Although the lack of significant evidence for increasing case numbers due to the cessation of smallpox vaccination has been discussed [9], we detected all recent human cowpox cases in people too young to have been vaccinated against smallpox.
There are several different strategies for increasing case finding, such as active case finding (ACF), enhanced case finding (ECF) [ 29], and expanded passive case finding via increased interaction with private sectors [ 30].
In response to the recent gang-rape incident, a legislator in Rajasthan suggested banning skirts as a uniform for girls in private schools, citing it as the reason for increased cases of sexual harassment.
She also notes that the fact that many immigrants flock to Florida makes for increased cases of identity fraud, in part because these newcomers lack of knowledge of the lending system makes them vulnerable to schemes.
However, the change in age distribution of patients toward a much older age group suggests that increased testing is not the main reason for increased case detection.
Future studies should address whether the binary toxin or an unknown co-expressed factor might be responsible for increased case-fatality rates.
While the most commonly used diagnostic tool (sputum smear microscopy) is imperfect and can only detect on average half of the cases, new molecular-based tools for TB diagnosis are available, and are part of the WHO strategy for increased case detection [ 27].
For the decreasing case, replacing φ and ψ by -φ and -ψ, respectively, apply the above discussion for the increasing case.
Although vaccination is the key strategy for preventing disease, vaccine for boosters was unavailable during 2011, which might be a reason for the increased cases.
The number of cases at baseline was lower in the intervention district compared to the controls, and this may partly account for the increased case finding, where starting low gives a high proportional increase.
