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Huebl L, Nnyombi A, Kihumuro A, Lukwago D, Walakira E, Kutalek R. Perceptions of yellow fever emergency mass vaccinations among vulnerable groups in Uganda: A qualitative study. PLoS Negl Trop Dis 2024; 18:e0012173. [PMID: 38739650 DOI: 10.1371/journal.pntd.0012173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Yellow fever (YF), a mosquito-borne viral hemorrhagic fever, is endemic in Uganda and causes frequent outbreaks. A total of 1.6 million people were vaccinated during emergency mass immunization campaigns in 2011 and 2016. This study explored local perceptions of YF emergency mass immunization among vulnerable groups to inform future vaccination campaigns. METHODOLOGY In this qualitative study, we conducted 43 semi-structured interviews, 4 focus group discussions, and 10 expert interviews with 76 participants. Data were collected in six affected districts with emergency mass vaccination. We included vulnerable groups (people ≥ 65 years and pregnant women) who are typically excluded from YF vaccination except during mass immunization. Data analysis was conducted using grounded theory. Inductive coding was utilized, progressing through open, axial, and selective coding. PRINCIPAL FINDINGS Participants relied on community sources for information about the YF mass vaccination. Information was disseminated door-to-door, in community spaces, during religious gatherings, and on the radio. However, most respondents had no knowledge of the vaccine, and it was unclear to them whether a booster dose was required. In addition, the simultaneous presidential election during the mass vaccination campaign led to suspicion and resistance to vaccination. The lack of reliable and trustworthy information and the politicization of vaccination campaigns reinforced mistrust of YF vaccines. CONCLUSIONS/SIGNIFICANCE People in remote areas affected by YF outbreaks rely on community sources of information. We therefore recommend improving health education, communication, and engagement through respected and trusted community members. Vaccination campaigns can never be seen as detached from political systems and power relations.
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Affiliation(s)
- Lena Huebl
- Unit Medical Anthropology and Global Health, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aloysious Nnyombi
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Aban Kihumuro
- Department of Nursing and Health Sciences, Bishop Stuart University, Mbarara, Uganda
| | - Denis Lukwago
- Cluster Monitoring and Evaluation Lead, Rakai Health Sciences Program, Masaka, Uganda
| | - Eddy Walakira
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Ruth Kutalek
- Unit Medical Anthropology and Global Health, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Belem LRW, Ibemgbo SA, Gomgnimbou MK, Verma DK, Kaboré A, Kumar A, Sangaré I, Sunil S. Development of Multiplex Molecular Assays for Simultaneous Detection of Dengue Serotypes and Chikungunya Virus for Arbovirus Surveillance. Curr Issues Mol Biol 2024; 46:2093-2104. [PMID: 38534750 DOI: 10.3390/cimb46030134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/28/2024] Open
Abstract
The major arboviruses mainly belong to the Bunyaviridae, Togaviridae, and Flaviviridae families, among which the chikungunya virus and dengue virus have emerged as global public health problems. The main objective of this study was to develop specific, sensitive, and cost-effective molecular multiplex RT-PCR and RT-qPCR assays for the rapid and simultaneous detection of CHIKV and the four serotypes of DENV for arbovirus surveillance. Specific primers for all viruses were designed, and one-step multiplex RT-PCR (mRT-PCR) and RT-qPCR (mRT-qPCR) were developed using reference strains of the CHIKV and DENV serotypes. The specificity of the test for all the viruses was confirmed through sequencing. The standard curves showed a high correlation coefficient, R2 = 0.99, for DENV-2 and DENV-3; R2 = 0.98, for DENV-4; and CHIKV; R2 = 0.93, for DENV-1. The limits of detection were calculated to be 4.1 × 10-1 copies/reaction for DENV-1, DENV-3, and CHIKV and 4.1 × 101 for DENV-2 and DENV-4. The specificity and sensitivity of the newly developed mRT-PCR and mRT-qPCR were validated using positive serum samples collected from India and Burkina Faso. The sensitivity of mRT-PCR and mRT-qPCR are 91%, and 100%, respectively. The specificity of both assays was 100%. mRT-PCR and mRT-qPCR assays are low-cost, and a combination of both will be a useful tool for arbovirus surveillance.
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Affiliation(s)
- Louis Robert W Belem
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
- Centre d'Excellence Africain en Innovations Biotechnologiques pour l'Elimination des Maladies à Transmission Vectorielle (CEA/ITECH-MTV), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
- Ecole Doctorale Sciences Naturelles et Agronomiques (ED-SNA), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
- Laboratoire de Recherche, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso BP 10278, Burkina Faso
| | - Sylvester Agha Ibemgbo
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Michel Kiréopori Gomgnimbou
- Centre d'Excellence Africain en Innovations Biotechnologiques pour l'Elimination des Maladies à Transmission Vectorielle (CEA/ITECH-MTV), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
- Laboratoire de Recherche, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso BP 10278, Burkina Faso
- Institut Supérieur des Sciences de la Santé (INSSA), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
| | - Dileep Kumar Verma
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Antoinette Kaboré
- Laboratoire National de Référence, Institut National de Santé Publique, Ouagadougou BP 10278, Burkina Faso
| | - Ankit Kumar
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
| | - Ibrahim Sangaré
- Centre d'Excellence Africain en Innovations Biotechnologiques pour l'Elimination des Maladies à Transmission Vectorielle (CEA/ITECH-MTV), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
- Laboratoire de Recherche, Centre MURAZ, Institut National de Santé Publique, Bobo-Dioulasso BP 10278, Burkina Faso
- Institut Supérieur des Sciences de la Santé (INSSA), Université Nazi Boni, Bobo-Dioulasso 01 BP 1091, Burkina Faso
- Centre Hospitalier Universitaire Souro Sanou (CHUSS), Bobo-Dioulasso 01 BP 676, Burkina Faso
| | - Sujatha Sunil
- Vector Borne Diseases Group, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India
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Kiwanuka GN, Bajunirwe F, Alele PE, Oloro J, Mindra A, Marshall P, Loue S. Public health and research ethics education: the experience of developing a new cadre of bioethicists at a Ugandan institution. BMC Med Educ 2024; 24:1. [PMID: 38172860 PMCID: PMC10763195 DOI: 10.1186/s12909-023-04974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no "gold standard" for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still "foreign" is challenging and necessitates supportive leadership at all institutional levels.
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Affiliation(s)
- Gertrude N Kiwanuka
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Francis Bajunirwe
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Oloro
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Arnold Mindra
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Patricia Marshall
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sana Loue
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Lukindu M, Mukwaya LG, Masembe C, Birungi J. Behavioral Changes of Some Arboviral Vectors in Zika Forest: A Concern for Emerging and Re-Emerging Diseases in Uganda. Vector Borne Zoonotic Dis 2023; 23:653-661. [PMID: 37669008 DOI: 10.1089/vbz.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Background: The increasing reports on emerging/re-emerging arboviral disease outbreaks or epidemics in Sub-Saharan Africa have been impacted by factors, including the changing climate plus human activities that have resulted in land cover changes. These factors influence the prevalence, incidence, behavior, and distribution of vectors and vector-borne diseases. In this study, we assessed the potential effect of land cover changes on the distribution and oviposition behavior of some arboviral vectors in Zika forest, Uganda, which has decreased by an estimated 7 hectares since 1952 due to an increase in anthropogenic activities in the forest and its periphery. Materials and Methods: Immature mosquitoes were collected using bamboo pots and placed at various levels of a steel tower in the forest and at different intervals from the forest periphery to areas among human dwellings. Collections were conducted for 20 months. Results and Conclusion: Inside the forest, 22,280 mosquitoes were collected belonging to four arboviral vectors: Aedes aegypti, Aedes africanus, Aedes apicoargenteus, and Aedes cumminsii. When compared with similar studies conducted in the forest in 1964, there was a change from a sylvatic to a tendency of peridomestic behavior in A. africanus, which was now collected among human dwellings. There was an unexpected change in the distribution of A. aegypti, which was not only collected outside the forest as in previous reports but also collected in the forest. Conversely, A. cumminsii originally collected in the forest expanded its ranges with collections outside the forest in this study. Aedes simpsoni maintained its distribution range outside the forest among agricultural sites. We suspect that land cover changes were favorable to most of the arboviral vectors hence enhancing their proliferation and habitat range. This potentially increases the transmission of arboviral diseases in the area, hence impacting the epidemiology of emerging/remerging diseases in Uganda.
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Affiliation(s)
- Martin Lukindu
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Louis G Mukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Charles Masembe
- Department of Zoology, Entomology and Fisheries Science, College of Natural Sciences School, Makerere University, Kampala, Uganda
| | - Josephine Birungi
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
- International Livestock Research Institute, Nairobi, Kenya
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Hansen CA, Staples JE, Barrett ADT. Fractional Dosing of Yellow Fever Live Attenuated 17D Vaccine: A Perspective. Infect Drug Resist 2023; 16:7141-7154. [PMID: 38023411 PMCID: PMC10640814 DOI: 10.2147/idr.s370013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Yellow fever virus (YFV) is a mosquito-borne flavivirus that causes over 109,000 severe infections and over 51,000 deaths annually in endemic areas of sub-Saharan Africa and tropical South America. The virus has a transmission cycle involving mosquitoes and humans or non-human primates (NHPs) as the vertebrate hosts. Although yellow fever (YF) is prevented by a live attenuated vaccine (strain 17D), recent epidemics in Angola, the Democratic Republic of the Congo (DRC), and Brazil put great pressure on vaccine stockpiles. This resulted in the World Health Organization (WHO) and Pan American Health Organization (PAHO) implementing, on an emergency basis only, off-label dose-sparing techniques and policies during 2016-2018 to protect as many people in DRC and Brazil as possible from disease during unexpected large outbreaks of YF. Subsequently non-inferiority studies involving full doses compared to fractional doses indicated promising results, leading some policy-makers and scientists to consider utilizing YF vaccine fractional doses in non-emergency scenarios. Although the additional data on the immunogenicity and safety of fractional doses are promising, there are several questions and considerations that remain regarding the use of fractional doses, including differences in the initial antibody kinetics, differences in the immune response in certain populations, and durability of the immune response to fractional doses compared to full doses. Until the remaining knowledge gaps are addressed, full doses instead of fractional doses should continue to be used unless there are insufficient doses of the vaccine available to control outbreaks of YF.
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Affiliation(s)
- Clairissa A Hansen
- Department of Pathology and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, 77555-4036, USA
| | - J Erin Staples
- Arboviral Diseases Branch, U.S. Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Alan D T Barrett
- Department of Pathology and Sealy Institute for Vaccine Sciences, University of Texas Medical Branch, Galveston, TX, 77555-4036, USA
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Bonney JHK, Sanders T, Pratt D, Agbodzi B, Laryea D, Agyeman NKF, Kumordjie S, Attiku K, Adams PL, Boateng GA, Ohene SA, Tamal C, Mawuli G, Yeboah C, Dadzie S, Kubio C, Asiedu-Bekoe F, Odoom JK. Molecular Characterization of Circulating Yellow Fever Viruses from Outbreak in Ghana, 2021-2022. Emerg Infect Dis 2023; 29:1818-1826. [PMID: 37610174 PMCID: PMC10461649 DOI: 10.3201/eid2909.221671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Yellow fever virus, transmitted by infected Aedes spp. mosquitoes, causes an acute viral hemorrhagic disease. During October 2021-February 2022, a yellow fever outbreak in some communities in Ghana resulted in 70 confirmed cases with 35 deaths (case-fatality rate 50%). The outbreak started in a predominantly unvaccinated nomadic community in the Savannah region, from which 65% of the cases came. The molecular amplification methods we used for diagnosis produced full-length DNA sequences from 3 confirmed cases. Phylogenetic analysis characterized the 3 sequences within West Africa genotype II; strains shared a close homology with sequences from Cote d'Ivoire and Senegal. We deployed more sensitive advanced molecular diagnostic techniques, which enabled earlier detection, helped control spread, and improved case management. We urge increased efforts from health authorities to vaccinate vulnerable groups in difficult-to-access areas and to educate the population about potential risks for yellow fever infections.
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Juan-Giner A, Namulwana ML, Kimathi D, Grantz KH, Fall G, Dia M, Bob NS, Sall AA, Nerima C, Sahani MK, Mulogo EM, Ampeire I, Hombach J, Nanjebe D, Mwanga-Amumpaire J, Cummings DAT, Bejon P, Warimwe GM, Grais RF. Immunogenicity and safety of fractional doses of 17D-213 yellow fever vaccine in children (YEFE): a randomised, double-blind, non-inferiority substudy of a phase 4 trial. Lancet Infect Dis 2023; 23:965-973. [PMID: 37127047 DOI: 10.1016/s1473-3099(23)00131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Current supply shortages constrain yellow fever vaccination activities, particularly outbreak response. Although fractional doses of all WHO-prequalified yellow fever vaccines have been shown to be safe and immunogenic in a randomised controlled trial in adults, they have not been evaluated in a randomised controlled trial in young children (9-59 months old). We aimed to assess the immunogenicity and safety of fractional doses compared with standard doses of the WHO-prequalified 17D-213 vaccine in young children. METHODS This substudy of the YEFE phase 4 study was conducted at the Epicentre Mbarara Research Centre (Mbarara, Uganda). Eligible children were aged 9-59 months without contraindications for vaccination, without history of previous yellow fever vaccination or infection and not requiring yellow fever vaccination for travelling. Participants were randomly assigned, using block randomisation, 1:1 to standard or fractional (one-fifth) dose of yellow fever vaccine. Investigators, participants, and laboratory personnel were blinded to group allocation. Participants were followed for immunogenicity and safety at 10 days, 28 days, and 1 year after vaccination. The primary outcome was non-inferiority in seroconversion (-10 percentage point margin) 28 days after vaccination measured by 50% plaque reduction neutralisation test (PRNT50) in the per-protocol population. Safety and seroconversion at 10 days and 12-16 months after vaccination (given COVID-19 resctrictions) were secondary outcomes. This study is registered with ClinicalTrials.gov, NCT02991495. FINDINGS Between Feb 20, 2019, and Sept 9, 2019, 433 children were assessed, and 420 were randomly assigned to fractional dose (n=210) and to standard dose (n=210) 17D-213 vaccination. 28 days after vaccination, 202 (97%, 95% CI 95-99) of 207 participants in the fractional dose group and 191 (100%, 98-100) of 191 in the standard dose group seroconverted. The absolute difference in seroconversion between the study groups in the per-protocol population was -2 percentage points (95% CI -5 to 1). 154 (73%) of 210 participants in the fractional dose group and 168 (80%) of 210 in the standard dose group reported at least one adverse event 28 days after vaccination. At 10 days follow-up, seroconversion was lower in the fractional dose group than in the standard dose group. The most common adverse events were upper respiratory tract infections (n=221 [53%]), diarrhoea (n=68 [16%]), rhinorrhoea (n=49 [12%]), and conjunctivitis (n=28 [7%]). No difference was observed in incidence of adverse events and serious adverse events between study groups. CONCLUSIONS Fractional doses of the 17D-213 vaccine were non-inferior to standard doses in inducing seroconversion 28 days after vaccination in children aged 9-59 months when assessed with PRNT50, but we found fewer children seroconverted at 10 days. The results support consideration of the use of fractional dose of yellow fever vaccines in WHO recommendations for outbreak response in the event of a yellow fever vaccine shortage to include children. FUNDING Médecins Sans Frontières Foundation.
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Affiliation(s)
| | | | - Derick Kimathi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Kyra H Grantz
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | - Edgar M Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | | | - Joachim Hombach
- Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | | | | | - Derek A T Cummings
- Department of Biology and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - George M Warimwe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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Faggioni G, De Santis R, Moramarco F, Di Donato M, De Domenico A, Molinari F, Petralito G, Fortuna C, Venturi G, Rezza G, Lista F. Pan-Yellow Fever Virus Detection and Lineage Assignment by Real-Time RT-PCR and Amplicon Sequencing. J Virol Methods 2023; 316:114717. [PMID: 36972832 DOI: 10.1016/j.jviromet.2023.114717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
Yellow fever disease is a viral zoonosis that may result in a severe hemorrhagic disease. A safe and effective vaccine used in mass immunization campaigns has allowed control and mitigation against explosive outbreaks in endemic areas. Since the 1960's, re-emergent of the yellow fever virus has been observed. The timely implementation of control measures, to avoid or contain an ongoing outbreak requires rapid specific viral detection methods. Here a novel molecular assay, expected to detect all known yellow fever virus strains, is described. The method has demonstrated high sensitivity and specificity in real-time RT-PCR as well as in an endpoint RT-PCR set-up. Sequence alignment and phylogenetic analysis reveal that the amplicon resulting from the novel method covers a genomic region whose mutational profile is completely associated to the yellow fever viral lineages. Therefore, sequencing analysis of this amplicon allows for assignment of the viral lineage.
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Affiliation(s)
| | | | | | | | | | | | | | - Claudia Fortuna
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Giulietta Venturi
- Department of Infectious, Parasitic and Immunomediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Giovanni Rezza
- Health Prevention Directorate, Ministry of Health, Rome, Italy.
| | - Florigio Lista
- Army Medical Center, Scientific Department, Rome, Italy.
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Byaruhanga T, Kayiwa JT, Nankya AM, Ataliba IJ, McClure CP, Ball JK, Lutwama JJ. Arbovirus circulation, epidemiology and spatiotemporal distribution in Uganda. IJID Reg 2023; 6:171-176. [PMID: 36915800 PMCID: PMC10006739 DOI: 10.1016/j.ijregi.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Background Arboviruses are endemic in Uganda; however, little is known about their epidemiology, seasonality and spatiotemporal distribution. Our study sought to provide information on arbovirus outbreaks from acute clinical presentations. Methods Immunoglobulin M (IgM) and confirmatory Plaque Reduction Neutralisation Test (PRNT) results for arbovirus diagnosis of samples collected from patients attending sentinel sites from 2016-19 were analysed retrospectively. Demographic data were analysed with SaTScan and SPSS software to determine the epidemiology and spatiotemporal distribution of arboviruses. Results Arbovirus activity peaked consistently during March-May rainy seasons. Overall, arbovirus seroprevalence was 9.5%. Of 137 IgM positives, 52.6% were confirmed by PRNT, of which 73.6% cases were observed in central Uganda with Yellow Fever Virus had the highest prevalence (27.8%). The 5-14 age group were four times more likely to be infected with an arbovirus p=0.003, 4.1 (95% CI 1.3-12.3). Significant arboviral activity was observed among outdoor workers(p=0.05) . Spatiotemporal analysis indicated arboviral activity in 23 of the 85 districts analysed.. Interpretation Our study shows that arbovirus activity peaks during the March-May rainy season and highlights the need for YFV mass vaccination to reduce the clinical burden of arboviruses transmitted within the region.
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Affiliation(s)
- Timothy Byaruhanga
- University of Nottingham School of Life Sciences, Wolfson Centre for Global Virus Research, Nottingham, UK
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging infectious diseases
| | - John T. Kayiwa
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging infectious diseases
| | - Annet M. Nankya
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging infectious diseases
| | - Irene J. Ataliba
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging infectious diseases
| | - C. Patrick McClure
- University of Nottingham School of Life Sciences, Wolfson Centre for Global Virus Research, Nottingham, UK
| | - Jonathan K. Ball
- University of Nottingham School of Life Sciences, Wolfson Centre for Global Virus Research, Nottingham, UK
| | - Julius J. Lutwama
- Uganda Virus Research Institute, Department of Arbovirology, Emerging and Re-emerging infectious diseases
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Nabatanzi M, Bakiika H, Nabukenya I, Lamorde M, Bukirwa J, Achan MI, Babigumira PA, Nakiire L, Lubanga T, Mbabazi E, Taremwa RB, Mayinja H, Nakinsige A, Makanga DK, Muruta A, Okware S, Komakech I, Makumbi I, Wetaka MM, Kayiwa J, Ocom F, Ario AR, Nabatanzi S, Ojwang J, Boore A, Yemanaberhan R, Lee CT, Obuku E, Stowell D. Building National Health Security Through a Rapid Self-Assessment and Annual Operational Plan in Uganda, May to September 2021. Health Secur 2023; 21:130-140. [PMID: 36940291 PMCID: PMC10701509 DOI: 10.1089/hs.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 03/22/2023] Open
Abstract
Uganda established a National Action Plan for Health Security in 2019, following a Joint External Evaluation (JEE) of International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited capacity declined from 30% to 20%, and indicators with no capacity declined from 10% to 2%. More indicators had developed (47% vs 40%), demonstrated (29% vs 20%), and sustained (2% vs 0%) capacities in 2021 compared with 2017. Using the self-assessment JEE scores, 72 specific activities from the International Health Regulations (2005) benchmarks tool were selected for inclusion in a 1-year operational plan (2021-2022). In contrast to the 264 broad activities in the 5-year national action plan, the operational plan prioritized a small number of activities to enable sectors to focus limited resources on implementation. While certain capacities improved before and during implementation of the action plan, countries may benefit from using short-term operational planning to develop realistic and actionable health security plans to improve health security capacities.
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Affiliation(s)
- Maureen Nabatanzi
- Maureen Nabatanzi, MPHN, FETP, is an Epidemiologist, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Herbert Bakiika
- Herbert Bakiika MPH, is a One Health Specialist, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Immaculate Nabukenya
- Immaculate Nabukenya, PhD, is an Epidemiologist, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Mohammed Lamorde
- Mohammed Lamorde, MD, PhD, is Head of Department, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Justine Bukirwa
- Justine Bukirwa is a Technical Officer, Laboratory Systems, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Martha I. Achan
- Martha I. Achan, LLB, LLM, is a Legal Advisor, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Peter A. Babigumira
- Peter A. Babigumira, BPharm, is Technical Advisor, Emergency Preparedness and Response, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Lydia Nakiire
- Lydia Nakiire, MPH, FETP, is an Epidemiologist, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Timothy Lubanga
- Timothy Lubanga is Commissioner, Monitoring and Evaluation Department, Office of the Prime Minister, Kampala, Uganda
| | - Enid Mbabazi
- Enid Mbabazi, MD, is a Medical Officer, Office of the Prime Minister, Kampala, Uganda
| | - Roland B. Taremwa
- Roland B. Taremwa is a Monitoring and Evaluation Specialist, Office of the Prime Minister, Kampala, Uganda
| | - Harriet Mayinja
- Harriet Mayinja is a Research Officer, Integrated Epidemiology, Surveillance and Public Health Emergencies Department, Ministry of Health, Kampala, Uganda
| | - Anne Nakinsige
- Anne Nakinsige, MD, is Principal Epidemiologist, Integrated Epidemiology, Surveillance and Public Health Emergencies Department, Ministry of Health, Kampala, Uganda
| | - Douglas K. Makanga
- Douglas K. Makanga, MD, is a Medical Officer, Integrated Epidemiology, Surveillance and Public Health Emergencies Department, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Allan Muruta, MD, MPH, is Commissioner, Integrated Epidemiology, Surveillance and Public Health Emergencies Department, Ministry of Health, Kampala, Uganda
| | - Solome Okware
- Solome Okware, MD, MPH, is an Epidemiologist, World Health Emergencies Cluster, World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Innocent Komakech
- Innocent Komakech, MD, MPH, is an Emergency Readiness Officer, World Health Emergencies Cluster, World Health Organization, Uganda Country Office, Kampala, Uganda
| | - Issa Makumbi
- Issa Makumbi, MD, MSc, is Director, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Milton M. Wetaka
- Milton M. Wetaka is a Laboratory and Logistics Specialist, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Joshua Kayiwa
- Joshua Kayiwa, MSc, is a Data Analyst, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Felix Ocom
- Felix Ocom, MD, is Deputy Manager, Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
| | - Alex R. Ario
- Alex R. Ario, MD, PhD, is Managing Director, Uganda National Institute for Public Health, Ministry of Health, Kampala, Uganda
| | - Sandra Nabatanzi
- Sandra Nabatanzi, MSC, is an Emergency Management and Response Specialist and Outbreak Coordinator, Division of Global Health Protection, US Centers for Disease Control and Prevention Uganda Country Office, Kampala, Uganda
| | - Joseph Ojwang
- Joseph Ojwang, MD, MPH, is a Public Health Specialist, Division of Global Health Protection, US Centers for Disease Control and Prevention Uganda Country Office, Kampala, Uganda
| | - Amy Boore
- Amy Boore, MD, PhD, is Director, Division of Global Health Protection, US Centers for Disease Control and Prevention Uganda Country Office, Kampala, Uganda
| | - Rahel Yemanaberhan
- Rahel Yemanaberhan, MSc, is Regional Technical Advisor (East Africa), Resolve to Save Lives Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Christopher T. Lee
- Christopher T. Lee, MD, MPH, is Director of Global Preparedness and Response, Resolve to Save Lives, New York, NY
| | - Ekwaro Obuku
- Ekwaro Obuku, MD, PhD, is Senior Technical Advisor, Data and Policy, Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Daniel Stowell
- Daniel Stowell, MPH, is a Global Health Security Specialist, US Centers for Disease Control and Prevention, Atlanta, GA
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Frassetto FP, Rosemberg S. Neuropathology of yellow fever autopsy cases. Trop Dis Travel Med Vaccines 2023; 9:1. [PMID: 36707912 PMCID: PMC9883951 DOI: 10.1186/s40794-022-00187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/14/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Yellow fever is a viral hemorrhagic fever caused by yellow fever virus, a mosquito-borne flavivirus. Despite an effective vaccine, major outbreaks continue to occur around the world. Even though it is not a proven neurotropic virus, neurological symptoms in more severe clinical forms are frequent. The understanding of this apparent paradox is still rarely addressed in literature. METHODS The brains of thirty-eight patients with yellow fever confirmed by RT-PCR, who underwent autopsy, were analyzed morphologically to identify and characterize neuropathological changes. The data were compared with brains collected from individuals without the disease, as a control group. Both cases and controls were subdivided according to the presence or absence of co-concurrent septic shock, to exclude changes of the sepsis associated encephalopathy. To verify possible morphological differences between the yellow fever cases groups, between the control groups, and between the cases and the controls, we applied the statistical tests Fisher's exact test and chi-square, with p values < 0.05 considered statistically significant. RESULTS All cases and controls presented, at least focally, neuropathological changes, which included edema, meningeal and parenchymal inflammatory infiltrate and hemorrhages, and perivascular inflammatory infiltrate. We did not find an unequivocal aspect of encephalitis. The only parameter that, after statistical analysis, can be attributed to yellow fever was the perivascular inflammatory infiltrate. CONCLUSIONS The neuropathological findings are sufficient to justify the multiple clinical neurologic disturbances detected in the YF cases. Since most of the parameters evaluated did not show statistically significant difference between cases and controls, an explanation for most of the neuropathological findings may be the vascular changes, consequent to shock induced endotheliopathy, associated with stimulation of the immune system inherent to systemic infectious processes. The statistical difference obtained in yellow fever cases regarding perivascular infiltrate can be can be explained by the immune activation inherent to the condition.
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Affiliation(s)
- Fernando Pereira Frassetto
- grid.11899.380000 0004 1937 0722Department of Pathology, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP Brazil ,grid.261331.40000 0001 2285 7943Present Address: Department of Radiation Oncology, Ohio State University, OH Columbus, United States of America
| | - Sergio Rosemberg
- grid.11899.380000 0004 1937 0722Department of Pathology, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP Brazil
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12
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Harris JR, Kadobera D, Kwesiga B, Kabwama SN, Bulage L, Kyobe HB, Kagirita AA, Mwebesa HG, Wanyenze RK, Nelson LJ, Boore AL, Ario AR. Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda. BMC Health Serv Res 2022; 22:1532. [PMID: 36526999 PMCID: PMC9756722 DOI: 10.1186/s12913-022-08781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda. METHODS We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs. RESULTS Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners. CONCLUSION Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.
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Affiliation(s)
- Julie R. Harris
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Steven N. Kabwama
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Henry B. Kyobe
- grid.4991.50000 0004 1936 8948University of Oxford, Kellogg College, Oxford, UK ,grid.415705.2Ministry of Health, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lisa J. Nelson
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda ,grid.415705.2Ministry of Health, Kampala, Uganda
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13
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Agha SB, Tchouassi DP, Turell MJ, Bastos ADS, Sang R. Risk assessment of urban yellow fever virus transmission in Kenya: is Aedes aegypti an efficient vector? Emerg Microbes Infect 2022; 11:1272-1280. [PMID: 35387573 PMCID: PMC9090368 DOI: 10.1080/22221751.2022.2063762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The absence of urban yellow fever epidemics in East Africa remains a mystery amidst the proliferation of Aedes aegypti in this region. To understand the transmission dynamics of the disease, we tested urban (Mombasa, Kisumu, and Nairobi) Aedes mosquito populations in Kenya for their susceptibility to an East African yellow fever virus (YFV) genotype. Overall, 22% (n = 805) of the Ae. aegypti that were orally challenged with an infectious dose of YFV had a midgut infection, with comparable rates for Mombasa and Kisumu (χ2 = 0.35, df = 1, P = 0.55), but significantly lower rates for Nairobi (χ2 ≥ 11.08, df = 1, P ≤ 0.0009). Variations in YFV susceptibility (midgut infection) among Ae. aegypti subspecies were not associated with discernable cytochrome c oxidase subunit 1 gene haplotypes. Remarkably, no YFV dissemination or transmission was observed among the orally challenged Ae. aegypti populations. Moreover, Ae. aegypti mosquitoes that were intrathoracically inoculated with YFV failed to transmit the virus via capillary feeding. In contrast, dissemination (oral exposure) and transmission (intrathoracic inoculation) of YFV was observed among a few peri-domestic Ae. bromeliae mosquitoes (n = 129) that were assessed from these urban areas. Our study highlights an inefficient urban Ae. aegypti population, and the potential for Ae. bromeliae in sustaining an urban YFV transmission in Kenya. An assessment of urban Ae. aegypti susceptibility to other YFV genotypes, and vector potential of urban Ae. bromeliae populations in Kenya is recommended to guide cost-effective vaccination.
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Affiliation(s)
- Sheila B Agha
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya.,Department of Zoology and Entomology, University of Pretoria, Hatfield, South Africa
| | - David P Tchouassi
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | | | - Armanda D S Bastos
- Department of Zoology and Entomology, University of Pretoria, Hatfield, South Africa
| | - Rosemary Sang
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya.,Arbovirus/Viral Hemorrhagic Fever Laboratory, Center for Virus Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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14
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Sang R, Lutomiah J, Chepkorir E, Tchouassi DP. Evolving dynamics of Aedes-borne diseases in Africa: a cause for concern. Curr Opin Insect Sci 2022; 53:100958. [PMID: 35878761 DOI: 10.1016/j.cois.2022.100958] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Aedes-borne viruses, yellow fever (YF), dengue, Chikungunya and Zika are taking a huge toll on global health as Africa faces re-emergence with potential for massive human catastrophe. Transmission driven by diverse vectors in ecological settings that range from urban to rural and sylvatic habitats with human and nonhuman primate/reservoir activities across such habitats has facilitated virus movement and spillover to susceptible human populations. Approved vaccine exists for YF, although availability for routine and mass vaccination is often constrained. Integrating vector surveillance, understanding disease ecology with rationalised vaccination in high-risk areas (YF) remains important in disease prevention and control. We review trends in disease occurrence in Africa, hinting on gaps in disease detection and management and the prospects for prevention and/or control.
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Affiliation(s)
- Rosemary Sang
- International Centre of Insect Physiology and Ecology, P.O. Box 30772-00100, Nairobi, Kenya.
| | - Joel Lutomiah
- Center for Virus Research, Kenya Medical Research Institute, Kenya
| | - Edith Chepkorir
- Center for Virus Research, Kenya Medical Research Institute, Kenya
| | - David P Tchouassi
- International Centre of Insect Physiology and Ecology, P.O. Box 30772-00100, Nairobi, Kenya
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15
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Oyono MG, Kenmoe S, Abanda NN, Takuissu GR, Ebogo-Belobo JT, Kenfack-Momo R, Kengne-Nde C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko’o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Bowo-Ngandji A, Nkie Esemu S, Ndip L. Epidemiology of yellow fever virus in humans, arthropods, and non-human primates in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010610. [PMID: 35867659 PMCID: PMC9307179 DOI: 10.1371/journal.pntd.0010610] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022] Open
Abstract
Yellow fever (YF) has re-emerged in the last two decades causing several outbreaks in endemic countries and spreading to new receptive regions. This changing epidemiology of YF creates new challenges for global public health efforts. Yellow fever is caused by the yellow fever virus (YFV) that circulates between humans, the mosquito vector, and non-human primates (NHP). In this systematic review and meta-analysis, we review and analyse data on the case fatality rate (CFR) and prevalence of YFV in humans, and on the prevalence of YFV in arthropods, and NHP in sub-Saharan Africa (SSA). We performed a comprehensive literature search in PubMed, Web of Science, African Journal Online, and African Index Medicus databases. We included studies reporting data on the CFR and/or prevalence of YFV. Extracted data was verified and analysed using the random effect meta-analysis. We conducted subgroup, sensitivity analysis, and publication bias analyses using the random effect meta-analysis while I2 statistic was employed to determine heterogeneity. This review was registered with PROSPERO under the identification CRD42021242444. The final meta-analysis included 55 studies. The overall case fatality rate due to YFV was 31.1% (18.3–45.4) in humans and pooled prevalence of YFV infection was 9.4% (6.9–12.2) in humans. Only five studies in West and East Africa detected the YFV in mosquito species of the genus Aedes and in Anopheles funestus. In NHP, YFV antibodies were found only in members of the Cercopithecidae family. Our analysis provides evidence on the ongoing circulation of the YFV in humans, Aedes mosquitoes and NHP in SSA. These observations highlight the ongoing transmission of the YFV and its potential to cause large outbreaks in SSA. As such, strategies such as those proposed by the WHO’s Eliminate Yellow Fever Epidemics (EYE) initiative are urgently needed to control and prevent yellow fever outbreaks in SSA.
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Affiliation(s)
- Martin Gael Oyono
- Centre for Research on Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
- Laboratory of Parasitology and Ecology, Department of Animal Biology and Physiology, University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- * E-mail:
| | - Ngu Njei Abanda
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Cyprien Kengne-Nde
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
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16
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Dkhar SA, Quansar R, Haq I, Khan SMS. Vaccine usage and wastage in a designated Yellow Fever Vaccination Centre in North India. Clin Exp Vaccine Res 2021; 10:240-244. [PMID: 34703806 PMCID: PMC8511585 DOI: 10.7774/cevr.2021.10.3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Yellow fever is a viral hemorrhagic fever transmitted through the bite of mosquitoes. World Health Organization guidelines advocate a single dose of vaccine for life-long protective immunity against yellow fever. Yellow fever vaccine is included in routine childhood immunization schedules in countries at medium or high risk of yellow fever. For some travelers, visiting endemic countries, yellow fever vaccination is recommended to protect the travelers. We calculated the yellow fever vaccine wastage rate at a designated center in North India. Materials and Methods This is a record-based study. The data for the study was obtained from the immunization center of Government Medical College, Srinagar, Jammu and Kashmir. The particulars for every vaccine recipient were present in the register. The vaccine wastage rate was calculated. The analysis was done in IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and results were presented as numbers and frequencies. Results A total of 136 doses were issued out of which 111 doses were administered from November 2017 till October 2020. The maximum number of travelers was young adults (26.1%). In 83.7% of cases, the area of the visit was Africa. The vaccine wastage rate was 18.4%. Conclusion The vaccine wastage rate was not very high and was within that recommended for vaccines in routine immunization.
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Affiliation(s)
- Sabira Aalia Dkhar
- Department of Community Medicine, Government Medical College, Srinagar, India
| | - Ruqia Quansar
- Department of Community Medicine, Government Medical College, Srinagar, India
| | - Inaamul Haq
- Department of Community Medicine, Government Medical College, Srinagar, India
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17
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Nwaiwu AU, Musekiwa A, Tamuzi JL, Sambala EZ, Nyasulu PS. The incidence and mortality of yellow fever in Africa: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1089. [PMID: 34688249 PMCID: PMC8536483 DOI: 10.1186/s12879-021-06728-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/01/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Understanding the occurrence of yellow fever epidemics is critical for targeted interventions and control efforts to reduce the burden of disease. We assessed data on the yellow fever incidence and mortality rates in Africa. METHODS We searched the Cochrane Library, SCOPUS, MEDLINE, CINAHL, PubMed, Embase, Africa-wide and Web of science databases from 1 January 1975 to 30th October 2020. Two authors extracted data from included studies independently and conducted a meta-analysis. RESULTS Of 840 studies identified, 12 studies were deemed eligible for inclusion. The incidence of yellow fever per 100,000 population ranged from < 1 case in Nigeria, < 3 cases in Uganda, 13 cases in Democratic Republic of the Congo, 27 cases in Kenya, 40 cases in Ethiopia, 46 cases in Gambia, 1267 cases in Senegal, and 10,350 cases in Ghana. Case fatality rate associated with yellow fever outbreaks ranged from 10% in Ghana to 86% in Nigeria. The mortality rate ranged from 0.1/100,000 in Nigeria to 2200/100,000 in Ghana. CONCLUSION The yellow fever incidence rate is quite constant; in contrast, the fatality rates vary widely across African countries over the study period. Standardized demographic health surveys and surveillance as well as accurate diagnostic measures are essential for early recognition, treatment and control.
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Affiliation(s)
- Akuoma U Nwaiwu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alfred Musekiwa
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Health Systems & Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Adam A, Jassoy C. Epidemiology and Laboratory Diagnostics of Dengue, Yellow Fever, Zika, and Chikungunya Virus Infections in Africa. Pathogens 2021; 10:pathogens10101324. [PMID: 34684274 PMCID: PMC8541377 DOI: 10.3390/pathogens10101324] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Arbovirus infections are widespread, and their disease burden has increased in the past decade. In Africa, arbovirus infections and fever with unknown etiology are common. Due to the lack of well-established epidemiologic surveillance systems and accurate differential diagnosis in most African countries, little is known about the prevalence of human arbovirus infections in Africa. The aim of this review is to summarize the available epidemiological data and diagnostic laboratory tools of infections with dengue, yellow fever, Zika, and chikungunya viruses, all transmitted by Aedes mosquitoes. Studies indicate that these arboviral infections are endemic in most of Africa. Surveillance of the incidence and prevalence of the infections would enable medical doctors to improve the diagnostic accuracy in patients with typical symptoms. If possible, arboviral diagnostic tests should be added to the routine healthcare systems. Healthcare providers should be informed about the prevalent arboviral diseases to identify possible cases.
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Affiliation(s)
- Awadalkareem Adam
- Correspondence: (A.A.); (C.J.); Tel.: +49-341-9714314 (C.J.); Fax: +49-341-9714309 (C.J.)
| | - Christian Jassoy
- Correspondence: (A.A.); (C.J.); Tel.: +49-341-9714314 (C.J.); Fax: +49-341-9714309 (C.J.)
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Mayanja MN, Mwiine FN, Lutwama JJ, Ssekagiri A, Egesa M, Thomson EC, Kohl A. Mosquito-borne arboviruses in Uganda: history, transmission and burden. J Gen Virol 2021; 102. [PMID: 34609940 DOI: 10.1099/jgv.0.001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mosquito-transmitted arboviruses constitute a large proportion of emerging infectious diseases that are both a public health problem and a threat to animal populations. Many such viruses were identified in East Africa, a region where they remain important and from where new arboviruses may emerge. We set out to describe and review the relevant mosquito-borne viruses that have been identified specifically in Uganda. We focused on the discovery, burden, mode of transmission, animal hosts and clinical manifestation of those previously involved in disease outbreaks. A search for mosquito-borne arboviruses detected in Uganda was conducted using search terms 'Arboviruses in Uganda' and 'Mosquitoes and Viruses in Uganda' in PubMed and Google Scholar in 2020. Twenty-four mosquito-borne viruses from different animal hosts, humans and mosquitoes were documented. The majority of these were from family Peribunyaviridae, followed by Flaviviridae, Togaviridae, Phenuiviridae and only one each from family Rhabdoviridae and Reoviridae. Sixteen (66.7%) of the viruses were associated with febrile illnesses. Ten (41.7%) of them were first described locally in Uganda. Six of these are a public threat as they have been previously associated with disease outbreaks either within or outside Uganda. Historically, there is a high burden and endemicity of arboviruses in Uganda. Given the many diverse mosquito species known in the country, there is also a likelihood of many undescribed mosquito-borne viruses. Next generation diagnostic platforms have great potential to identify new viruses. Indeed, four novel viruses, two of which were from humans (Ntwetwe and Nyangole viruses) and two from mosquitoes (Kibale and Mburo viruses) were identified in the last decade using next generation sequencing. Given the unbiased approach of detection of viruses by this technology, its use will undoubtedly be critically important in the characterization of mosquito viromes which in turn will inform other diagnostic efforts.
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Affiliation(s)
- Martin N Mayanja
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda.,MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
| | - Frank N Mwiine
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Julius J Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Alfred Ssekagiri
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Egesa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
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20
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Näslund J, Ahlm C, Islam K, Evander M, Bucht G, Lwande OW. Emerging Mosquito-Borne Viruses Linked to Aedes aegypti and Aedes albopictus: Global Status and Preventive Strategies. Vector Borne Zoonotic Dis 2021; 21:731-746. [PMID: 34424778 DOI: 10.1089/vbz.2020.2762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Emerging mosquito-borne viruses continue to cause serious health problems and economic burden among billions of people living in and near the tropical belt of the world. The highly invasive mosquito species Aedes aegypti and Aedes albopictus have successively invaded and expanded their presence as key vectors of Chikungunya virus, dengue virus, yellow fever virus, and Zika virus, and that has consecutively led to frequent outbreaks of the corresponding viral diseases. Of note, these two mosquito species have gradually adapted to the changing weather and environmental conditions leading to a shift in the epidemiology of the viral diseases, and facilitated their establishment in new ecozones inhabited by immunologically naive human populations. Many abilities of Ae. aegypti and Ae. albopictus, as vectors of significant arbovirus pathogens, may affect the infection and transmission rates after a bloodmeal, and may influence the vector competence for either virus. We highlight that many collaborating risk factors, for example, the global transportation systems may result in sporadic and more local outbreaks caused by mosquito-borne viruses related to Ae. aegypti and/or Ae. albopictus. Those local outbreaks could in synergy grow and produce larger epidemics with pandemic characters. There is an urgent need for improved surveillance of vector populations, human cases, and reliable prediction models. In summary, we recommend new and innovative strategies for the prevention of these types of infections.
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Affiliation(s)
- Jonas Näslund
- Swedish Defence Research Agency, CBRN, Defence and Security, Umeå, Sweden
| | - Clas Ahlm
- Department of Clinical Microbiology, Umeå University, Umea, Sweden.,Arctic Research Centre at Umeå University, Umea, Sweden
| | - Koushikul Islam
- Department of Clinical Microbiology, Umeå University, Umea, Sweden
| | - Magnus Evander
- Department of Clinical Microbiology, Umeå University, Umea, Sweden.,Arctic Research Centre at Umeå University, Umea, Sweden
| | - Göran Bucht
- Department of Clinical Microbiology, Umeå University, Umea, Sweden
| | - Olivia Wesula Lwande
- Department of Clinical Microbiology, Umeå University, Umea, Sweden.,Arctic Research Centre at Umeå University, Umea, Sweden
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21
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Mayanja MN, Mwiine FN, Lutwama JJ, Ssekagiri A, Egesa M, Thomson EC, Kohl A. Mosquito-borne arboviruses in Uganda: history, transmission and burden. J Gen Virol 2021; 102. [PMID: 34166178 DOI: 10.1099/jgv.0.001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mosquito-transmitted arboviruses constitute a large proportion of emerging infectious diseases that are both a public health problem and a threat to animal populations. Many such viruses were identified in East Africa, a region where they remain important and from where new arboviruses may emerge. We set out to describe and review the relevant mosquito-borne viruses that have been identified specifically in Uganda. We focused on the discovery, burden, mode of transmission, animal hosts and clinical manifestation of those previously involved in disease outbreaks. A search for mosquito-borne arboviruses detected in Uganda was conducted using search terms 'Arboviruses in Uganda' and 'Mosquitoes and Viruses in Uganda' in PubMed and Google Scholar in 2020. Twenty-four mosquito-borne viruses from different animal hosts, humans and mosquitoes were documented. The majority of these were from family Peribunyaviridae, followed by Flaviviridae, Togaviridae, Phenuiviridae and only one each from family Rhabdoviridae and Reoviridae. Sixteen (66.7 %) of the viruses were associated with febrile illnesses. Ten (41.7 %) of them were first described locally in Uganda. Six of these are a public threat as they have been previously associated with disease outbreaks either within or outside Uganda. Historically, there is a high burden and endemicity of arboviruses in Uganda. Given the many diverse mosquito species known in the country, there is also a likelihood of many undescribed mosquito-borne viruses. New generation diagnostic platforms have great potential to identify new viruses. Indeed, four novel viruses, two of which were from humans (Ntwetwe and Nyangole viruses) and two from mosquitoes (Kibale and Mburo viruses) including the 2010 yellow fever virus (YFV) outbreak were identified in the last decade using next generation sequencing. Given the unbiased approach of detection of viruses by this technology, its use will undoubtedly be critically important in the characterization of mosquito viromes which in turn will inform other diagnostic efforts.
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Affiliation(s)
- Martin N Mayanja
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.,Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda.,MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
| | - Frank N Mwiine
- School of Biosecurity, Biotechnical and Laboratory Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Julius J Lutwama
- Department of Arbovirology, Emerging and Re-emerging Infectious Diseases, Uganda Virus Research Institute, Entebbe, Uganda
| | - Alfred Ssekagiri
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses Egesa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
| | - Alain Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow G61 1QH, UK
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22
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Siya A, Mafigiri R, Migisha R, Kading RC. Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance. Int J Environ Res Public Health 2021; 18:8562. [PMID: 34444315 PMCID: PMC8394296 DOI: 10.3390/ijerph18168562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs' perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.
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Affiliation(s)
- Aggrey Siya
- Department of Environmental Management, Makerere University, Kampala P.O. Box 7062, Uganda
- EcoHealth180, Kween District, Kapchorwa P.O. Box 250, Uganda
| | - Richardson Mafigiri
- Global Health Department, Infectious Diseases Institute, Makerere University, Kampala P.O. Box 22418, Uganda;
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda;
| | - Rebekah C. Kading
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA;
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23
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Rugarabamu S, Mwanyika GO, Rumisha SF, Sindato C, Lim HY, Misinzo G, Mboera LEG. Seroprevalence and associated risk factors of selected zoonotic viral hemorrhagic fevers in Tanzania. Int J Infect Dis 2021; 109:174-181. [PMID: 34242761 DOI: 10.1016/j.ijid.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the seroprevalence of selected zoonotic viral hemorrhagic fevers (VHFs) and their associated risk factors in Tanzania. METHODS Blood samples were collected from consenting outpatients and community members in eight districts selected from five ecological zones of Tanzania. Serum was harvested and tested for the presence of immunoglobulin G (IgG) and M (IgM) antibodies against Crimean-Congo hemorrhagic fever (CCHF), Ebola virus disease (EVD), Marburg virus disease (MVD), Rift Valley fever (RVF), and yellow fever (YF). RESULTS The presence of IgM and IgG antibodies against CCHF, EVD, MVD, RVF, and YF was detected in 64 of 500 samples (12.8%). The prevalences of IgM and IgG antibodies to CCHF, EVD, MVD, RFV, and YF were 2.0%, 3.4%, 1.2%, 4.8%, and 1.4%, respectively. Contact with wild animals (OR = 1.2, CI = 1.3-1.6) and keeping goats (OR = 1.3, CI = 1.5-1.9) were significantly associated with RVF, while contact with bats (OR = 1.2, CI = 1.1-1.5) was associated with MVD. CONCLUSION The findings of this study provide evidence of exposure to CCHF, EVD, MVD, RVF, and YF in Tanzania. Since most of these VHFs occurred without apparent clinical forms of the disease, these findings call for the need to strengthen the surveillance system and management of febrile illnesses in Tanzania.
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Affiliation(s)
- Sima Rugarabamu
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania; Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Gaspary O Mwanyika
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania; Mbeya University of Science and Technology, Mbeya, Tanzania.
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania; Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, Perth, Western Australia.
| | - Calvin Sindato
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; National Institute for Medical Research, Tabora Research Centre, Tabora, Tanzania.
| | - Hee-Young Lim
- Korea Disease Control and Prevention Agency, National Institute of Health, Osong, Chungchungbukdo, Republic of Korea.
| | - Gerald Misinzo
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania; Department of Veterinary Microbiology, Parasitology and Biotechnology, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
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Abstract
BACKGROUND Yellow fever (YF) is a vector-borne viral hemorrhagic disease endemic in Africa and Latin America. In 2016, the World Health Organization (WHO) developed the Eliminate YF Epidemics strategy aiming at eliminating YF epidemics by 2026. METHODS We developed a spatiotemporal model of YF, accounting for the impact of temperature, vector distribution, and socioeconomic factors on disease transmission. We validated our model against previous estimates of YF basic reproductive number (R0). We used the model to estimate global risk of YF outbreaks and vaccination efforts needed to achieve elimination of YF epidemics. RESULTS We showed that the global risk of YF outbreaks is highly heterogeneous. High-risk transmission areas (R0 > 6) are mainly found in West Africa and the Equatorial region of Latin America. We showed that vaccination coverage needed to eliminate YF epidemics in an endemic country varies substantially between districts. In many endemic countries, a 90% vaccination coverage is needed to achieve elimination. However, in some high-risk districts in Africa, a 95% coverage may be required. CONCLUSIONS Global elimination of YF epidemics requires higher population-level immunity than the 80% coverage recommended by the WHO. Optimal YF vaccination strategy should be tailored to the risk profile of each endemic country.
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Affiliation(s)
- Martial L Ndeffo-Mbah
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences.,Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut
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25
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Juan-Giner A, Kimathi D, Grantz KH, Hamaluba M, Kazooba P, Njuguna P, Fall G, Dia M, Bob NS, Monath TP, Barrett AD, Hombach J, Mulogo EM, Ampeire I, Karanja HK, Nyehangane D, Mwanga-Amumpaire J, Cummings DAT, Bejon P, Warimwe GM, Grais RF. Immunogenicity and safety of fractional doses of yellow fever vaccines: a randomised, double-blind, non-inferiority trial. Lancet 2021; 397:119-127. [PMID: 33422245 PMCID: PMC7794660 DOI: 10.1016/s0140-6736(20)32520-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/28/2020] [Accepted: 11/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Stocks of yellow fever vaccine are insufficient to cover exceptional demands for outbreak response. Fractional dosing has shown efficacy, but evidence is limited to the 17DD substrain vaccine. We assessed the immunogenicity and safety of one-fifth fractional dose compared with standard dose of four WHO-prequalified yellow fever vaccines produced from three substrains. METHODS We did this randomised, double-blind, non-inferiority trial at research centres in Mbarara, Uganda, and Kilifi, Kenya. Eligible participants were aged 18-59 years, had no contraindications for vaccination, were not pregnant or lactating, had no history of yellow fever vaccination or infection, and did not require yellow fever vaccination for travel. Eligible participants were recruited from communities and randomly assigned to one of eight groups, corresponding to the four vaccines at standard or fractional dose. The vaccine was administered subcutaneously by nurses who were not masked to treatment, but participants and other study personnel were masked to vaccine allocation. The primary outcome was proportion of participants with seroconversion 28 days after vaccination. Seroconversion was defined as post-vaccination neutralising antibody titres at least 4 times pre-vaccination measurement measured by 50% plaque reduction neutralisation test (PRNT50). We defined non-inferiority as less than 10% decrease in seroconversion in fractional compared with standard dose groups 28 days after vaccination. The primary outcome was measured in the per-protocol population, and safety analyses included all vaccinated participants. This trial is registered with ClinicalTrials.gov, NCT02991495. FINDINGS Between Nov 6, 2017, and Feb 21, 2018, 1029 participants were assessed for inclusion. 69 people were ineligible, and 960 participants were enrolled and randomly assigned to vaccine manufacturer and dose (120 to Bio-Manguinhos-Fiocruz standard dose, 120 to Bio-Manguinhos-Fiocruz fractional dose, 120 to Chumakov Institute of Poliomyelitis and Viral Encephalitides standard dose, 120 to Chumakov Institute of Poliomyelitis and Viral Encephalitides fractional dose, 120 to Institut Pasteur Dakar standard dose, 120 to Institut Pasteur Dakar fractional dose, 120 to Sanofi Pasteur standard dose, and 120 to Sanofi Pasteur fractional dose). 49 participants had detectable PRNT50 at baseline and 11 had missing PRNT50 results at baseline or 28 days. 900 were included in the per-protocol analysis. 959 participants were included in the safety analysis. The absolute difference in seroconversion between fractional and standard doses by vaccine was 1·71% (95% CI -2·60 to 5·28) for Bio-Manguinhos-Fiocruz, -0·90% (-4·24 to 3·13) for Chumakov Institute of Poliomyelitis and Viral Encephalitides, 1·82% (-2·75 to 5·39) for Institut Pasteur Dakar, and 0·0% (-3·32 to 3·29) for Sanofi Pasteur. Fractional doses from all four vaccines met the non-inferiority criterion. The most common treatment-related adverse events were headache (22·2%), fatigue (13·7%), myalgia (13·3%) and self-reported fever (9·0%). There were no study-vaccine related serious adverse events. INTERPRETATION Fractional doses of all WHO-prequalified yellow fever vaccines were non-inferior to the standard dose in inducing seroconversion 28 days after vaccination, with no major safety concerns. These results support the use of fractional dosage in the general adult population for outbreak response in situations of vaccine shortage. FUNDING The study was funded by Médecins Sans Frontières Foundation, Wellcome Trust (grant no. 092654), and the UK Department for International Development. Vaccines were donated in kind.
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Affiliation(s)
| | - Derick Kimathi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Kyra H Grantz
- Department of Biology, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mainga Hamaluba
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | | | - Patricia Njuguna
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | | | - Alan D Barrett
- Sealy Institute for Vaccines Sciences and Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Joachim Hombach
- Immunization, Vaccines & Biologicals, WHO, Geneva, Switzerland
| | - Edgar M Mulogo
- Department of Community Health, Mbarara University of Science & Technology, Mbarara, Uganda
| | | | - Henry K Karanja
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Philip Bejon
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - George M Warimwe
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
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Eastwood G, Sang RC, Lutomiah J, Tunge P, Weaver SC. Sylvatic Mosquito Diversity in Kenya-Considering Enzootic Ecology of Arboviruses in an Era of Deforestation. Insects 2020; 11:insects11060342. [PMID: 32503123 PMCID: PMC7349089 DOI: 10.3390/insects11060342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
As new and re-emerging vector-borne diseases are occurring across the world, East Africa represents an interesting location, being the origin of several arboviruses with a history of urbanization and global spread. Rapid expansion of urban populations and alteration of natural habitats creates the opportunity for arboviruses to host-switch from wild, sylvatic hosts or vectors into urban transmission affecting human populations. Although mosquito surveillance regularly takes place in urban areas of Kenya, for example identifying vectors of dengue virus or malaria viruses, little work has been carried out to determine the distribution and abundance of sylvatic vectors. Here, we describe the mosquito vector species and diversity collected at twelve forest habitats of rural Kenya. We conducted arbovirus screening of over 14,082 mosquitoes (47 species, 11 genera) as 1520 pools, and detected seven viruses (six bunyaviruses, and one flavivirus-bunyavirus co-infection) isolated from pools of Aedes dentatus,Anopheles funestus, Culex annulioris, and Cx. vansomereni. Awareness of sylvatic vector species and their location is a critical part of understanding the ecological foci and enzootic cycling of pathogens that may be of concern to public, animal or wildlife health. As natural ecosystems come under anthropogenic pressures, such knowledge can inform us of the One Health potential for spillover or spillback leading to outbreaks, and assist in vector control strategies.
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Affiliation(s)
- Gillian Eastwood
- Institute for Human Infections and Immunity, Center for Tropical Diseases, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
- College of Agriculture & Life Sciences, Virginia Tech, Blacksburg, VA 24060, USA
- Correspondence: ; Tel.: +1-516-655-7462
| | - Rosemary C. Sang
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Way, Nairobi, Kenya; (R.C.S.); (J.L.); (P.T.)
| | - Joel Lutomiah
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Way, Nairobi, Kenya; (R.C.S.); (J.L.); (P.T.)
| | - Philip Tunge
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Way, Nairobi, Kenya; (R.C.S.); (J.L.); (P.T.)
| | - Scott C. Weaver
- World Reference Center for Emerging Viruses and Arboviruses, Institute for Human Infections and Immunity, Center for Tropical Diseases, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA;
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27
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Huebl L, Nnyombi A, Walakira E, Kutalek R. Yellow Fever Vaccine Safety Perception of Pregnant Women in Emergency Response Mass Vaccination in Uganda. Am J Trop Med Hyg 2020; 103:160-163. [PMID: 32458783 DOI: 10.4269/ajtmh.19-0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Yellow fever vaccine, a live attenuated vaccine, is primarily administered to pregnant women during outbreaks. A qualitative study was conducted in pregnant women on the perception of yellow fever mass vaccination. In total, interviews with 20 women-13 semi-structured interviews and one focus group discussion with seven participants-were analyzed. This study showed that conflicting information about vaccine safety led to concern about miscarriage. Furthermore, it was believed that vaccination during gestation would concurrently immunize the fetus by transplacental antibody transfer. Consultation of health workers at the vaccination site led to diverse recommendations. When vaccinating pregnant women, clear health communication is crucial. Vaccine recommendations should be obeyed, and health workers should be trained to address emerging vaccine concerns. Pregnant women should be informed that a booster dose is recommended to achieve lifelong immunity. After pregnancy, a booster should be offered to women in endemic areas.
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Affiliation(s)
- Lena Huebl
- Department of Social and Preventive Medicine, Unit Medical Anthropology and Global Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Aloysious Nnyombi
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Eddy Walakira
- Department of Social Work and Social Administration, Makerere University, Kampala, Uganda
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Unit Medical Anthropology and Global Health, Center for Public Health, Medical University of Vienna, Vienna, Austria
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28
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Jean K, Hamlet A, Benzler J, Cibrelus L, Gaythorpe KAM, Sall A, Ferguson NM, Garske T. Eliminating yellow fever epidemics in Africa: Vaccine demand forecast and impact modelling. PLoS Negl Trop Dis 2020; 14:e0008304. [PMID: 32379756 PMCID: PMC7237041 DOI: 10.1371/journal.pntd.0008304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/19/2020] [Accepted: 04/17/2020] [Indexed: 01/21/2023] Open
Abstract
Background To counter the increasing global risk of Yellow fever (YF), the World Health Organisation initiated the Eliminate Yellow fever Epidemics (EYE) strategy. Estimating YF burden, as well as vaccine impact, while accounting for the features of urban YF transmission such as indirect benefits of vaccination, is key to informing this strategy. Methods and findings We developed two model variants to estimate YF burden in sub-Saharan Africa, assuming all infections stem from either the sylvatic or the urban cycle of the disease. Both relied on an ecological niche model fitted to the local presence of any YF reported event in 34 African countries. We calibrated under-reporting using independent estimates of transmission intensity provided by 12 serological surveys performed in 11 countries. We calculated local numbers of YF infections, deaths and disability-adjusted life years (DALYs) lost based on estimated transmission intensity while accounting for time-varying vaccination coverage. We estimated vaccine demand and impact of future preventive mass vaccination campaigns (PMVCs) according to various vaccination scenarios. Vaccination activities conducted in Africa between 2005 and 2017 were estimated to prevent from 3.3 (95% CI 1.2–7.7) to 6.1 (95% CI 2.4–13.2) millions of deaths over the lifetime of vaccinees, representing extreme scenarios of none or maximal herd effects, respectively. By prioritizing provinces based on the risk of urban YF transmission in future PMVCs, an average of 37.7 million annual doses for PMVCs over eight years would avert an estimated 9,900,000 (95% CI 7,000,000–13,400,000) infections and 480,000 (180,000–1,140,000) deaths over the lifetime of vaccinees, corresponding to 1.7 (0.7–4.1) deaths averted per 1,000 vaccine doses. Conclusions By estimating YF burden and vaccine impact over a range of spatial and temporal scales, while accounting for the specificity of urban transmission, our model can be used to inform the current EYE strategy. As large-scale vaccination campaigns are begun or continued with the aim to eliminate yellow fever (YF) epidemics in several countries, estimating disease burden and vaccine impact is timely. We developed two model variants to estimate YF burden in sub-Saharan Africa, each either representing the sylvatic or urban cycle of the disease. Both relied on an ecological niche model fitted to known records of YF in 34 African countries and calibrated using serological survey data. Local numbers of YF infections and deaths were derived while accounting for time-varying vaccination coverage. We estimated vaccine demand and the impact of future preventive mass vaccination campaigns according to various vaccination scenarios. By providing burden and vaccine impact estimates over a range of spatial and temporal scales, and accounting for the specificity of urban transmission, our model can be used to inform the current international strategy to counter the increasing global risk of yellow fever.
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Affiliation(s)
- Kévin Jean
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France
- Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place London, United Kingdom
- * E-mail:
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place London, United Kingdom
| | - Justus Benzler
- Infectious Hazard Management, World Health Organization, Geneva, Switzerland
- Robert Koch-Institut, Nordufer, Berlin, Germany
| | - Laurence Cibrelus
- Infectious Hazard Management, World Health Organization, Geneva, Switzerland
| | - Katy A. M. Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place London, United Kingdom
| | - Amadou Sall
- Arbovirus and viral haemorrhagic fever unit, Institut Pasteur de Dakar, Dakar, Senegal
| | - Neil M. Ferguson
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place London, United Kingdom
| | - Tini Garske
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, St Mary’s Campus, Norfolk Place London, United Kingdom
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Marinho PES, Alvarenga PPM, Crispim APC, Candiani TMS, Alvarenga AM, Bechler IM, Alves PA, Dornas FP, de Oliveira DB, Bentes AA, Christo PP, Kroon EG. Wild-Type Yellow Fever Virus RNA in Cerebrospinal Fluid of Child. Emerg Infect Dis 2019; 25:1567-1570. [PMID: 31310221 PMCID: PMC6649336 DOI: 10.3201/eid2508.181479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We report a 3-year-old child who was hospitalized because of severe manifestations of the central nervous system. The child died after 6 days of hospitalization. Analysis of postmortem cerebrospinal fluid showed the presence of yellow fever virus RNA. Nucleotide sequencing confirmed that the virus was wild-type yellow fever virus.
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Tomashek KM, Challberg M, Nayak SU, Schiltz HF. Disease Resurgence, Production Capability Issues and Safety Concerns in the Context of an Aging Population: Is There a Need for a New Yellow Fever Vaccine? Vaccines (Basel) 2019; 7:E179. [PMID: 31717289 DOI: 10.3390/vaccines7040179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022] Open
Abstract
Yellow fever is a potentially fatal, mosquito-borne viral disease that appears to be experiencing a resurgence in endemic areas in Africa and South America and spreading to non-endemic areas despite an effective vaccine. This trend has increased the level of concern about the disease and the potential for importation to areas in Asia with ecological conditions that can sustain yellow fever virus transmission. In this article, we provide a broad overview of yellow fever burden of disease, natural history, treatment, vaccine, prevention and control initiatives, and vaccine and therapeutic agent development efforts.
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Ario AR, Bulage L, Kadobera D, Kwesiga B, Kabwama SN, Tusiime P, Wanyenze RK. Uganda public health fellowship program's contribution to building a resilient and sustainable public health system in Uganda. Glob Health Action 2019; 12:1609825. [PMID: 31117889 PMCID: PMC6534252 DOI: 10.1080/16549716.2019.1609825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Low-income countries with relatively weak-health systems are highly vulnerable to public health threats. Effective public health system with a workforce to investigate outbreaks can reduce disease impact on livelihoods and economic development. Building effective public health partnerships is critical for sustainability of such a system. Uganda has made significant progress in responding to emergencies during the past quarter century, but its public health workforce is still inadequate in number and competency. Objectives: To reinforce implementation of priority public health programs in Uganda and cultivate core capacities for compliance with International Health Regulations. Methods: To develop a competent workforce to manage epidemics and improve disease surveillance, Uganda Ministry of Health (MoH) established an advanced-level Field Epidemiology Training Program, called Public Health Fellowship Program (PHFP); closely modelled after the US CDC’s Epidemic Intelligence Service. PHFP is a 2-year, full-time, non-degree granting program targeting mid-career public health professionals. Fellows spend 85% of their field time in MoH placements learning through service delivery and gaining competencies in major domains. Results: During 2015–2018, PHFP enrolled 41 fellows, and graduated 30. Fellows were placed in 19 priority areas at MoH and completed 235 projects (91 outbreaks, 12 refugee assessments, 50 surveillance, and 60 epidemiologic studies, 3 cost analysis and 18 quality improvement); made 194 conference presentations; prepared 63 manuscripts for peer-reviewed publications (27 published as of December 2018); produced MoH bulletins, and developed three case studies. Projects have resulted in public health interventions with improvements in surveillance systems and disease control. Conclusion: During the 4 years of existence, PHFP has contributed greatly to improving real-time disease surveillance and outbreak response core capacities. Enhanced focus on evidence-based targeted approaches has increased effectiveness in outbreak response and control, and integration of PHFP within MoH has contributed to building a resilient and sustainable health system in Uganda.
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Affiliation(s)
- Alex Riolexus Ario
- a Ministry of Health of Uganda , Kampala , Uganda.,b Uganda National Institute of Public Health , Kampala , Uganda.,c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Lilian Bulage
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda.,d African Field Epidemiology Network , Kampala , Uganda
| | - Daniel Kadobera
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Benon Kwesiga
- c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Steven N Kabwama
- e Uganda Public Health Fellowship Program and Makerere University School of Public Health , Kampala , Uganda
| | - Patrick Tusiime
- a Ministry of Health of Uganda , Kampala , Uganda.,c Uganda Public Health Fellowship Program , Ministry of Health , Kampala , Uganda
| | - Rhoda K Wanyenze
- e Uganda Public Health Fellowship Program and Makerere University School of Public Health , Kampala , Uganda
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Ng V, Rees EE, Lindsay LR, Drebot MA, Brownstone T, Sadeghieh T, Khan SU. Could exotic mosquito-borne diseases emerge in Canada with climate change? Can Commun Dis Rep 2019; 45:98-107. [PMID: 31285699 PMCID: PMC6587696 DOI: 10.14745/ccdr.v45i04a04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Of the 3,500 species of mosquitoes worldwide, only a small portion carry and transmit the mosquito-borne diseases (MBDs) that cause approximately half a million deaths annually worldwide. The most common exotic MBDs, such as malaria and dengue, are not currently established in Canada, in part because of our relatively harsh climate; however, this situation could evolve with climate change. Mosquitoes native to Canada may become infected with new pathogens and move into new regions within Canada. In addition, new mosquito species may move into Canada from other countries, and these exotic species may bring exotic MBDs as well. With high levels of international travel, including to locations with exotic MBDs, there will be more travel-acquired cases of MBDs. With climate change, there is the potential for exotic mosquito populations to become established in Canada. There is already a small area of Canada where exotic Aedes mosquitoes have become established although, to date, there is no evidence that these carry any exotic (or already endemic) MBDs. The increased risks of spreading MBDs, or introducing exotic MBDs, will need a careful clinical and public health response. Clinicians will need to maintain a high level of awareness of current trends, to promote mosquito bite prevention strategies, and to know the laboratory tests needed for early detection and when to report laboratory results to public health. Public health efforts will need to focus on ongoing active surveillance, public and professional awareness and mosquito control. Canadians need to be aware of the risks of acquiring exotic MBDs while travelling abroad as well as the risk that they could serve as a potential route of introduction for exotic MBDs into Canada when they return home.
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Affiliation(s)
- V Ng
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - EE Rees
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - LR Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - MA Drebot
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
| | - T Brownstone
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - T Sadeghieh
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Department of Population Medicine, University of Guelph, Guelph, ON
| | - SU Khan
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, St. Hyacinthe, QC and Winnipeg, MB
- Department of Population Medicine, University of Guelph, Guelph, ON
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Abstract
Bats are known to harbor and transmit many emerging and re-emerging viruses, many of which are extremely pathogenic in humans but do not cause overt pathology in their bat reservoir hosts: henipaviruses (Nipah and Hendra), filoviruses (Ebola and Marburg), and coronaviruses (SARS-CoV and MERS-CoV). Direct transmission cycles are often implicated in these outbreaks, with virus shed in bat feces, urine, and saliva. An additional mode of virus transmission between bats and humans requiring further exploration is the spread of disease via arthropod vectors. Despite the shared ecological niches that bats fill with many hematophagous arthropods (e.g. mosquitoes, ticks, biting midges, etc.) known to play a role in the transmission of medically important arboviruses, knowledge surrounding the potential for bats to act as reservoirs for arboviruses is limited. To this end, a comprehensive literature review was undertaken examining the current understanding and potential for bats to act as reservoirs for viruses transmitted by blood-feeding arthropods. Serosurveillance and viral isolation from either free-ranging or captive bats are described in relation to four arboviral groups (Bunyavirales, Flaviviridae, Reoviridae, Togaviridae). Further, ecological associations between bats and hematophagous viral vectors are characterized (e.g. bat bloodmeals in mosquitoes, ingestion of mosquitoes by bats, etc). Lastly, knowledge gaps related to hematophagous ectoparasites (bat bugs and bed bugs (Cimicidae) and bat flies (Nycteribiidae and Streblidae)), in addition to future directions for characterization of bat-vector-virus relationships are described.
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Affiliation(s)
- Anna C Fagre
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
| | - Rebekah C Kading
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
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