American Journal of Tropical Medicine and Hygiene
March 2016; 94 (3)
http://www.ajtmh.org/content/current

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Perspective Piece
Travel Vaccines Enter the Digital Age: Creating a Virtual Immunization Record
Kumanan Wilson, Katherine M. Atkinson, and Cameron P. Bell
Am J Trop Med Hyg 2016 94:485-488; Published online December 28, 2015, doi:10.4269/ajtmh.15-0510
Abstract
At present, proof of immunization against diseases such as yellow fever is required at some international borders in concordance with the International Health Regulations. The current standard, the International Certificate of Vaccination or Prophylaxis (ICVP), has limitations as a paper record including the possibility of being illegible, misplaced, or damaged. We believe that a complementary, digital record would offer advantages to public health and travelers alike. These include enhanced availability and reliability, potential to include lot specific information, and integration with immunization information systems. Challenges exist in implementation, particularly pertaining to verification at border crossings. We describe a potential course for the development and implementation of a digital ICVP record.

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Articles
Community Attitudes Toward Mass Drug Administration for Control and Elimination of Neglected Tropical Diseases After the 2014 Outbreak of Ebola Virus Disease in Lofa County, Liberia
Joshua Bogus, Lincoln Gankpala, Kerstin Fischer, Alison Krentel, Gary J. Weil, Peter U. Fischer,
Karsor Kollie, and Fatorma K. Bolay
Am J Trop Med Hyg 2016 94:497-503; Published online December 14, 2015, doi:10.4269/ajtmh.15-0591
Abstract
The recent outbreak of Ebola virus disease (EVD) interrupted mass drug administration (MDA) programs to control and eliminate neglected tropical diseases in Liberia. MDA programs treat entire communities with medication regardless of infection status to interrupt transmission and eliminate lymphatic filariasis and onchocerciasis. Following reports of hostilities toward health workers and fear that they might be spreading EVD, it was important to determine whether attitudes toward MDA might have changed after the outbreak. We surveyed 140 community leaders from 32 villages in Lofa County, Liberia, that had previously participated in MDA and are located in an area that was an early epicenter of the EVD outbreak. Survey respondents reported a high degree of community trust in the MDA program, and 97% thought their communities were ready to resume MDA. However, respondents predicted that fewer people would comply with MDA after the EVD epidemic than before. The survey also uncovered fears in the community that EVD and MDA might be linked. Respondents suggested that MDA programs emphasize to people that the medications are identical to those previously distributed and that MDA programs have nothing to do with EVD.

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Articles
Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica
Danny V. Colombara, Bernardo Hernández, Claire R. McNellan, Sima S. Desai, Marielle C. Gagnier, Annie Haakenstad, Casey Johanns, Erin B. Palmisano, Diego Ríos-Zertuche, Alexandra Schaefer, Paola Zúñiga-Brenes, Nicholas Zyznieuski, Emma Iriarte, and Ali H. Mokdad
Am J Trop Med Hyg 2016 94:544-552; Published online January 19, 2016, doi:10.4269/ajtmh.15-0750
Abstract
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011–2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ2 tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0–5 months, those 6–23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.