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Ikejezie J, Miglietta A, Hammermeister Nezu I, Adele S, Higdon MM, Feikin D, Lata H, Mesfin S, Idoko F, Shimizu K, Acma A, Moro S, Attar Cohen H, Sinnathamby MA, Otieno JR, Temre Y, Ajong BN, Mirembe BB, Guinko TN, Sodagar V, Schultz C, Muianga J, De Barros S, Escobar Corado Waeber AR, Jin Y, Rico Chinchilla A, Izawa Y, Khare S, Poole M, Alexander N, Ciobanu S, Dorji T, Hassan M, Kato M, Matsui T, Ogundiran O, Pebody RG, Phengxay M, Riviere-Cinnamond A, Greene-Cramer BJ, Peron E, Archer BN, Subissi L, Kassamali ZA, Awofisayo-Okuyelu A, le Polain de Waroux O, Hamblion E, Pavlin BI, Morgan O, Fall IS, Van Kerkhove MD, Mahamud A. Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update. BMJ Glob Health 2024; 9:e014466. [PMID: 38580376 PMCID: PMC11002403 DOI: 10.1136/bmjgh-2023-014466] [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: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024] Open
Abstract
On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.
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Affiliation(s)
| | | | | | - Sandra Adele
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Feikin
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Friday Idoko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kazuki Shimizu
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ayse Acma
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Moro
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Homa Attar Cohen
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Yosef Temre
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Tondri Noe Guinko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Vaishali Sodagar
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Craig Schultz
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Joao Muianga
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stéphane De Barros
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yeowon Jin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yurie Izawa
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Shagun Khare
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Marcia Poole
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Nyka Alexander
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Silviu Ciobanu
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tshewang Dorji
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Mahmoud Hassan
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Richard G Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manilay Phengxay
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Emilie Peron
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Esther Hamblion
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Boris Igor Pavlin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Abdi Mahamud
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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Attar Cohen H, Mesfin S, Ikejezie J, Kassamali Z, Campbell F, Adele S, Guinko N, Idoko F, Mirembe BB, Mitri ME, Nezu I, Shimizu K, Ngongheh AB, Sklenovska N, Gumede N, Mosha FS, Mohamed B, Corpuz A, Pebody R, Marklewitz M, Gresh L, Mendez Rico JA, Hundal K, Kato M, Babu A, Archer BN, le Polain de Waroux O, Van Kerkhove MD, Mahamud A, Subissi L, Pavlin BI. Surveillance for variants of SARS-CoV-2 to inform risk assessments. Bull World Health Organ 2023; 101:707-716. [PMID: 37961054 PMCID: PMC10630725 DOI: 10.2471/blt.23.290093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 11/15/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have emerged, some leading to large increases in infections, hospitalizations and deaths globally. The virus's impact on public health depends on many factors, including the emergence of new viral variants and their global spread. Consequently, the early detection and surveillance of variants and characterization of their clinical effects are vital for assessing their health risk. The unprecedented capacity for viral genomic sequencing and data sharing built globally during the pandemic has enabled new variants to be rapidly detected and assessed. This article describes the main variants circulating globally between January 2020 and June 2023, the genetic features driving variant evolution, and the epidemiological impact of these variants across countries and regions. Second, we report how integrating genetic variant surveillance with epidemiological data and event-based surveillance, through a network of World Health Organization partners, supported risk assessment and helped provide guidance on pandemic responses. In addition, given the evolutionary characteristics of circulating variants and the immune status of populations, we propose future directions for the sustainable genomic surveillance of SARS-CoV-2 variants, both nationally and internationally: (i) optimizing variant surveillance by including environmental monitoring; (ii) coordinating laboratory assessment of variant evolution and phenotype; (iii) linking data on circulating variants with clinical data; and (iv) expanding genomic surveillance to additional pathogens. Experience during the COVID-19 pandemic has shown that genomic surveillance of pathogens can provide essential, timely and evidence-based information for public health decision-making.
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Affiliation(s)
- Homa Attar Cohen
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Samuel Mesfin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Juniorcaius Ikejezie
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Zyleen Kassamali
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Finlay Campbell
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Sandra Adele
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Noe Guinko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Friday Idoko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Bernadette Basuta Mirembe
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Maria Elizabeth Mitri
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ingrid Nezu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Kazuki Shimizu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ajong Brian Ngongheh
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Nikola Sklenovska
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | | | - Basant Mohamed
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Aura Corpuz
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Lionel Gresh
- Pan American Health Organization, WashingtonD.C., United States of America
| | | | - Kareena Hundal
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Masaya Kato
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Amarnath Babu
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Brett N Archer
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | - Maria D Van Kerkhove
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Abdirahman Mahamud
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Lorenzo Subissi
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Boris I Pavlin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
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3
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Hoxha A, Kerr SM, Laurenson-Schafer H, Sklenovská N, Mirembe BB, Nezu IH, Ndumbi P, Fitzner J, Almiron M, Vila M, Pebody R, Vaughan AM, Haussig JM, de Sousa LA, Lukoya OC, Sanni OF, Nabeth P, Naiene JD, Kato M, Matsui T, Kuppalli K, Mala PO, Lewis RF, de Waroux OLP, Pavlin BI. Mpox in Children and Adolescents during Multicountry Outbreak, 2022-2023. Emerg Infect Dis 2023; 29:2125-2129. [PMID: 37647121 PMCID: PMC10521596 DOI: 10.3201/eid2910.230516] [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: 09/01/2023] Open
Abstract
The 2022-2023 mpox outbreak predominantly affected adult men; 1.3% of reported cases were in children and adolescents <18 years of age. Analysis of global surveillance data showed 1 hospital intensive care unit admission and 0 deaths in that age group. Transmission routes and clinical manifestations varied across age subgroups.
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Affiliation(s)
| | | | - Henry Laurenson-Schafer
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Nikola Sklenovská
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Bernadette Basuta Mirembe
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Ingrid Hammermeister Nezu
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Patricia Ndumbi
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Julia Fitzner
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Maria Almiron
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Marcelo Vila
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Richard Pebody
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Aisling M. Vaughan
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Joana M. Haussig
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Luis Alves de Sousa
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Okot Charles Lukoya
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Olaniyi Felix Sanni
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Pierre Nabeth
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Jeremias Domingos Naiene
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Masaya Kato
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Tamano Matsui
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Krutika Kuppalli
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Peter Omondi Mala
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Rosamund F. Lewis
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Olivier le Polain de Waroux
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - Boris I. Pavlin
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
| | - WHO Mpox surveillance and Analytics Team
- Health Emergencies Programme, World Health Organization (WHO), Geneva, Switzerland (A. Hoxha, H. Laurenson-Schafer, N. Sklenovska, B.B. Mirembe, I.H. Nezu, P. Ndumbi, J. Fitzner, K. Kuppalli, P.O. Mala, R.F. Lewis, O. le Polain de Waroux, B.I. Pavlin)
- CPC Analytics, Berlin, Germany (S.M. Kerr)
- WHO Regional Office for the Americas, Washington, DC, USA (M. Almiron, M. Vila)
- WHO Regional Office for Europe, Copenhagen, Denmark (R. Pebody, A.M. Vaughan)
- European Centre for Disease Prevention and Control, Solna, Sweden (J.M. Haussig, L. Alves de Sousa)
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo (O.C. Lukoya, O.F. Sanni)
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt (P. Nabeth, J.D. Naiene)
- WHO Regional Office for South-East Asia, Delhi, India (M. Kato)
- WHO Regional Office for the Western Pacific, Manila, Philippines (T. Matsui)
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4
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Laurenson-Schafer H, Sklenovská N, Hoxha A, Kerr SM, Ndumbi P, Fitzner J, Almiron M, de Sousa LA, Briand S, Cenciarelli O, Colombe S, Doherty M, Fall IS, García-Calavaro C, Haussig JM, Kato M, Mahamud AR, Morgan OW, Nabeth P, Naiene JD, Navegantes WA, Ogundiran O, Okot C, Pebody R, Matsui T, Ramírez HLG, Smallwood C, Tasigchana RFP, Vaughan AM, Williams GS, Mala PO, Lewis RF, Pavlin BI, le Polain de Waroux O. Description of the first global outbreak of mpox: an analysis of global surveillance data. Lancet Glob Health 2023; 11:e1012-e1023. [PMID: 37349031 PMCID: PMC10281644 DOI: 10.1016/s2214-109x(23)00198-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND In May 2022, several countries with no history of sustained community transmission of mpox (formerly known as monkeypox) notified WHO of new mpox cases. These cases were soon followed by a large-scale outbreak, which unfolded across the world, driven by local, in-country transmission within previously unaffected countries. On July 23, 2022, WHO declared the outbreak a Public Health Emergency of International Concern. Here, we aim to describe the main epidemiological features of this outbreak, the largest reported to date. METHODS In this analysis of global surveillance data we analysed data for all confirmed mpox cases reported by WHO Member States through the global surveillance system from Jan 1, 2022, to Jan 29, 2023. Data included daily aggregated numbers of mpox cases by country and a case reporting form (CRF) containing information on demographics, clinical presentation, epidemiological exposure factors, and laboratory testing. We used the data to (1) describe the key epidemiological and clinical features of cases; (2) analyse risk factors for hospitalisation (by multivariable mixed-effects binary logistic regression); and (3) retrospectively analyse transmission trends. Sequencing data from GISAID and GenBank were used to analyse monkeypox virus (MPXV) genetic diversity. FINDINGS Data from 82 807 cases with submitted CRFs were included in the analysis. Cases were primarily due to clade IIb MPXV (mainly lineage B.1, followed by lineage A.2). The outbreak was driven by transmission among males (73 560 [96·4%] of 76 293 cases) who self-identify as men who have sex with men (25 938 [86·9%] of 29 854 cases). The most common reported route of transmission was sexual contact (14 941 [68·7%] of 21 749). 3927 (7·3%) of 54 117 cases were hospitalised, with increased odds for those aged younger than 5 years (adjusted odds ratio 2·12 [95% CI 1·32-3·40], p=0·0020), aged 65 years and older (1·54 [1·05-2·25], p=0·026), female cases (1·61 [1·35-1·91], p<0·0001), and for cases who are immunosuppressed either due to being HIV positive and immunosuppressed (2·00 [1·68-2·37], p<0·0001), or other immunocompromising conditions (3·47 [1·84-6·54], p=0·0001). INTERPRETATION Continued global surveillance allowed WHO to monitor the epidemic, identify risk factors, and inform the public health response. The outbreak can be attributed to clade IIb MPXV spread by newly described modes of transmission. FUNDING WHO Contingency Fund for Emergencies. TRANSLATIONS For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | - Ana Hoxha
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Julia Fitzner
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | - Maria Almiron
- WHO Regional Office for the Americas, Washington, DC, USA
| | | | - Sylvie Briand
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Meg Doherty
- Health Emergencies Programme, WHO, Geneva, Switzerland
| | | | | | - Joana M Haussig
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Masaya Kato
- WHO Regional Office for South-East Asia, Delhi, India
| | | | | | - Pierre Nabeth
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Opeayo Ogundiran
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Charles Okot
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Tamano Matsui
- WHO Regional Office for the Western Pacific, Manila, Philippines
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5
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McMenamin M, Kolmer J, Djordjevic I, Campbell F, Laurenson-Schafer H, Abbate JL, Abdelgawad BM, Babu A, Balde T, Batra N, Bélorgeot VD, Brindle H, Dorji T, Esmail M, Hammermeister Nezu I, Hernández-García L, Hassan M, Idoko F, Karmin S, Kassamali ZA, Kato M, Matsui T, Duan M, Motaze V, Ogundiran O, Pavlin BI, Riviere-Cinnamond A, Ryan K, Schmidt T, Sedai T, Van Kerkhove MD, Zakaria T, Höhle M, Mahamud AR, le Polain de Waroux O. WHO Global Situational Alert System: a mixed methods multistage approach to identify country-level COVID-19 alerts. BMJ Glob Health 2023; 8:e012241. [PMID: 37495371 PMCID: PMC10373705 DOI: 10.1136/bmjgh-2023-012241] [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: 03/14/2023] [Accepted: 05/14/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Globally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched. METHODS The process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of 'High' or above were added to an operational watchlist and assistance was deployed as needed. RESULTS Since June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%-67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available. CONCLUSIONS The system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators.
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Affiliation(s)
- Martina McMenamin
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Jessica Kolmer
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Irena Djordjevic
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Finlay Campbell
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | | | - Jessica Lee Abbate
- WHO Health Emergencies Programme, WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Basma Mostafa Abdelgawad
- WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Amarnath Babu
- WHO Health Emergencies Programme, WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Thierno Balde
- WHO Health Emergencies Programme, WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Neale Batra
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Victoria D Bélorgeot
- WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hannah Brindle
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Tshewang Dorji
- WHO Health Emergencies Programme, WHO Regional Office for the Americas, Washington, DC, USA
| | | | | | | | - Mahmoud Hassan
- WHO Health Emergencies Programme, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Friday Idoko
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | | | | | - Masaya Kato
- WHO Health Emergencies Programme, WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tamano Matsui
- WHO Health Emergencies Programme, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Mengjuan Duan
- WHO Health Emergencies Programme, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Villyen Motaze
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Opeayo Ogundiran
- WHO Health Emergencies Programme, WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Boris I Pavlin
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Ana Riviere-Cinnamond
- WHO Health Emergencies Programme, WHO Regional Office for the Americas, Washington, DC, USA
| | - Kathleen Ryan
- WHO Health Emergencies Programme, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Tanja Schmidt
- WHO Health Emergencies Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Tika Sedai
- WHO Health Emergencies Programme, WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | | | - Teresa Zakaria
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
| | - Michael Höhle
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
- Stockholm University, Stockholm, Sweden
| | - Abdi R Mahamud
- WHO Health Emergencies Programme, WHO Headquarters, Geneva, Switzerland
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6
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Mousa A, Winskill P, Watson OJ, Ratmann O, Monod M, Ajelli M, Diallo A, Dodd PJ, Grijalva CG, Kiti MC, Krishnan A, Kumar R, Kumar S, Kwok KO, Lanata CF, le Polain de Waroux O, Leung K, Mahikul W, Melegaro A, Morrow CD, Mossong J, Neal EF, Nokes DJ, Pan-Ngum W, Potter GE, Russell FM, Saha S, Sugimoto JD, Wei WI, Wood RR, Wu J, Zhang J, Walker P, Whittaker C. Social contact patterns and implications for infectious disease transmission: a systematic review and meta-analysis of contact surveys. eLife 2021; 10:70294. [PMID: 34821551 PMCID: PMC8765757 DOI: 10.7554/elife.70294] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 05/12/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focused on high-income settings. Methods: Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys, we explored how contact characteristics (number, location, duration, and whether physical) vary across income settings. Results: Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income strata on the frequency, duration, and type of contacts individuals made. Conclusions: These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens and the effectiveness of different non-pharmaceutical interventions. Funding: This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1). Infectious diseases, particularly those caused by airborne pathogens like SARS-CoV-2, spread by social contact, and understanding how people mix is critical in controlling outbreaks. To explore these patterns, researchers typically carry out large contact surveys. Participants are asked for personal information (such as gender, age and occupation), as well as details of recent social contacts, usually those that happened in the last 24 hours. This information includes, the age and gender of the contact, where the interaction happened, how long it lasted, and whether it involved physical touch. These kinds of surveys help scientists to predict how infectious diseases might spread. But there is a problem: most of the data come from high-income countries, and there is evidence to suggest that social contact patterns differ between places. Therefore, data from these countries might not be useful for predicting how infections spread in lower-income regions. Here, Mousa et al. have collected and combined data from 27 contact surveys carried out before the COVID-19 pandemic to see how baseline social interactions vary between high- and lower-income settings. The comparison revealed that, in higher-income countries, the number of daily contacts people made decreased with age. But, in lower-income countries, younger and older individuals made similar numbers of contacts and mixed with all age groups. In higher-income countries, more contacts happened at work or school, while in low-income settings, more interactions happened at home and people were also more likely to live in larger, intergenerational households. Mousa et al. also found that gender affected how long contacts lasted and whether they involved physical contact, both of which are key risk factors for transmitting airborne pathogens. These findings can help researchers to predict how infectious diseases might spread in different settings. They can also be used to assess how effective non-medical restrictions, like shielding of the elderly and workplace closures, will be at reducing transmissions in different parts of the world.
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Affiliation(s)
- Andria Mousa
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Peter Winskill
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Oliver John Watson
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Mélodie Monod
- Department of Mathematics, Imperial College London, London, United Kingdom
| | - Marco Ajelli
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, United States
| | - Aldiouma Diallo
- VITROME, Institut de Recherche pour le Developpement, Dakar, Senegal
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Carlos G Grijalva
- Division of Pharmacoepidemiology, Department of Health Policy, Vanderbilt University Medical Center, Nashville, United States
| | | | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Kumar
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Kin O Kwok
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Kathy Leung
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Wiriya Mahikul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Alessia Melegaro
- Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Carl D Morrow
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Eleanor Fg Neal
- Infection and Immunity, Murdoch Children's Research Institute, Victoria, Australia
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Gail E Potter
- National Institute for Allergies and Infectious Diseases, National Institutes of Health, Rockville, United States
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute, Victoria, Australia
| | - Siddhartha Saha
- US Centers for Disease Control and Prevention, New Delhi, India
| | - Jonathan D Sugimoto
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs, Seattle, United States
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Robin R Wood
- Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Joseph Wu
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Juanjuan Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Patrick Walker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
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7
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Abstract
The increase in cases of coronavirus disease 2019 (COVID-19) worldwide has been paralleled by increasing information, and misinformation. Accurate public health messaging is essential to counter this, but education may also have a role. Early in the outbreak, The London School of Hygiene & Tropical Medicine partnered with FutureLearn to develop a massive open online course (MOOC) on COVID-19. Our approach was grounded in social constructivism, supporting participation, sharing uncertainties, and encouraging discussion. The first run of the course included over 200,000 participants from 184 countries, with over 88,000 comments at the end of the three-week run. Many participants supported each other's learning in their responses and further questions. Our experience suggests that open education can complement traditional messaging, potentially providing a sustainable approach to countering the spread of misinformation in public health.
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Affiliation(s)
- Anna C. Seale
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Maryirene Ibeto
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Josie Gallo
- Centre for Excellence in Learning and Teaching, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Olivier le Polain de Waroux
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
| | - Judith R. Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Jenny Fogarty
- Centre for Excellence in Learning and Teaching, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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8
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Carter SE, Ahuka-Mundeke S, Pfaffmann Zambruni J, Navarro Colorado C, van Kleef E, Lissouba P, Meakin S, le Polain de Waroux O, Jombart T, Mossoko M, Bulemfu Nkakirande D, Esmail M, Earle-Richardson G, Degail MA, Umutoni C, Anoko JN, Gobat N. How to improve outbreak response: a case study of integrated outbreak analytics from Ebola in Eastern Democratic Republic of the Congo. BMJ Glob Health 2021; 6:bmjgh-2021-006736. [PMID: 34413078 PMCID: PMC8380808 DOI: 10.1136/bmjgh-2021-006736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity of the CASS was to conduct operational social science analyses that were useful to decision makers. This included ensuring that research questions were relevant, driven by epidemiological data from the field, that research could be conducted rapidly (ie, often within days), that findings were regularly and systematically presented to partners and that recommendations were co-developed with response actors. The implementation of the recommendations based on CASS analytics was also monitored over time, to measure their impact on response operations. This practice paper presents the CASS logic model, developed through a field-based externally led consultation, and documents key factors contributing to the usefulness and adaption of CASS and IOA to guide replication for future outbreaks.
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Affiliation(s)
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Esther van Kleef
- Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | | | | | - Mathias Mossoko
- Ministry of Health, Kinshasa, The Democratic Republic of the Congo
| | | | - Marjam Esmail
- Public Health Emergencies, UNICEF, New York, New York, USA
| | - Giulia Earle-Richardson
- National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie-Amelie Degail
- Health Emergencies Programme, World Health Organization, Geneve, Switzerland
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9
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Amirthalingam G, Whitaker H, Brooks T, Brown K, Hoschler K, Linley E, Borrow R, Brown C, Watkins N, Roberts DJ, Solomon D, Gower CM, de Waroux OLP, Andrews NJ, Ramsay ME. Seroprevalence of SARS-CoV-2 among Blood Donors and Changes after Introduction of Public Health and Social Measures, London, UK. Emerg Infect Dis 2021; 27:1795-1801. [PMID: 34152947 PMCID: PMC8237903 DOI: 10.3201/eid2707.203167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/22/2022] Open
Abstract
We describe results of testing blood donors in London, UK, for severe acute respiratory disease coronavirus 2 (SARS-CoV-2) IgG before and after lockdown measures. Anonymized samples from donors 17–69 years of age were tested using 3 assays: Euroimmun IgG, Abbott IgG, and an immunoglobulin receptor-binding domain assay developed by Public Health England. Seroprevalence increased from 3.0% prelockdown (week 13, beginning March 23, 2020) to 10.4% during lockdown (weeks 15–16) and 12.3% postlockdown (week 18) by the Abbott assay. Estimates were 2.9% prelockdown, 9.9% during lockdown, and 13.0% postlockdown by the Euroimmun assay and 3.5% prelockdown, 11.8% during lockdown, and 14.1% postlockdown by the receptor-binding domain assay. By early May 2020, nearly 1 in 7 donors had evidence of past SARS-CoV-2 infection. Combining results from the Abbott and Euroimmun assays increased seroprevalence by 1.6%, 2.3%, and 0.6% at the 3 timepoints compared with Euroimmun alone, demonstrating the value of using multiple assays.
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10
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Campbell F, Archer B, Laurenson-Schafer H, Jinnai Y, Konings F, Batra N, Pavlin B, Vandemaele K, Van Kerkhove MD, Jombart T, Morgan O, le Polain de Waroux O. Increased transmissibility and global spread of SARS-CoV-2 variants of concern as at June 2021. Euro Surveill 2021; 26:2100509. [PMID: 34142653 PMCID: PMC8212592 DOI: 10.2807/1560-7917.es.2021.26.24.2100509] [Citation(s) in RCA: 490] [Impact Index Per Article: 163.3] [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] [Indexed: 11/20/2022] Open
Abstract
We present a global analysis of the spread of recently emerged SARS-CoV-2 variants and estimate changes in effective reproduction numbers at country-specific level using sequence data from GISAID. Nearly all investigated countries demonstrated rapid replacement of previously circulating lineages by the World Health Organization-designated variants of concern, with estimated transmissibility increases of 29% (95% CI: 24-33), 25% (95% CI: 20-30), 38% (95% CI: 29-48) and 97% (95% CI: 76-117), respectively, for B.1.1.7, B.1.351, P.1 and B.1.617.2.
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Affiliation(s)
- Finlay Campbell
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Brett Archer
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yuka Jinnai
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Franck Konings
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Neale Batra
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Boris Pavlin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Katelijn Vandemaele
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Thibaut Jombart
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland,London School of Hygiene and Tropical Medicine, London, United Kingdom,Imperial College London, London, United Kingdom
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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11
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Mazhar MKA, Finger F, Evers ES, Kuehne A, Ivey M, Yesurajan F, Shirin T, Ajim N, Kabir A, Musto J, White K, Baidjoe A, le Polain de Waroux O. An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox's Bazar, Bangladesh: Findings from enhanced epidemiological surveillance. PLoS One 2021; 16:e0250505. [PMID: 33914782 PMCID: PMC8084213 DOI: 10.1371/journal.pone.0250505] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/07/2021] [Indexed: 12/20/2022] Open
Abstract
In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population.
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Affiliation(s)
| | - Flavio Finger
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Egmond Samir Evers
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Anna Kuehne
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Public Health England, Letchworth Garden, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, United Kingdom
| | | | - Francis Yesurajan
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Ahammadul Kabir
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Jennie Musto
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | | | - Amrish Baidjoe
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- International Committee of the Red Cross, Geneva, Switzerland
| | - Olivier le Polain de Waroux
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Public Health England, Letchworth Garden, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, United Kingdom
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12
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Polonsky JA, Ivey M, Mazhar MKA, Rahman Z, le Polain de Waroux O, Karo B, Jalava K, Vong S, Baidjoe A, Diaz J, Finger F, Habib ZH, Halder CE, Haskew C, Kaiser L, Khan AS, Sangal L, Shirin T, Zaki QA, Salam MA, White K. Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study. PLoS Med 2021; 18:e1003587. [PMID: 33793554 PMCID: PMC8059831 DOI: 10.1371/journal.pmed.1003587] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 09/02/2020] [Revised: 04/21/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. CONCLUSIONS To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.
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Affiliation(s)
- Jonathan A. Polonsky
- World Health Organization, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Melissa Ivey
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Ziaur Rahman
- Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Olivier le Polain de Waroux
- World Health Organization, Geneva, Switzerland
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, London, United Kingdom
| | - Basel Karo
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Information Centre for International Health Protection (ZIG 1), Robert Koch Institute (RKI), Berlin, Germany
| | - Katri Jalava
- World Health Organization Country Office for Bangladesh, Dhaka, Bangladesh
| | - Sirenda Vong
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Amrish Baidjoe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
| | - Flavio Finger
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Epicentre, Paris, France
| | - Zakir H. Habib
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - Laurent Kaiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ali S. Khan
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- College of Public Health, University of Nebraska Medical Center, Nebraska, United States of America
| | - Lucky Sangal
- World Health Organization Country Office for India, New Delhi, India
| | - Tahmina Shirin
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Quazi Ahmed Zaki
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Kate White
- Médecins Sans Frontières, Amsterdam, the Netherlands
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13
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Chandra NL, Bolt H, Dan-Nwafor C, Ipadeola O, Ilori E, Namara G, Olayinka AT, Ukponu W, Iniobong A, Amedu M, Akano A, Akabike KO, Okhuarobo U, Fagbemi S, Sampson E, Newitt S, Verlander NQ, Bausch DG, le Polain de Waroux O, Ihekweazu C. Factors associated with delayed presentation to healthcare facilities for Lassa fever cases, Nigeria 2019: a retrospective cohort study. BMC Infect Dis 2021; 21:143. [PMID: 33541278 PMCID: PMC7863257 DOI: 10.1186/s12879-021-05822-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions. Methods We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation. Results Of 389 cases, median presentation time was 6 days (IQR 4–10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13–17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0–4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5–12 and 13–17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5–9 days and 20–60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41–95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time. Conclusions Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes.
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Affiliation(s)
- Nastassya L Chandra
- UK Field Epidemiology Training Programme, Public Health England, London, UK. .,UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK.
| | - Hikaru Bolt
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Geoffrey Namara
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Adebola T Olayinka
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Winifred Ukponu
- Georgetown University, Centre for Global Health Practice and Impact, Abuja, Nigeria
| | | | | | | | | | | | | | | | - Sophie Newitt
- Public Health England, National Infection Service, London, UK
| | | | - Daniel G Bausch
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier le Polain de Waroux
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
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14
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Garry S, Abdelmagid N, Baxter L, Roberts N, le Polain de Waroux O, Ismail S, Ratnayake R, Favas C, Lewis E, Checchi F. Considerations for planning COVID-19 treatment services in humanitarian responses. Confl Health 2020; 14:80. [PMID: 33250932 PMCID: PMC7686825 DOI: 10.1186/s13031-020-00325-6] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.
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Affiliation(s)
- Sylvia Garry
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Nada Abdelmagid
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Louisa Baxter
- Save the Children UK, 1 St John's Ln, Farringdon, London, EC1M 4AR UK
| | - Natalie Roberts
- Centre de réflexion sur l'action et les savoirs humanitaires (CRASH), Fondation MSF (Médecins Sans Frontières), 13-34 avenue Jean Jaurès, 75019 Paris, France
| | - Olivier le Polain de Waroux
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK.,UK Public Health Rapid Support Team (UK-PHRST), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Sharif Ismail
- Department of Global Health and Development, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Ruwan Ratnayake
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Caroline Favas
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Elizabeth Lewis
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Francesco Checchi
- Health in Humanitarian Crises Centre, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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15
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Seale AC, Ibeto M, Gallo J, le Polain de Waroux O, Glynn JR, Fogarty J. Learning from each other in the COVID-19 pandemic. Wellcome Open Res 2020; 5:105. [PMID: 34853816 PMCID: PMC8602955 DOI: 10.12688/wellcomeopenres.15973.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 02/15/2024] Open
Abstract
The increase in cases of coronavirus disease 2019 (COVID-19) worldwide has been paralleled by increasing information, and misinformation. Accurate public health messaging is essential to counter this, but education may also have a role. Early in the outbreak, The London School of Hygiene & Tropical Medicine partnered with FutureLearn to develop a massive open online course (MOOC) on COVID-19. Our approach was grounded in social constructivism, supporting participation, sharing uncertainties, and encouraging discussion. The first run of the course included over 200,000 participants from 184 countries, with over 88,000 comments at the end of the three-week run. Many participants supported each other's learning in their responses and further questions. Our experience suggests that open education, and supporting the development of communities of learners, can complement traditional messaging, providing a sustainable approach to countering the spread of misinformation.
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Affiliation(s)
- Anna C. Seale
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Maryirene Ibeto
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Josie Gallo
- Centre for Excellence in Learning and Teaching, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Olivier le Polain de Waroux
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine and Public Health England, London, UK
| | - Judith R. Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Jenny Fogarty
- Centre for Excellence in Learning and Teaching, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Polonsky JA, Baidjoe A, Kamvar ZN, Cori A, Durski K, Edmunds WJ, Eggo RM, Funk S, Kaiser L, Keating P, de Waroux OLP, Marks M, Moraga P, Morgan O, Nouvellet P, Ratnayake R, Roberts CH, Whitworth J, Jombart T. Outbreak analytics: a developing data science for informing the response to emerging pathogens. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180276. [PMID: 31104603 PMCID: PMC6558557 DOI: 10.1098/rstb.2018.0276] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite continued efforts to improve health systems worldwide, emerging pathogen epidemics remain a major public health concern. Effective response to such outbreaks relies on timely intervention, ideally informed by all available sources of data. The collection, visualization and analysis of outbreak data are becoming increasingly complex, owing to the diversity in types of data, questions and available methods to address them. Recent advances have led to the rise of outbreak analytics, an emerging data science focused on the technological and methodological aspects of the outbreak data pipeline, from collection to analysis, modelling and reporting to inform outbreak response. In this article, we assess the current state of the field. After laying out the context of outbreak response, we critically review the most common analytics components, their inter-dependencies, data requirements and the type of information they can provide to inform operations in real time. We discuss some challenges and opportunities and conclude on the potential role of outbreak analytics for improving our understanding of, and response to outbreaks of emerging pathogens. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control‘. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.
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Affiliation(s)
- Jonathan A Polonsky
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland.,3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Amrish Baidjoe
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Zhian N Kamvar
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Anne Cori
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Kara Durski
- 2 Department of Infectious Hazard Management, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - W John Edmunds
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Rosalind M Eggo
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Sebastian Funk
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Laurent Kaiser
- 3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Patrick Keating
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Olivier le Polain de Waroux
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK.,9 Public Health England , Wellington House, 133-155 Waterloo Road, London SE1 8UG , UK
| | - Michael Marks
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Paula Moraga
- 10 Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster Medical School, Lancaster University , Lancaster LA1 4YW , UK
| | - Oliver Morgan
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - Pierre Nouvellet
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,11 School of Life Sciences, University of Sussex , Sussex House, Brighton BN1 9RH , UK
| | - Ruwan Ratnayake
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Chrissy H Roberts
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Jimmy Whitworth
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Thibaut Jombart
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
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Kunkel A, Keita M, Diallo B, le Polain de Waroux O, Subissi L, Wague B, Molala R, Lonfandjo P, Bokete SB, Perea W, Djingarey MH. Assessment of a health facility based active case finding system for Ebola virus disease in Mbandaka, Democratic Republic of the Congo, June-July 2018. BMC Infect Dis 2019; 19:981. [PMID: 31752717 PMCID: PMC6873572 DOI: 10.1186/s12879-019-4600-4] [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] [Received: 03/14/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022] Open
Abstract
Background The ninth outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo occurred in Équateur Province from 8 May-24 July 2018. A system of health facility (HF)-based active case finding (ACF) was implemented in Mbandaka, a regional capital with four confirmed EVD cases, following completion of contact tracing. The goal of this HF-based ACF system was to look for undetected EVD cases among patients that visited HFs beginning one week prior to the system’s implementation. Methods From 23 June – 24 July 2018, ACF teams visited HFs in Mbandaka and reviewed all medical records as far back as 17 June for any consultations meeting the suspected EVD case definition. The teams then assessed whether to validate these as suspected EVD cases based on factors such as recovery, epidemiological links, and their clinical judgement. ACF teams also assessed HFs’ awareness of EVD symptoms and the process for alerting suspected cases. We calculated descriptive statistics regarding the characteristics of reviewed consultations, alert cases, and visited HFs. We also used univariate and multivariate random effects logistic regression models to evaluate the impact of repeated ACF visits to the same HF on the staff’s awareness of EVD. Results ACF teams reviewed 37,746 consultations, of which 690 met the definition of a suspected case of EVD. Two were validated as suspected EVD cases and transferred to the Ebola Treatment Unit for testing; both tested negative. Repeated ACF visits to the same HF were significantly associated with improved EVD awareness (p < 0.001) in univariate and multivariate analyses. Conclusion HF-based ACF during EVD outbreaks may improve EVD awareness and reveal many individuals meeting the suspected case definition. However, many who meet this definition may not have EVD, depending on the population size covered by ACF and amount of ongoing EVD transmission. Given the burdensome procedure of testing suspected EVD cases, future HF-based ACF systems would benefit from improved clarity on which patients require further testing.
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Affiliation(s)
- Amber Kunkel
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France. .,Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.
| | - Mory Keita
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Boubacar Diallo
- WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Olivier le Polain de Waroux
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,Public Health England, London, UK.,UK-Public Health Rapid Support Team, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Bocar Wague
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland.,Ministry of Health of Mauritania, Nouakchott, Mauritania
| | - Roger Molala
- Provincial Health Division of the Équateur Region, Mbandaka, Democratic Republic of the Congo
| | - Pierre Lonfandjo
- Provincial Health Division of the Équateur Region, Mbandaka, Democratic Republic of the Congo
| | - Sébastien Bokoo Bokete
- Provincial Health Division of the Équateur Region, Mbandaka, Democratic Republic of the Congo
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18
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van Zandvoort K, Checchi F, Diggle E, Eggo RM, Gadroen K, Mulholland K, McGowan CR, le Polain de Waroux O, Rao VB, Satzke C, Flasche S. Pneumococcal conjugate vaccine use during humanitarian crises. Vaccine 2019; 37:6787-6792. [PMID: 31562004 DOI: 10.1016/j.vaccine.2019.09.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/16/2019] [Revised: 08/16/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022]
Abstract
Streptococcus pneumoniae is a common human commensal that causes a sizeable part of the overall childhood mortality in low income settings. Populations affected by humanitarian crises are at especially high risk, because a multitude of risk factors that are enhanced during crises increase pneumococcal transmission and disease severity. Pneumococcal conjugate vaccines (PCVs) provide effective protection and have been introduced into the majority of routine childhood immunisation programmes globally, though several barriers have hitherto limited their uptake during humanitarian crises. When PCV coverage cannot be sustained during crises or when PCV has not been part of routine programmes, mass vaccination campaigns offer a quick acting and programmatically feasible bridging solution until services can be restored. However, we currently face a paucity of evidence on which to base the structure of such campaigns. We believe that, now that PCV can be procured at a substantially reduced price through the Humanitarian Mechanism, this lack of information is a remaining hurdle to PCV use in humanitarian crises. Considering the difficulties in conducting research in crises, we propose an evidence generation pathway consisting of primary data collection in combination with mathematical modelling followed by quasi-experimental evaluation of a PCV intervention, which can inform on optimal vaccination strategies that consider age targeting, dosing regimens and impact duration.
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Affiliation(s)
- Kevin van Zandvoort
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Kartini Gadroen
- Médecins Sans Frontières, Amsterdam, the Netherlands; Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands
| | - Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Catherine R McGowan
- Save the Children UK, London, UK; Department of Public Health, Environments, and Society, London School of Hygiene & Tropical Medicine. London, UK
| | - Olivier le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK; UK Public Health Rapid Support Team, London, UK; Public Health England, London, UK
| | - V Bhargavi Rao
- Manson Unit, Médecins Sans Frontières (MSF UK), London, UK
| | - Catherine Satzke
- Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
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19
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le Polain de Waroux O, Flasche S, Kucharski AJ, Langendorf C, Ndazima D, Mwanga-Amumpaire J, Grais RF, Cohuet S, Edmunds WJ. Identifying human encounters that shape the transmission of Streptococcus pneumoniae and other acute respiratory infections. Epidemics 2018; 25:72-79. [PMID: 30054196 PMCID: PMC6227246 DOI: 10.1016/j.epidem.2018.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/28/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 01/23/2023] Open
Abstract
Although patterns of social contacts are believed to be an important determinant of infectious disease transmission, it remains unclear how the frequency and nature of human interactions shape an individual's risk of infection. We analysed data on daily social encounters individually matched to data on S. pneumoniae carriage and acute respiratory symptoms (ARS), from 566 individuals who took part in a survey in South-West Uganda. We found that the frequency of physical (i.e. skin-to-skin), long (≥1 h) and household contacts - which capture some measure of close (i.e. relatively intimate) contact - was higher among pneumococcal carriers than non-carriers, and among people with ARS compared to those without, irrespective of their age. With each additional physical encounter the age-adjusted risk of carriage and ARS increased by 6% (95%CI 2-9%) and 7% (2-13%) respectively. In contrast, the number of casual contacts (<5 min long) was not associated with either pneumococcal carriage or ARS. A detailed analysis by age of contacts showed that the number of close contacts with young children (<5 years) was particularly higher among older children and adult carriers than non-carriers, while the higher number of contacts among people suffering from ARS was more homogeneous across contacts of all ages. Our findings provide key evidence that the frequency of close interpersonal contact is important for transmission of respiratory infections, but not that of casual contacts. Those results are essential for both improving disease prevention and control efforts as well as informing research on infectious disease dynamics and transmission models, and more studies should be undertaken to further validate our results.
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Affiliation(s)
- Olivier le Polain de Waroux
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom.
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
| | - Celine Langendorf
- Department of Research, Epicentre, 8 Rue Saint-Sabin, 75011, Paris, France
| | - Donny Ndazima
- Epicentre Mbarara Research Centre, PO Box 1956, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Epicentre Mbarara Research Centre, PO Box 1956, Mbarara, Uganda; Mbarara Universityof Science and Technology, Mbarara University, PO Box 1410, Mbarara, Uganda
| | - Rebecca F Grais
- Department of Research, Epicentre, 8 Rue Saint-Sabin, 75011, Paris, France
| | - Sandra Cohuet
- Department of Field Epidemiology, Epicentre, 8 Rue Saint-Sabin, 75011, Paris, France
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom
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André E, Rusumba O, Evans CA, Ngongo P, Sanduku P, Elvis MM, Celestin HN, Alain IR, Musafiri EM, Kabuayi JP, le Polain de Waroux O, Aït-Khaled N, Delmée M, Zech F. Patient-led active tuberculosis case-finding in the Democratic Republic of the Congo. Bull World Health Organ 2018; 96:522-530. [PMID: 30104792 PMCID: PMC6083386 DOI: 10.2471/blt.17.203968] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/23/2018] [Accepted: 04/18/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the effect of using volunteer screeners in active tuberculosis case-finding in South Kivu, the Democratic Republic of the Congo, especially among groups at high risk of tuberculosis infection. METHODS To identify and screen high-risk groups in remote communities, we trained volunteer screeners, mainly those who had themselves received treatment for tuberculosis or had a family history of the disease. A non-profit organization was created and screeners received training on the disease and its transmission at 3-day workshops. Screeners recorded the number of people screened, reporting a prolonged cough and who attended a clinic for testing, as well as test results. Data were evaluated every quarter during the 3-year period of the intervention (2014-2016). FINDINGS Acceptability of the intervention was high. Volunteers screened 650 434 individuals in their communities, 73 418 of whom reported a prolonged cough; 50 368 subsequently attended a clinic for tuberculosis testing. Tuberculosis was diagnosed in 1 in 151 people screened, costing 0.29 United States dollars (US$) per person screened and US$ 44 per person diagnosed. Although members of high-risk groups with poorer access to health care represented only 5.1% (33 002/650 434) of those screened, they contributed 19.7% (845/4300) of tuberculosis diagnoses (1 diagnosis per 39 screened). The intervention resulted in an additional 4300 sputum-smear-positive pulmonary tuberculosis diagnoses, 42% (4 300/10 247) of the provincial total for that period. CONCLUSION Patient-led active tuberculosis case-finding represents a valuable complement to traditional case-finding, and should be used to assist health systems in the elimination of tuberculosis.
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Affiliation(s)
- Emmanuel André
- Department of Microbiology and Immunology, KU Leuven, Herestraat 49, Box 1030, 3000 Leuven, Belgium
| | - Olivier Rusumba
- Ambassadeurs de Lutte Contre la Tuberculose, Bukavu, Democratic Republic of Congo
| | - Carlton A Evans
- Section of Infectious Diseases and Immunity, Imperial College London, London, England
| | - Philippe Ngongo
- Coordination Provinciale Lèpre et Tuberculose du Sud-Kivu, Bukavu, Democratic Republic of Congo
| | - Pasteur Sanduku
- Coordination Provinciale Lèpre et Tuberculose du Sud-Kivu, Bukavu, Democratic Republic of Congo
| | | | | | - Ishara Rusumba Alain
- Ambassadeurs de Lutte Contre la Tuberculose, Bukavu, Democratic Republic of Congo
| | - Eric Mulume Musafiri
- Coordination Provinciale Lèpre et Tuberculose du Sud-Kivu, Bukavu, Democratic Republic of Congo
| | - Jean-Pierre Kabuayi
- Challenge TB, United States Agency for International Development, United States of America
| | - Olivier le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - Nadia Aït-Khaled
- International Union against Tuberculosis and Lung Disease, Paris, France
| | - Michel Delmée
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Francis Zech
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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21
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Nackers F, Cohuet S, le Polain de Waroux O, Langendorf C, Nyehangane D, Ndazima D, Nanjebe D, Karani A, Tumwesigye E, Mwanga-Amumpaire J, Scott JAG, Grais RF. Carriage prevalence and serotype distribution of Streptococcus pneumoniae prior to 10-valent pneumococcal vaccine introduction: A population-based cross-sectional study in South Western Uganda, 2014. Vaccine 2017; 35:5271-5277. [PMID: 28784282 PMCID: PMC6616034 DOI: 10.1016/j.vaccine.2017.07.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/06/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Background Information on Streptococcus pneumoniae nasopharyngeal (NP) carriage before the pneumococcal conjugate vaccine (PCV) introduction is essential to monitor impact. The 10-valent PCV (PCV10) was officially introduced throughout Ugandan national childhood immunization programs in 2013 and rolled-out countrywide during 2014. We aimed to measure the age-specific Streptococcus pneumoniae carriage and serotype distribution across all population age groups in the pre-PCV10 era in South Western Uganda. Methods We conducted a two-stage cluster, age-stratified, cross-sectional community-based study in Sheema North sub-district between January and March 2014. One NP swab was collected and analyzed for each participant in accordance with World Health Organization guidelines. Results NP carriage of any pneumococcal serotype was higher among children <2 years old (77%; n = 387) than among participants aged ≥15 years (8.5%; n = 325) (chi2 p < 0.001). Results Of the 623 positive cultures, we identified 49 serotypes among 610 (97.9%) isolates; thirteen (2.1%) isolates were non-typeable. Among <2 years old, serotypes 6A, 6B, 14, 15B, 19F and 23F accounted for half of all carriers. Carriage prevalence with PCV10 serotypes was 29.4% among individuals aged <2 years (n = 387), 23.4% in children aged 2–4 years (n = 217), 11.4% in 5–14 years (n = 417), and 0.4% among individuals ≥15 years of age (n = 325). The proportion of carried pneumococci serotypes contained in PCV10 was 38.1% (n = 291), 32.8% (n = 154), 29.4% (n = 156), and 4.4% (n = 22) among carriers aged <2 years, 2–4 years, 5–14 years and ≥15 years, respectively. Discussion In Sheema district, the proportion of PCV10 serotypes was low (<40%), across all age groups, especially among individuals aged 15 years or older (<5%). PCV10 introduction is likely to impact transmission among children and to older individuals, but less likely to substantially modify pneumococcal NP ecology among individuals aged 15 years or older.
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Affiliation(s)
| | | | - Olivier le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom
| | | | - Dan Nyehangane
- Epicentre, Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda
| | - Donny Ndazima
- Epicentre, Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda
| | - Deborah Nanjebe
- Epicentre, Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda
| | - Angela Karani
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Elioda Tumwesigye
- Kabwohe Medical Research Centre, P.O. Box 347, Bushenyi, Kabwohe, Uganda
| | - Juliet Mwanga-Amumpaire
- Epicentre, Mbarara Research Centre, P.O. Box 1956, Mbarara, Uganda; Mbarara University of Science and Technology, P.O. Box 1404, Mbarara, Uganda
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
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22
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Watson CH, Coriakula J, Ngoc DTT, Flasche S, Kucharski AJ, Lau CL, Thieu NTV, le Polain de Waroux O, Rawalai K, Van TT, Taufa M, Baker S, Nilles EJ, Kama M, Edmunds WJ. Social mixing in Fiji: Who-eats-with-whom contact patterns and the implications of age and ethnic heterogeneity for disease dynamics in the Pacific Islands. PLoS One 2017; 12:e0186911. [PMID: 29211731 PMCID: PMC5718486 DOI: 10.1371/journal.pone.0186911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022] Open
Abstract
Empirical data on contact patterns can inform dynamic models of infectious disease transmission. Such information has not been widely reported from Pacific islands, nor strongly multi-ethnic settings, and few attempts have been made to quantify contact patterns relevant for the spread of gastrointestinal infections. As part of enteric fever investigations, we conducted a cross-sectional survey of the general public in Fiji, finding that within the 9,650 mealtime contacts reported by 1,814 participants, there was strong like-with-like mixing by age and ethnicity, with higher contact rates amongst iTaukei than non-iTaukei Fijians. Extra-domiciliary lunchtime contacts follow these mixing patterns, indicating the overall data do not simply reflect household structures. Inter-ethnic mixing was most common amongst school-age children. Serological responses indicative of recent Salmonella Typhi infection were found to be associated, after adjusting for age, with increased contact rates between meal-sharing iTaukei, with no association observed for other contact groups. Animal ownership and travel within the geographical division were common. These are novel data that identify ethnicity as an important social mixing variable, and use retrospective mealtime contacts as a socially acceptable metric of relevance to enteric, contact and respiratory diseases that can be collected in a single visit to participants. Application of these data to other island settings will enable communicable disease models to incorporate locally relevant mixing patterns in parameterisation.
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Affiliation(s)
- Conall H Watson
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Dung Tran Thi Ngoc
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Nga Tran Vu Thieu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam
| | - Olivier le Polain de Waroux
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Tan Trinh Van
- School of Medicine, Fiji National University, Suva, Fiji
| | - Mere Taufa
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eric J Nilles
- Division of Pacific Technical Support, World Health Organization-Western Pacific Region, Suva, Fiji
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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le Polain de Waroux O, Saliba V, Cottrell S, Young N, Perry M, Bukasa A, Ramsay M, Brown K, Amirthalingam G. Summer music and arts festivals as hot spots for measles transmission: experience from England and Wales, June to October 2016. ACTA ACUST UNITED AC 2016; 21:30390. [PMID: 27881230 PMCID: PMC5114485 DOI: 10.2807/1560-7917.es.2016.21.44.30390] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Received: 09/20/2016] [Accepted: 11/03/2016] [Indexed: 12/02/2022]
Abstract
We report 52 cases of measles linked to music and arts festivals in England and Wales, between mid-June and mid-October 2016. Nearly half were aged 15 to 19 years. Several individuals who acquired measles at one festival subsequently attended another festival while infectious, resulting in multiple interlinked outbreaks. Transmission within festivals resulted in a geographical spread of cases nationally as well as internationally, which presents particular challenges for measles control.
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Affiliation(s)
| | - Vanessa Saliba
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Simon Cottrell
- Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, United Kingdom
| | - Nick Young
- Public Health England South West, Public Health England, Exeter, United Kingdom
| | - Malorie Perry
- Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, United Kingdom
| | - Antoaneta Bukasa
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Mary Ramsay
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
| | - Kevin Brown
- Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom
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Verroken A, Defourny L, le Polain de Waroux O, Belkhir L, Laterre PF, Delmée M, Glupczynski Y. Correction: Clinical Impact of MALDI-TOF MS Identification and Rapid Susceptibility Testing on Adequate Antimicrobial Treatment in Sepsis with Positive Blood Cultures. PLoS One 2016; 11:e0160537. [PMID: 27658295 PMCID: PMC5033485 DOI: 10.1371/journal.pone.0160537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Verroken A, Defourny L, le Polain de Waroux O, Belkhir L, Laterre PF, Delmée M, Glupczynski Y. Clinical Impact of MALDI-TOF MS Identification and Rapid Susceptibility Testing on Adequate Antimicrobial Treatment in Sepsis with Positive Blood Cultures. PLoS One 2016; 11:e0156299. [PMID: 27228001 PMCID: PMC4881997 DOI: 10.1371/journal.pone.0156299] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/12/2016] [Indexed: 11/18/2022] Open
Abstract
Shortening the turn-around time (TAT) of positive blood culture (BC) identification (ID) and susceptibility results is essential to optimize antimicrobial treatment in patients with sepsis. We aimed to evaluate the impact on antimicrobial prescription of a modified workflow of positive BCs providing ID and partial susceptibility results for Enterobacteriaceae (EB), Pseudomonas aeruginosa and Staphylococcus aureus on the day of BC positivity detection. This study was divided into a pre-intervention period (P0) with a standard BC workflow followed by 2 intervention periods (P1, P2) with an identical modified workflow. ID was performed with MALDI-TOF MS from blood, on early or on overnight subcultures. According to ID results, rapid phenotypic assays were realized to detect third generation cephalosporin resistant EB/P. aeruginosa or methicillin resistant S. aureus. Results were transmitted to the antimicrobial stewardship team for patient's treatment revision. Times to ID, to susceptibility results and to optimal antimicrobial treatment (OAT) were compared across the three study periods. Overall, 134, 112 and 154 positive BC episodes in P0, P1 and P2 respectively were included in the analysis. Mean time to ID (28.3 hours in P0) was reduced by 65.3% in P1 (10.2 hours) and 61.8% in P2 (10.8 hours). Mean time to complete susceptibility results was reduced by 27.5% in P1 and 27% in P2, with results obtained after 32.4 and 32.6 hours compared to 44.7 hours in P0. Rapid tests allowed partial susceptibility results to be obtained after a mean time of 11.8 hours in P1 and 11.7 hours in P2. Mean time to OAT was decreased to 21.6 hours in P1 and to 17.9 hours in P2 compared to 36.1 hours in P0. Reducing TAT of positive BC with MALDI-TOF MS ID and rapid susceptibility testing accelerated prescription of targeted antimicrobial treatment thereby potentially improving the patients' clinical outcome.
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Affiliation(s)
- Alexia Verroken
- Institut de recherche expérimentale et clinique (IREC), pôle de microbiologie (MBLG), Université catholique de Louvain, Brussels, Belgium
- Laboratoire de microbiologie, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
- * E-mail:
| | - Lydwine Defourny
- Laboratoire de microbiologie, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
| | - Olivier le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leïla Belkhir
- Département de médecine interne et pathologies infectieuses, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
| | - Pierre-François Laterre
- Département des soins intensifs, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
| | - Michel Delmée
- Institut de recherche expérimentale et clinique (IREC), pôle de microbiologie (MBLG), Université catholique de Louvain, Brussels, Belgium
- Laboratoire de microbiologie, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
| | - Youri Glupczynski
- National Reference Centre for Monitoring Antimicrobial Resistance in Gram-negative bacteria, CHU UCL Namur, Yvoir, Belgium
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le Polain de Waroux O, Cohuet S, Bishop L, Johnson S, Shaw K, Maguire H, Charlett A, Fraser G. Prevalence of and risks for internal contamination among hospital staff caring for a patient contaminated with a fatal dose of polonium-210. Infect Control Hosp Epidemiol 2011; 32:1010-5. [PMID: 21931252 DOI: 10.1086/661913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Alexander Litvinenko died on November 23, 2006, from acute radiation sickness syndrome caused by ingestion of polonium-210 (²¹⁰Po). OBJECTIVE The objective was to assess the prevalence of and risk factors for internal contamination with ²¹⁰Po in healthcare workers (HCWs) caring for the contaminated patient. SETTING Hospital. PARTICIPANTS HCWs who had direct contact with the patient. METHODS We interviewed 43 HCWs and enquired about their activities and use of personal protective equipment (PPE). Internal contamination was defined as urinary ²¹⁰Po excretion above 20 mBq within 24 hours. We obtained risk ratios (RRs) for internal contamination using Poisson regression. RESULTS Thirty-seven HCWs (86%) responded, and 8 (22%) showed evidence of internal contamination, all at very low levels that were unlikely to cause adverse health outcomes. Daily care of the patient (washing and toileting the patient) was the main risk factor (RR, 3.6 [95% confidence interval (CI), 1.1-11.6]). In contrast, planned invasive procedures were not associated with a higher risk. There was some evidence of a higher risk associated with handling blood samples (RR, 3.5 [95% CI, 0.8-15.6]) and changing urine bags and/or collecting urine samples (RR, 2.7 [95% CI, 0.8-9.5]). There was also some evidence that those who reported not always using standard PPE were at higher risk than were others (RR, 2.5 [95% CI, 0.8-8.1]). CONCLUSIONS The sensitive quantitative measurement enabled us to identify factors associated with contamination, which by analogy to other conditions with similar transmission mechanisms may help improve protection and preparedness in staff dealing with an ill patient who experiences an unknown illness.
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