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Mould allergies and allergic rhinitis order atomoxetine no prescription medications 5113, often called hay fever atomoxetine 40 mg with mastercard symptoms parkinsons disease, affect about 10 to 20 per cent of the population purchase atomoxetine overnight treatment 34690 diagnosis, Dr. Paul Keith, an allergist and associate professor at McMaster University, said in an interview. Hypersensitivity pneumonitis (HP) can develop over time in people who are sensitive to mold spores in the air. Even people that have a history of nasal allergies but do not have a known history of asthma may experience thunderstorm asthma.” People with asthma and allergic rhinitis often notice increased symptoms during and after storms, especially thunderstorms. "You could have very lush growth, but if rains hit at strategic times of spring, they could essentially wash out the pollen and reduce the pollen count," said Dyer. One thing they do agree on, however, is that the county is likely to experience a nasty grass pollen season, beginning within the next few weeks and hitting its peak around the end of spring. There are a few common mistakes among those who suspect that their cold-like symptoms are actually related to a pollen allergy. Nasal steroid sprays, such as Flonase, Nasonex or Rhinocort, suppress inflammation and other allergic symptoms where they start, in the nasal airways and throat. Over-the-counter allergy/cold medications may help people with mild allergies that last only a couple of days several times a year. When the rain stops and the sun comes out, the mold problem is reduced, but the pollens fill the air. When it rains, the pollen count is low, but mold can be at its worst, with spores traveling more than 50 miles in the air. For rainy allergy symptoms, many people choose pre-treatment measures to prevent rain headaches before they begin. Changes in barometric pressure and pollen after rain can also affect sinus pain in some people as well. It will also address the effects of pollen after rain on a barometric pressure headache and how to find relief from rainy allergy symptoms. The night-time hay fever attack is more likely in the city because it takes longer for air to cool in the urban environment because the pavements and buildings give out heat, keeping the air warm. But if the rain is occurring around a thunderstorm, then the humidity in the air around this time can make pollen grains burst open, releasing a high density of pollen grains into the surrounding air. Additionally, mold spores can increase after heavy rains, causing even more suffering for people allergic to mold. I do often get patients thinking they could be allergic to mold, but these are not the symptoms of true allergies,” she says. Rainy season also creates the perfect environment for mold—sometimes lots of it—to invade our homes. In addition, grass pollen levels can be affected by temperature, time of day and rain. Many of the plants (especially grasses) and molds are common to most plant zones in the US. Additionally, other related plants can also trigger the same symptoms. Weather conditions can affect the amount of pollen in the air at any given time. Pollens from spring trees, grasses, weeds and ragweed cause significant allergic reactions. If you have allergies at the same time every year, get ahead of the problem and ask your doctor for allergy remedies which you can begin taking ahead of time and in many cases you can prevent the symptoms before they even begin. A wet growing season would have the opposite effect, with rain aiding the growth of pollen-producing grass, plants and trees. If the mild conditions continue into spring, the higher pollen counts will be found earlier in the season. The change of seasons has a big impact on allergies and pollen generation: a mild winter can mean an early start to the allergy season with earlier onset of pollination of trees and plants. Pollen tends to travel more with warm, dry and windy weather, all of which can increase unpleasant allergy symptoms. Allergy symptoms are often reduced on rainy or windless days because the pollen does not circulate as much during these conditions. Weather plays an important role in how much pollen is produced, how it is distributed and how much pollen is in the air at any given time. If you suffer with allergies to pollen, the spring and summer months can be especially unpleasant and spoil many a day spent outdoors enjoying the fine weather. Our own Pollinosan tablets should be taken three times daily , meaning that the levels of these hayfever-fighting herbs stay constant in your body all day and night. How to combat night-time hayfever symptoms. This in particular explains why some people experience their worst symptoms early in the morning, after a night of sleeping in a pollen-laden bedroom. Spirometry, patient history, the Clinical COPD Questionnaire(CCQ) and the Asthma Control Questionnaire(ACQ) were assessed; we used the latter to evaluate morning (question 2) and night symptoms (question 1). A total of 1159 (51.9%) patients reported morning symptoms (ACQ question 2>0) and 879 (39.4%) had night complaints (ACQ question 1>0). Dust mites are some of the most bothersome allergens that you can find around your home. The U.S. National Institute of Allergy and Infectious Diseases encourages people to wash their sheets in temperatures exceeding 130° in order to kill dust mites. Bedding offers the perfect warm and moist living environment for dust mites as well as other types of allergens. Now that you are more familiar with the five most common bedroom allergens, it is time plan your strategy and fight back. If it is the flu and within 72 hours from the start of symptoms, there are some treatments your doctor can order you that may shorten the amount of time you are feeling sick. Dust mites are microscopic insects that live all around us and feed on the millions of dead skin cells that fall off our bodies every day. To reduce allergic reactions and symptoms from pollen allergies, the AAFA recommends that you: In test tubes, quercetin stops the production and release of histamine, which causes allergy symptoms, such as a runny nose and watery eyes. History of allergies, especially hay fever, or asthma. Not everyone is allergic to dust mites, but if you are, then, beyond nasal congestion, you may also experience coughing, shortness of breath, wheezing, and headaches. And considering that your head is on the pillow for roughly seven to nine hours a day, you spend a lot of time up close and personal with dust mites. More than 75% of hay fever sufferers are allergic to at least one common houseplant, found a Belgian study. One potential reason: Bacteria and yeast in the alcohol produce histamines, chemicals that cause telltale allergy symptoms like stuffy nose and itchy eyes. At BreatheAmerica, we believe that your cure is found not by treating your symptoms, but by taking a comprehensive look at your medical history and finding a solution that promotes total airway health We may find that you have more of an allergy trigger problem than an asthma problem. The purpose of the pollen count is to help those with hayfever be able to identify days when the pollen count is high. She says allergy tests rarely confirm wattle is what sets off hayfever for most people. Otherwise known as seasonal allergic rhinitis, hayfever affects about 15 per cent of Australians.
Spoil the pleasures of spring-time for people with pollen allergies discount atomoxetine 10 mg mastercard medications causing pancreatitis. Eye Drops such as ketotifen (Zaditor) can be bought over the counter to relieve seasonal allergy symptoms such itchy cheap atomoxetine 25 mg with visa treatment diabetes, watery eyes buy cheap atomoxetine 40mg on line medicine 5e. It is important to consult a doctor on treating Hay Fever if you do not find relief from the symptoms with medication, or if you have another condition that can worsen Hay Fever symptoms, such as nasal polyps, asthma, or frequent sinus infections. Hay fever causes symptoms such as runny nose, itchy eyes, congestion, sneezing, and sinus pressure to occur. Your doctor may also diagnose you with other conditions related to allergies, such as Hay Fever and Asthma. Mold is also a common spring allergy trigger that spreads like pollen. When these pollens get into the nose of someone who is allergic, they cause the person to release histamines into the blood that lead to symptoms such as runny nose, itchy eyes, and more. The Asthma and Allergy Foundation of America states that grasses are the most widespread trigger for individuals with hay fever. Birch is one of the most common triggers in northern latitudes, where a lot of people with hay fever react to its pollen. Trees are the cause of a good numbers of springtime seasonal allergies. Mold also causes typical allergy symptoms, such as sneezing, congestion, a runny nose, or watery eyes that are itchy. Sometimes the immune system incorrectly identifies substances or even parts of the body as a threat, causing an allergic skin reaction to occur. Patients who suffer from severe allergies or cannot avoid allergens are often good candidates for allergen immunotherapy. Allergy medications can be very effective in controlling symptoms but do not cure the allergic reaction. Allergy eye drops help relieve the symptoms of eye allergies. There are two types of immunotherapy treatments: subcutaneous immunotherapy (SCIT), also known as allergy shots, and sublingual immunotherapy (SLIT), or allergy drops. Usually, perennial allergies cause nasal symptoms ( allergic rhinitis ) but not eye symptoms ( allergic conjunctivitis ). However, allergic conjunctivitis can result when certain substances are purposely or inadvertently placed in the eyes. For most people, the best long term treatment for venom allergy is immunotherapy, or allergy shots. The other mainstays of allergy treatment - avoiding allergens or using medicines to control symptoms - only make temporary changes. This allergic reaction is triggered by food and environmental allergens and causes white blood cells in the throat to become inflamed. This type of testing is particularly appropriate for people with asthma that is not well-controlled, those who are pregnant, who have rare skin conditions that do not allow them to stop taking antihistamine medication for five days prior to skin testing, or who are taking a high blood pressure medication, or certain types of eye drops. Inhaling allergens such as dust mite droppings, mold, pet dander and pollen creates asthmatic symptoms. Up to 80 percent of asthma patients have allergic triggers, and more than 60 percent of allergy patients have symptoms of asthma or signs of reactive airway disease on breathing tests. Many patients find significant relief with immunotherapy, which can be done with allergy shots or the sometimes preferred liquid drops under the tongue. Many eye care practitioners believe the best type of soft contact lenses for people prone to eye allergies are daily disposable lenses that are discarded after a single use, which decreases the buildup of allergens and other debris on the lens surface. As the old saying goes: "An ounce of prevention is worth a pound of cure." (By the way, Benjamin Franklin said that — the same guy who invented bifocals !) The best approach to controlling your eye allergy symptoms is to do everything you can to limit your exposure to common allergens you are sensitive to. Eye allergies also can be caused by reactions to certain cosmetics or eye drops , including artificial tears used for treating dry eyes that contain preservatives. The most common airborne allergens that cause eye allergies are pollen, mold, dust and pet dander. Normally harmless substances that cause problems for individuals who are predisposed to allergic reactions are called allergens. The American College of Allergy, Asthma and Immunology estimates that 50 million people in the United States have seasonal allergies, and its prevalence is increasing — affecting up to 30 percent of adults and up to 40 percent of children. But small doses of the foods can blunt allergic reactions. The aim is to get the body slowly used to the allergen and thereby build up immunological protection that will reduce or even prevent further allergic reactions. The food is introduced slowly to the immune system in the hope of the allergic individual tolerating the food without overreacting to it. The particular food is ingested daily and is gradually increased to a determined maximum amount (maintenance dose) with the goal of allowing the food to eventually be consumed without an allergic reaction (i.e., desensitized). Treatment for the uncomfortable symptoms of allergic conjunctivitis include over-the-counter and prescription drops and medications. Allergy shots can be very beneficial to alleviate environmental allergy symptoms for a long time and can greatly minimize risk of severe reaction if allergic to insect stings. Symptoms of inhaled or skin reactions may include itchy watery eyes, sneezing, rashes, hives, or an itchy runny nose. What types of medications are used for asthma and respiratory symptoms resulting from an allergic reaction? Immunotherapy is a type of treatment for allergic children with hay fever and/or asthma. What are types of medications used for asthma and respiratory symptoms resulting from an allergic reaction? Mild reactions include local symptoms (affecting a specific area of the body) such as a rash or hives ; itchiness, watery/red eyes, hay fever , and runny nose. Anyone who has had allergic reactions from bee stings should be seen by a board-certified allergy/immunology doctor to confirm by skin and/or blood testing to bee venom that they have an allergy. Treatment may include medications to control nasal/eye and chest symptoms. The first time an allergy-prone person is exposed to a specific allergen (such as pollen), the body responds by producing allergic (IgE) antibodies. Modified Food Allergens — The immune system of an allergic person recognizes specific proteins in an allergenic food (kind of like if I was allergic to sandwiches” but my immune system only reacts to the lettuce in that sandwich). In recent presentations of the data, the OIT studies have been able to temporarily desensitize many patients, but there have been more reactions during the building-up phase and target dose” phase compared to some other treatments. Sublingual immunotherapy, or allergy drops, is a way to treat allergies without shots or medicines. Of course, the preferable way to treat allergies is to avoid the foods that cause allergies in the first place, thereby avoiding the occurrence of allergic reactions. In combination with medication or immunotherapy, Dr. Langford will educate you on how to avoid the circumstances that trigger your asthma or allergic reactions. They also explain the differences between allergic reactions that take place in the eye and those that affect other parts of the body. The dose gradually increases over time to help your body become immune to the allergens. Artificial tear drops help relieve eye allergies temporarily by washing allergens from the eye. Once you have been diagnosed with a food allergy, talk to your doctor about how to treat your allergic reactions.
These episodes respond to the administration of parenteral glucose and water (Chap 10 mg atomoxetine medicine 93 948. The disorders of ketolysis may present with a more or less pure ketoacidosis in which there is no hypogly- cemia buy atomoxetine 10 mg otc symptoms 7 days pregnant, hyperglycemia purchase atomoxetine toronto symptoms norovirus, organic aciduria, lactic acidemia, B2 Metabolic Emergencies 35 B2. Deﬁnitive diagnosis documents deﬁciencies in tyrate to acetoacetate are useful in elucidating activity of a growing group of enzymes and mutations the area of metabolic defect. It is also true that levels are variable; even in patients with known mito- chondrial disease the concentration of lactic acid is not The lactic acidemias represent a family of disorders of always increased. Under these circumstances large distant from many of the enzymatic steps that are defec- elevations of pyruvate concentration might be expected, tive, especially those of the electron transport chain. Accumulating pyruvate does not For the evaluation of energy metabolism, lactate lead to large elevations of pyruvate concentration; but should be determined repeatedly throughout the day rather to conversion to its two sinks, lactate and ala- (especially before and after meals). Alanine is not falsely fall into two categories, defects in gluconeogenesis raised by problems of technique. It is important rigorous about methods of sampling and to obtain in the work-up to distinguish clearly into which of the blood ﬂowing freely without a tourniquet. Continued fasting for up to 24 hours Elevated [Lactate] Ratio requires gluconeognesis to avoid hypoglycemia. If urinary lactate is acidemia, resulting from absorption of d-lactic acid pro- found more consistently elevated than blood lactate, duced by intestinal bacteria (see also Chap. Most predominant or even isolated disease of the kidney is such patients have obvious malabsorption or short-gut to be considered. At ﬁrst seemingly unrelated to the syndromes, metabolic acidosis, and massive lactic aci- underlying mitochondrial disorders, patients often duria, found by colorimetric test or by urinary organic show a constant thrombocytosis and hypertrichosis. Testing for lactate in routine clinical Before embarking on a speciﬁc investigation for lac- chemistry is now usually done in an enzymatic assay, tic acidemia it is important to exclude conditions that which is speciﬁc for l-lactate, so this situation is often cause secondary lactic acidemia. The discrepancy between urine emia, hypoventilation, shock, or hypoperfusion are and blood lactate levels, plus the history, is the key to generally readily recognized as patients with sepsis, diagnosis. Anaerobic exercise also cin or metronidazole will cause a dramatic fall in d-lac- produces lactic acidemia, but this is seldom clinically tate production, and the lactic acidemia will disappear. A variety of inherited metabolic diseases produce secondary lactic Remember acidemia including propionic aciduria, methylmalonic Before embarking on a work-up for lactic acidemia aciduria, isovaleric aciduria, 3-hydroxy-3-methylglutaric exclude functions or secondary lactic acidemias, which aciduria, and pyroglutamic aciduria. In primary Acidemia (Congenital or Late- defects of the respiratory chain, the redox state may become more abnormal; in addition, and there may even Onset) be a rise of total ketone bodies (paradoxical ketonemia). A postprandial fall of lactate occurs in glycogen storage Once it has been decided that a patient has lactic aci- disease type I and defects of gluconeogenesis. Fasting with pyruvate, 3-hydroxybutyrate and acetoacetate pref- studies are not appropriate in the diagnosis of a child erably from the same samples collected in tubes pre- with a defect in fatty acid oxidation. Elevated ratios of the cytosolic Prior to the initiation of fasting, blood is obtained for (lactate:pyruvate >20) as well as of the mitochondrial glucose, lactate, pyruvate, and alanine. An ele- order to deplete the liver of glycogen made from glu- vated ratio of lactate:pyruvate without elevation of the cose, and the glucose response is determined at 15, 30, 3-hydroxybutyrate:acetoacetate ratio is indicative of 45, 60, and 90min. In these patients, be a sizeable increase in glucose (>20%) except in gly- elevations of the amino acids citrulline and lysine may cogenosis type I. The ﬁrst 16 h are the least hazardous; so should happen overnight T(ime) = 0° (4 p. Lactate, pyruvate, 3-hydroxybutyrate, acetoacetate collected in perchloric acid tube. Collect urine for quantitative analysis of organic acids If blood sugar is <40 mg/dL (2. In the presence of any symptoms or if glucose does not rise, give 2 mL of 20% or 4 mL of 10% glucose/kg b. During this time if as to the area of the defect may be obtained by loading there is no rise in glucose, the defect is in gluconeo- tests, with fructose (Chap. Glucose is given intravenously to restore nor- Each compound is given by mouth as a 20% solution moglycemia without waiting for the usual interval of a 6–12 h postprandially in a dose of 1 g/kg. The elucidation of alanine, acylcarnitines, free fatty acids, and ketone oxidation defects may be initiated by obtaining a skin bodies are determined at the end of the fast. A diet high in fat and glycemic patient concentrations of insulin, growth low in carbohydrate, with vitamin supplementation hormone and glucagon are also obtained at the time the can be begun while waiting for sufﬁcient quantities fast is terminated. Fibroblasts may be assayed for will be raised in a struggling child, and as a result of a defects in the pyruvate dehydrogenase complex. Defects in the ﬁrst enzyme of the complex, pyruvate Errors in sample acquisition, technique, and sample decarboxylase or E1a, can also be tested for by muta- handling all raise the lactate level measured by the tional analysis. I glycogen storage disease, there is minimal produc- tion of glucose in response to glucagon, whereas lac- tate will increase markedly. In the further work-up of a patient with a defect in gluconeogenesis who fails the fasting test it is conve- Key References nient to assay biotinidase in serum or blood spot, and carboxylase activity in leukocytes or ﬁbroblasts; in this Munnich A (2006) Defects of the respiratory chain. Springer, Berlin, dase deﬁciency) or pyruvate carboxylase deﬁciency can pp 197–209 be made. Hodder Arnold, London, pp 303–369 whom these are not the diagnoses, such as those with Smeitink J, van den Heuvel L, DiMauro S (2001) The genetics fructose-1,6-diphosphatase deﬁciency, require liver and pathology of oxidative phosphorylation. Nat Rev Genet biopsy for deﬁnitive enzyme assay, but the diagnosis 2:342–352 B2 Metabolic Emergencies 39 B2. This permits the distinction of ketotic hypo- with Hypoglycemia glycemia, which includes the disorders of carbohydrate metabolism and the transient disorder termed ketotic hypoglycemia, from hypoketotic hypoglycemia, which, William L. Nyhan in the absence of hyperinsulinemia, includes most of the disorders of fatty acid oxidation. Key Facts Acute hypoglycemia is a manifestation of a variety of different disorders. Its prompt recognition and rever- › Timely determination of blood concentrations sal are critical because this absence of substrate for of insulin, growth hormone, and cortisol at the cerebral metabolism can lead to permanent damage of time of hypoglycemia can elucidate endocrino- brain just as surely as can lack of oxygen. Hypoglycemia is deﬁned as a educate these colleagues of the importance of serum concentration under 50mg/dL (3mmol/L) or a obtaining metabolic testing. However, there is little evi- totic hypoglycemia is best made by determina- dence that the brain of the very young is any more toler- tion of free-fatty acids, acetoacetate, and ant of hypoglycemia, and we prefer to maintain 3-hydroxybutyrate at the time of hypoglycemia. There may be vomit- ing, but this may be the result of an intercurrent illness that induces the acute hypoglycemic episode. Headache, Hypoglycemia must be recognized promptly and lethargy, altered behavior, or psychosis may be seen in treated effectively, if permanent damage to the brain is older children and adults, while apnea, tachypnea, to be prevented. Treatment means bringing the blood cyanosis, or hypothermia may occur in the newborn. Rational treatment demands a speciﬁc diagnosis are a chronic occurrence, for example, patients with von of the disease causing the hypoglycemia. Determination Gierke disease or glycogen synthase deﬁciency tolerate of the blood concentrations of insulin, growth hor- surprisingly low levels without symptomatology. Also, mone, and cortisol at the time of hypoglycemia leads sudden drops in glucose levels are more apt to induce to the deﬁnition of the classic forms of hypoglycemia. The meta- bolic causes of hypoglycemia may be elucidated by the response to fasting and determination of the levels of B2.
Other Lymphatic flariasis is closely associated with the economies and infrastructure of endemic communities generic 10mg atomoxetine with visa symptoms stroke. Tere is an established link between reduced produc- tivity discount 18 mg atomoxetine amex medicine hat, poverty and the prevalence of lymphatic flariasis 40 mg atomoxetine mastercard symptoms vaginitis. Prevention and control measures Case management Identifcation of microflariae in a blood smear by microscopic examination con- frms the diagnosis of active infection. Blood collection should be done at night, when microflariae circulate in peripheral blood. However, as lymphoedema devel- I ops many years afer infection, the results of laboratory tests are most likely to be negative for these patients. A single dose at 6 mg/kg is equally efective for killing the adult worm and in reducing the number of micro- flaria. Knowledge of the geographical distribution of lymphatic flariasis and Loa loa is useful for decision-making on appropriate treatment. Prevention Transmission of infection can be interrupted by Minimizing contact between humans and vectors (through vector control and avoiding mosquito bites; Reducing the amount of infectious agent the vector can acquire (by treating the human host). The Global Programme to Eliminate Lymphatic Filariasis, launched in 2000, has two main goals: to interrupt transmission of infection and to prevent disability caused by the disease. Note that onchocerciasis has recently re-emerged in the south-western regions of Côte d’Ivoire. Epidemic control Because of relatively low infectivity and long incubation, epidemics of lymphatic flariasis are unlikely. Coordinated use of anthelminthic drugs in control interventions: a manual for health professionals and programme managers. If treatment for falciparum malaria is inefective or delayed, the parasite will multiply and severe malaria may result. Features of severe malaria include: coma (cerebral malaria), metabolic acidosis, severe anaemia, hypoglycaemia and, in adults, acute renal failure or acute pulmonary oedema. If untreated, severe malaria is almost always fatal; with treatment, fatality is about 15–20%. Patients can progress from having minor symptoms to severe disease within a few hours. In Côte d’Ivoire, young children are at risk of severe malaria, as are pregnant women in whom immunity is reduced. Infectious agent The main parasite species in Côte d’Ivoire is Plasmodium falciparum. This causes the most life-threatening form of the disease and accounts for > 90% of all deaths attributable to malaria. Case defnition Uncomplicated malaria Patient with fever or history of fever within the past 48 hours (with or without other symptoms such as nausea, vomiting and diarrhoea, headache, back pain, chills, muscle pains and fatigue). Severe malaria Patient with symptoms as for uncomplicated malaria, plus drowsiness with extreme weakness and associated signs and symptoms related to organ failure (e. Communicable disease epidemiological profle 121 Confrmed case (uncomplicated or severe) Patient with uncomplicated or severe malaria with laboratory confrmation of diag- nosis by blood flm for malaria parasites or other diagnostic tests for Plasmodium antigen. Mode of transmission This is a vector-borne disease, the vector being female Anopheles mosquitoes, which bite mainly between dusk and dawn. The major Anopheles species in Cote d’Ivoire are: arabiensis, brochieri, coustani, funesThis, gambiae, hancocki, hargreavesi, melas, moucheti, nili, paludis, and pharoensis. Rarely, malaria may also be transmitted through transfusion by injection of infected blood and in utero or during delivery. Important biological features of major malaria vectors in Africa Anopheles Resting Feeding time Host Breeding sites Insecticide species location and location preferences susceptibility A. Communicable disease epidemiological profle 122 Malaria should be considered in all cases of unexplained fever that start at any time between 1 week afer the frst possible exposure to malaria risk and 2 months (or even later in rare cases) afer the last possible exposure. Period of communicability Transmission is related to the presence of infective female Anopheles mosquitoes and of infective gametocytes in the blood of patients. Untreated or insufciently treated patients may be a source of infection for mosquitoes for up to 1–2 years for P. Epidemiology Disease burden Malaria remains a major public health problem globally. In 2006 there were an estimated 247 million cases and 881 000 deaths; 91% of deaths occurred in Africa and 85% were of children aged less than 5 years. In most countries, reported cases under-represent the actual total number of malaria cases, since many cases are not reported to national health-information systems nor captured by public health services as the patient seeks care at private pharmacies or from traditional healers. Estimated numbers of malaria cases and deaths, Côte d’Ivoire, 2006 Parameter Age group Estimated number Lower estimate Upper estimate of cases number cases number cases Fever suspected of All ages 21 572 000 13 289 000 30 133 000 being malaria < 5 years 12 056 000 2 016 000 23 275 000 Malaria cases All ages 7 029 000 4 330 000 9 818 000 < 5 years 3 928 000 Malaria deaths All ages 20 000 10 000 30 000 < 5 years 18 000 9 400 28 000 Malaria case-fatality All ages 0. Communicable disease epidemiological profle 123 Côte d’Ivoire had an estimated 7 million malaria cases in 2006 (Table 10), i. Tere was no evidence of a systematic decline in the number of malaria cases during 2001–2006. Malaria is the most frequent cause of medi- cal visits and hospitalization in Côte d’Ivoire and accounts for 33% of all hospital deaths. Children aged less than 5 years probably have around one to six malaria episodes each year (with an average of three episodes), and adults have around one to three episodes per year (more in rural settings). Malaria contributes to anaemia, neurological impairment and complications in pregnancy. Geographical distribution Malaria transmission occurs all over Cote d’Ivoire, ranging from high to very high. Seasonality Factors that infuence transmission include altitude, rainfall, humidity, tempera- ture and vegetation. Transmission occurs all year round throughout the country, but is more seasonal in the north, with upsurges during and just afer the rainy season; heavy unseasonal rain may lead to an increase in the number of cases. Outbreaks Malaria transmission is stable so there is no risk of epidemic in the general pop- ulation. Displaced populations arriving from areas of lower or no transmission of falciparum malaria may be at risk of an outbreak. Alert threshold Among populations displaced from areas of low endemicity, the following obser- vations may be used to trigger an outbreak investigation: A doubling of the number of cases compared with the baseline (average weekly number of cases reported over the previous 2–3 weeks), adjusted for fuctua- tions in clinic attendance due to external factors such as a sudden population infux. An increase in the incidence of severe cases and an increase in the incidence of cases in children aged > 5 years and in adults. Risk factors for increased burden Population movement Increased transmission and incidence associated with infux of less-immune popu- lations from an area of lower endemicity to an area of higher endemicity. Communicable disease epidemiological profle 125 Overcrowding Increased population density may lead to increased exposure to mosquito bites in temporary shelters. Poor access to health services Delay in access to efective treatment increases the likelihood of severe disease and death. This delay also increases the pool of carriers of the malaria gametocyte (the mature sexual stage of the parasite in humans that, once picked up in the blood meal of a mosquito, develops into the infective stage for transmission to another human).