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Lako RLL, Meagher N, Wamala JF, Ndyahikayo J, Ademe Tegegne A, Olu OO, Price DJ, Rajatonirina S, Farley E, Okeibunor JC, Mize VA. Transmissibility and severity of COVID-19 in a humanitarian setting: First few X investigation of cases and contacts in Juba, South Sudan, 2020. Influenza Other Respir Viruses 2023; 17:e13200. [PMID: 38019703 PMCID: PMC10655784 DOI: 10.1111/irv.13200] [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: 04/02/2023] [Revised: 08/07/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The first few 'X' (FFX) studies provide evidence to guide public health decision-making and resource allocation. The adapted WHO Unity FFX protocol for COVID-19 was implemented to gain an understanding of the clinical, epidemiological, virological and household transmission dynamics of the first cases of COVID-19 infection detected in Juba, South Sudan. METHODS Laboratory-confirmed COVID-19 cases were identified through the national surveillance system, and an initial visit was conducted with eligible cases to identify all close contacts. Consenting cases and close contacts were enrolled between June 2020 and December 2020. Demographic, clinical information and biological samples were taken at enrollment and 14-21 days post-enrollment for all participants. RESULTS Twenty-nine primary cases and 82 contacts were included in the analyses. Most primary cases (n = 23/29, 79.3%) and contacts (n = 61/82, 74.4%) were male. Many primary cases (n = 18/29, 62.1%) and contacts (n = 51/82, 62.2%) were seropositive for SARS-CoV-2 at baseline. The secondary attack rate among susceptible contacts was 12.9% (4/31; 95% CI: 4.9%-29.7%). All secondary cases and most (72%) primary cases were asymptomatic. Reported symptoms included coughing (n = 6/29, 20.7%), fever or history of fever (n = 4/29, 13.8%), headache (n = 3/29, 10.3%) and shortness of breath (n = 3/29, 10.3%). Of 38 cases, two were hospitalised (5.3%) and one died (2.6%). CONCLUSIONS These findings were used to develop the South Sudanese Ministry of Health surveillance and contract tracing protocols, informing local COVID-19 case definitions, follow-up protocols and data management systems. This investigation demonstrates that rapid FFX implementation is critical in understanding the emerging disease and informing response priorities.
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Affiliation(s)
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at The Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | | | | | | | | | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at The Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global HealthThe University of MelbourneMelbourneAustralia
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Lewis HC, Marcato AJ, Meagher N, Valenciano M, Villanueva‐Cabezas J, Spirkoska V, Fielding JE, Karahalios A, Subissi L, Nardone A, Cheng B, Rajatonirina S, Okeibunor J, Aly EA, Barakat A, Jorgensen P, Azim T, Wijesinghe PR, Le L, Rodriguez A, Vicari A, Van Kerkhove MD, McVernon J, Pebody R, Price DJ, Bergeri I, Alemu MA, Alvi Y, Bukusi EA, Chung PS, Dambadarjaa D, Das AK, Dub T, Dulacha D, Ebrahim F, González‐Duarte MA, Guruge D, Heraud J, Heredia‐Melo DC, Herman‐Roloff A, Herring BL, Inbanathan FY, Islam F, Jeewandara KC, Kant S, Khan W, Lako R, Leite J, Malavige GN, Mandakh U, Mariam W, Mend T, Mize VA, Musa S, Nohynek H, Olu OO, Osorio‐Merchán MB, Pereyaslov D, Randremanana RV, de Dieu Randria MJ, Ransom J, Saxena S, Sharma P, Sreedevi A, Satheesh M, Subhashini KJ, Tippet‐Barr BA, Usha A, Wamala JF, Watare SH, Yadav K. Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis. Influenza Other Respir Viruses 2022; 16:803-819. [PMID: 36825117 PMCID: PMC9343340 DOI: 10.1111/irv.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2 = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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Affiliation(s)
- Hannah C. Lewis
- World Health OrganizationGenevaSwitzerland,World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Adrian J. Marcato
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Marta Valenciano
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Juan‐Pablo Villanueva‐Cabezas
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,The Nossal Institute for Global HealthThe University of MelbourneMelbourneAustralia
| | - Violeta Spirkoska
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - James E. Fielding
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Anthony Nardone
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Brianna Cheng
- World Health OrganizationGenevaSwitzerland,School of Population and Global HealthMcGill UniversityMontrealQuebecCanada
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Eman A. Aly
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | - Amal Barakat
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | | | - Tasnim Azim
- World Health Organization, Regional Office for South‐East AsiaNew DelhiIndia
| | | | - Linh‐Vi Le
- World Health Organization, Regional Office for the Western PacificManilaPhilippines
| | - Angel Rodriguez
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | | | - Jodie McVernon
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia
| | - Richard Pebody
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | | | | | - Yasir Alvi
- Department of Community Medicine Hamdard Institute of Medical Sciences and Research New Delhi India
| | | | - Pui Shan Chung
- World Health Organization, Regional Office for the Western Pacific Manila Philippines
| | - Davaalkham Dambadarjaa
- School of Public Health Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Ayan K. Das
- Department of Microbiology Hamdard Institute of Medical Science and Research New Delhi India
- Hakeem Abdul Hameed Centenary Hospital New Delhi India
| | - Timothée Dub
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Faiqa Ebrahim
- World Health Organization Country Office Addis Ababa Ethiopia
| | | | | | | | | | | | - Belinda L. Herring
- World Health Organization, Regional Office for Africa Brazzaville Republic of Congo
| | | | - Farzana Islam
- Hamdard Institute of Medical Sciences and Research (HIMSR) New Delhi India
| | - Kamal Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Nugegoda Sri Lanka
| | - Shashi Kant
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Wasiq Khan
- World Health Organization, Regional Office for the Eastern Mediterranean Cairo Egypt
| | | | - Juliana Leite
- World Health Organization, Regional Office for the Americas (Pan American Health Organization) Washington DC USA
| | | | - Undram Mandakh
- Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Warisha Mariam
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Tsogt Mend
- National Center for Communicable Diseases Ulaanbaatar Mongolia
| | | | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
- Sarajevo School of Science and Technology Sarajevo Bosnia and Herzegovina
| | - Hanna Nohynek
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | | | | | - James Ransom
- Centers for Disease Control and Prevention Juba South Sudan
| | - Sonal Saxena
- Department of Microbiology Maulana Azad Medical College New Delhi India
| | - Pragya Sharma
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Aswathy Sreedevi
- Department of Community Medicine Amrita Institute of Medical Sciences Kochi Kerala India
| | - Mini Satheesh
- Kerala University of Health Sciences Kerala India
- Government Medical College Thiruvananthapuram Kerala India
| | - K. J. Subhashini
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Beth A. Tippet‐Barr
- U.S. Centers for Disease Control and Prevention Nairobi Kenya
- Nyanja Health Research Institute Salima Malawi
| | - Anuja Usha
- Regional Prevention of Epidemic and Infectious Disease Cell Government of Kerala Kerala India
| | | | | | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
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Moeti M, Cabore J, Kasolo F, Yoti Z, Zawaira F, Chibi M, Rajatonirina S, Karamagi H, Rees H, Mihigo R, Yao M, Impouma B, Okeibunor JC, Talisuna AO. The COVID-19 pandemic: research and health development in the World Health Organisation Africa region. Pan Afr Med J 2021; 35:50. [PMID: 33623575 PMCID: PMC7875729 DOI: 10.11604/pamj.supp.2020.35.2.23628] [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: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
Concerns have been expressed about the view point of WHO AFRO concerning research for health in the African Region. WHO AFRO considers research a critical component in the improvement of health in the Africa region. Ensuring the effectiveness of our strategies, policies and programmes requires evidence. In the context of the ongoing COVID-19 outbreak, WHO research interests cover key areas of the response. The WHO AFRO consider research as critical in our efforts at protecting people against health emergencies and pandemics like the COVID-19 and ensuring universal access to proven interventions. In view of this, the WHO has taken steps to strengthen capacity for research in the region. The results of these efforts may take time to manifest but will surely do as we persist in our drive, with support from our partners.
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Affiliation(s)
| | | | | | - Zabulon Yoti
- WHO Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | - Helen Rees
- Witwatersrand Reproductive Health and HIV Institute, South Africa
| | | | - Michel Yao
- WHO Regional Office for Africa, Brazzaville, Congo
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Abstract
Background Influenza infection is a serious public health problem that causes an estimated 3 to 5 million cases and 250,000 deaths worldwide every year. The epidemiology of influenza is well-documented in high- and middle-income countries, however minimal effort had been made to understand the epidemiology, burden and seasonality of influenza in Africa. This study aims to assess the state of knowledge of seasonal influenza epidemiology in Africa and identify potential data gaps for policy formulation following the 2009 pandemic. Method We reviewed articles from Africa published into four databases namely: MEDLINE (PubMed), Google Scholar, Cochrane Library and Scientific Research Publishing from 2010 to 2019. Results We screened titles and abstracts of 2070 studies of which 311 were selected for full content evaluation and 199 studies were considered. Selected articles varied substantially on the basis of the topics they addressed covering the field of influenza surveillance (n=80); influenza risk factors and co-morbidities (n=15); influenza burden (n=37); influenza vaccination (n=40); influenza and other respiratory pathogens (n=22) and influenza diagnosis (n=5). Conclusion Significant progress has been made since the last pandemic in understanding the influenza epidemiology in Africa. However, efforts still remain for most countries to have sufficient data to allow countries to prioritize strategies for influenza prevention and control.
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Affiliation(s)
- Adamou Lagare
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | | | - Jean Testa
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
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Broor S, Campbell H, Hirve S, Hague S, Jackson S, Moen A, Nair H, Palekar R, Rajatonirina S, Smith PG, Venter M, Wairagkar N, Zambon M, Ziegler T, Zhang W. Leveraging the Global Influenza Surveillance and Response System for global respiratory syncytial virus surveillance-opportunities and challenges. Influenza Other Respir Viruses 2019; 14:622-629. [PMID: 31444997 PMCID: PMC7578328 DOI: 10.1111/irv.12672] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/17/2019] [Accepted: 07/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV)-associated acute lower respiratory infection is a common cause for hospitalization and hospital deaths in young children globally. There is urgent need to generate evidence to inform immunization policies when RSV vaccines become available. The WHO piloted a RSV surveillance strategy that leverages the existing capacities of the Global Influenza Surveillance and Response System (GISRS) to better understand RSV seasonality, high-risk groups, validate case definitions, and develop laboratory and surveillance standards for RSV. METHODS The RSV sentinel surveillance strategy was piloted in 14 countries. Patients across all age groups presenting to sentinel hospitals and clinics were screened all year-round using extended severe acute respiratory infection (SARI) and acute respiratory infection (ARI) case definitions for hospital and primary care settings, respectively. Respiratory specimens were tested for RSV at the National Influenza Centre (NIC) using standardized molecular diagnostics that had been validated by an External Quality Assurance program. The WHO FluMart data platform was adapted to receive case-based RSV data and visualize interactive visualization outputs. RESULTS Laboratory standards for detecting RSV by RT-PCR were developed. A review assessed the feasibility and the low incremental costs for RSV surveillance. Several challenges were addressed related to case definitions, sampling strategies, the need to focus surveillance on young children, and the data required for burden estimation. CONCLUSIONS There was no evidence of any significant adverse impact on the functioning of GISRS which is primarily intended for virologic and epidemiological surveillance of influenza.
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Affiliation(s)
- Shobha Broor
- Medicine and Health Sciences, Shree Guru Gobind Singh Tricentenary University, Gurugram, India
| | - Harry Campbell
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | - Siddhivinayak Hirve
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Siri Hague
- Department of Influenza, Norwegian Institute of Public Health, Oslo, Norway
| | - Sandra Jackson
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Ann Moen
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
| | - Harish Nair
- Usher Institute of Population Health Research and Informatics, University of Edinburgh, Edinburgh, UK
| | | | | | - Peter G Smith
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Marietjie Venter
- Center for Viral Zoonosis, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | - Maria Zambon
- Virus Reference Department, Public Health England, London, UK
| | - Thedi Ziegler
- Research Center for Child Psychiatry, University of Turku, Turku, Finland
| | - Wenqing Zhang
- Global Influenza Program, Influenza Preparedness and Response, World Health Organization, Geneva, Switzerland
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Rude JM, Kortimai L, Mosoka F, April B, Nuha M, Katawera V, Nagbe T, Tamba A, Desmound W, Mulbah R, Pierre F, Onuche EM, Chukwudi JO, Talisuna A, Yahaya AA, Rajatonirina S, Nyenswah T, Dahn B, Gasasira A, Fall IS. Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018. Pan Afr Med J 2019; 33:6. [PMID: 31404290 PMCID: PMC6675931 DOI: 10.11604/pamj.supp.2019.33.2.17095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/13/2018] [Accepted: 01/07/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis.
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Affiliation(s)
| | | | | | | | | | | | - Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Fall IS, Rajatonirina S, Yahaya AA, Zabulon Y, Nsubuga P, Nanyunja M, Wamala J, Njuguna C, Lukoya CO, Alemu W, Kasolo FC, Talisuna AO. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ Glob Health 2019; 4:e001427. [PMID: 31354972 PMCID: PMC6615866 DOI: 10.1136/bmjgh-2019-001427] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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: 01/19/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 11/04/2022] Open
Abstract
In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa. In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014. By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level. After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.
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Affiliation(s)
- Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Soatiana Rajatonirina
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Yoti Zabulon
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | | | - Joseph Wamala
- World Health Organization, Country Office, Juba, South Sudan
| | - Charles Njuguna
- World Health Organization, Country Office, Free Town, Sierra Leone
| | - Charles Okot Lukoya
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
| | | | - Francis Chisaka Kasolo
- World Health Organization, Regional Office for Africa, Country Support, Brazzaville, Congo
| | - Ambrose Otau Talisuna
- World Health Organization, Regional Office for Africa, Health Emergencies programme, Brazzaville, Congo
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Nagbe T, Yealue K, Yeabah T, Rude JM, Fallah M, Skrip L, Agbo C, Mouhamoud N, Okeibunor JC, Tuopileyi R, Talisuna A, Yahaya AA, Rajatonirina S, Frimpong JA, Stephen M, Hamblion E, Nyenswah T, Dahn B, Gasasira A, Fall IS. Integrated disease surveillance and response implementation in Liberia, findings from a data quality audit, 2017. Pan Afr Med J 2019; 33:10. [PMID: 31402968 PMCID: PMC6675580 DOI: 10.11604/pamj.supp.2019.33.2.17608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/14/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction in spite of the efforts and resources committed by the division of infectious disease and epidemiology (DIDE) of the national public health institute of Liberia (NPHIL)/Ministry of health to strengthening integrated disease surveillance and response (IDSR) across the country, quality data management system remains a challenge to the Liberia NPHIL/MoH (Ministry of health), with incomplete and inconsistent data constantly being reported at different levels of the surveillance system. As part of the monitoring and evaluation strategy for IDSR continuous improvement, data quality assessment (DQA) of the IDSR system to identify successes and gaps in the disease surveillance information system (DSIS) with the aim of ensuring data accuracy, reliability and credibility of generated data at all levels of the health system; and to inform an operational plan to address data quality needs for IDSR activities is required. Methods multi-stage cluster sampling that included stage 1: simple random sample (SRS) of five counties, stage 2: simple random sample of two districts and stage 3: simple random sample of three health facilities was employed during the study pilot assessment done in Montserrado County with Liberia institute of bio medical research (LIBR) inclusive. A total of thirty (30) facilities was targeted, twenty nine (29) of the facilities were successfully audited: one hospital, two health centers, twenty clinics and respondents included: health facility surveillance focal persons (HFSFP), zonal surveillance officers (ZSOs), district surveillance officers (DSOs) and County surveillance officers (CSOs). Results the assessment revealed that data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the subnational level. The findings indicated the following: 23% (7/29) of health facilities having dedicated phone for reporting, 20% (6/29) reported no cell phone network, 17% (5/29) reported daily access to internet, 56.6% (17/29) reported a consistent supply of electricity, and no facility reported access to functional laptop. It was also established that 40% of health facilities have experienced a stock out of laboratory specimens packaging supplies in the past year. About half of the surveyed health facilities delivered specimens through riders and were assisted by the DSOs. There was a large variety in the reported packaging process, with many staff unable to give clear processes. The findings during the exercise also indicated that 91% of health facility staff were mentored on data quality check and data management including the importance of the timeliness and completeness of reporting through supportive supervision and mentorship; 65% of the health facility assessed received supervision on IDSR core performance indicator; and 58% of the health facility officer in charge gave feedback to the community level. Conclusion public health is a data-intensive field which needs high-quality data and authoritative information to support public health assessment, decision-making and to assure the health of communities. Data quality assessment is important for public health. In this review completeness, accuracy, and timeliness were the three most-assessed attributes. Quantitative data quality assessment primarily used descriptive surveys and data audits, while qualitative data quality assessment methods include primarily interviews, questionnaires administration, documentation reviews and field observations. We found that data-use and data-process have not been given adequate attention, although they were equally important factors which determine the quality of data. Other limitations of the previous studies were inconsistency in the definition of the attributes of data quality, failure to address data users' concerns and a lack of triangulation of mixed methods for data quality assessment. The reliability and validity of the data quality assessment were rarely reported. These gaps suggest that in the future, data quality assessment for public health needs to consider equally the three dimensions of data quality, data use and data process. Measuring the perceptions of end users or consumers towards data quality will enrich our understanding of data quality issues. Data use is limited to risk communication and sensitization, no examples of use of data for prioritization or decision making at the sub national level.
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Affiliation(s)
- Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | - Laura Skrip
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | - Mary Stephen
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Esther Hamblion
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Bernice Dahn
- National Public Health Institute, Monrovia, Liberia
| | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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9
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Katawera V, Kohar H, Mahmoud N, Raftery P, Wasunna C, Humrighouse B, Hardy P, Saindon J, Schoepp R, Makvandi M, Hensley L, Condell O, Durski K, Singaravelu S, Gahimbare L, Olinger G, Kateh F, Naidoo D, Nsubuga P, Formenty P, Nyenswah T, Coulibaly SO, Okeibunor JC, Talisuna A, Yahaya AA, Rajatonirina S, Williams D, Dahn B, Gasasira A, Fall IS. Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations. Pan Afr Med J 2019; 33:8. [PMID: 31404295 PMCID: PMC6675925 DOI: 10.11604/pamj.supp.2019.33.2.17366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.
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Affiliation(s)
| | | | | | | | - Christine Wasunna
- Formarly Academic Consortium Combating Ebola in Liberia, Monrovia, Liberia
| | - Ben Humrighouse
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - John Saindon
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Randal Schoepp
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Monear Makvandi
- Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Lisa Hensley
- National Institutes of Health,Bethesda, United States of America
| | | | - Kara Durski
- World Health Organization, Geneva, Switzerland
| | | | | | - Gene Olinger
- National Institutes of Health,Bethesda, United States of America
| | | | | | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States of America
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Desmond Williams
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Alex Gasasira
- World Health Organization, Monrovia, Liberia.,Ministry of Health, Monrovia, Liberia.,Formarly Academic Consortium Combating Ebola in Liberia, Monrovia, Liberia.,United States Centers for Disease Control and Prevention, Atlanta, United States of America.,United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America.,Sandia National Laboratories, Albuquerque, New Mexico, United States of America.,National Institutes of Health,Bethesda, United States of America.,World Health Organization, Geneva, Switzerland.,Global Public Health Solutions, Atlanta, Georgia, United States of America.,World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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10
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Nagbe T, Williams GS, Rude JM, Flomo S, Yeabah T, Fallah M, Skrip L, Agbo C, Mahmoud N, Okeibunor JC, Yealue K, Talisuna A, Yahaya AA, Rajatonirina S, Clarke A, Hamblion E, Nyenswah T, Dahn B, Gasasira A, Fall IS. Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017. Pan Afr Med J 2019; 33:7. [PMID: 31402966 PMCID: PMC6675928 DOI: 10.11604/pamj.supp.2019.33.2.17172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/23/2018] [Accepted: 04/15/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia. Methods We conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017. Results From January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown. Conclusion Revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.
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Affiliation(s)
- Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | - Sumor Flomo
- National Public Health Institute, Monrovia, Liberia
| | | | | | - Laura Skrip
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | - Esther Hamblion
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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11
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Sumo J, George G, Weah V, Skrip L, Rude JM, Clement P, Naiene JD, Luwaga L, Okeibunor JC, Talisuna A, Yahaya AA, Rajatonirina S, Fallah M, Nyenswah T, Dahn B, Gasasira A, Fall IS. Risk communication during disease outbreak response in post-Ebola Liberia: experiences in Sinoe and Grand Kru counties. Pan Afr Med J 2019; 33:4. [PMID: 31402964 PMCID: PMC6675579 DOI: 10.11604/pamj.supp.2019.33.2.16877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/20/2018] [Accepted: 02/22/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Lessons learned from the Ebola virus disease (EVD) outbreak enabled Liberia to develop a health plan for strengthening public health capacity against potential public health threats. risk communication is one of the core pillars that provide life-saving information and knowledge for the public to take preventive and proactive actions against public health threats. These were applied in response to the post-ebola meningococcal septicemia and meningitis outbreaks in Sinoe and Grand Kru counties. This paper documents risk communication experiences in these post-ebola outbreaks in Liberia. Methods Risk Communication and health promotion strategies were deployed in developing response plans and promptly disseminating key messages to affected communities to mitigate the risks. Other strategies included engagement of community leaders, partnership with the media and dissemination of messages through the community radios, active monitoring community risk perceptions and compliance, rumor management, mobile stage and interpersonal communication (IPC) during the Meningococcal disease outbreaks in Sinoe and Grand Kru counties. Results In Sinoe, about 36,891 households or families in 10 health districts were reached through IPC and dialogue. Circulating rumors such as “Ebola” was the cause of deaths was timely and promptly mitigated. There was increased trust and adherence to health advice including prompt reporting of sick people to the nearest health facility in the two counties. Conclusion Risk communication and health promotion encouraged community support and involvement in any response to public threats and events. No doubt, risk communication and health promotion play an important role in preparedness and response to public health emergencies.
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Affiliation(s)
- John Sumo
- Health Promotion Division, Ministry of Health, Monrovia, Liberia
| | - Geraldine George
- Health Promotion Division, Ministry of Health, Monrovia, Liberia
| | - Vera Weah
- Health Promotion Division, Ministry of Health, Monrovia, Liberia
| | - Laura Skrip
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | - Bernice Dahn
- National Public Health Institute, Monrovia, Liberia
| | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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12
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Nagbe T, Naiene JD, Rude JM, Mahmoud N, Kromah M, Sesay J, Chukwudi OJ, Stephen M, Talisuna A, Yahaya AA, Rajatonirina S, Fallah M, Nyenswah T, Dahn B, Gasasira A, Fall IS. The implementation of integrated disease surveillance and response in Liberia after Ebola virus disease outbreak 2015-2017. Pan Afr Med J 2019; 33:3. [PMID: 31404272 PMCID: PMC6675929 DOI: 10.11604/pamj.supp.2019.33.2.16820] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/22/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although Liberia adapted the integrated diseases surveillance and response (IDSR) in 2004 as a platform for implementation of International Health Regulation (IHR (2005)), IDSR was not actively implemented until 2015. Some innovations and best practices were observed during the implementation of IDSR in Liberia after Ebola virus disease outbreak. This paper describes the different approaches used for implementation of IDSR in Liberia from 2015 to 2017. METHODS We conducted a cross-sectional study using the findings from IDSR supervisions conducted from September to November 2017 and perused the outbreaks linelists submitted by the counties to the national level from January to December 2017 and key documents available at the national level. RESULTS In 2017, the country piloted the use of mobile phones application to store and send data from the health facilities to the national level. In addition, an electronic platform for acute flaccid paralysis (AFP) surveillance called Auto-Visual AFP Detection and Reporting (AVADAR) was piloted in Montserrado County during the first semester of 2017. The timeliness and completeness of reports submitted from the counties to national level were above the target of 80% stable despite the challenges like insufficient resources, including skilled staff. CONCLUSION IDSR is being actively implemented in Liberia since 2015. Although the country is facing the same challenges as other countries during the early stages of implementation of IDSR, the several innovations were implemented in a short time. The surveillance system reveled to be resilient, despite the challenges.
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Affiliation(s)
- Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | | | | | - Mary Stephen
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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13
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Clarke A, Blidi N, Yokie J, Momolu M, Agbo C, Tuopileyi R, Rude JM, Seid M, Dereje Y, Wambai Z, Gasasira A, Skrip L, Kennedy N, Lablah E, Okeibunor JC, Djingarey MH, Talisuna A, Yahaya AA, Rajatonirina S, Fall IS. Strengthening immunization service delivery post Ebola virus disease (EVD) outbreak in Liberia 2015-2017. Pan Afr Med J 2019; 33:5. [PMID: 31402965 PMCID: PMC6675927 DOI: 10.11604/pamj.supp.2019.33.2.17116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 02/22/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction The Ebola virus disease (EVD) outbreak in Liberia from 2014-2015 setback the already fragile health system which was recovering from the effects of civil unrest. This led to significant decline in immunization coverage and key polio free certification indicators. The Liberia investment plan was developed to restore immunization service delivery and overall health system. Methods We conducted a desk review to summarize performance of immunization coverage, polio eradication, measles control, new vaccines and technologies. Data sources include program reports, scientific and grey literature, District Health Information System (DHIS2), Integrated Diseases Surveillance and Response (IDSR) database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel spreadsheets, ONA software and Arc GIS. Results There was a 36% increase in national coverage for Penta 3 in 2017 compared to 2014 from WUENIC data. Penta 3 dropout rate reduced by 2.5 fold from 15.3% in 2016 to 6.4% in 2017; while MCV1 coverage improved by 23% from 64% in 2015 to 87% in 2017. There was a rebound of non-polio AFP rate (NPAFP) rate from 1.2 in 2015 to 4.3 in 2017. Furthermore, there was a 2-fold increase in the number of AFP cases receiving 3 or more doses of OPV from 36% in 2015 to 61% in 2017. Conclusion Liberia demonstrated strong rebound of immunization services following the largest and most devastating EVD outbreak in West Africa in 2014 - 2015. Immunization coverage improved and dropout rates reduced. However, there are still opportunities for improvement in the immunization program both at national and sub-national levels.
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Affiliation(s)
| | | | | | | | | | | | | | - Mohammed Seid
- World Health Organization Country Office, Monrovia, Liberia
| | | | - Zakari Wambai
- World Health Organization Country Office, Monrovia, Liberia
| | - Alex Gasasira
- World Health Organization Country Office, Monrovia, Liberia
| | - Laura Skrip
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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14
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Clarke A, Blidi N, Dahn B, Agbo C, Tuopileyi R, Rude MJ, Williams GS, Seid M, Gasasira A, Wambai Z, Skrip L, Nagbe T, Nyenswah T, Chukwudi JO, Johnson T, Talisuna A, Yahaya AA, Rajatonirina S, Fall IS. Strengthening acute flaccid paralysis surveillance post Ebola virus disease outbreak 2015 - 2017: the Liberia experience. Pan Afr Med J 2019; 33:2. [PMID: 31402963 PMCID: PMC6675926 DOI: 10.11604/pamj.supp.2019.33.2.16848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/15/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Liberia remains at high risk of poliovirus outbreaks due to importation. The country maintained certification level acute flaccid paralysis (AFP) surveillance indicators each year until 2014 due to Ebola outbreak. During this time, there was a significant drop in non-polio AFP rate to (1.2/100,000 population under 15 years) in 2015 from 2.9/100, 000 population in 2013, due to a variety of reasons including suspension on shipment of acute flaccid paralysis stool specimen to the polio regional lab in Abidjan, refocusing of surveillance officers attention solely on Ebola virus disease (EVD) surveillance, inactivation of national polio expert committee (NPEC) and National Certification Committee (NCC). The Ministry of Health (MOH) supported by partners worked to restore AFP surveillance post EVD outbreak and ensure that Liberia maintains its polio free certification. Methods We conducted a desk review to summarize key activities conducted to restore acute flaccid paralysis (AFP) surveillance based on World Health Organization (WHO) AFP surveillance guidelines for Africa region. We also reviewed AFP surveillance indicators and introduction of new technologies. Data sources were from program reports, scientific and gray literature, AFP database, auto visual AFP detection and reporting (AVADAR) and ONA Servers. Data analysis was done using Microsoft excel and access spread sheets, ONA software and Geographic Information System (Arc GIS). Results AFP surveillance indicators improved with a rebound of non-polio AFP rate (NPAFP) rate from 1.2/100, 000 population under 15 years in 2015 to 4.3 in 2017. The stool adequacy rate at the national level also improved from 79% in 2016 to 82% in 2017, meeting the global target. The percentage of counties meeting the two critical AFP surveillance indicators NPAFP rate and stool adequacy improved from 47% in 2016 to 67% in 2017.The Last polio case reported in Liberia was in late 2010. Conclusion There was significant improvement in the key AFP surveillance indicators such as NPAFP rate and stool adequacy with a 3.5 fold increase in NPAFP from 2014 to 2017. By 2017, the stool adequacy rate was up to target levels compared to 2016, which was below target level of 80%. The number of counties meeting target for the two critical AFP surveillance indicators also increased by 20% points between 2016 and 2017. Similarly there was approximately two-fold increase in the oral polio vaccines (OPV) coverage for the reported AFP cases between 2015 and 2017. Strategies employed to address gaps in AFP surveillance included enhanced active case search for AFP, re-instatement of laboratory testing, supportive supervision in addition to facilitating enhanced community engagement in surveillance activities. New technologies such as AVADAR Pilot, electronic integrated supportive supervision (ISS) and electronic surveillance (eSurv) tools were introduced to improve real time AFP case reporting. However, there remain residual gaps in AFP surveillance in the country especially at the sub-national level. Similarly, the newly introduced technologies will require continued funding and capacity building for MOH staff to ensure sustainability of the initiatives.
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Affiliation(s)
| | | | | | | | | | | | | | - Mohammed Seid
- World Health Organization, Country Office, Monrovia, Liberia
| | - Alex Gasasira
- World Health Organization, Country Office, Monrovia, Liberia
| | - Zakari Wambai
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Laura Skrip
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Thomas Nagbe
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | | | - Ticha Johnson
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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15
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Njuguna C, Jambai A, Chimbaru A, Nordstrom A, Conteh R, Latt A, O-tipo S, Musoke R, Githuku J, Yoti Z, Yahaya A, Talisuna A, Rajatonirina S, Fall IS. Revitalization of integrated disease surveillance and response in Sierra Leone post Ebola virus disease outbreak. BMC Public Health 2019; 19:364. [PMID: 30940125 PMCID: PMC6444503 DOI: 10.1186/s12889-019-6636-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/28/2018] [Accepted: 03/08/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Ministry of Health and Sanitation (MOHS) in Sierra Leone partially rolled out the implementation of Integrated Disease Surveillance and Response (IDSR) in 2003. After the Ebola virus disease outbreak in 2014-2015, there was need to strengthen IDSR to ensure prompt detection and response to epidemic-prone diseases. We describe the processes, successes and challenges of revitalizing public health surveillance in a country recovering from a protracted Ebola virus disease outbreak. METHODS The revitalization process began with adaptation of the revised IDSR guidelines and development of customized guidelines to suit the health care systems in Sierra Leone. Public health experts defined data flow, system operations, case definitions, frequency and channels of reporting and dissemination. Next, phased training of IDSR focal persons in each health facility and the distribution of data collection and reporting tools was done. Monitoring activities included periodic supportive supervision and data quality assessments. Rapid response teams were formed to investigate and respond to disease outbreak alerts in all districts. RESULTS Submission of reports through the IDSR system began in mid-2015 and by the 35th epidemiologic week, all district health teams were submitting reports. The key performance indicators measuring the functionality of the IDSR system in 2016 and 2017 were achieved (WHO Africa Region target ≥80%); the annual average proportion of timely weekly health facility reports submitted to the next level was 93% in 2016 and 97% in 2017; the proportion of suspected outbreaks and public health events detected through the IDSR system was 96% (n = 87) in 2016 and 100% (n = 85) in 2017. CONCLUSION With proper planning, phased implementation and adequate investment of resources, it is possible to establish a functional IDSR system in a country recovering from a public health crisis. A functional IDSR system requires well trained workforce, provision of the necessary tools and guidelines, information, communication and technology infrastructure to support data transmission, provision of timely feedback as well as logistical support.
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Affiliation(s)
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Roland Conteh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Jane Githuku
- World Health Organization, Freetown, Sierra Leone
| | - Zablon Yoti
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ali Yahaya
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Ambrose Talisuna
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Ibrahima Socé Fall
- World Health Organization Regional Office for Africa, Brazzaville, Congo
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16
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Razanajatovo NH, Guillebaud J, Harimanana A, Rajatonirina S, Ratsima EH, Andrianirina ZZ, Rakotoariniaina H, Andriatahina T, Orelle A, Ratovoson R, Irinantenaina J, Rakotonanahary DA, Ramparany L, Randrianirina F, Richard V, Heraud JM. Epidemiology of severe acute respiratory infections from hospital-based surveillance in Madagascar, November 2010 to July 2013. PLoS One 2018; 13:e0205124. [PMID: 30462659 PMCID: PMC6248916 DOI: 10.1371/journal.pone.0205124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/23/2018] [Accepted: 09/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Few comprehensive data exist regarding the epidemiology of severe acute respiratory infections (SARI) in low income countries. This study aimed at identifying etiologies and describing clinical features of SARI-associated hospitalization in Madagascar. METHODS It is a prospective surveillance of SARI in 2 hospitals for 3 years. Nasopharyngeal swabs, sputum, and blood were collected from SARI patients enrolled and tested for viruses and bacteria. Epidemiological and clinical information were obtained from case report forms. RESULTS Overall, 876 patients were enrolled in the study, of which 83.1% (728/876) were tested positive for at least one pathogen. Viral and bacterial infections occurred in 76.1% (667/876) and 35.8% (314/876) of tested samples, respectively. Among all detected viruses, respiratory syncytial virus (RSV) was the most common (37.7%; 348/924) followed by influenza virus A (FLUA, 18.4%; 170/924), rhinovirus (RV, 13.5%; 125/924), and adenovirus (ADV, 8.3%; 77/924). Among bacteria, Streptococcus pneumoniae (S. pneumoniae, 50.3%, 189/370) was the most detected followed by Haemophilus influenzae type b (Hib, 21.4%; 79/370), and Klebsiella (4.6%; 17/370). Other Streptococcus species were found in 8.1% (30/370) of samples. Compared to patients aged less than 5 years, older age groups were significantly less infected with RSV. On the other hand, patients aged more than 64 years (OR = 3.66) were at higher risk to be infected with FLUA, while those aged 15-29 years (OR = 3.22) and 30-64 years (OR = 2.39) were more likely to be infected with FLUB (influenza virus B). CONCLUSION The frequency of influenza viruses detected among SARI patients aged 65 years and more highlights the need for health authorities to develop strategies to reduce morbidity amongst at-risk population through vaccine recommendation. Amongst young children, the demonstrated burden of RSV should guide clinicians for a better case management of children. These findings reveal the need to develop point-of-care tests to avoid overuse of antibiotics and to promote vaccine that could reduce drastically the RSV hospitalizations.
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Affiliation(s)
| | - Julia Guillebaud
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Aina Harimanana
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | | | | | | | | | - Arnaud Orelle
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Rila Ratovoson
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | | | - Lovasoa Ramparany
- Center for Biological Analysis, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | - Vincent Richard
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Jean-Michel Heraud
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
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17
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Woyessa AB, Mengesha M, Belay D, Tayachew A, Ayele W, Beyene B, Kassa W, Zemelak E, Demissie G, Amare B, Boulanger L, Granados C, Williams T, Tareke I, Rajatonirina S, Jima D. Epidemiology of influenza in Ethiopia: findings from influenza sentinel surveillance and respiratory infection outbreak investigations, 2009-2015. BMC Infect Dis 2018; 18:449. [PMID: 30176806 PMCID: PMC6122732 DOI: 10.1186/s12879-018-3365-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 04/12/2018] [Accepted: 08/29/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Influenza is an acute viral disease of the respiratory tract which is characterized by fever, headache, myalgia, prostration, coryza, sore throat and cough. Globally, an estimated 3 to 5 million cases of severe influenza illness and 291 243-645 832 seasonal influenza-associated respiratory deaths occur annually. Although recent efforts from some African countries to describe burden of influenza disease and seasonality, these data are missing for the vast majority, including Ethiopia. Ethiopia established influenza sentinel surveillance in 2008 aiming to determine influenza strains circulating in the country and know characteristics, trend and burden of influenza viruses. METHODS We used influenza data from sentinel surveillance sites and respiratory disease outbreak investigations from 2009 to 2015 for this analysis. We obtained the data by monitoring patients with influenza-like illness (ILI) at three health-centers, severe acute respiratory infection (SARI) at five hospitals and investigating patients during different respiratory infection outbreaks. Throat-swab specimens in viral transport media were transported to the national reference laboratory within 72 h of collection using a cold-chain system. We extracted viral RNA from throat-swabs and subjected to real-time PCR amplification. We further subtyped and characterized Influenza A-positive specimens using CDC real-time reverse transcription PCR protocol. RESULTS A total of 4962 throat-swab samples were collected and 4799 (96.7%) of them were tested. Among them 988 (20.6%) were influenza-positive and of which 349 (35.3%) were seasonal influenza A(H3N2), 321 (32.5%) influenza A(H1N1)pdm2009 and 318 (32.0%) influenza B. Positivity rate was 29.5% in persons 5-14 years followed by 26.4% in 15-44 years, 21.2% in > 44 years and 6.4% in under five children. The highest positivity rate observed in November (37.5%) followed by March (27.6%), December (26.4%), October (24.4%) and January (24.3%) while the lowest positivity rate was in August (7.7%). CONCLUSION In Ethiopia, seasonal Influenza A(H3N2), Influenza A(H1N1)pdm2009 and Influenza B viruses were circulating during 2009-2015. Positivity rate and number of cases peaked in November and December. Influenza is one of public health problems in Ethiopia and the need to introduce influenza vaccine and antivirus is important to prevent and treat the disease in future.
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Affiliation(s)
- Abyot Bekele Woyessa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Mesfin Mengesha
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Desalegn Belay
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Adamu Tayachew
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Workenesh Ayele
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Berhane Beyene
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Woubayehu Kassa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Etsehiwot Zemelak
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Gelila Demissie
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Daddi Jima
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
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Rajatonirina S, Rakotomanana F, Randrianasolo L, Razanajatovo NH, Andriamandimby SF, Ravolomanana L, Randrianarivo-Solofoniaina AE, Reynes JM, Piola P, Finlay-Vickers A, Heraud JM, Richard V. Early-warning health and process indicators for sentinel surveillance in Madagascar 2007-2011. Online J Public Health Inform 2014; 6:e197. [PMID: 25598869 PMCID: PMC4292534 DOI: 10.5210/ojphi.v6i3.5400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Epidemics pose major threats in resource-poor countries, and surveillance tools for their early detection and response are often inadequate. In 2007, a sentinel surveillance system was established in Madagascar, with the aim of rapidly identifying potential epidemics of febrile or diarrhoeal syndromes and issuing alerts. We present the health and process indicators for the five years during which this system was constructed, showing the spatiotemporal trends, early-warning sign detection capability and process evaluation through timely analyses of high-quality data. METHODS The Malagasy sentinel surveillance network is currently based on data for fever and diarrhoeal syndromes collected from 34 primary health centres and reported daily via the transmission of short messages from mobile telephones. Data are analysed daily at the Institut Pasteur de Madagascar to make it possible to issue alerts more rapidly, and integrated process indicators (timeliness, data quality) are used to monitor the system. RESULTS From 2007 to 2011, 917,798 visits were reported. Febrile syndromes accounted for about 11% of visits annually, but the trends observed differed between years and sentinel sites. From 2007 to 2011, 21 epidemic alerts were confirmed. However, delays in data transmission were observed (88% transmitted within 24 hours in 2008; 67% in 2011) and the percentage of forms transmitted each week for validity control decreased from 99.9% in 2007 to 63.5% in 2011. CONCLUSION A sentinel surveillance scheme should take into account both epidemiological and process indicators. It must also be governed by the main purpose of the surveillance and by local factors, such as the motivation of healthcare workers and telecommunication infrastructure. Permanent evaluation indicators are required for regular improvement of the system.
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Affiliation(s)
| | | | | | | | | | - Lisette Ravolomanana
- Directions des Urgences et de la Lutte contre les
Maladies Négligées (DULMN), Ministère de la Santé
Publique, Antananarivo, Madagascar
| | | | - Jean-Marc Reynes
- Unité de Virologie, Institut Pasteur de
Madagascar. Present address: Unité de Biologie des Infections Virales
Emergentes / Institut Pasteur de Lyon
| | - Patrice Piola
- Unité d’Epidémiologie, Institut
Pasteur de Madagascar, Antananarivo, Madagascar
| | - Alyssa Finlay-Vickers
- Malaria Branch, Division of Parasitic Diseases US
Centers for Disease Control and Prevention, President's Malaria Initiative,
Madagascar
| | - Jean-Michel Heraud
- Unité de Virologie, Institut Pasteur de
Madagascar, Antananarivo, Madagascar
| | - Vincent Richard
- Unité d'épidémiologie,
Institut Pasteur de Dakar, Dakar, Sénégal
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Ratovoson R, Raharimanga V, Rakotosamimanana N, Ravaloson B, Ratsitorahina M, Randremanana R, Ramarokoto H, Rajatonirina S, Rasolofo V, Richard V. Increase in the number of tuberculosis cases treated following tuberculin skin testing in first-year schoolchildren in Madagascar. PLoS One 2014; 9:e95494. [PMID: 24743554 PMCID: PMC3990634 DOI: 10.1371/journal.pone.0095494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/27/2014] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis continues to cause unacceptably high levels of disease and death worldwide. Active preventive strategies are required to improve tuberculosis control and to increase the number of cases treated in developing countries. The aim of this study was to evaluate the utility of the tuberculin skin test (TST) in first-year schoolchildren as a means of increasing the number of tuberculosis cases detected through the screening of close contacts. Methods All members of the households of 90 schoolchildren assigned to three groups on the basis of TST category (≤5 mm, [5–15)mm, ≥15 mm) were screened for sputum smear-positive pulmonary tuberculosis. The percentage detection of tuberculosis in close contacts was compared between TST categories. Results We identified 433 close contacts of the 90 schoolchildren, who were then evaluated for tuberculosis. We identified 11 cases of pulmonary tuberculosis among the close contacts (7 already on treatment and 4 previously undiagnosed): 0 in TST category ≤5 mm, 3 in TST category [5–15) mm and 8 in TST category ≥15 mm). This approach increased the detection of tuberculosis cases by a factor of 1.6 in first-year schoolchildren of the TST ≥5 mm group. Conclusion TST in first-year schoolchildren is a potentially effective method for improving the detection of tuberculosis in close contacts.
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Affiliation(s)
- Rila Ratovoson
- Epidemiology Unit, Pasteur Institute in Antananarivo, Antananarivo, Madagascar
| | | | | | - B. Ravaloson
- Tuberculosis Treatment Center, Ministry of Health, Antananarivo, Madagascar
| | | | - Rindra Randremanana
- Epidemiology Unit, Pasteur Institute in Antananarivo, Antananarivo, Madagascar
| | | | | | - Voahangy Rasolofo
- Mycobacteria Unit, Pasteur Institute in Antananarivo, Antananarivo, Madagascar
| | - Vincent Richard
- Epidemiology Unit, Pasteur Institute in Antananarivo, Antananarivo, Madagascar
- Epidemiology Unit, Pasteur Institute in Dakar, Dakar, Senegal
- * E-mail:
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Randrianirina F, Ratsima EH, Ramparany L, Randremanana R, Rakotonirina HC, Andriamanantena T, Rakotomanana F, Rajatonirina S, Richard V, Talarmin A. Antimicrobial resistance of bacterial enteropathogens isolated from stools in Madagascar. BMC Infect Dis 2014; 14:104. [PMID: 24568189 PMCID: PMC3937528 DOI: 10.1186/1471-2334-14-104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/10/2014] [Indexed: 12/03/2022] Open
Abstract
Background Diarrheal diseases are a major public health problem in developing countries, and are one of the main causes of hospital admissions in Madagascar. The Pasteur Institute of Madagascar undertook a study to determine the prevalence and the pathogenicity of bacterial, viral and protozoal enteropathogens in diarrheal and non-diarrheal stools of children aged less than 5 years in Madagascar. We present here the results of the analysis of antimicrobial susceptibility of the bacteria isolated during this study. Methods The study was conducted in the community setting in 14 districts of Madagascar from October 2008 to May 2009. Conventional methods and PCR were used to identify the bacteria; antimicrobial susceptibility was determined using an agar diffusion method for enterobacteriaceae and MICs were measured by an agar dilution method for Campylobacter sp. In addition to the strains isolated during this study, Salmonella sp and Shigella sp isolated at the Pasteur Institute of Madagascar from 2005 to 2009 were included in the analysis to increase the power of the study. Results Twenty-nine strains of Salmonella sp, 35 strains of Shigella sp, 195 strains of diarrheagenic E. coli, 203 strains of C. jejuni and 71 strains of C. coli isolated in the community setting were tested for antibiotic resistance. Fifty-five strains of Salmonella sp and 129 strains of Shigella sp isolated from patients referred to the Pasteur Institute of Madagascar were also included in the study. Many E. coli and Shigella isolates (around 80%) but fewer Salmonella isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. A small proportion of strains of each species were resistant to ciprofloxacin and only 3% of E. coli strains presented a resistance to third generation cephalosporins due to the production of extended-spectrum beta-lactamases. The resistance of Campylobacter sp to ampicillin was the most prevalent, whereas less than 5% of isolates were resistant to each of the other antibiotics. Conclusion The highest prevalence of antimicrobial resistance was to ampicillin and trimethoprim/sulfamethoxazole. Antibiotic treatment is not recommended for children with diarrhea in Madagascar and the emphasis should be placed on oral rehydration.
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Orelle A, Razanajatovo NH, Rajatonirina S, Hoffmann J, Randrianasolo L, Razafitrimo GM, Naidoo D, Richard V, Heraud JM. Epidemiological and virological characterization of 2009 pandemic influenza A virus subtype H1N1 in Madagascar. J Infect Dis 2013; 206 Suppl 1:S140-7. [PMID: 23169961 DOI: 10.1093/infdis/jis533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Madagascar was one of the first African countries to be affected by the 2009 pandemic of influenza A virus subtype H1N1 [A(H1N1)pdm2009] infection. The outbreak started in the capital city, Antananarivo, and then spread throughout the country from October 2009 through February 2010. METHODS Specimens from patients presenting with influenza-like illness were collected and shipped to the National Influenza Center in Madagascar for analyses, together with forms containing patient demographic and clinical information. RESULTS Of the 2303 specimens tested, 1016 (44.1%) and 131 (5.7%) yielded A(H1N1)pdm09 and seasonal influenza virus, respectively. Most specimens (42.0%) received were collected from patients <10 years old. Patients <20 years old were more likely than patients >50 years old to be infected with A(H1N1)pdm09 (odds ratio, 2.1; 95% confidence interval, 1.7-2.6; P < .01). Although phylogenetic analyses of A(H1N1)pdm09 suggested multiple introductions of the virus into Madagascar, no antigenic differences between A(H1N1)pdm09 viruses recovered in Madagascar and those that circulated worldwide were observed. CONCLUSIONS The high proportion of respiratory specimens positive for A(H1N1)pdm09 is consistent with a widespread transmission of the pandemic in Madagascar. The age distribution of cases of A(H1N1)pdm09 infection suggests that children and young adults could be targeted for interventions that aim to reduce transmission during an influenza pandemic.
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Affiliation(s)
- Arnaud Orelle
- National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Université d’Ankatso, Antananarivo, Madagascar.
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Randremanana R, Randrianirina F, Gousseff M, Dubois N, Razafindratsimandresy R, Hariniana ER, Garin B, Randriamanantena A, Rakotonirina HC, Ramparany L, Ramarokoto CE, Rakotomanana F, Ratsitorahina M, Rajatonirina S, Talarmin A, Richard V. Case-control study of the etiology of infant diarrheal disease in 14 districts in Madagascar. PLoS One 2012; 7:e44533. [PMID: 23028555 PMCID: PMC3444445 DOI: 10.1371/journal.pone.0044533] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/03/2012] [Indexed: 02/04/2023] Open
Abstract
Background Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar. Methods Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR). Results Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of Entamoeba histolytica, Trichomonas intestinalis and Giardia lamblia were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity. Conclusion In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.
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Affiliation(s)
- Rindra Randremanana
- Epidemiologic Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
| | | | - Marie Gousseff
- Epidemiologic Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
| | - Natasha Dubois
- Virological Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
| | | | | | - Benoit Garin
- Virological Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
| | | | | | - Lovasoa Ramparany
- Molecular Biology Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
| | | | | | | | | | | | - Vincent Richard
- Epidemiologic Unit, Institut Pasteur in Madagascar, Antananarivo, Madagascar
- * E-mail:
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Rajatonirina S, Heraud JM, Randrianasolo L, Orelle A, Razanajatovo NH, Raoelina YN, Ravolomanana L, Rakotomanana F, Ramanjato R, Randrianarivo-Solofoniaina AE, Richard V. Short message service sentinel surveillance of influenza-like illness in Madagascar, 2008-2012. Bull World Health Organ 2012; 90:385-9. [PMID: 22589573 DOI: 10.2471/blt.11.097816] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 03/12/2012] [Accepted: 03/13/2012] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The revision of the International Health Regulations (IHR) and the threat of influenza pandemics and other disease outbreaks with a major impact on developing countries have prompted bolstered surveillance capacity, particularly in low-resource settings. APPROACH Surveillance tools with well-timed, validated data are necessary to strengthen disease surveillance. In 2007 Madagascar implemented a sentinel surveillance system for influenza-like illness (ILI) based on data collected from sentinel general practitioners. SETTING Before 2007, Madagascar's disease surveillance was based on the passive collection and reporting of data aggregated weekly or monthly. The system did not allow for the early identification of outbreaks or unexpected increases in disease incidence. RELEVANT CHANGES An innovative case reporting system based on the use of cell phones was launched in March 2007. Encrypted short message service, which costs less than 2 United States dollars per month per health centre, is now being used by sentinel general practitioners for the daily reporting of cases of fever and ILI seen in their practices. To validate the daily data, practitioners also report epidemiological and clinical data (e.g. new febrile patient's sex, age, visit date, symptoms) weekly to the epidemiologists on the research team using special patient forms. LESSONS LEARNT Madagascar's sentinel ILI surveillance system represents the country's first nationwide "real-time" surveillance system. It has proved the feasibility of improving disease surveillance capacity through innovative systems despite resource constraints. This type of syndromic surveillance can detect unexpected increases in the incidence of ILI and other syndromic illnesses.
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Rajatonirina S, Heraud JM, Orelle A, Randrianasolo L, Razanajatovo N, Rajaona YR, Randrianarivo-Solofoniaina AE, Rakotomanana F, Richard V. The spread of influenza A(H1N1)pdm09 virus in Madagascar described by a sentinel surveillance network. PLoS One 2012; 7:e37067. [PMID: 22615893 PMCID: PMC3353907 DOI: 10.1371/journal.pone.0037067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 08/10/2011] [Accepted: 04/17/2012] [Indexed: 12/04/2022] Open
Abstract
Background The influenza A(H1N1)pdm09 virus has been a challenge for public health surveillance systems in all countries. In Antananarivo, the first imported case was reported on August 12, 2009. This work describes the spread of A(H1N1)pdm09 in Madagascar. Methods The diffusion of influenza A(H1N1)pdm09 in Madagascar was explored using notification data from a sentinel network. Clinical data were charted to identify peaks at each sentinel site and virological data was used to confirm viral circulation. Results From August 1, 2009 to February 28, 2010, 7,427 patients with influenza-like illness were reported. Most patients were aged 7 to 14 years. Laboratory tests confirmed infection with A(H1N1)pdm09 in 237 (33.2%) of 750 specimens. The incidence of patients differed between regions. By determining the epidemic peaks we traced the diffusion of the epidemic through locations and time in Madagascar. The first peak was detected during the epidemiological week 47-2009 in Antananarivo and the last one occurred in week 07-2010 in Tsiroanomandidy. Conclusion Sentinel surveillance data can be used for describing epidemic trends, facilitating the development of interventions at the local level to mitigate disease spread and impact.
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Rajatonirina S, Heraud JM, Randrianasolo L, Razanajatovo N, Ramandimbisoa T, Ratsitorahina M, Richard V. Pandemic influenza A(H1N1) 2009 virus outbreak among boarding school pupils in Madagascar: compliance and adverse effects of prophylactic oseltamivir treatment. J Infect Dev Ctries 2011; 5:156-62. [PMID: 21444983 DOI: 10.3855/jidc.1318] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 10/09/2010] [Accepted: 09/09/2010] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION In October 2009, the first outbreak of pandemic influenza A(H1N1) 2009 virus in Madagascar occurred at a school in Antananarivo. Among the first 12 cases, five were reported in boarding pupils at the school. The school closed 10 days into the outbreak. Mass oseltamivir prophylactic treatment was used to contain the outbreak. This study aimed to determine the transmission of infection among boarding school pupils and to evaluate the adverse effects of oseltamivir chemoprophylactic treatment and their impact on compliance. METHODOLOGY After conducting an initial investigation of the outbreak we administered a questionnaire to 132 boarders who were present after the school re-opened. Questions addressed symptoms of influenza-like illness, compliance with chemoprophylaxis, and adverse effects. RESULTS Of 59 boarders, 20 (45.0%) had confirmed pandemic influenza A (H1N1) infection. Among the asymptomatic boarders, compliance with oseltamivir chemoprophylaxis was moderate: 56.2% took the full 10-day course, and 66.9% completed at least seven days. In contrast, among symptomatic boarders, only two did not take the full course of oseltamivir. Fifty percent of the boarders receiving oseltamivir experienced symptoms such as fatigue (38.7%), difficulty concentrating (22.6%) and headaches (19.4%). Bad compliance was not associated with adverse effects. CONCLUSION Since the symptoms of pandemic influenza A(H1N1) 2009 virus were generally mild, the burden of adverse effects must be considered when deciding on mass oseltamivir chemoprophylaxis among teenagers.
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Rajatonirina S, Rakotosolofo B, Rakotomanana F, Richard V. Impact de l’épidémie du virus A(H1N1)v sur la mortalité, Antananarivo, Madagascar, 2009. Rev Epidemiol Sante Publique 2010. [DOI: 10.1016/j.respe.2010.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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