Capillariasis%20

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Capillariasis Objectives of Investigation

• Describe extent (prevalence) and severity
  (morbidity
• and mortality) of epidemic
• Confirm (or refute) etiologic agent as
  nematode C.
• phillipinesis
• Identify original source of epidemic
• Identify mode(s) of transmission
• Recommend strategy for control of epidemic

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Resources Available

• Personnel epidemiologist, lab techs, trilingual
  (?) nursing students
• Small regional hospital
• Limited equipment dissecting scope, stool cups,
  aquariums
• Consultants parasitologist, internist

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Research Agenda

• Select study site
• Establish diagnostic criteria
• Identify affected population
• STOP epidemic

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Capillariasis Diagnostic Criteria
Pathologic protein losing enteropathy Clinical
diarrhea, weight loss, malaise,
anorexia, edema, and tummy rumbling Laborator
y Presence of capillaria eggs and/or larvae in
stool specimens
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Population Distribution of Pudoc WestOctober
1965 January 1968

• Age Male Female Total
• (percent in age category)
• lt1 5 6 11 (2)
• 1-4 54 50 107 (15)
• 5-9 62 52 115 (16)
• 10-14 49 46 95 (13)
• 15-19 32 35 67 (9)
• 20-29 57 62 119 (16)
• 30-39 44 44 88 (12)
• 40-49 17 23 40 (6)
• 50-59 17 21 38 (5)
• 60 15 30 45 (6)
• Total 352 369 725 (100)

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Cumulative Population

• Population 725
• Gender ratio (MF) 0.95
• Households 112

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Case Characteristics

• Gender ratio
• Cases 1.771
• Deaths 1.851
• Relatively few children

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Family/Household Study Questionnaire
Household number Name Age Sex Address Relationship
to index case Occupation and approximate time
spent in each () Household pets illnesses or
deaths? Number of individuals in
household Dietary history Sanitary history
place of defecation consistent? Adequacy and
use of water supply Travel history Use of shoes
and percent of time used Specimen taken Specimens
from pets History of cough, respiratory
difficulties, joint or muscle pain
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Relationship of Infection to Disease

• cases with capillariasis 100
• Non-cases with capillariasis 16
• Interval to symptoms 1 month (11-72 days)

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Distribution of Capillariasis within Households

• No cases 20 households
• One case 28 households
• gt1 case 64 households
• Sequential (gt1 month) 53/64 (83) households
• interval between cases

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Initial vs. Subsequent Cases

• Initial cases
• Gender ratio (MF) 71
• Percentage of males aged 10-59 79
• Close to sea
• Subsequent cases
• Gender ratio (MF) 11
• Age distribution same as population
• Even geographic distribution

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Evidence in Favor of Indirect Transmission

• Age-sex distribution of initial cases
• Association of disease with occupation
• Proximity of cases to the sea
• Decreasing density of cases with distance from
  coast
• Evidence in Favor of Direct Transmission
• Age-sex distribution of subsequent cases
• Distribution of cases within multiple case
  households
• Intervals between household cases suggesting
  sequential infection
• Distribution of involved households within the
  barrio
• Effect of treatment on the spread of the epidemic