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Doshi RH, Nsasiirwe S, Dahlke M, Atagbaza A, Aluta OE, Tatsinkou AB, Dauda E, Vilajeliu A, Gurung S, Tusiime J, Braka F, Bwaka A, Wanyoike S, Brooks DJ, Blanc DC, Alexander JP, Dahl BA, Lindstrand A, Wiysonge CS. COVID-19 Vaccination Coverage - World Health Organization African Region, 2021-2023. MMWR Morb Mortal Wkly Rep 2024; 73:307-311. [PMID: 38602879 PMCID: PMC11008790 DOI: 10.15585/mmwr.mm7314a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
With the availability of authorized COVID-19 vaccines in early 2021, vaccination became an effective tool to reduce COVID-19-associated morbidity and mortality. Initially, the World Health Organization (WHO) set an ambitious target to vaccinate 70% of the global population by mid-2022. However, in July 2022, WHO recommended that all countries, including those in the African Region, prioritize COVID-19 vaccination of high-risk groups, including older adults and health care workers, to have the greatest impact on morbidity and mortality. As of December 31, 2023, approximately 860 million doses of COVID-19 vaccine had been delivered to countries in the African Region, and 646 million doses had been administered. Cumulatively, 38% of the African Region's population had received ≥1 dose, 32% had completed a primary series, and 21% had received ≥1 booster dose. Cumulative total population coverage with ≥1 dose ranged by country from 0.3% to 89%. Coverage with the primary series among older age groups was 52% (range among countries = 15%-96%); primary series coverage among health care workers was 48% (range = 13%-99%). Although the COVID-19 public health emergency of international concern was declared over in May 2023, current WHO recommendations reinforce the need to vaccinate priority populations at highest risk for severe COVID-19 disease and death and build more sustainable programs by integrating COVID-19 vaccination into primary health care, strengthening immunization across the life course, and improving pandemic preparedness.
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Doshi RH, Mukadi PK, Casey RM, Kizito GM, Gao H, Nguete U B, Laven J, Sabi L, Kaba DK, Muyembe-Tamfum JJ, Hyde TB, Ahuka-Mundeke S, Staples JE. Immunological response to fractional-dose yellow fever vaccine administered during an outbreak in Kinshasa, Democratic Republic of the Congo: results 5 years after vaccination from a prospective cohort study. Lancet Infect Dis 2024:S1473-3099(23)00809-5. [PMID: 38335976 DOI: 10.1016/s1473-3099(23)00809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND In 2016, outbreaks of yellow fever in Angola and the Democratic Republic of the Congo led to a global vaccine shortage. A fractional dose of 17DD yellow fever vaccine (containing one-fifth [0·1 ml] of the standard dose) was used during a pre-emptive mass campaign in August, 2016, in Kinshasa, Democratic Republic of the Congo among children aged 2 years and older and non-pregnant adults (ie, those aged 18 years and older). 1 year following vaccination, 97% of participants were seropositive; however, the long-term durability of the immune response is unknown. We aimed to conduct a prospective cohort study and invited participants enrolled in the previous evaluation to return 5 years after vaccination to assess durability of the immune response. METHODS Participants returned to one of six health facilities in Kinshasa in 2021, where study staff collected a brief medical history and blood specimen. We assessed neutralising antibody titres against yellow fever virus using a plaque reduction neutralisation test with a 50% cutoff (PRNT50). Participants with a PRNT50 titre of 10 or higher were considered seropositive. The primary outcome was the proportion of participants seropositive at 5 years. FINDINGS Among the 764 participants enrolled, 566 (74%) completed the 5-year visit. 5 years after vaccination, 539 (95·2%, 95% CI 93·2-96·7) participants were seropositive, including 361 (94·3%, 91·5-96·2) of 383 who were seronegative and 178 (97·3%, 93·8-98·8) of 183 who were seropositive at baseline. Geometric mean titres (GMTs) differed significantly across age groups for those who were initially seronegative with the lowest GMT among those aged 2-5 years and highest among those aged 13 years and older. INTERPRETATION A fractional dose of the 17DD yellow fever vaccine induced an immunologic response with detectable titres at 5 years among the majority of participants in the Democratic Republic of the Congo. These findings support the use of fractional-dose vaccination for outbreak prevention with the potential for sustained immunity. FUNDING Gavi, the Vaccine Alliance through the CDC Foundation. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Patrick K Mukadi
- Centers for Disease Control and Prevention Foundation, Atlanta, GA, USA; Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Rebecca M Casey
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gabriel M Kizito
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beatrice Nguete U
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Janeen Laven
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Lilliane Sabi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Didine K Kaba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - J Erin Staples
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Perera SM, Garbern SC, Mbong EN, Fleming MK, Muhayangabo RF, Ombeni AB, Kulkarni S, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Mustafa SHB, Earle-Richardson G, Fukunaga R, Abad N, Soke GN, Prybylski D, Fitter DL, Levine AC, Doshi RH. Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo. PLOS Glob Public Health 2024; 4:e0002566. [PMID: 38236844 PMCID: PMC10796044 DOI: 10.1371/journal.pgph.0002566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.
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Affiliation(s)
- Shiromi M. Perera
- International Medical Corps, Washington, District of Columbia, United States of America
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dieula Delissaint Tchoualeu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Song
- Brown University, Providence, Rhode Island, United States of America
| | - Jasmine Powell
- Brown University, Providence, Rhode Island, United States of America
| | - Monique Gainey
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Doshi RH, Garbern SC, Kulkarni S, Perera SM, Fleming MK, Muhayangabo RF, Ombeni AB, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Hans Bateyi Mustafa S, Earle-Richardson G, Gao H, Abad N, Soke GN, Fitter DL, Hyde TB, Prybylski D, Levine AC, Jalloh MF, Mbong EN. Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021. Front Public Health 2023; 11:1080700. [PMID: 37559741 PMCID: PMC10408297 DOI: 10.3389/fpubh.2023.1080700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. Methods In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). Results Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. Discussion Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.
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Affiliation(s)
- Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Bailey Glenn
- James A. Ferguson Infectious Disease Program, Baltimore, MD, United States
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terri B. Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam C. Levine
- International Medical Corps, Washington, DC, United States
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Mohamed F. Jalloh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
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Garbern SC, Perera SM, Mbong EN, Kulkarni S, Fleming MK, Ombeni AB, Muhayangabo RF, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Gao H, Mutumwa RM, Mustafa SHB, Abad N, Soke GN, Prybylski D, Doshi RH, Fukunaga R, Levine AC. COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021. Vaccines (Basel) 2023; 11:973. [PMID: 37243077 PMCID: PMC10223943 DOI: 10.3390/vaccines11050973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.
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Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | | | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, USA
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Mukadi P, Higgins SG, Budd R, Randall C, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Wells C, Rimoin AW. Reported History of Measles and Long-term Impact on Tetanus Antibody Detected in Children 9-59 Months of Age and Receiving 3 Doses of Tetanus Vaccine in the Democratic Republic of the Congo. Pediatr Infect Dis J 2023; 42:338-345. [PMID: 36795582 PMCID: PMC9990594 DOI: 10.1097/inf.0000000000003840] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Recent studies suggest measles-induced immune amnesia could have long-term immunosuppressive effects via preferential depletion of memory CD150+ lymphocytes, and associations with a 2-3 year period of increased mortality and morbidity from infectious diseases other than measles has been shown in children from wealthy and low-income countries. To further examine the associations previous measles virus infection may have on immunologic memory among children in the Democratic Republic of the Congo (DRC), we assessed tetanus antibody levels among fully vaccinated children, with and without a history of measles. METHODS We assessed 711 children 9-59 months of age whose mothers were selected for interview in the 2013-2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report and classification of children who had measles in the past was completed using maternal recall and measles IgG serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. Tetanus IgG antibody serostatus was similarly obtained. A logistic regression model was used to identify association of measles and other predictors with subprotective tetanus IgG antibody. RESULTS Subprotective geometric mean concentration tetanus IgG antibody values were seen among fully vaccinated children 9-59 months of age, who had a history of measles. Controlling for potential confounding variables, children classified as measles cases were less likely to have seroprotective tetanus toxoid antibody (odds ratio: 0.21; 95% confidence interval: 0.08-0.55) compared with children who had not had measles. CONCLUSIONS History of measles was associated with subprotective tetanus antibody among this sample of children in the DRC who were 9-59 months of age and fully vaccinated against tetanus.
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Affiliation(s)
- Hayley R. Ashbaugh
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - James D. Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Nicole A. Hoff
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Reena H. Doshi
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, Democratic Republic of the Congo
| | | | - Roger Budd
- DYNEX Technologies Incorporated, Chantilly, Virginia
| | | | | | | | - Sue K. Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Christine Wells
- UCLA IDRE Statistical Consulting Group, University of California, Los Angeles, Los Angeles, California
| | - Anne W. Rimoin
- From the Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Soeters HM, Doshi RH, Fleming M, Adegoke OJ, Ajene U, Aksnes BN, Bennett S, Blau EF, Carlton JG, Clements S, Conklin L, Dahlke M, Duca LM, Feldstein LR, Gidudu JF, Grant G, Hercules M, Igboh LS, Ishizumi A, Jacenko S, Kerr Y, Konne NM, Kulkarni S, Kumar A, Lafond KE, Lam E, Longley AT, McCarron M, Namageyo-Funa A, Ortiz N, Patel JC, Perry RT, Prybylski D, Reddi P, Salman O, Sciarratta CN, Shragai T, Siddula A, Sikare E, Tchoualeu DD, Traicoff D, Tuttle A, Victory KR, Wallace A, Ward K, Wong MKA, Zhou W, Schluter WW, Fitter DL, Mounts A, Bresee JS, Hyde TB. CDC's COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Emerg Infect Dis 2022; 28:S208-S216. [PMID: 36502382 DOI: 10.3201/eid2813.212123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.
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Zola Matuvanga T, Doshi RH, Muya A, Cikomola A, Milabyo A, Nasaka P, Mitashi P, Muhindo-Mavoko H, Ahuka S, Nzaji M, Hoff NA, Perry R, Mukamba Musenga E. Challenges to COVID-19 vaccine introduction in the Democratic Republic of the Congo - a commentary. Hum Vaccin Immunother 2022; 18:2127272. [PMID: 36165731 DOI: 10.1080/21645515.2022.2127272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
COVID-19 vaccination in the Democratic Republic of the Congo (DRC) began in April 2021. A month later, most COVID-19 vaccine doses were reallocated to other African countries, due to low vaccine uptake and the realization that the doses would expire before use. Based on data available on 13 August 2022, 2.76% of the DRC population had been fully vaccinated with last dose of primary series of COVID-19 vaccine, placing the country second to last in Africa and in the last five in global COVID-19 vaccination coverage. The DRC's reliance on vaccine donations requires continuous adaptation of the vaccine deployment plan to match incoming COVID-19 vaccines shipments. Challenges in planning vaccine deployments, vaccinating priority populations, coordinating, and implementing the communications plan, disbursing funds, and conducting supervision of vaccination activities have contributed to low COVID-19 vaccine coverage. In addition, the spread of rumors through social media and by various community and religious leaders resulted in high levels of vaccine hesitancy. A strong risk communication and community engagement plan, coupled with innovative efforts to target the highest-risk populations are critical to increase vaccine uptake during the next phase of COVID-19 vaccine introduction.
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Affiliation(s)
| | - Reena H Doshi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Albert Muya
- Infodemic management, World Health Organization, Kinshasa, DRC
| | - Aimé Cikomola
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Augustin Milabyo
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Pablito Nasaka
- Immunization and vaccination department, World Health Organization, Kinshasa, DRC
| | - Patrick Mitashi
- Department of tropical Medecine, University of Kinshasa, Kinshasa, DRC
| | | | - Steve Ahuka
- Department of Virology, National Institute for Biomedical Research (INRB), Kinshasa, DRC
| | - Michel Nzaji
- Expanded Program on immunization, Democratic Republic of the Congo, Kinshasa, DRC
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, CA, USA
| | - Robert Perry
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, Hladik W. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda. BMC Pregnancy Childbirth 2022; 22:646. [PMID: 35978285 PMCID: PMC9382809 DOI: 10.1186/s12884-022-04977-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - Reena H Doshi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
| | - Herbert Kiyingi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Jonathan Standish
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, USA
| | - Wolfgang Hladik
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
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10
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Cheng A, Ghanem-Uzqueda A, Hoff NA, Ashbaugh H, Doshi RH, Mukadi P, Budd R, Higgins SG, Randall C, Gerber S, Kabamba M, Ngoie Mwamba G, Okitolonda-Wemakoy E, Muyembe-Tanfum JJ, Rimoin AW. Tetanus seroprotection among children in the Democratic Republic of the Congo, 2013–2014. PLoS One 2022; 17:e0268703. [PMID: 35587922 PMCID: PMC9119496 DOI: 10.1371/journal.pone.0268703] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background Tetanus is a potentially fatal disease that is preventable through vaccination. While the Democratic Republic of the Congo (DRC) has continued to improve implementing routine vaccination activities throughout the country, they have struggled to maintain high childhood vaccine coverage. This study aims to examine the seroprevalence of tetanus in children 6 to 59 months to identify areas for intervention and improvement of vaccination coverage. Methods In collaboration with the 2013–2014 Demographic and Health Survey, we assessed the seroprevalence of tetanus antibodies among children in the DRC. Dried blood spot samples collected from children 6–59 months of age were processed using a prototype DYNEX Multiplier® chemiluminescent automated immunoassay instrument with a multiplex measles, mumps, rubella, varicella and tetanus assay. Multivariable logistic regression was used to determine factors associated with tetanus vaccination and seroprotection. Results Overall, 36.1% of children 6–59 months of age reported receiving at least 1 dose of tetanus vaccine while 28.7% reported receiving 3 doses; tetanus seroprotection was 40%. Increasing age in children was associated with decreased tetanus seroprotection, but increased number tetanus vaccinations received. Factors related to increased tetanus seroprotection included number of children in the household, wealth index of the family, urban residence compared to rural, level of maternal education, and province and geography. Conclusions Our findings in this nationally representative sample indicate that serology biomarkers may help identify children who are not fully immunized to tetanus more accurately than reported vaccination. While children may be captured for routine immunization activities, as children age, decreasing seroprevalence may indicate additional need to bolster routine vaccination activities and documentation of vaccination in school aged children. Additionally, the study highlights gaps in rural residential areas and vaccination coverage based on maternal education, indicating that policies targeting maternal education and awareness could improve the coverage and seroprevalence of tetanus antibodies in the DRC.
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Affiliation(s)
- Alvan Cheng
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Angie Ghanem-Uzqueda
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Nicole A. Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Hayley Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Reena H. Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
| | - Patrick Mukadi
- School of Medicine, Kinshasa University, Kinshasa, Democratic Republic of the Congo
| | - Roger Budd
- DYNEX Technologies Incorporated, Chantilly, Virginia, United States of America
| | - Stephen G. Higgins
- Lentigen Technology, Incorporated, Gaithersburg, Maryland, United States of America
| | - Christina Randall
- DYNEX Technologies Incorporated, Chantilly, Virginia, United States of America
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Michel Kabamba
- Expanded Program on Immunization, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Anne W. Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- * E-mail:
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11
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Brennan T, Hidle A, Doshi RH, An Q, Loharikar A, Casey R, Badiane O, Ndiaye A, Diallo A, Loko Roka J, Mejia N, Abimbola T. Cost of human papillomavirus vaccine delivery in a single-age cohort, routine-based vaccination program in Senegal. Vaccine 2022; 40 Suppl 1:A77-A84. [PMID: 34955325 PMCID: PMC10496089 DOI: 10.1016/j.vaccine.2021.11.057] [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: 05/06/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In 2018, Senegal introduced human papillomavirus (HPV) vaccine into its routine immunization program for all nine-year-old girls nationwide. We evaluated the costs of Senegal's introduction of HPV vaccine via this delivery approach. METHODS We conducted a retrospective, incremental, ingredients-based cost evaluation from the provider perspective. The study timeframe included Senegal's first planning meeting in 2018 through data collection in early 2020. We collected costs from all involved units at the national and regional levels. A multi-stage cluster sampling approach was used to obtain a nationally representative sample of districts and health facilities. Weights were applied to costs from sampled units to estimate costs across all units. The cost evaluation was based on four dimensions: program activity, resource input, payer, and administrative level. Total costs were divided by the number of HPV doses administered to determine cost per dose and per dimension. RESULTS Excluding vaccine program activity costs, the total financial and economic delivery costs of Senegal's HPV vaccination program were US$ 1,152,351 and US$ 2,838,466, respectively (US$ 3.07 and US$ 7.56 per dose, respectively). A total of 375,608 HPV vaccine doses were administered during the cost evaluation. Training and per diem represented the largest shares of financial costs. Service delivery and personnel time accounted for the largest shares of economic costs. By administrative level, district and health facility levels had the largest shares of financial and economic costs, respectively. Senegal's Ministry of Health accounted for the largest share of financial and economic costs. Including vaccine program activity costs (US$ 4.68/per dose), the total financial cost was US$ 2,911,343 (US$ 7.75 per dose). CONCLUSION This cost evaluation can support Senegal's future vaccine introductions and inform other countries planning to introduce HPV vaccine nationwide. These findings support previous costing studies which anticipated potential economies of scale during the transition from HPV vaccine pilot demonstration projects to national introduction.
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Affiliation(s)
| | | | - Reena H Doshi
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Qian An
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anagha Loharikar
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Casey
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ousseynou Badiane
- Government of Senegal, Ministry of Health and Social Action, Dakar, Senegal
| | - Alassane Ndiaye
- Government of Senegal, Ministry of Health and Social Action, Dakar, Senegal
| | - Aliou Diallo
- World Health Organization - Senegal, Dakar, Senegal
| | - Jerlie Loko Roka
- Senegal Centers for Disease Control and Prevention, Dakar, Senegal
| | - Nelly Mejia
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Taiwo Abimbola
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Alfonso VH, Voorman A, Hoff NA, Weldon WC, Gerber S, Gadoth A, Halbrook M, Goldsmith A, Mukadi P, Doshi RH, Ngoie-Mwamba G, Fuller TL, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Poliovirus immunity among adults in the Democratic Republic of the Congo: a cross-sectional serosurvey. BMC Infect Dis 2022; 22:30. [PMID: 34986786 PMCID: PMC8728990 DOI: 10.1186/s12879-021-06951-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination efforts to eradicate polio currently focus on children under 5 years of age, among whom most cases of poliomyelitis still occur. However, in the Democratic Republic of the Congo (DRC), an outbreak of wild poliovirus type 1 occurred in 2010-2011 in which 16% of cases occurred among adults; in a related outbreak in the neighboring Republic of Congo, 75% of cases occurred among the same adult age-group. Given that infected adults may transmit poliovirus, this study was designed to assess adult immunity against polioviruses. METHODS We assessed poliovirus seroprevalence using dried blood spots from 5,526 adults aged 15-59 years from the 2013-2014 Demographic and Health Survey in the DRC. RESULTS Among adults in the DRC, 74%, 72%, and 57% were seropositive for neutralizing antibodies for poliovirus types 1, 2, and 3, respectively. For all three serotypes, seroprevalence tended to be higher among older age groups, those living in households with more children, and among women. CONCLUSIONS Protection against poliovirus is generally low among adults in the DRC, particularly for type 3 poliovirus. The lack of acquired immunity in adults suggests a potentially limited poliovirus circulation over the lifetime of those surveyed (spanning 1954 through 2014) and transmission of vaccine-derived poliovirus in this age group while underscoring the risk of these outbreaks among adults in the DRC.
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Affiliation(s)
- Vivian H. Alfonso
- Department of Epidemiology, University of California, Los Angeles, USA
- McKing Consulting, Atlanta, GA USA
| | - Arie Voorman
- Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Nicole A. Hoff
- Department of Epidemiology, University of California, Los Angeles, USA
| | - William C. Weldon
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Adva Gadoth
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Megan Halbrook
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Amelia Goldsmith
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, Democratic Republic of the Congo
| | - Reena H. Doshi
- Department of Epidemiology, University of California, Los Angeles, USA
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Trevon L. Fuller
- Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, USA
| | | | | | - Anne W. Rimoin
- Department of Epidemiology, University of California, Los Angeles, USA
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13
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Doshi RH, Casey RM, Adrien N, Ndiaye A, Brennan T, Roka JL, Bathily A, Ndiaye C, Li A, Garon J, Badiane O, Diallo A, Loharikar A. Feasibility and acceptability of nationwide HPV vaccine introduction in Senegal: Findings from community-level cross-sectional surveys, 2020. PLOS Glob Public Health 2022; 2:e0000130. [PMID: 36962130 PMCID: PMC10021483 DOI: 10.1371/journal.pgph.0000130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/02/2022] [Indexed: 12/24/2022]
Abstract
In Senegal, cervical cancer is the most common cancer among women and the leading cause of morbidity and mortality from all cancers. In 2018, Senegal launched a national human papillomavirus (HPV) vaccination program with Gavi, the Vaccine Alliance (Gavi), support. HPV vaccination was incorporated into the national immunization program as a two-dose schedule, with a 6-12-month interval, to nine-year-old girls via routine immunization (RI) services at health facilities, schools and community outreach services throughout the year. During February to March 2020, we conducted interviews to assess the awareness, feasibility, and acceptability of the HPV vaccination program with a cross-sectional convenience sample of healthcare workers (HCWs), school personnel, community healthcare workers (cHCWs), parents, and community leaders from 77 rural and urban health facility catchment areas. Participants were asked questions on HPV vaccine knowledge, delivery, training, and community acceptability of the program. We conducted a descriptive analysis stratified by respondent type. Data were collected from 465 individuals: 77 HCW, 78 school personnel, 78 cHCWs, 152 parents, and community leaders. The majority of HCWs (83.1%) and cHCWs (74.4%) and school personnel (57.7%) attended a training on HPV vaccine before program launch. Of all respondents, most (52.5-87.2%) were able to correctly identify the target population. The majority of respondents (60.2-77.5%) felt that the vaccine was very accepted or accepted in the community. Senegal's HPV vaccine introduction program, among the first national programs in the African region, was accepted by community stakeholders. Training rates were high, and most respondents identified the target population correctly. However, continued technical support is needed for the integration of HPV vaccination as a RI activity for this non-traditional age group. The Senegal experience can be a useful resource for countries planning to introduce the HPV vaccine.
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Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
| | - Rebecca M Casey
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Nedghie Adrien
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Alassane Ndiaye
- Expanded Programme on Immunization, Ministry of Health and Social Action, Dakar, Senegal
| | - Timothy Brennan
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Jerlie Loko Roka
- Division of Global Health Protection, Centers for Disease control and Prevention, Dakar, Senegal
| | | | | | - Anyie Li
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Julie Garon
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
- CDC Foundation, Atlanta, Georgia, United States Of America
| | - Ousseynou Badiane
- Expanded Programme on Immunization, Ministry of Health and Social Action, Dakar, Senegal
| | | | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States Of America
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14
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Bratcher A, Hoff NA, Doshi RH, Gadoth A, Halbrook M, Mukadi P, Musene K, Ilunga-Kebela B, Spencer D, Bramble MS, McIlwan D, Kelly JD, Mukadi D, Kingebeni PM, Ahuka S, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Zoonotic risk factors associated with seroprevalence of Ebola virus GP antibodies in the absence of diagnosed Ebola virus disease in the Democratic Republic of Congo. PLoS Negl Trop Dis 2021; 15:e0009566. [PMID: 34383755 PMCID: PMC8384205 DOI: 10.1371/journal.pntd.0009566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/24/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Ebola virus (EBOV) is a zoonotic filovirus spread through exposure to infected bodily fluids of a human or animal. Though EBOV is capable of causing severe disease, referred to as Ebola Virus Disease (EVD), individuals who have never been diagnosed with confirmed, probable or suspected EVD can have detectable EBOV antigen-specific antibodies in their blood. This study aims to identify risk factors associated with detectable antibody levels in the absence of an EVD diagnosis. METHODOLOGY Data was collected from September 2015 to August 2017 from 1,366 consenting individuals across four study sites in the DRC (Boende, Kabondo-Dianda, Kikwit, and Yambuku). Seroreactivity was determined to EBOV GP IgG using Zaire Ebola Virus Glycoprotein (EBOV GP antigen) ELISA kits (Alpha Diagnostic International, Inc.) in Kinshasa, DRC; any result above 4.7 units/mL was considered seroreactive. Among the respondents, 113 (8.3%) were considered seroreactive. Several zoonotic exposures were associated with EBOV seroreactivity after controlling for age, sex, healthcare worker status, location, and history of contact with an EVD case, namely: ever having contact with bats, ever having contact with rodents, and ever eating non-human primate meat. Contact with monkeys or non-human primates was not associated with seroreactivity. CONCLUSIONS This analysis suggests that some zoonotic exposures that have been linked to EVD outbreaks can also be associated with EBOV GP seroreactivity in the absence of diagnosed EVD. Future investigations should seek to clarify the relationships between zoonotic exposures, seroreactivity, asymptomatic infection, and EVD.
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Affiliation(s)
- Anna Bratcher
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Nicole A. Hoff
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Reena H. Doshi
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Adva Gadoth
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Megan Halbrook
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | - Kamy Musene
- Kinshasa School of Public Health, Kinshasa, DRC
| | - Benoit Ilunga-Kebela
- Direction de lutte contre la maladie-Ministère de la santé Publique, Kinshasa, DRC
| | - D’Andre Spencer
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Matthew S. Bramble
- Center for Genetic Medicine Research, Children’s National Medical Center, Washington DC, United States of America
| | - David McIlwan
- Department of Microbiology and Immunology, Stanford University, Stanford, California, United States of America
| | - J. Daniel Kelly
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Daniel Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | | | - Steve Ahuka
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | | | | | - Anne W. Rimoin
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
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15
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Higgins SG, Budd R, Randall C, Mwamba GN, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Rimoin AW. Measles antibody levels among vaccinated and unvaccinated children 6-59 months of age in the Democratic Republic of the Congo, 2013-2014. Vaccine 2021; 38:2258-2265. [PMID: 32057333 PMCID: PMC7026690 DOI: 10.1016/j.vaccine.2019.09.047] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/02/2019] [Accepted: 09/11/2019] [Indexed: 01/13/2023]
Abstract
Background Measles is endemic in the Democratic Republic of the Congo (DRC), and 89–94% herd immunity is required to halt its transmission. Much of the World Health Organization African Region, including the DRC, has vaccination coverage below the 95% level required to eliminate measles, heightening concern of inadequate measles immunity. Methods We assessed 6706 children aged 6–59 months whose mothers were selected for interview in the 2013–2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report, and classification of children who had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. A logistic regression model was used to identify associations of covariates with measles and seroprotection, and vaccine effectiveness (VE) was calculated. Results Out of our sample, 64% of children were seroprotected. Measles vaccination was associated with protection against measles (OR: 0.15, 95% CI: 0.03, 0.81) when administered to children 12 months of age or older. Vaccination was predictive of seroprotection at all ages. VE was highest (88%) among children 12–24 months of age. Conclusion Our results demonstrated lower than expected seroprotection against measles among vaccinated children. Understanding the factors that affect host immunity to measles will aid in developing more efficient and effective immunization programs in DRC.
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Affiliation(s)
- Hayley R Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States.
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | | | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, The Democratic Republic of the Congo
| | - Stephen G Higgins
- Lentigen Technology, Incorporated, Gaithersburg, MD 20878, United States
| | - Roger Budd
- DYNEX Technologies Incorporated, Chantilly, VA 20151, United States
| | | | - Guillaume Ngoie Mwamba
- Expanded Program on Immunization, Ministry of Public Health, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, WA 98109, United States
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
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16
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Wallace M, James AE, Silver R, Koh M, Tobolowsky FA, Simonson S, Gold JAW, Fukunaga R, Njuguna H, Bordelon K, Wortham J, Coughlin M, Harcourt JL, Tamin A, Whitaker B, Thornburg NJ, Tao Y, Queen K, Uehara A, Paden CR, Zhang J, Tong S, Haydel D, Tran H, Kim K, Fisher KA, Marlow M, Tate JE, Doshi RH, Sokol T, Curran KG. Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May-June, 2020. Emerg Infect Dis 2021; 27:421-429. [PMID: 33395380 PMCID: PMC7853536 DOI: 10.3201/eid2702.204158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/04/2023] Open
Abstract
To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control.
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17
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Doshi RH, Hoff NA, Bratcher A, Mukadi P, Gadoth A, Nicholson BP, Williams R, Mukadi D, Mossoko M, Wasiswa J, Mwanza A, Sinai C, Alfonso VH, Shah R, Bramble MS, Ilunga-Kebela B, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Rimoin AW. Risk factors for Ebola exposure in healthcare workers in Boende, Tshuapa Province, Democratic Republic of the Congo. J Infect Dis 2020; 226:608-615. [PMID: 33269402 PMCID: PMC9441197 DOI: 10.1093/infdis/jiaa747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Healthcare workers (HCW) are more likely to be exposed to Ebola virus (EBOV) during an outbreak compared to people in the general population due to close physical contact with patients and potential exposure to infectious fluids. However, not all will fall ill. Despite evidence of subclinical and paucisymptomatic Ebola Virus Disease (EVD), the prevalence and associated risk factors remains unknown. We conducted a serosurvey among healthcare workers in the town of Boende in Tshuapa Province, Democratic Republic of Congo (DRC). Human anti-EBOV Glycoprotein (GP) IgG titers were measured using a commercially available ELISA kit. We assessed associations between anti-EBOV IgG seroreactivity, defined as ≥2.5 units/mL and risk factors using univariable and multivariable logistic regression. Sensitivity analyses explored a more conservative cutoff >5 units/mL. Overall, 22.5% of HCWs were seroreactive for EBOV. In multivariable analyses, using any form of personal protective equipment (PPE) when interacting with a confirmed, probable, or suspect EVD case was negatively associated with seroreactivity [0.23 (95% CI: 0.07, 0.73)]. Our results suggest high exposure to EBOV among HCWs and provide additional evidence for asymptomatic or minimally symptomatic EVD. Further studies should be conducted to determine the probability of onward transmission and if seroreactivity is associated with immunity.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Anna Bratcher
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Adva Gadoth
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | | | | | - Daniel Mukadi
- Institut National de Recherche Biomédicale, Kinshasa, DRC.,Faculté de Médecine, Université de Kinshasa, DRC
| | - Matthias Mossoko
- Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | - Joseph Wasiswa
- UCLA-DRC Research Program, Kinshasa, DRC.,Direction de lutte contre la Maladie-Ministère de la Santé Publique, DRC
| | | | - Cyrus Sinai
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Vivian H Alfonso
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Rupal Shah
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
| | - Matthew S Bramble
- Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, D.C. USA
| | | | | | | | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, CA, USA
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18
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Doshi RH, Fleming M, Mukoka AK, Carter RJ, Hyde TB, Choi M, Nzaji MK, Bateyi SH, Christie A, Nichol ST, Damon IK, Beach M, Musenga EM, Fitter DL. Vaccination of contacts of Ebola virus disease survivors to prevent further transmission. Lancet Glob Health 2020; 8:e1455-e1456. [PMID: 33220205 PMCID: PMC10662388 DOI: 10.1016/s2214-109x(20)30454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Monica Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Rosalind J Carter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mary Choi
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Athalia Christie
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Inger K Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Beach
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David L Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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19
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Njuguna H, Wallace M, Simonson S, Tobolowsky FA, James AE, Bordelon K, Fukunaga R, Gold JAW, Wortham J, Sokol T, Haydel D, Tran H, Kim K, Fisher KA, Marlow M, Tate JE, Doshi RH, Curran KG. Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility - Louisiana, April-May 2020. MMWR Morb Mortal Wkly Rep 2020; 69:836-840. [PMID: 32614816 PMCID: PMC7332096 DOI: 10.15585/mmwr.mm6926e2] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2020; 6:e19893. [PMID: 32396517 PMCID: PMC7351262 DOI: 10.2196/19893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/12118.].
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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21
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Gadoth A, Mvumbi G, Hoff NA, Musene K, Mukadi P, Ashbaugh HR, Doshi RH, Javanbakht M, Gorbach P, Okitolonda-Wemakoy E, Klausner JD, Rimoin AW. Urogenital Schistosomiasis and Sexually Transmitted Coinfections among Pregnant Women in a Schistosome-Endemic Region of the Democratic Republic of Congo. Am J Trop Med Hyg 2020; 101:828-836. [PMID: 31392943 DOI: 10.4269/ajtmh.19-0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.
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Affiliation(s)
- Adva Gadoth
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Gisèle Mvumbi
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Kamy Musene
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Hayley R Ashbaugh
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Pamina Gorbach
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | | | - Jeffrey D Klausner
- Department of Medicine, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.,Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
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22
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Doshi RH, Alfonso VH, Morier D, Hoff NA, Sinai C, Mulembakani P, Kisalu N, Cheng A, Ashbaugh H, Gadoth A, Cowell B, Okitolonda EW, Muyembe-Tamfum JJ, Rimoin AW. Monkeypox Rash Severity and Animal Exposures in the Democratic Republic of the Congo. Ecohealth 2020; 17:64-73. [PMID: 31875271 DOI: 10.1007/s10393-019-01459-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 11/07/2019] [Indexed: 05/25/2023]
Abstract
Experimental studies have suggested a larger inoculum of monkeypox virus may be associated with increased rash severity; however, little data are available on the relationship between specific animal exposures and rash severity in endemic regions. Using cross-sectional data from an active surveillance program conducted between 2005 and 2007 in the Sankuru Province of the Democratic Republic of the Congo, we explored the possible relationship between rash severity and exposures to rodents and non-human primates among confirmed MPX cases. Among the 223 PCR-confirmed MPX cases identified during active surveillance, the majority of cases (n = 149) presented with mild rash (5-100 lesions) and 33% had a more serious presentation (> 100 lesions). No association between exposure to rodents and rash severity was found in the multivariable analysis. Those that self-reported hunting NHP 3 weeks prior to onset of MPX symptoms had 2.78 times the odds of severe rash than those that did not report such exposure (95% CI: 1.18, 6.58). This study provides a preliminary step in understanding the association between animal exposure and rash severity and demonstrates correlation with exposure to NHPs and human MPX presentation. Additional research exploring the relationship between rash severity and NHPs is warranted.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Vivian H Alfonso
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Douglas Morier
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Cyrus Sinai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Prime Mulembakani
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Neville Kisalu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Alvan Cheng
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Hayley Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Brian Cowell
- Texas A&M School of Public Health, College Station, TX, USA
| | - Emile W Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA.
- , Los Angeles, USA.
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23
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Guagliardo SAJ, Doshi RH, Reynolds MG, Dzabatou-Babeaux A, Ndakala N, Moses C, McCollum AM, Petersen BW. Do Monkeypox Exposures Vary by Ethnicity? Comparison of Aka and Bantu Suspected Monkeypox Cases. Am J Trop Med Hyg 2020; 102:202-205. [PMID: 31769405 PMCID: PMC6947767 DOI: 10.4269/ajtmh.19-0457] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/30/2019] [Indexed: 11/14/2022] Open
Abstract
In 2017, a monkeypox outbreak occurred in Likouala Department, Republic of the Congo. Many of the affected individuals were of Aka ethnicity, hunter-gatherers indigenous to Central Africa who have worse health outcomes in comparison with other forest-dwelling peoples. To test the hypothesis that Aka people have different risk factors for monkeypox, we analyzed questionnaire data for 39 suspected cases, comparing Aka and Bantu groups. Aka people were more likely to touch animal urine/feces, find dead animals in/around the home, eat an animal that was found dead, or to have been scratched or bitten by an animal (P < 0.05, all variables). They were also more likely to visit the forest ≥ once/week, sleep outside, or sleep on the ground (P < 0.001, all variables), providing opportunities for contact with monkeypox reservoirs during the night. The Aka and possibly other vulnerable groups may warrant special attention during educational and health promotion programs.
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Affiliation(s)
- Sarah Anne J. Guagliardo
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nestor Ndakala
- Field Epidemiology Training Program, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Cynthia Moses
- International Communication and Education Fund, Kinshasa, Democratic Republic of the Congo
| | - Andrea M. McCollum
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett W. Petersen
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2019; 5:e12118. [PMID: 31407673 PMCID: PMC6771531 DOI: 10.2196/12118] [Citation(s) in RCA: 19] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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25
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Mulangu S, Alfonso VH, Hoff NA, Doshi RH, Mulembakani P, Kisalu NK, Okitolonda-Wemakoy E, Kebela BI, Marcus H, Shiloach J, Phue JN, Wright LL, Muyembe-Tamfum JJ, Sullivan NJ, Rimoin AW. Serologic Evidence of Ebolavirus Infection in a Population With No History of Outbreaks in the Democratic Republic of the Congo. J Infect Dis 2019; 217:529-537. [PMID: 29329455 DOI: 10.1093/infdis/jix619] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 06/06/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Previous studies suggest that cases of Ebola virus disease (EVD) may go unreported because they are asymptomatic or unrecognized, but evidence is limited by study designs and sample size. Methods A large population-based survey was conducted (n = 3415) to assess animal exposures and behaviors associated with Ebolavirus antibody prevalence in rural Kasai Oriental province of the Democratic Republic of Congo (DRC). Fourteen villages were randomly selected and all healthy individuals ≥1 year of age were eligible. Results Overall, 11% of subjects tested positive for Zaire Ebolavirus (EBOV) immunoglobulin G antibodies. Odds of seropositivity were higher for study participants older than 15 years of age and for males. Those residing in Kole (closer to the outbreak site) tested positive at a rate 1.6× higher than Lomela, with seropositivity peaking at a site located between Kole and Lomela. Multivariate analyses of behaviors and animal exposures showed that visits to the forest or hunting and exposure to rodents or duikers predicted a higher likelihood of EBOV seropositivity. Conclusions These results provide serologic evidence of Ebolavirus exposure in a population residing in non-EBOV outbreak locations in the DRC and define statistically significant activities and animal exposures that associate with EBOV seropositivity.
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Affiliation(s)
- Sabue Mulangu
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, Maryland.,Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | | | - Nicole A Hoff
- UCLA Fielding School of Public Health, Los Angeles, California
| | - Reena H Doshi
- UCLA Fielding School of Public Health, Los Angeles, California
| | | | - Neville K Kisalu
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, Maryland
| | | | - Benoit Ilunga Kebela
- Division de la Lutte Contre les Maladies, Ministere de la Santé, Kinshasa, Democratic Republic of the Congo
| | - Hadar Marcus
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, Maryland
| | - Joseph Shiloach
- Biotechnology Core Laboratory, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, Maryland
| | - Je-Nie Phue
- Biotechnology Core Laboratory, National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, Maryland
| | - Linda L Wright
- National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | - Nancy J Sullivan
- National Institute of Allergy and Infectious Diseases, Vaccine Research Center, Bethesda, Maryland
| | - Anne W Rimoin
- UCLA Fielding School of Public Health, Los Angeles, California
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26
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Rimoin AW, Lu K, Bramble MS, Steffen I, Doshi RH, Hoff NA, Mukadi P, Nicholson BP, Alfonso VH, Olinger G, Sinai C, Yamamoto LK, Ramirez CM, Okitolonda Wemakoy E, Kebela Illunga B, Pettitt J, Logue J, Bennett RS, Jahrling P, Heymann DL, Piot P, Muyembe-Tamfum JJ, Hensley LE, Simmons G. Ebola Virus Neutralizing Antibodies Detectable in Survivors of theYambuku, Zaire Outbreak 40 Years after Infection. J Infect Dis 2019; 217:223-231. [PMID: 29253164 PMCID: PMC5853670 DOI: 10.1093/infdis/jix584] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 12/24/2022] Open
Abstract
The first reported outbreak of Ebola virus disease occurred in 1976 in Yambuku, Democratic Republic of Congo. Antibody responses in survivors 11 years after infection have been documented. However, this report is the first characterization of anti-Ebola virus antibody persistence and neutralization capacity 40 years after infection. Using ELISAs we measured survivor’s immunological response to Ebola virus Zaire (EBOV) glycoprotein and nucleoprotein, and assessed VP40 reactivity. Neutralization of EBOV was measured using a pseudovirus approach and plaque reduction neutralization test with live EBOV. Some survivors from the original EBOV outbreak still harbor antibodies against all 3 measures. Interestingly, a subset of these survivors’ serum antibodies could still neutralize live virus 40 years postinitial infection. These data provide the longest documentation of both anti-Ebola serological response and neutralization capacity within any survivor cohort, extending the known duration of response from 11 years postinfection to at least 40 years after symptomatic infection.
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Affiliation(s)
- Anne W Rimoin
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Matthew S Bramble
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles.,Department of Genetic Medicine Research, Children's Research Institute, Children's National Medical Center, Washington, District of Columbia
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Nicole A Hoff
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, DRC
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Vivian H Alfonso
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Gerrard Olinger
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Cyrus Sinai
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | - Lauren K Yamamoto
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Christina M Ramirez
- Department of Biostatistics, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles
| | | | | | | | - James Logue
- Integrated Research Facility at Fort Detrick
| | | | | | - David L Heymann
- Chatham House Center on Global Health Security, London, UK.,London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lisa E Hensley
- Integrated Research Facility at Fort Detrick.,Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
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Doshi RH, Guagliardo SAJ, Doty JB, Babeaux AD, Matheny A, Burgado J, Townsend MB, Morgan CN, Satheshkumar PS, Ndakala N, Kanjingankolo T, Kitembo L, Malekani J, Kalemba L, Pukuta E, N'kaya T, Kangoula F, Moses C, McCollum AM, Reynolds MG, Mombouli JV, Nakazawa Y, Petersen BW. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerg Infect Dis 2019; 25:281-289. [PMID: 30666937 PMCID: PMC6346463 DOI: 10.3201/eid2502.181222] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Monkeypox, caused by a zoonotic orthopoxvirus, is endemic in Central and West Africa. Monkeypox has been sporadically reported in the Republic of the Congo. During March 22-April 5, 2017, we investigated 43 suspected human monkeypox cases. We interviewed suspected case-patients and collected dried blood strips and vesicular and crust specimens (active lesions), which we tested for orthopoxvirus antibodies by ELISA and monkeypox virus and varicella zoster virus DNA by PCR. An ecologic investigation was conducted around Manfouété, and specimens from 105 small mammals were tested for anti-orthopoxvirus antibodies or DNA. Among the suspected human cases, 22 met the confirmed, probable, and possible case definitions. Only 18 patients had available dried blood strips; 100% were IgG positive, and 88.9% (16/18) were IgM positive. Among animals, only specimens from Cricetomys giant pouched rats showed presence of orthopoxvirus antibodies, adding evidence to this species' involvement in the transmission and maintenance of monkeypox virus in nature.
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Hoff NA, Mukadi P, Doshi RH, Bramble MS, Lu K, Gadoth A, Sinai C, Spencer D, Nicholson BP, Williams R, Mossoko M, Ilunga-Kebela B, Wasiswa J, Okitolonda-Wemakoy E, Alfonso VH, Steffen I, Muyembe-Tamfum JJ, Simmons G, Rimoin AW. Serologic Markers for Ebolavirus Among Healthcare Workers in the Democratic Republic of the Congo. J Infect Dis 2019; 219:517-525. [PMID: 30239838 PMCID: PMC6350949 DOI: 10.1093/infdis/jiy499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/18/2018] [Indexed: 12/17/2022] Open
Abstract
Healthcare settings have played a major role in propagation of Ebola virus (EBOV) outbreaks. Healthcare workers (HCWs) have elevated risk of contact with EBOV-infected patients, particularly if safety precautions are not rigorously practiced. We conducted a serosurvey to determine seroprevalence against multiple EBOV antigens among HCWs of Boende Health Zone, Democratic Republic of the Congo, the site of a 2014 EBOV outbreak. Interviews and specimens were collected from 565 consenting HCWs. Overall, 234 (41.4%) of enrolled HCWs were reactive to at least 1 EBOV protein: 159 (28.1%) were seroreactive for anti-glycoprotein immunoglobulin G (IgG), 89 (15.8%) were seroreactive for anti-nucleoprotein IgG, and 54 (9.5%) were VP40 positive. Additionally, sera from 16 (2.8%) HCWs demonstrated neutralization capacity. These data demonstrate that a significant proportion of HCWs have the ability to neutralize virus, despite never having developed Ebola virus disease symptoms, highlighting an important and poorly documented aspect of EBOV infection and progression.
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Affiliation(s)
- Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- Institut National de Recherche Biomédicale, Washington, District of Columbia
- Faculté de Médecine, Université de Kinshasa, Democratic Republic of the Congo (DRC), Washington, District of Columbia
| | - Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Matthew S Bramble
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Kai Lu
- Blood Systems Research Institute, San Francisco
- Department of Laboratory Medicine, University of California, San Francisco
| | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Cyrus Sinai
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - D’Andre Spencer
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Bradley P Nicholson
- Molecular Epidemiology Research Laboratory, Veterans Affairs Medical Center, Durham, North Carolina
| | | | - Matthias Mossoko
- Direction de lutte contre la Maladie, Ministère de la Santé Publique
| | | | - Joseph Wasiswa
- University of California, Los Angeles-DRC Research Program
- Direction de lutte contre la Maladie, Ministère de la Santé Publique
| | | | - Vivian H Alfonso
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Imke Steffen
- Blood Systems Research Institute, San Francisco
- Department of Laboratory Medicine, University of California, San Francisco
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale, Washington, District of Columbia
- Faculté de Médecine, Université de Kinshasa, Democratic Republic of the Congo (DRC), Washington, District of Columbia
| | - Graham Simmons
- Blood Systems Research Institute, San Francisco
- Department of Laboratory Medicine, University of California, San Francisco
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Bramble MS, Hoff N, Gilchuk P, Mukadi P, Lu K, Doshi RH, Steffen I, Nicholson BP, Lipson A, Vashist N, Sinai C, Spencer D, Olinger G, Wemakoy EO, Illunga BK, Pettitt J, Logue J, Marchand J, Varughese J, Bennett RS, Jahrling P, Cavet G, Serafini T, Ollmann Saphire E, Vilain E, Muyembe-Tamfum JJ, Hensely LE, Simmons G, Crowe JE, Rimoin AW. Pan-Filovirus Serum Neutralizing Antibodies in a Subset of Congolese Ebolavirus Infection Survivors. J Infect Dis 2018; 218:1929-1936. [PMID: 30107445 PMCID: PMC6217721 DOI: 10.1093/infdis/jiy453] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
One year after a Zaire ebolavirus (EBOV) outbreak occurred in the Boende Health Zone of the Democratic Republic of the Congo during 2014, we sought to determine the breadth of immune response against diverse filoviruses including EBOV, Bundibugyo (BDBV), Sudan (SUDV), and Marburg (MARV) viruses. After assessing the 15 survivors, 5 individuals demonstrated some degree of reactivity to multiple ebolavirus species and, in some instances, Marburg virus. All 5 of these survivors had immunoreactivity to EBOV glycoprotein (GP) and EBOV VP40, and 4 had reactivity to EBOV nucleoprotein (NP). Three of these survivors showed serologic responses to the 3 species of ebolavirus GPs tested (EBOV, BDBV, SUDV). All 5 samples also exhibited ability to neutralize EBOV using live virus, in a plaque reduction neutralization test. Remarkably, 3 of these EBOV survivors had plasma antibody responses to MARV GP. In pseudovirus neutralization assays, serum antibodies from a subset of these survivors also neutralized EBOV, BDBV, SUDV, and Taï Forest virus as well as MARV. Collectively, these findings suggest that some survivors of naturally acquired ebolavirus infection mount not only a pan-ebolavirus response, but also in less frequent cases, a pan-filovirus neutralizing response.
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Affiliation(s)
- Matthew S Bramble
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Nicole Hoff
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Pavlo Gilchuk
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick Mukadi
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Kai Lu
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Reena H Doshi
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Imke Steffen
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - Bradly P Nicholson
- Institute for Medical Research, Durham Veterans Affairs Medical Center, North Carolina
| | - Allen Lipson
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Neerja Vashist
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | - Cyrus Sinai
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - D’andre Spencer
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Garrard Olinger
- Boston University, School of Medicine, Department of Medicine, Massachusetts
| | | | - Benoit Kebela Illunga
- Direction de la Lutte Contre les Maladies, Ministère de la Sante, Kinshasa, Democratic Republic of the Congo
| | - James Pettitt
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Jonathan Marchand
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Justin Varughese
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Richard S Bennett
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | - Peter Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
| | | | | | - Erica Ollmann Saphire
- Skaggs Institute for Chemical Biology, La Jolla, California
- Department of Immunology and Microbial Science, Scripps Research Institute, La Jolla, California
| | - Eric Vilain
- Department of Genetic Medicine Research, Children’s Research Institute, Children’s National Medical Center, Washington, District of Columbia
| | | | - Lisa E Hensely
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Frederick, Maryland
- Emerging Viral Pathogens Section, NIAID, NIH, Frederick, Maryland
| | - Graham Simmons
- Blood Systems Research Institute, and Department of Laboratory Medicine, University of California, San Francisco
| | - James E Crowe
- Vanderbilt Vaccine Center, and Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
- Departments of Pediatrics and Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Higgins SG, Budd R, Randall C, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Rimoin AW. Association of Previous Measles Infection With Markers of Acute Infectious Disease Among 9- to 59-Month-Old Children in the Democratic Republic of the Congo. J Pediatric Infect Dis Soc 2018; 8:531-538. [PMID: 30346573 PMCID: PMC6933309 DOI: 10.1093/jpids/piy099] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transient immunosuppression and increased susceptibility to other infections after measles infection is well known, but recent studies have suggested the occurrence of an "immune amnesia" that could have long-term immunosuppressive effects. METHODS We examined the association between past measles infection and acute episodes of fever, cough, and diarrhea among 2350 children aged 9 to 59 months whose mothers were selected for interview in the 2013-2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey (DHS). Classification of children who had had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained via dried-blood-spot analysis with a multiplex immunoassay. The association with time since measles infection and fever, cough, and diarrhea outcomes was also examined. RESULTS The odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25-2.60) among children for whom measles was reported compared to children with no history of measles. Measles vaccination demonstrated a protective association against selected clinical markers of acute infectious diseases. CONCLUSION Our results suggest that measles might have a long-term effect on selected clinical markers of acute infectious diseases among children aged 9 to 59 months in the DRC. These findings support the immune-amnesia hypothesis suggested by others and underscore the need for continued evaluation and improvement of the DRC's measles vaccination program.
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Affiliation(s)
- Hayley R Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles,Correspondence: H. R. Ashbaugh, DVM, PhD, UCLA Fielding School of Public Health, Department of Epidemiology, Box 951772, 650 Charles Young Dr., South, Los Angeles, CA 90095 ()
| | - James D Cherry
- David Geffen School of Medicine, University of California, Los Angeles
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Vivian H Alfonso
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- School of Medicine, Kinshasa University, Democratic Republic of the Congo
| | | | - Roger Budd
- Dynex Technologies Incorporated, Chantilly, Virginia
| | | | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Doshi RH, Sande E, Ogwal M, Kiyingi H, McIntyre A, Kusiima J, Musinguzi G, Serwadda D, Hladik W. Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda. PLoS One 2018; 13:e0201352. [PMID: 30231030 PMCID: PMC6145590 DOI: 10.1371/journal.pone.0201352] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.
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Affiliation(s)
- Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Moses Ogwal
- Makerere University School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Anne McIntyre
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joy Kusiima
- Makerere University School of Public Health, Kampala, Uganda
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Doshi RH, Guagliardo SAJ, Dzabatou-Babeaux A, Likouayoulou C, Ndakala N, Moses C, Olson V, McCollum AM, Petersen BW. Strengthening of Surveillance during Monkeypox Outbreak, Republic of the Congo, 2017. Emerg Infect Dis 2018; 24:1158-1160. [PMID: 29774865 PMCID: PMC6004878 DOI: 10.3201/eid2406.180248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Reports of 10 suspected cases of monkeypox in Likouala Department, Republic of the Congo, triggered an investigation and response in March 2017 that included community education and surveillance strengthening. Increasing numbers of outbreaks suggest that monkeypox virus is becoming a more prevalent human pathogen. Diverse approaches are necessary for disease control and prevention.
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Ashbaugh HR, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Cherry JD, Rimoin AW. Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo. Vaccine 2018; 36:587-593. [PMID: 29248265 PMCID: PMC5780300 DOI: 10.1016/j.vaccine.2017.11.049] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS). METHODS We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. RESULTS Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. CONCLUSIONS Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control.
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Affiliation(s)
- Hayley R Ashbaugh
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
| | - Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Vivian H Alfonso
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Adva Gadoth
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States
| | - Patrick Mukadi
- Kinshasa University, School of Medicine, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, WA 98109, United States
| | - James D Cherry
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
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Voorman A, Hoff NA, Doshi RH, Alfonso V, Mukadi P, Muyembe-Tamfum JJ, Wemakoy EO, Bwaka A, Weldon W, Gerber S, Rimoin AW. Polio immunity and the impact of mass immunization campaigns in the Democratic Republic of the Congo. Vaccine 2017; 35:5693-5699. [PMID: 28882442 PMCID: PMC5628608 DOI: 10.1016/j.vaccine.2017.08.063] [Citation(s) in RCA: 12] [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: 06/06/2017] [Revised: 07/31/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to prevent outbreaks from wild and vaccine-derived poliovirus, maintenance of population immunity in non-endemic countries is critical. METHODS We estimated population seroprevalence using dried blood spots collected from 4893 children 6-59months olds in the 2013-2014 Demographic and Health Survey in the Democratic Republic of the Congo (DRC). RESULTS Population immunity was 81%, 90%, and 70% for poliovirus types 1, 2, and 3, respectively. Among 6-59-month-old children, 78% reported at least one dose of polio in routine immunization, while only 15% had three doses documented on vaccination cards. All children in the study had been eligible for at least two trivalent oral polio vaccine campaigns at the time of enrollment; additional immunization campaigns seroconverted 5.0%, 14%, and 5.5% of non-immune children per-campaign for types 1, 2, and 3, respectively, averaged over relevant campaigns for each serotype. CONCLUSIONS Overall polio immunity was high at the time of the study, though pockets of low immunity cannot be ruled out. The DRC still relies on supplementary immunization campaigns, and this report stresses the importance of the quality and coverage of those campaigns over their quantity, as well as the importance of routine immunization.
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Affiliation(s)
- Arend Voorman
- The Bill and Melinda Gates Foundation, Seattle 98109, USA
| | - Nicole A Hoff
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Reena H Doshi
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Vivian Alfonso
- Department of Epidemiology, University of California, Los Angeles 90095, USA
| | - Patrick Mukadi
- National Institute for Biomedical Research (INRB), Kinshasa, The Democratic Republic of the Congo
| | | | | | - Ado Bwaka
- Expanded Programme on Immunization, McKing Consulting, Kinshasa, The Democratic Republic of the Congo
| | - William Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta 30329, USA
| | - Sue Gerber
- The Bill and Melinda Gates Foundation, Seattle 98109, USA
| | - Anne W Rimoin
- Department of Epidemiology, University of California, Los Angeles 90095, USA.
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Doshi RH, Eckhoff P, Cheng A, Hoff NA, Mukadi P, Shidi C, Gerber S, Wemakoy EO, Muyembe-Tafum JJ, Kominski GF, Rimoin AW. Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo. Vaccine 2017; 35:6187-6194. [PMID: 28966000 DOI: 10.1016/j.vaccine.2017.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/28/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose. METHODS We modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children. RESULTS Compared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million. DISCUSSION Vaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | | | - Alvan Cheng
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Patrick Mukadi
- Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Calixte Shidi
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Sue Gerber
- Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA.
| | - Emile Okitolonda Wemakoy
- Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo.
| | | | - Gerald F Kominski
- Department of Health Policy and Management, UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
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Hoff NA, Morier DS, Kisalu NK, Johnston SC, Doshi RH, Hensley LE, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Lloyd-Smith JO, Rimoin AW. Varicella Coinfection in Patients with Active Monkeypox in the Democratic Republic of the Congo. Ecohealth 2017; 14:564-574. [PMID: 28894977 DOI: 10.1007/s10393-017-1266-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 05/25/2023]
Abstract
From 2006 to 2007, an active surveillance program for human monkeypox (MPX) in the Democratic Republic of the Congo identified 151 cases of coinfection with monkeypox virus and varicella zoster virus from 1158 suspected cases of human MPX (13%). Using clinical and socio-demographic data collected with standardized instruments by trained, local nurse supervisors, we examined a variety of hypotheses to explain the unexpectedly high proportion of coinfections among the sample, including the hypothesis that the two viruses occur independently. The probabilities of disease incidence and selection necessary to yield the observed sample proportion of coinfections under an assumption of independence are plausible given what is known and assumed about human MPX incidence. Cases of human MPX are expected to be underreported, and more coinfections are expected with improved surveillance.
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Affiliation(s)
- Nicole A Hoff
- UCLA Fielding School of Public Health, 41-275 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
| | - Douglas S Morier
- UCLA Fielding School of Public Health, 41-275 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Neville K Kisalu
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Sara C Johnston
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Reena H Doshi
- UCLA Fielding School of Public Health, 41-275 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Lisa E Hensley
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | | | - James O Lloyd-Smith
- UCLA Fielding School of Public Health, 41-275 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA
| | - Anne W Rimoin
- UCLA Fielding School of Public Health, 41-275 CHS, 650 Charles E. Young Dr. South, Los Angeles, CA, 90095, USA.
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Rimoin AW, Alfonso VH, Hoff NA, Doshi RH, Mulembakani P, Kisalu NK, Muyembe JJ, Okitolonda EW, Wright LL. Human Exposure to Wild Animals in the Sankuru Province of the Democratic Republic of the Congo. Ecohealth 2017; 14:552-563. [PMID: 28831639 DOI: 10.1007/s10393-017-1262-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 05/11/2017] [Accepted: 06/15/2017] [Indexed: 05/25/2023]
Abstract
Due to the high level of biological diversity in the Congo Basin and human population dependence on bushmeat, the DRC represents an ideal location for expanding knowledge on wild animal exposures and thus the potential for transmission of zoonotic pathogens. However, limited information exists on patterns and extent of contact with wildlife in such communities. Using a cross-sectional study, 14 villages in the Sankuru Province of the DRC were surveyed between August and September 2007. Villagers ≥ 1 year of age and at home of the time of the survey were eligible and enrolled to describe and assess factors associated with animal exposures (both activity and type of animal). Among respondents, 91% reported exposure to rodents, 89% to duikers, 78% to non-human primates (NHPs), and 32% reported contact with bats in the month prior to the survey. The most frequently reported activities included eating (95%), cooking (70%), and butchering or skinning of animals (55%). The activities and animals to which subjects had contact varied by sex and age. Moreover, we observed a high correlation of the same activities across animal types. In this and other populations that rely on bushmeat, there is a high frequency of exposure to multiple animal species through various modalities. In the event of future zoonotic disease outbreaks, effective public health interventions and campaigns that mitigate the risk of animal contact during outbreaks need to be broad to include various modes of contact and should be directed to both men and women across all age groups. As available information is limited, further studies are necessary to better understand the complex relationships and exposures individuals have with animals.
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Affiliation(s)
- Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA, USA.
| | - Vivian Helena Alfonso
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA, USA
| | - Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA, USA
| | - Prime Mulembakani
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nevile K Kisalu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Emile W Okitolonda
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Linda L Wright
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Hoff NA, Doshi RH, Colwell B, Kebela-Illunga B, Mukadi P, Mossoko M, Spencer D, Muyembe-Tamfum JJ, Okitolonda-Wemakoy E, Lloyd-Smith J, Rimoin AW. Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013. ACTA ACUST UNITED AC 2017; 25. [PMID: 30123790 PMCID: PMC6095679 DOI: 10.9734/ijtdh/2017/35885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/09/2022]
Abstract
Objective Evaluating the effectiveness of a surveillance system, and how it improves over time has significant implications for disease control and prevention. In the Democratic Republic of Congo (DRC), the Integrated Disease Surveillance and Response (IDSR) was implemented to estimate the burden of disease, monitor changes in disease occurrence, and inform resource allocation. For this effort we utilized national passive surveillance data from DRC's IDSR to explore reporting trends of human monkeypox (MPX) from 2001 to 2013. Methods We obtained surveillance data on MPX cases occurring between January 2001 and December 2013 from the DRC Ministry of Health (MoH). Phases of the surveillance system, yearly trends in reporting and estimated incidence for MPX were analyzed using SAS v9.2 and Health Mapper. Results Between 2001 and 2013, three discrete surveillance phases were identified that described the evolution of the surveillance system. Overall, an increase in suspected MPX cases was reported, beyond what would be expected from simply an improved reporting system. When restricting the analysis to the "stable phase," national estimated incidence increased from 2.13 per 100,000 in 2008 to 2.84 per 100,000 in 2013. Conclusions The reported increase in MPX, based on an evolving surveillance system, is likely to be a true increase in disease occurrence rather than simply improvements to the surveillance system. Further analyses should provide critical information for improved prevention and control strategies and highlight areas of improvement for future data collection efforts.
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Affiliation(s)
- Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Brian Colwell
- Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Benoit Kebela-Illunga
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - D'Andre Spencer
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Ashbaugh HR, Kuang B, Gadoth A, Alfonso VH, Mukadi P, Doshi RH, Hoff NA, Sinai C, Mossoko M, Kebela BI, Muyembe JJ, Wemakoy EO, Rimoin AW. Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system. Trop Med Int Health 2017; 22:1141-1153. [PMID: 28653456 DOI: 10.1111/tmi.12917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. METHODS Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. RESULTS Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. CONCLUSION Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities.
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Affiliation(s)
- Hayley R Ashbaugh
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Brandon Kuang
- David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Adva Gadoth
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Vivian H Alfonso
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Patrick Mukadi
- School of Medicine, Kinshasa University, Kinshasa, Democratic Republic of Congo
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Cyrus Sinai
- Fielding School of Public Health, University of California, Los Angeles, USA
| | - Mathias Mossoko
- Direction for Disease Control, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Benoit Ilunga Kebela
- Direction for Disease Control, Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of Congo
| | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, USA
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Doshi RH, Mukadi P, Shidi C, Mulumba A, Hoff NA, Gerber S, Okitolonda-Wemakoy E, Ilunga BK, Muyembe JJ, Rimoin AW. Field evaluation of measles vaccine effectiveness among children in the Democratic Republic of Congo. Vaccine 2015; 33:3407-14. [PMID: 25937449 DOI: 10.1016/j.vaccine.2015.04.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/13/2014] [Revised: 04/10/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Large-scale measles outbreaks in areas with high administrative vaccine coverage rates suggest the need to re-evaluate measles prevention and control in the Democratic Republic of Congo (DRC). Monitoring of measles Vaccine Effectiveness (VE) is a useful measure of quality control in immunization programs. We estimated measles VE among children aged 12-59 months in the Democratic Republic of Congo (DRC) using laboratory surveillance data from 2010-2012. METHODS We used the case-based surveillance system with laboratory confirmation to conduct a case-control study using the test negative design. Cases and controls were selected based on presence (n=1044) or absence (n=1335) of measles specific antibody IgM or epidemiologic linkage. Risk factors for measles were assessed using unconditional logistic regression, stratified by age. RESULTS Among children 12-59 months, measles vaccination was protective against measles [aOR (95%C)], 0.20 (0.15-0.26) and estimated VE was 80% (95% CI 74-85%). Year of diagnosis, 2011: 6.02 (4.16-8.72) and 2012; 8.31 (5.57-12.40) was a risk factor for measles when compared to 2010. Compared to Kinshasa, children in Bas-Congo, Kasai-Oriental, Maniema and South Kivu provinces all had higher odds of developing measles. Measles VE was similar for children 12-23 months and 24-59 months (80% and 81% respectively). CONCLUSIONS Repeated occurrences of measles outbreaks and lower than expected VE estimates suggest the need to further evaluate measles vaccine efficacy and improve vaccine delivery strategies in DRC.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Patrick Mukadi
- Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Calixte Shidi
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Audry Mulumba
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Sue Gerber
- Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA.
| | - Emile Okitolonda-Wemakoy
- Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Benoit Kebela Ilunga
- Division of Disease Control, Ministry of Public Health, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Jean-Jacques Muyembe
- National Institute for Biomedical Research, Minister of Public Health, Avenue de la Democratie, Kinshasa, Democratic Republic of the Congo.
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
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