviews with healthcare providers in eight provinces and collected quantitative epidemiological data on patients with CKD diagnoses from six national-level databases between 2015 and 2018. Datasets show a total of 17,484 dialysis patients in 2018, or 567 patients per million population (pmp), with an annual cost exceeding 11% of Ecuador's public health budget. Each year, there were 139-162 pmp new dialysis patients, while doctors reported waiting lists. The number of patients on peritoneal dialysis was static; those on hemodialysis increased over time. Only 13 of 24 provinces were found to have dialysis services, and nephrologists were clustered in major cities, which limits access, delays medical attention, and adds a travel burden on patients. Prevention and screening programs are scarce, while hospitalization is an important reality for CKD patients. CKD is an emerging public health crisis that has increased dramatically over the last decade in Ecuador and is expected to continue, making coverage for all patients impossible and the current structure, unsustainable. A patient registry would help health policymakers and administrators estimate the demand and progression of patients with consideration for comorbidities, disease stage, requirements and costs, mortality and follow-up. This should be used to help identify where to focus prevention and improved treatment efforts. Organized monitoring of CKD patients would benefit from improvements in patient referral. Community-based education and prevention programs, the strengthening of primary healthcare capacity (including basic routine tests) and improved nephrology services ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360 ; 610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Chronic kidney disease in Ecuador

Irene Torres / Rachel Sippy / Kevin Louis Bardosh / Ramya Bhargava / Martín Lotto-Batista / Abigail E. Bideaux / Ramon Garcia-Trabanino / Amelia Goldsmith / Sriram S. Narsipur / Anna M. Stewart-Ibarra

PLoS ONE, Vol 17, Iss

An epidemiological and health system analysis of an emerging public health crisis

2022 Volume 3

Abstract	The absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of CKD along with increasing diabetes, hypertension and population age. From 2012, augmented funding for renal replacement therapy expanded dialysis clinics and patient coverage. We conducted 73 in-depth sociological interviews with healthcare providers in eight provinces and collected quantitative epidemiological data on patients with CKD diagnoses from six national-level databases between 2015 and 2018. Datasets show a total of 17,484 dialysis patients in 2018, or 567 patients per million population (pmp), with an annual cost exceeding 11% of Ecuador’s public health budget. Each year, there were 139–162 pmp new dialysis patients, while doctors reported waiting lists. The number of patients on peritoneal dialysis was static; those on hemodialysis increased over time. Only 13 of 24 provinces were found to have dialysis services, and nephrologists were clustered in major cities, which limits access, delays medical attention, and adds a travel burden on patients. Prevention and screening programs are scarce, while hospitalization is an important reality for CKD patients. CKD is an emerging public health crisis that has increased dramatically over the last decade in Ecuador and is expected to continue, making coverage for all patients impossible and the current structure, unsustainable. A patient registry would help health policymakers and administrators estimate the demand and progression of patients with consideration for comorbidities, disease stage, requirements and costs, mortality and follow-up. This should be used to help identify where to focus prevention and improved treatment efforts. Organized monitoring of CKD patients would benefit from improvements in patient referral. Community-based education and prevention programs, the strengthening of primary healthcare capacity (including basic routine tests) and improved nephrology services ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360 ; 610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Household and climate factors influence Aedes aegypti presence in the arid city of Huaquillas, Ecuador.

James L Martin / Catherine A Lippi / Anna M Stewart-Ibarra / Efraín Beltrán Ayala / Erin A Mordecai / Rachel Sippy / Froilán Heras Heras / Jason K Blackburn / Sadie J Ryan

PLoS Neglected Tropical Diseases, Vol 15, Iss 11, p e

2021 Volume 0009931

Abstract: Arboviruses transmitted by Aedes aegypti (e.g., dengue, chikungunya, Zika) are of major public health concern on the arid coastal border of Ecuador and Peru. This high transit border is a critical disease surveillance site due to human movement- ... ...

Abstract	Arboviruses transmitted by Aedes aegypti (e.g., dengue, chikungunya, Zika) are of major public health concern on the arid coastal border of Ecuador and Peru. This high transit border is a critical disease surveillance site due to human movement-associated risk of transmission. Local level studies are thus integral to capturing the dynamics and distribution of vector populations and social-ecological drivers of risk, to inform targeted public health interventions. Our study examines factors associated with household-level Ae. aegypti presence in Huaquillas, Ecuador, while accounting for spatial and temporal effects. From January to May of 2017, adult mosquitoes were collected from a cohort of households (n = 63) in clusters (n = 10), across the city of Huaquillas, using aspirator backpacks. Household surveys describing housing conditions, demographics, economics, travel, disease prevention, and city services were conducted by local enumerators. This study was conducted during the normal arbovirus transmission season (January-May), but during an exceptionally dry year. Household level Ae. aegypti presence peaked in February, and counts were highest in weeks with high temperatures and a week after increased rainfall. Univariate analyses with proportional odds logistic regression were used to explore household social-ecological variables and female Ae. aegypti presence. We found that homes were more likely to have Ae. aegypti when households had interruptions in piped water service. Ae. aegypti presence was less likely in households with septic systems. Based on our findings, infrastructure access and seasonal climate are important considerations for vector control in this city, and even in dry years, the arid environment of Huaquillas supports Ae. aegypti breeding habitat.
Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
Subject code	910
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Seasonal patterns of dengue fever in rural Ecuador

Rachel Sippy / Diego Herrera / David Gaus / Ronald E Gangnon / Jonathan A Patz / Jorge E Osorio

PLoS Neglected Tropical Diseases, Vol 13, Iss 5, p e

2009-2016.

2019 Volume 0007360

Abstract: Season is a major determinant of infectious disease rates, including arboviruses spread by mosquitoes, such as dengue, chikungunya, and Zika. Seasonal patterns of disease are driven by a combination of climatic or environmental factors, such as ... ...

Abstract	Season is a major determinant of infectious disease rates, including arboviruses spread by mosquitoes, such as dengue, chikungunya, and Zika. Seasonal patterns of disease are driven by a combination of climatic or environmental factors, such as temperature or rainfall, and human behavioral time trends, such as school year schedules, holidays, and weekday-weekend patterns. These factors affect both disease rates and healthcare-seeking behavior. Seasonality of dengue fever has been studied in the context of climatic factors, but short- and long-term time trends are less well-understood. With 2009-2016 medical record data from patients diagnosed with dengue fever at two hospitals in rural Ecuador, we used Poisson generalized linear modeling to determine short- and long-term seasonal patterns of dengue fever, as well as the effect of day of the week and public holidays. In a subset analysis, we determined the impact of school schedules on school-aged children. With a separate model, we examined the effect of climate on diagnosis patterns. In the first model, the most important predictors of dengue fever were annual sinusoidal fluctuations in disease, long-term trends (as represented by a spline for the full study duration), day of the week, and hospital. Seasonal trends showed single peaks in case diagnoses, during mid-March. Compared to the average of all days, cases were more likely to be diagnosed on Tuesdays (risk ratio (RR): 1.26, 95% confidence interval (CI) 1.05-1.51) and Thursdays (RR: 1.25, 95% CI 1.02-1.53), and less likely to be diagnosed on Saturdays (RR: 0.81, 95% CI 0.65-1.01) and Sundays (RR: 0.74, 95% CI 0.58-0.95). Public holidays were not significant predictors of dengue fever diagnoses, except for an increase in diagnoses on the day after Christmas (RR: 2.77, 95% CI 1.46-5.24). School schedules did not impact dengue diagnoses in school-aged children. In the climate model, important climate variables included the monthly total precipitation, an interaction between total precipitation and monthly ...
Keywords	Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
Subject code	910
Language	English
Publishing date	2019-05-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A decade of arbovirus emergence in the temperate southern cone of South America

Elizabet L. Estallo / Rachel Sippy / Anna M. Stewart-Ibarra / Marta G. Grech / Elisabet M. Benitez / Francisco F. Ludueña-Almeida / Mariela Ainete / María Frias-Cespedes / Michael Robert / Moory M. Romero / Walter R. Almirón

Heliyon, Vol 6, Iss 9, Pp e04858- (2020)

dengue, Aedes aegypti and climate dynamics in Córdoba, Argentina

2020

Abstract: Background: Argentina is located at the southern temperate range of arboviral transmission by the mosquito Aedes aegypti and has experienced a rapid increase in disease transmission in recent years. Here we present findings from an entomological ... ...

Abstract	Background: Argentina is located at the southern temperate range of arboviral transmission by the mosquito Aedes aegypti and has experienced a rapid increase in disease transmission in recent years. Here we present findings from an entomological surveillance study that began in Córdoba, Argentina, following the emergence of dengue in 2009. Methods: From 2009 to 2017, larval surveys were conducted monthly, from November to May, in 600 randomly selected households distributed across the city. From 2009 to 2013, ovitraps (n = 177) were sampled weekly to monitor the oviposition activity of Ae. aegypti. We explored seasonal and interannual dynamics of entomological variables and dengue transmission. Cross correlation analysis was used to identify significant lag periods. Results: Aedes aegypti were detected over the entire study period, and abundance peaked during the summer months (January to March). We identified a considerable increase in the proportion of homes with juvenile Ae. aegypti over the study period (from 5.7% of homes in 2009–10 to 15.4% of homes in 2016–17). Aedes aegypti eggs per ovitrap and larval abundance were positively associated with temperature in the same month. Autochthonous dengue transmission peaked in April, following a peak in imported dengue cases in March; autochthonous dengue was not positively associated with vector or climate variables. Conclusions: This longitudinal study provides insights into the complex dynamics of arbovirus transmission and vector populations in a temperate region of arbovirus emergence. Our findings suggest that Córdoba is well suited for arbovirus disease transmission, given the stable and abundant vector populations. Further studies are needed to better understand the role of regional human movement.
Keywords	Aedes aegypti ; Argentina ; Dengue ; Ovitrap ; Larval surveys ; Surveillance ; Science (General) ; Q1-390 ; Social sciences (General) ; H1-99
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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