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Nkosi N, Preiser W, van Zyl G, Claassen M, Cronje N, Maritz J, Newman H, McCarthy K, Ntshoe G, Essel V, Korsman S, Hardie D, Smuts H. Molecular characterisation and epidemiology of enterovirus-associated aseptic meningitis in the Western and Eastern Cape Provinces, South Africa 2018-2019. J Clin Virol 2021; 139:104845. [PMID: 33962182 DOI: 10.1016/j.jcv.2021.104845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/25/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Enteroviruses are amongst the most common causes of aseptic meningitis. Between November 2018 and May 2019, an outbreak of enterovirus-associated aseptic meningitis cases was noted in the Western and Eastern Cape Provinces, South Africa. OBJECTIVES To describe the epidemiology and phylogeography of enterovirus infections during an aseptic meningitis outbreak in the Western and Eastern Cape Provinces of South Africa. METHODS Cerebrospinal fluid samples from suspected cases were screened using a polymerase chain reaction targeting the 5'UTR. Confirmed enterovirus-associated meningitis samples underwent molecular typing through species-specific VP1/VP2 primers and pan-species VP1 primers. RESULTS Between November 2018 and May 2019, 3497 suspected cases of aseptic meningitis were documented in the Western and Eastern Cape Provinces. Median age was 8 years (range 0-61), interquartile range (IQR=4-13 years), 405/735 (55%) male. 742/3497 (21%) cases were laboratory - confirmed enterovirus positive by routine diagnostic PCR targeting the 5'UTR. 128/742 (17%) underwent molecular typing by VP1 gene sequencing. Echovirus 4 (E4) was detected in 102/128 (80%) cases. Echovirus 9 was found in 7%, Coxsackievirus A13 in 3%. 10 genotypes contributed to the remaining 10% of cases. Synonymous mutations were found in most cases, with sporadic amino acid changes in 13 (12.7%) cases. CONCLUSION The aseptic meningitis outbreak was associated with echovirus 4. Stool samples are valuable for molecular typing in CSF confirmed EV-associated aseptic meningitis.
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Affiliation(s)
- Nokwazi Nkosi
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa.
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa
| | - Gert van Zyl
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa
| | - Mathilda Claassen
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa
| | - Nadine Cronje
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa; PathCare Reference Laboratory, N1 City, Goodwood, Cape Town, South Africa
| | - Jean Maritz
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa; PathCare Reference Laboratory, N1 City, Goodwood, Cape Town, South Africa
| | - Howard Newman
- Division of Medical Virology, Department of Pathology, Stellenbosch University and the National Health Laboratory Service Tygerberg, Cape Town, South Africa; PathCare Reference Laboratory, N1 City, Goodwood, Cape Town, South Africa
| | - Kerrigan McCarthy
- Division of Public Health, Surveillance and Response, National Institute of Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg, South Africa
| | - Genevie Ntshoe
- Division of Public Health, Surveillance and Response, National Institute of Communicable Diseases of the National Health Laboratory Service, Sandringham, Johannesburg, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Vivien Essel
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Stephen Korsman
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa and the National Health Laboratory Service, Anzio Road, Observatory, Cape Town, South Africa
| | - Diana Hardie
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa and the National Health Laboratory Service, Anzio Road, Observatory, Cape Town, South Africa
| | - Heidi Smuts
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa and the National Health Laboratory Service, Anzio Road, Observatory, Cape Town, South Africa
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Engelbrecht S, Delaney K, Kleinhans B, Wilkinson E, Tegally H, Stander T, van Zyl G, Preiser W, de Oliveira T. Multiple Early Introductions of SARS-CoV-2 to Cape Town, South Africa. Viruses 2021; 13:v13030526. [PMID: 33810168 PMCID: PMC8005015 DOI: 10.3390/v13030526] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Cape Town was the first city in South Africa to experience the full impact of the coronavirus disease 2019 (COVID-19) pandemic. We acquired samples from all suspected cases and their contacts during the first month of the pandemic from Tygerberg Hospital. Nanopore sequencing generated SARS-CoV-2 whole genomes. Phylogenetic inference with maximum likelihood and Bayesian methods were used to determine lineages that seeded the local epidemic. Three patients were known to have travelled internationally and an outbreak was detected in a nearby supermarket. Sequencing of 50 samples produced 46 high-quality genomes. The sequences were classified as lineages: B, B.1, B.1.1.1, B.1.1.161, B.1.1.29, B.1.8, B.39, and B.40. All the sequences from persons under investigation (PUIs) in the supermarket outbreak (lineage B.1.8) fall within a clade from the Netherlands with good support (p > 0.9). In addition, a new mutation, 5209A>G, emerged within the Cape Town cluster. The molecular clock analysis suggests that this occurred around 13 March 2020 (95% confidence interval: 9-17 March). The phylogenetic reconstruction suggests at least nine early introductions of SARS-CoV-2 into Cape Town and an early localized transmission in a shopping environment. Genomic surveillance was successfully used to investigate and track the spread of early introductions of SARS-CoV-2 in Cape Town.
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Affiliation(s)
- Susan Engelbrecht
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (K.D.); (B.K.); (G.v.Z.); (W.P.)
- Tygerberg Business Unit, National Health Laboratory Service (NHLS), Cape Town 8000, South Africa;
- Correspondence: (S.E.); (T.d.O.); Tel.: +27-21-9389357 (S.E.)
| | - Kayla Delaney
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (K.D.); (B.K.); (G.v.Z.); (W.P.)
| | - Bronwyn Kleinhans
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (K.D.); (B.K.); (G.v.Z.); (W.P.)
| | - Eduan Wilkinson
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (E.W.); (H.T.)
| | - Houriiyah Tegally
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (E.W.); (H.T.)
| | - Tania Stander
- Tygerberg Business Unit, National Health Laboratory Service (NHLS), Cape Town 8000, South Africa;
| | - Gert van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (K.D.); (B.K.); (G.v.Z.); (W.P.)
- Tygerberg Business Unit, National Health Laboratory Service (NHLS), Cape Town 8000, South Africa;
| | - Wolfgang Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa; (K.D.); (B.K.); (G.v.Z.); (W.P.)
- Tygerberg Business Unit, National Health Laboratory Service (NHLS), Cape Town 8000, South Africa;
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa; (E.W.); (H.T.)
- Centre for Aids Programme of Research in South Africa (CAPRISA), Durban 4000, South Africa
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
- Correspondence: (S.E.); (T.d.O.); Tel.: +27-21-9389357 (S.E.)
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Okeyo I, Lehmann U, Schneider H. The impact of differing frames on early stages of intersectoral collaboration: the case of the First 1000 Days Initiative in the Western Cape Province. Health Res Policy Syst 2020; 18:3. [PMID: 31918724 PMCID: PMC6953299 DOI: 10.1186/s12961-019-0508-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/20/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While intersectoral collaboration is considered valuable and important for achieving health outcomes, there are few examples of successes. The literature on intersectoral collaboration suggests that success relies on a shared understanding of what can be achieved collectively and whether stakeholders can agree on mutual goals or acceptable trade-offs. When health systems are faced with negotiating intersectoral responses to complex issues, achieving consensus across sectors can be a challenging and uncertain process. Stakeholders may present divergent framings of the problem based on their disciplinary background, interests and institutional mandates. This raises an important question about how different frames of problems and solutions affect the potential to work across sectors during the initiating phases of the policy process. METHODS In this paper, this question was addressed through an analysis of the case of the First 1000 Days (FTD) Initiative, an intersectoral approach targeting early childhood in the Western Cape Province of South Africa. We conducted a documentary analysis of 34 policy and other documents on FTD (spanning global, national and subnational spheres) using Schmidt's conceptualisation of policy ideas in order to elicit framings of the policy problem and solutions. RESULTS We identified three main frames, associated with different sectoral positionings - a biomedical frame, a nurturing care frame and a socioeconomic frame. Anchored in these different frames, ideas of the problem (definition) and appropriate policy solutions engaged with FTD and the task of intersectoral collaboration at different levels, with a variety of (sometimes cross) purposes. CONCLUSIONS The paper concludes on the importance of principled engagement processes at the beginning of collaborative processes to ensure that different framings are revealed, reflected upon and negotiated in order to arrive at a joint determination of common goals.
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Affiliation(s)
- Ida Okeyo
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
| | - Helen Schneider
- School of Public Health and UWC/SAMRC Health Services to Systems Research Unit, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535 Republic of South Africa
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