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Mohamud AK, Ali IA, Ali AI, Dirie NI, Inchon P, Ahmed OA, Mohamud AA. Assessment of healthcare workers' knowledge and attitude on Ebola virus disease in Somalia: a multicenter nationwide survey. BMC Public Health 2023; 23:1650. [PMID: 37641041 PMCID: PMC10464228 DOI: 10.1186/s12889-023-16562-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In September 2022, a new Ebola outbreak was reported in Uganda, East Africa, and 142 confirmed cases, including 19 Healthcare workers (HCWs) reported. Ebola is not endemic in Somalia, but the country is at a reasonable risk of the virus being introduced due to the direct connection with daily flights from Uganda without border health control and prevention activities. Therefore, evaluating HCWs' Knowledge and attitude is crucial since this is the first time being evaluated in Somalia. The study's objective is to evaluate the HCWs' Knowledge and attitude toward the Ebola virus disease in Somalia. METHOD An online self-administrated cross-sectional survey was conducted among HCWs (n = 1103) in all six federal member states of Somalia using a validated, reliable, well-structured questionnaire. Data we analyzed using descriptive statistics and Logistic regression were used to determine sociodemographic characteristics associated with poor Knowledge and negative attitude. RESULT Over one-third (37.3%) of HCWs had poor Knowledge; the mean knowledge score was 7.97 SD ± 2.15. Almost 40.1% of the HCWs had a negative attitude; the mean attitude was 27.81 SD ± 8.06. Low-income HCWs (AOR = 2.06, 95%CI:1.01-4.19), Married HCWs (AOR = 1.39, 95%CI: 1.110-1.963), Midwives (AOR = 2.76, 95%CI: 1.74-4.39), Lab technicians (AOR = 2.43, 95%CI: 1.43-4.14), HCWs work in Jubaland state of Somalia (AOR = 3.69, 95%CI: 2.39-5.70), Galmudug state (AOR = 8.50, 95%CI: 4.59-15.77), Hirshabelle state (AOR = 3.18, 95%CI: 2.15-4.71) were more likely to have poor Knowledge compared to their counterparts. HCWs who work in Hirshabelle state (AOR = 5.44,95%CI: 3.58-8.27), Jubaland state (AOR = 8.47, 95%CI: 4.69-15.29), and Galmudug state (AOR = 4.43, 95%CI: 3.03-6.48) was more likely to have a negative attitude than those working in the Banadir region administration. CONCLUSION Most Somali healthcare workers showed good Knowledge and a positive attitude toward the Ebola virus. The implementation to enhance Knowledge and attitude must specifically focus on low-income HCWs, Midwives, Lab technicalities, and those who work in Hirshabelle, Jubaland, and Galmudug states of Somalia.
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Affiliation(s)
| | - Ikran Abdulkadir Ali
- Department of Neonatal Intensive Care Unit in Yardimeli Hospital Mogadishu, Mogadishu, Somalia
| | - Ahmed Isse Ali
- Dermatology of Department, Mogadishu-Somali Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Najib Isse Dirie
- Department of Urology, Dr Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Pamornsri Inchon
- Department of Public Health, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand
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Misconceptions and Rumors about Ebola Virus Disease in Sub-Saharan Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084714. [PMID: 35457585 PMCID: PMC9027331 DOI: 10.3390/ijerph19084714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
We sought to summarize knowledge, misconceptions, beliefs, and practices about Ebola that might impede the control of Ebola outbreaks in Africa. We searched Medline, EMBASE, CINAHL, and Google Scholar (through May 2019) for publications reporting on knowledge, attitudes, and practices (KAP) related to Ebola in Africa. In total, 14 of 433 articles were included. Knowledge was evaluated in all 14 articles, and they all highlighted that there are misconceptions and risk behaviors during an Ebola outbreak. Some communities believed that Ebola spreads through the air, mosquito bites, malice from foreign doctors, witchcraft, and houseflies. Because patients believe that Ebola was caused by witchcraft, they sought help from traditional healers. Some people believed that Ebola could be prevented by bathing with salt or hot water. Burial practices where people touch Ebola-infected corpses were common, especially among Muslims. Discriminatory attitudes towards Ebola survivors or their families were also prevalent. Some Ebola survivors were not accepted back in their communities; the possibility of being ostracized from their neighborhoods was high and Ebola survivors had to lead a difficult social life. Most communities affected by Ebola need more comprehensive knowledge on Ebola. Efforts are needed to address misconceptions and risk behaviors surrounding Ebola for future outbreak preparedness in Africa.
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Huynh N, Baumann A, Loeb M. Reporting quality of the 2014 Ebola outbreak in Africa: A systematic analysis. PLoS One 2019; 14:e0218170. [PMID: 31237909 PMCID: PMC6592536 DOI: 10.1371/journal.pone.0218170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to conduct a systematic analysis of the reporting quality of the Ebola Virus Disease (EVD) outbreak in West Africa from 2014-2018 using the Modified STROBE statement. We included studies on the 2014 EVD outbreak alone, limited to those on human patients in Africa. We searched the following databases (MEDLINE, EMBASE, and Web of Science) for outbreak reports published between 2014-2018. We assessed factors potentially associated with the quality of reporting. A total of 69 of 131 (53%) articles within the full-text review fulfilled our eligibility criteria and underwent the Modified STROBE assessment for analyzing the quality of reporting. The Modified STROBE scores of the included studies ranged from 11-26 points and the mean was found to be 19.54 out of 30 with a standard deviation (SD) of ± 4.30. The top three reported Modified STROBE components were descriptive characteristics of study participants, scientific background and evidence rational, and clinical significance of observations. More than 75% of the studies met a majority of the criteria in the Modified STROBE assessment tool. Information that was commonly missing included addressing potential source of bias, sensitivity analysis, further results/analysis such as risk estimates and odds ratios, presence of a flowchart, and addressing missing data. In multivariable analysis, peer-reviewed publication was the only predictor that remained significantly associated with a higher Modified STROBE score. In conclusion, the large range of Modified STROBE scores observed indicates variability in the quality of outbreak reports for EVD. The review identified strong reporting in some areas, whereas other areas are in need of improvement, in particular providing an important description of the outbreak setting and identifying any external elements (potential biases and confounding factors) that could hinder the credibility of the findings.
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Affiliation(s)
- Nina Huynh
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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Kirchdoerfer RN, Saphire EO, Ward AB. Cryo-EM structure of the Ebola virus nucleoprotein-RNA complex. ACTA CRYSTALLOGRAPHICA SECTION F-STRUCTURAL BIOLOGY COMMUNICATIONS 2019; 75:340-347. [PMID: 31045563 DOI: 10.1107/s2053230x19004424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 02/17/2023]
Abstract
Ebola virus is an emerging virus that is capable of causing a deadly disease in humans. Replication, transcription and packaging of the viral genome are carried out by the viral nucleocapsid. The nucleocapsid is a complex of the viral nucleoprotein, RNA and several other viral proteins. The nucleoprotein forms large, RNA-bound, helical filaments and acts as a scaffold for additional viral proteins. The 3.1 Å resolution single-particle cryo-electron microscopy structure of the nucleoprotein-RNA helical filament presented here resembles previous structures determined at lower resolution, while providing improved molecular details of protein-protein and protein-RNA interactions. The higher resolution of the structure presented here will facilitate the design and characterization of novel and specific Ebola virus therapeutics targeting the nucleocapsid.
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Affiliation(s)
- Robert N Kirchdoerfer
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Erica Ollmann Saphire
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Andrew B Ward
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
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5
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Fulchini R, Kohler P, Kahlert CR, Albrich WC, Kuhn R, Hoffmann M, Schlegel M. Hand hygiene adherence in relation to influenza season during 6 consecutive years. Am J Infect Control 2018; 46:1311-1314. [PMID: 29784445 DOI: 10.1016/j.ajic.2018.04.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/26/2022]
Abstract
Hand hygiene (HH) is the single most important measure in reducing the burden of healthcare-acquired infections. Based on 12,740 HH opportunities observed during 6 consecutive years at our tertiary care center, HH adherence among healthcare workers (HCWs) was significantly better during influenza season compared to non-influenza periods, after controlling for important covariables (odds ratio = 1.17, 95% confidence interval 1.05-1.30). This finding suggests that HH awareness is increased during influenza periods, which could have implications for HCW education.
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6
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Wendelboe AM, McCumber M, Erb-Alvarez J, Mould N, Childs RW, Regens JL. Managing emerging transnational public health security threats: lessons learned from the 2014 West African Ebola outbreak. Global Health 2018; 14:75. [PMID: 30053868 PMCID: PMC6064117 DOI: 10.1186/s12992-018-0396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/11/2018] [Indexed: 11/11/2022] Open
Abstract
Background Pandemics pose significant security/stability risks to nations with fragile infrastructures. We evaluated characteristics of the 2014 West African Ebola outbreak to elucidate lessons learned for managing transnational public health security threats. Methods We used publically available data to compare demographic and outbreak-specific data for Guinea, Sierra Leone, and Liberia, including key indicator data by the World Health Organization. Pearson correlation statistics were calculated to compare country-level infrastructure characteristics with outbreak size and duration. Results Hospital bed density was inversely correlated with longer EVD outbreak duration (r = − 0.99). Country-specific funding amount allocations were more likely associated with number of incident cases than the population at-risk or infrastructure needs. Key indicators demonstrating challenges for Guinea included: number of unsafe burials, percent of EVD-positive samples, and days between symptom onset and case hospitalization. Sierra Leone’s primary key indicator was the number of districts with ≥1 security incident. Liberia controlled their outbreak before much of the key-indicator data were collected. Conclusion Many of the country-level factors, particularly the WHO key indicators were associated with controlling the epidemic. The infrastructure of countries affected by communicable diseases should be assessed by international political and public health leaders.
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Affiliation(s)
- Aaron M Wendelboe
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 323, Oklahoma City, OK, 73104, USA.
| | - Micah McCumber
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 323, Oklahoma City, OK, 73104, USA
| | - Julie Erb-Alvarez
- Indian Health Service, US Public Health Service, 701 Market Drive, Oklahoma City, OK, 73114, USA.,Division of Intramural Research, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Nicholas Mould
- Center for Intelligence and National Security, University of Oklahoma, 755 Research parkway, Suite 520, Oklahoma City, OK, 73104, USA
| | - Richard W Childs
- National Heart Lung and Blood Institute, Hematology Branch, Section of Transplantation Immunotherapy, National Institutes of Health, Building 10-CRC, Room 3-5330, Bethesda, MD, 20814, USA
| | - James L Regens
- Center for Intelligence and National Security, University of Oklahoma, 755 Research parkway, Suite 520, Oklahoma City, OK, 73104, USA
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7
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Wu L, Zhang Z, Gao H, Li Y, Hou L, Yao H, Wu S, Liu J, Wang L, Zhai Y, Ou H, Lin M, Wu X, Liu J, Lang G, Xin Q, Wu G, Luo L, Liu P, Shentu J, Wu N, Sheng J, Qiu Y, Chen W, Li L. Open-label phase I clinical trial of Ad5-EBOV in Africans in China. Hum Vaccin Immunother 2017; 13. [PMID: 28708962 DOI: 10.1002/smll.201701815] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/31/2017] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND To determine the safety and immunogenicity of a novel recombinant adenovirus type 5 vector based Ebola virus disease vaccine (Ad5-EBOV) in Africans in China. METHODS A phase 1, dose-escalation, open-label trial was conducted. 61 healthy Africans were sequentially enrolled, with 31 participants receiving one shot intramuscular injection and 30 participants receiving a double-shot regimen. Primary and secondary end points related to safety and immunogenicity were assessed within 28 d after vaccination. This study was registered with ClinicalTrials.gov (NCT02401373). RESULTS Ad5-EBOV is well tolerated and no adverse reaction of grade 3 or above was observed. 53 (86.89%) participants reported at least one adverse reaction within 28 d of vaccination. The most common reaction was fever and the mild pain at injection site, and there were no significant difference between these 2 groups. Ebola glycoprotein-specific antibodies appeared in all 61 participants and antibodies titers peaked after 28 d of vaccination. The geometric mean titres (GMTs) were similar between these 2 groups (1919.01 vs 1684.70 P = 0.5562). The glycoprotein-specific T-cell responses rapidly peaked after 14 d of vaccination and then decreased, however, the percentage of subjects with responses were much higher in the high-dose group (60.00% vs 9.68%, P = 0.0014). Pre-existing Ad5 neutralizing antibodies could significantly dampen the specific humoral immune response and cellular response to the vaccine. CONCLUSION The application of Ad5-EBOV demonstrated safe in Africans in China and a specific GP antibody and T-cell response could occur 14 d after the first immunization. This acceptable safety profile provides a reliable basis to proceed with trials in Africa.
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MESH Headings
- Adult
- Africa/epidemiology
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- China
- Ebola Vaccines/administration & dosage
- Ebola Vaccines/adverse effects
- Ebola Vaccines/immunology
- Ebolavirus/immunology
- Female
- Fever/ethnology
- Healthy Volunteers
- Hemorrhagic Fever, Ebola/epidemiology
- Hemorrhagic Fever, Ebola/ethnology
- Hemorrhagic Fever, Ebola/immunology
- Hemorrhagic Fever, Ebola/prevention & control
- Humans
- Immunity, Cellular
- Immunity, Humoral
- Immunogenicity, Vaccine
- Injections, Intramuscular
- Male
- Membrane Glycoproteins/immunology
- Middle Aged
- T-Lymphocytes/immunology
- Vaccination
- Young Adult
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Affiliation(s)
- Lihua Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Zhe Zhang
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Hainv Gao
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
- d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
| | - Yuhua Li
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - Lihua Hou
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Hangping Yao
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Shipo Wu
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Jian Liu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Ling Wang
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - You Zhai
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Huilin Ou
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Meihua Lin
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Xiaoxin Wu
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
- d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
| | - Jingjing Liu
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - Guanjing Lang
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Qian Xin
- f The General Hospital of People's Liberation Army , Beijing , China
| | - Guolan Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Li Luo
- g Department of Epidemiology and Biostatistics , School of Public Health, Southeast University , Nanjing , Jiangsu , China
| | - Pei Liu
- g Department of Epidemiology and Biostatistics , School of Public Health, Southeast University , Nanjing , Jiangsu , China
| | - Jianzhong Shentu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Nanping Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Jifang Sheng
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Yunqing Qiu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Wei Chen
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Lanjuan Li
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
- d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
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Abstract
Unprecedented global effort is under way to facilitate the testing of countermeasures in infectious disease emergencies. Better understanding of the various options for trial design is needed in advance of outbreaks, as is preliminary global agreement on the most suitable designs for the various scenarios. What would enhance the speed, validity, and ethics of clinical studies of such countermeasures? Focusing on studies of vaccine efficacy and effectiveness in emergencies, we highlight three needs: for formal randomized trials-even in most emergencies; for individually randomized trials-even in many emergencies; and for six areas of innovation in trial methodology. These needs should inform current updates of protocols and roadmaps.
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Affiliation(s)
- Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, and Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Nir Eyal
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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9
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Wu L, Zhang Z, Gao H, Li Y, Hou L, Yao H, Wu S, Liu J, Wang L, Zhai Y, Ou H, Lin M, Wu X, Liu J, Lang G, Xin Q, Wu G, Luo L, Liu P, Shentu J, Wu N, Sheng J, Qiu Y, Chen W, Li L. Open-label phase I clinical trial of Ad5-EBOV in Africans in China. Hum Vaccin Immunother 2017; 13:2078-2085. [PMID: 28708962 DOI: 10.1080/21645515.2017.1342021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To determine the safety and immunogenicity of a novel recombinant adenovirus type 5 vector based Ebola virus disease vaccine (Ad5-EBOV) in Africans in China. METHODS A phase 1, dose-escalation, open-label trial was conducted. 61 healthy Africans were sequentially enrolled, with 31 participants receiving one shot intramuscular injection and 30 participants receiving a double-shot regimen. Primary and secondary end points related to safety and immunogenicity were assessed within 28 d after vaccination. This study was registered with ClinicalTrials.gov (NCT02401373). RESULTS Ad5-EBOV is well tolerated and no adverse reaction of grade 3 or above was observed. 53 (86.89%) participants reported at least one adverse reaction within 28 d of vaccination. The most common reaction was fever and the mild pain at injection site, and there were no significant difference between these 2 groups. Ebola glycoprotein-specific antibodies appeared in all 61 participants and antibodies titers peaked after 28 d of vaccination. The geometric mean titres (GMTs) were similar between these 2 groups (1919.01 vs 1684.70 P = 0.5562). The glycoprotein-specific T-cell responses rapidly peaked after 14 d of vaccination and then decreased, however, the percentage of subjects with responses were much higher in the high-dose group (60.00% vs 9.68%, P = 0.0014). Pre-existing Ad5 neutralizing antibodies could significantly dampen the specific humoral immune response and cellular response to the vaccine. CONCLUSION The application of Ad5-EBOV demonstrated safe in Africans in China and a specific GP antibody and T-cell response could occur 14 d after the first immunization. This acceptable safety profile provides a reliable basis to proceed with trials in Africa.
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Affiliation(s)
- Lihua Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Zhe Zhang
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Hainv Gao
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China.,d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
| | - Yuhua Li
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - Lihua Hou
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Hangping Yao
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Shipo Wu
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Jian Liu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Ling Wang
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - You Zhai
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Huilin Ou
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Meihua Lin
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Xiaoxin Wu
- b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China.,d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
| | - Jingjing Liu
- e National Institutes for Food and Drug Control , Chongwen District, Beijing , China
| | - Guanjing Lang
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Qian Xin
- f The General Hospital of People's Liberation Army , Beijing , China
| | - Guolan Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Li Luo
- g Department of Epidemiology and Biostatistics , School of Public Health, Southeast University , Nanjing , Jiangsu , China
| | - Pei Liu
- g Department of Epidemiology and Biostatistics , School of Public Health, Southeast University , Nanjing , Jiangsu , China
| | - Jianzhong Shentu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Nanping Wu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Jifang Sheng
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Yunqing Qiu
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China
| | - Wei Chen
- c Beijing Institute of Biotechnology , Haidian District, Beijing , China
| | - Lanjuan Li
- a The First Affiliated Hospital, College of Medicine, Zhejiang University , Xiacheng District, Hangzhou , Zhejiang , China.,b The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Xiacheng District, Hangzhou , Zhejiang , China.,d Zhejiang University International Hospital , Xiacheng District, Hangzhou , Zhejiang , China
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Schafer IJ, Knudsen E, McNamara LA, Agnihotri S, Rollin PE, Islam A. The Epi Info Viral Hemorrhagic Fever (VHF) Application: A Resource for Outbreak Data Management and Contact Tracing in the 2014-2016 West Africa Ebola Epidemic. J Infect Dis 2016; 214:S122-S136. [PMID: 27587635 DOI: 10.1093/infdis/jiw272] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Epi Info Viral Hemorrhagic Fever application (Epi Info VHF) was developed in response to challenges managing outbreak data during four 2012 filovirus outbreaks. Development goals included combining case and contact data in a relational database, facilitating data-driven contact tracing, and improving outbreak data consistency and use. The application was first deployed in Guinea, when the West Africa Ebola epidemic was detected, in March 2014, and has been used in 7 African countries and 2 US states. Epi Info VHF enabled reporting of compatible data from multiple countries, contributing to international Ebola knowledge. However, challenges were encountered in accommodating the epidemic's unexpectedly large magnitude, addressing country-specific needs within 1 software product, and using the application in settings with limited Internet access and information technology support. Use of Epi Info VHF in the West Africa Ebola epidemic highlighted the fundamental importance of good data management for effective outbreak response, regardless of the software used.
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Affiliation(s)
- Ilana J Schafer
- Epi Info Team, Division of Health Informatics and Surveillance Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology
| | - Erik Knudsen
- Epi Info Team, Division of Health Informatics and Surveillance
| | - Lucy A McNamara
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Pierre E Rollin
- Viral Special Pathogens Branch, Division of High Consequence Pathogens and Pathology
| | - Asad Islam
- Epi Info Team, Division of Health Informatics and Surveillance
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11
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Bedrosian SR, Young CE, Smith LA, Cox JD, Manning C, Pechta L, Telfer JL, Gaines-McCollom M, Harben K, Holmes W, Lubell KM, McQuiston JH, Nordlund K, O'Connor J, Reynolds BS, Schindelar JA, Shelley G, Daniel KL. Lessons of Risk Communication and Health Promotion - West Africa and United States. MMWR Suppl 2016; 65:68-74. [PMID: 27386834 DOI: 10.15585/mmwr.su6503a10] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
During the response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC addressed the disease on two fronts: in the epidemic epicenter of West Africa and at home in the United States. Different needs drove the demand for information in these two regions. The severity of the epidemic was reflected not only in lives lost but also in the amount of fear, misinformation, and stigma that it generated worldwide. CDC helped increase awareness, promoted actions to stop the spread of Ebola, and coordinated CDC communication efforts with multiple international and domestic partners. CDC, with input from partners, vastly increased the number of Ebola communication materials for groups with different needs, levels of health literacy, and cultural preferences. CDC deployed health communicators to West Africa to support ministries of health in developing and disseminating clear, science-based messages and promoting science-based behavioral interventions. Partnerships in West Africa with local radio, television, and cell phone businesses made possible the dissemination of messages appropriate for maximum effect. CDC and its partners communicated evolving science and risk in a culturally appropriate way to motivate persons to adapt their behavior and prevent infection with and spread of Ebola virus. Acknowledging what is and is not known is key to effective risk communication, and CDC worked with partners to integrate health promotion and behavioral and cultural knowledge into the response to increase awareness of the actual risk for Ebola and to promote protective actions and specific steps to stop its spread. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
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Affiliation(s)
- Sara R Bedrosian
- Division of Public Affairs, Office of the Associate Director for Communication, CDC
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12
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Daughton AR, Velappan N, Abeyta E, Priedhorsky R, Deshpande A. Novel Use of Flu Surveillance Data: Evaluating Potential of Sentinel Populations for Early Detection of Influenza Outbreaks. PLoS One 2016; 11:e0158330. [PMID: 27391232 PMCID: PMC4938434 DOI: 10.1371/journal.pone.0158330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/14/2016] [Indexed: 11/18/2022] Open
Abstract
Influenza causes significant morbidity and mortality each year, with 2-8% of weekly outpatient visits around the United States for influenza-like-illness (ILI) during the peak of the season. Effective use of existing flu surveillance data allows officials to understand and predict current flu outbreaks and can contribute to reductions in influenza morbidity and mortality. Previous work used the 2009-2010 influenza season to investigate the possibility of using existing military and civilian surveillance systems to improve early detection of flu outbreaks. Results suggested that civilian surveillance could help predict outbreak trajectory in local military installations. To further test that hypothesis, we compare pairs of civilian and military outbreaks in seven locations between 2000 and 2013. We find no predictive relationship between outbreak peaks or time series of paired outbreaks. This larger study does not find evidence to support the hypothesis that civilian data can be used as sentinel surveillance for military installations. We additionally investigate the effect of modifying the ILI case definition between the standard Department of Defense definition, a more specific definition proposed in literature, and confirmed Influenza A. We find that case definition heavily impacts results. This study thus highlights the importance of careful selection of case definition, and appropriate consideration of case definition in the interpretation of results.
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Affiliation(s)
- Ashlynn R. Daughton
- Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, NM, United States of America
- * E-mail: (ARD); (AD)
| | - Nileena Velappan
- Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM, United States of America
| | - Esteban Abeyta
- Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, NM, United States of America
| | - Reid Priedhorsky
- High Performance Computing Division, Los Alamos National Laboratory, Los Alamos, NM, United States of America
| | - Alina Deshpande
- Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, Los Alamos, NM, United States of America
- * E-mail: (ARD); (AD)
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Dahl BA, Kinzer MH, Raghunathan PL, Christie A, De Cock KM, Mahoney F, Bennett SD, Hersey S, Morgan OW. CDC's Response to the 2014-2016 Ebola Epidemic - Guinea, Liberia, and Sierra Leone. MMWR Suppl 2016; 65:12-20. [PMID: 27388930 DOI: 10.15585/mmwr.su6503a3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa was the largest in the agency's history and occurred in a geographic area where CDC had little operational presence. Approximately 1,450 CDC responders were deployed to Guinea, Liberia, and Sierra Leone since the start of the response in July 2014 to the end of the response at the end of March 2016, including 455 persons with repeat deployments. The responses undertaken in each country shared some similarities but also required unique strategies specific to individual country needs. The size and duration of the response challenged CDC in several ways, particularly with regard to staffing. The lessons learned from this epidemic will strengthen CDC's ability to respond to future public health emergencies. These lessons include the importance of ongoing partnerships with ministries of health in resource-limited countries and regions, a cadre of trained CDC staff who are ready to be deployed, and development of ongoing working relationships with U.S. government agencies and other multilateral and nongovernment organizations that deploy for international public health emergencies. CDC's establishment of a Global Rapid Response Team in June 2015 is anticipated to meet some of these challenges. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
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