The Ebola outbreak, 2013-2016: old lessons for new epidemics

Investigation of and Strategies to Control the Final Cluster of the 2018-2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo

Background

On April 10, 2020, while the independent committee of the International Health Regulation was meeting to decide whether the 10th Ebola outbreak in the Demogratic Republic of Congo still constituted a Public Health Emergency of International Concern, a new confirmed case was reported in the city of Beni, the last epicenter of the epidemic. This study aimed to understand the source of this cluster and learn from the implemented control strategies for improved response in the future.

Methods

We conducted a combined epidemiological and genomic investigation to understand the origins and dynamics of transmission within this cluster and describe the strategy that successfully controlled the outbreak.

Results

Eight cases were identified as belonging to this final cluster. A total of 1028 contacts were identified. Whole-genome sequencing revealed that all cases belonged to the same cluster, the closest sequence to which was identified as a case from the Beni area with symptom onset in July 2019 and a difference of just 31 nucleotides. Outbreak control measures included community confinement of high-risk contacts.

Conclusions

This study illustrates the high risk of additional flare-ups in the period leading to the end-of-outbreak declaration and the importance of maintaining enhanced surveillance and confinement activities to rapidly control Ebola outbreaks.

Adeno-associated virus mediated expression of monoclonal antibody MR191 protects mice against Marburg virus and provides long-term expression in sheep

Vectored monoclonal antibody (mAb) expression mediated by adeno-associated virus (AAV) gene delivery leads to sustained therapeutic mAb expression and protection against a wide range of infectious diseases in both small and large animal models, including nonhuman primates. Using our rationally engineered AAV6 triple mutant capsid, termed AAV6.2FF, we demonstrate rapid and robust expression of two potent human antibodies against Marburg virus, MR78 and MR191, following intramuscular (IM) administration. IM injection of mice with 1 × 1011 vector genomes (vg) of AAV6.2FF-MR78 and AAV6.2FF-MR191 resulted in serum concentrations of approximately 141 μg/mL and 195 μg/mL of human IgG, respectively, within the first four weeks. Mice receiving 1 × 1011 vg (high) and 1 × 1010 vg (medium) doses of AAV6.2FF-MR191 were completely protected against lethal Marburg virus challenge. No sex-based differences in serum human IgG concentrations were observed; however, administering the AAV-mAb over multiple injection sites significantly increased serum human IgG concentrations. IM administration of three two-week-old lambs with 5 × 1012 vg/kg of AAV6.2FF-MR191 resulted in serum human IgG expression that was sustained for more than 460 days, concomitant with low levels of anti-capsid and anti-drug antibodies. AAV-mAb expression is a viable method for prolonging the therapeutic effect of recombinant mAbs and represents a potential alternative "vaccine" strategy for those with compromised immune systems or in possible outbreak response scenarios.

Meeting the Need for a Discussion of Unmet Medical Need

As Europe and the world continue to battle against COVID, the customary complacency of society over future threats is clearly on display. Just 30 months ago, such a massive disruption to global lives, livelihoods and quality of life seemed unimaginable. Some remedial European Union action is now emerging, and more is proposed, including in relation to tackling “unmet medical need” (UMN). This initiative—directing attention to the future of treating disease and contemplating incentives to stimulate research and development—is welcome in principle. But the current approach being considered by EU officials merits further discussion, because it may prove counter-productive, impeding rather than promoting innovation. This paper aims to feed into these ongoing policy discussions, and rather than presenting research in the classical sense, it discusses the key elements from a multistakeholder perspective. Its central concern is over the risk that the envisaged support will fail to generate valuable new treatments if the legislation is phrased in a rigidly linear manner that does not reflect the serpentine realities of the innovation process, or if the definition placed on unmet medical need is too restrictive. It cautions that such an approach presumes that “unmet need” can be precisely and comprehensively defined in advance on the basis of the past. It cautions that such an approach can reinforce the comfortable delusion that the future is totally predictable—the delusion that left the world as easy prey to COVID. Instead, the paper urges reflection on how the legislation that will shortly enter the pipeline can be phrased so as to allow for the flourishing of a culture capable of rapid adaptation to the unexpected.

Applications of self-replicating RNA

Self-replicating RNA viral vectors have been engineered for both prophylactic and therapeutic applications. Mainly the areas of infectious diseases and cancer have been targeted. Both positive and negative strand RNA viruses have been utilized including alphaviruses, flaviviruses, measles viruses and rhabdoviruses. The high-level of RNA amplification has provided efficient expression of viral surface proteins and tumor antigens. Immunization studies in animal models have elicit robust neutralizing antibody responses. In the context of infectious diseases, immunization with self-replicating RNA viral vectors has provided protection against challenges with lethal doses of pathogens in animal models. Similarly, immunization with vectors expressing tumor antigens has resulted in tumor regression and eradication and protection against tumor challenges in animal models. The transient nature and non-integration of viral RNA into the host genome are ideal features for vaccine development. Moreover, self-replicating RNA viral vectors show great flexibility as they can be applied as recombinant viral particles, RNA replicons or DNA replicon plasmids. Several clinical trials have been conducted especially in the area of cancer immunotherapy.

A participatory epidemiological and One Health approach to explore the community’s capacity to detect emerging zoonoses and surveillance network opportunities in the forest region of Guinea

The Ebola virus disease epidemic that threatened West Africa between 2013 and 2016 was of unprecedented health magnitude. After this health crisis, studies highlighted the need to introduce community-based surveillance systems and to adopt a One Health approach. This study aimed to provide preparatory insights for the definition of a community-based surveillance system for emerging zoonoses such as viral hemorrhagic fevers in Guinea. The objective was to explore the disease detection capacity and the surveillance network opportunities at the community level in two pilot areas in the forest region of Guinea, where the epidemic emerged. Based on a participatory epidemiological and One Health approach, we conducted Focus Group Discussions with human, animal and ecosystem health actors. We used a range of participatory tools, included semi-structured interviews, ranking, scoring and flow diagram, to estimate the local knowledge and perception of diseases and clinical signs and to investigate the existing health information exchange network and its related strengths and weaknesses. The results showed that there is heterogeneity in knowledge of diseases and perception of the clinical signs among actors and that there are preferred and more effective health communication channels opportunities. This preparatory study suggests that it is necessary to adapt the case definitions and the health communication channels to the different actors who can play a role in a future community-based surveillance system and provides recommendations for future surveillance activities to be carried out in West Africa.

Viral hemorrhagic diseases have a high risk of emergence in tropical regions. The consequences on public health are often disastrous in the low- and middle-income countries that face difficulties to control epidemics. This scenario has unfortunately occurred in West Africa between 2013 and 2016 with the Ebola virus disease epidemic. There is an urgent need to increase the capacity for rapid detection of the emergence of such diseases and adopting a One Health approach since most of them are zoonotic. Community-based surveillance seems appropriate to address this issue in the context of these countries. We collected preparatory data through semi-structured interviews of community actors in human health, animal health and ecosystem health in Guinea. We used participatory epidemiology that appears to be a consistent method to assess local knowledge and perceptions of diseases and clinical signs and to identify health information exchange network opportunities. We aimed to provide relevant recommendations for the design of adapted case definitions and surveillance network in the prospect of implementing a community-based surveillance system of viral hemorrhagic fevers in Guinea and future surveillance activities to be carried out in West Africa.

Asymmetric host movement reshapes local disease dynamics in metapopulations

Understanding how the movement of individuals affects disease dynamics is critical to accurately predicting and responding to the spread of disease in an increasingly interconnected world. In particular, it is not yet known how movement between patches affects local disease dynamics (e.g., whether pathogen prevalence remains steady or oscillates through time). Considering a set of small, archetypal metapopulations, we find three surprisingly simple patterns emerge in local disease dynamics following the introduction of movement between patches: (1) movement between identical patches with cyclical pathogen prevalence dampens oscillations in the destination while increasing synchrony between patches; (2) when patches differ from one another in the absence of movement, adding movement allows dynamics to propagate between patches, alternatively stabilizing or destabilizing dynamics in the destination based on the dynamics at the origin; and (3) it is easier for movement to induce cyclical dynamics than to induce a steady-state. Considering these archetypal networks (and the patterns they exemplify) as building blocks of larger, more realistically complex metapopulations provides an avenue for novel insights into the role of host movement on disease dynamics. Moreover, this work demonstrates a framework for future predictive modelling of disease spread in real populations.

Viral Inactivation and Biocompatibility Study of Electrically Activated Water Mist

In addition to the ongoing global problem of healthcare-acquired infections, the COVID-19 pandemic continues to pose a serious threat to the health of the global population. This unprecedented pandemic situation has reinforced the need for the development of technologies that can curb the transmission of viruses among human beings and help to control the infection. Existing disinfection techniques using either ultraviolet light or harsh chemicals pose safety risks and are not suitable for use in the presence of humans. Thus, the need for a safe and effective disinfection technique that can be used in the presence of humans to control viral transmission is evident. A technique that can continuously disinfect air and surfaces in indoor environments, where the chances of viral transmission are high, can be an indispensable tool to fight such a pandemic. The Airlens Minus Corona (AMC) device provided by Persapien Innovations has been developed to achieve this goal. In this study, the antiviral functionality and biocompatibility of AMC were evaluated. Activated water mist (AWM) generated from this device was tested in vitro and in vivo for its toxicity to cell lines and in animal model. The AWM was found to be non-cytotoxic to L-929 cell lines and had no sign of clinical toxicity in an animal model (rabbit). This device was further used to inactivate animal viruses and bacteriophages. The AWM was found to be effective in the complete inactivation of influenza A H1N1 virus within 5 minutes of direct treatment. This device was also found to be effective in inactivating >90% of bacteriophage particles.

Averting wildlife-borne infectious disease epidemics requires a focus on socio-ecological drivers and a redesign of the global food system

A debate has emerged over the potential socio-ecological drivers of wildlife-origin zoonotic disease outbreaks and emerging infectious disease (EID) events. This Review explores the extent to which the incidence of wildlife-origin infectious disease outbreaks, which are likely to include devastating pandemics like HIV/AIDS and COVID-19, may be linked to excessive and increasing rates of tropical deforestation for agricultural food production and wild meat hunting and trade, which are further related to contemporary ecological crises such as global warming and mass species extinction. Here we explore a set of precautionary responses to wildlife-origin zoonosis threat, including: (a) limiting human encroachment into tropical wildlands by promoting a global transition to diets low in livestock source foods; (b) containing tropical wild meat hunting and trade by curbing urban wild meat demand, while securing access for indigenous people and local communities in remote subsistence areas; and (c) improving biosecurity and other strategies to break zoonosis transmission pathways at the wildlife-human interface and along animal source food supply chains.

Misconceptions and Rumors about Ebola Virus Disease in Sub-Saharan Africa: A Systematic Review

We sought to summarize knowledge, misconceptions, beliefs, and practices about Ebola that might impede the control of Ebola outbreaks in Africa. We searched Medline, EMBASE, CINAHL, and Google Scholar (through May 2019) for publications reporting on knowledge, attitudes, and practices (KAP) related to Ebola in Africa. In total, 14 of 433 articles were included. Knowledge was evaluated in all 14 articles, and they all highlighted that there are misconceptions and risk behaviors during an Ebola outbreak. Some communities believed that Ebola spreads through the air, mosquito bites, malice from foreign doctors, witchcraft, and houseflies. Because patients believe that Ebola was caused by witchcraft, they sought help from traditional healers. Some people believed that Ebola could be prevented by bathing with salt or hot water. Burial practices where people touch Ebola-infected corpses were common, especially among Muslims. Discriminatory attitudes towards Ebola survivors or their families were also prevalent. Some Ebola survivors were not accepted back in their communities; the possibility of being ostracized from their neighborhoods was high and Ebola survivors had to lead a difficult social life. Most communities affected by Ebola need more comprehensive knowledge on Ebola. Efforts are needed to address misconceptions and risk behaviors surrounding Ebola for future outbreak preparedness in Africa.

Hybrid governance and disaster management in Freetown, Sierra Leone, Monrovia, Liberia, and Dar es Salaam, Tanzania

This paper introduces a hybrid governance-referring to situations where state and non-state actors collectively provide key services-perspective to disaster management. It contends that hybridity is often the norm rather than the exception in disaster management, particularly in developing countries where the state is frequently weak and may be unable or unwilling to supply essential services. In these instances, risks are addressed by state and non-state entities, ranging from citizens and non-governmental organisations to customary authorities. Given their important role in risk reduction, the disruption of hybrid processes by attempting to bring them within the remit of the state may create rather than diminish risk. To make this argument, the paper first outlines the key tenants of hybridity and their applicability to disasters before illustrating hybridity through three case studies of hybrid risk management in three cities in Africa: Freetown, Sierra Leone; Monrovia, Liberia; and Dar es Salaam, Tanzania.

The impact of the Covid-19 pandemic on primary health care utilization: an experience from Iran

Background

The Covid-19 pandemic affected the performance of Primary Health Care (PHC) worldwide. This study was performed to investigate the impact of the Covid-19 pandemic on the utilization of PHC in Iran.

Method

A before and after study conducted between 2019 and 2021. 56 medical science universities across the country were studied. The data extracted from Electronic Health Record (EHR) is entitled “SIB”. Three major indicators included a weighted average of essential services provided by (physician, dentist, mental health expert, midwife, nutritionist), percentage of actual delivered service, and percentage of customer satisfaction was selected as a criterion for assessing the PHC. Descriptive statistics and analytical statistics (Wilcoxon test) using SPSS 16 software were used for the data analyzing and reporting.

Results

There was a significant difference among the examined dimensions before and after Covid-19 separation in all studied indicators except the level of percentage of customer satisfaction (P < 0.05). So that the percentage of actually delivered services decreased about 1% and the weighted average of essential services provided by a physician, dentist, midwife, mental health experts, and nutritionist decreased 627.95, 718.81, 460.85, 2914.66, 2410.65 numbers, respectively.

Conclusion

Covid-19 Pandemic has affected the performance of Iranian PHC at the beginning and overall, has a negative consequence on utilization of services. Preparedness to respond to pandemics and develop programs and interventions is necessary to cover the weaknesses of the PHC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07753-5.

Impact of major disease outbreaks in the third millennium on adolescent and youth sexual and reproductive health and rights in low and/or middle-income countries: a systematic scoping review protocol

INTRODUCTION

Sexual and Reproductive Health and Rights (SRHR) of young people continue to present a high burden and remain underinvested. This is more so in low and middle-income countries (LMICs), where empirical evidence reveals disruption of SRHR maintenance, need for enhancement of programmes, resources and services during pandemics. Despite the importance of the subject, there is no published review yet combining recent disease outbreaks such as (H1N1/09, Zika, Ebola and SARS-COV-2) to assess their impact on adolescents and youth SRHR in LMICs.

METHODS AND ANALYSIS

We will adopt a four-step search to reach the maximum possible number of studies. In the first step, we will carry out a limitedpreliminary search in databases for getting relevant keywords (appendix 1). Second, we will search in four databases: Pubmed, Cochrane Library, Embase and PsycINFO. The search would begin from the inception of the first major outbreak in 2009 (H1N1/09) up to the date of publication of the protocol in early 2022. We will search databases using related keywords, screen title & abstract and review full texts of the selected titles to arrive at the list of eligible studies. In the third stage, we will check their eligibility to the included article's reference list. In the fourth stage, we will check the citations of included papers in phase 2 to complete our study selection. We will include all types of original studies and without any language restriction in our final synthesis. Our review results will be charted for each pandemic separately and include details pertaining to authors, year, country, region of the study, study design, participants (disaggregated by age and gender), purpose and report associated SRHR outcomes. The review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR).

PATIENT AND PUBLIC INVOLVEMENT

Patients or public were not involved in this study.

ETHICS AND DISSEMINATION

Ethical assessment is not required for this study. The results of the study will be presented in peer-reviewed publications and conferences on adolescent SRHR.

The Analogs of Furanyl Methylidene Rhodanine Exhibit Broad-Spectrum Inhibitory and Inactivating Activities against Enveloped Viruses, including SARS-CoV-2 and Its Variants

In recent years, infectious diseases caused by viral infections have seriously endangered human health, especially COVID-19, caused by SARS-CoV-2, which continues to spread worldwide. The development of broad-spectrum antiviral inhibitors is urgently needed. Here, we report a series of small-molecule compounds that proved effective against human coronaviruses (HCoV), such as SARS-CoV-2 and its variants of concern (VOCs), including Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), and Omicron (B.1.1.529), SARS-CoV, MERS-CoV, HCoV-OC43, and other viruses with class I viral fusion proteins, such as influenza virus, Ebola virus (EBOV), Nipah virus (NiV), and Lassa fever virus (LASV). They are also effective against class II enveloped viruses represented by ZIKV and class III enveloped viruses represented by vesicular stomatitis virus (VSV). Further studies have shown that these compounds may exert antiviral effects through a variety of mechanisms, including inhibiting the formation of the six-helix bundle, which is a typical feature of enveloped virus fusion with cell membranes, and/or targeting viral membrane to inactivate cell-free virions. These compounds are expected to become drug candidates against SARS-CoV-2 and other enveloped viruses.

Combating Infectious Diseases with Synthetic Biology

Over the past decades, there have been numerous outbreaks, including parasitic, fungal, bacterial, and viral infections, worldwide. The rate at which infectious diseases are emerging is disproportionate to the rate of development for new strategies that could combat them. Therefore, there is an increasing demand to develop novel, specific, sensitive, and effective methods for infectious disease diagnosis and treatment. Designed synthetic systems and devices are becoming powerful tools to treat human diseases. The advancement in synthetic biology offers efficient, accurate, and cost-effective platforms for detecting and preventing infectious diseases. Herein we focus on the latest state of living theranostics and its implications.

Generating Uniformly Cross-Reactive Ebolavirus spp. Anti-nucleoprotein Nanobodies to Facilitate Forward Capable Detection Strategies

It is often challenging for a single monoclonal antibody to cross-react equally with all species of a particular viral genus that are separated by time and geographies to ensure broad long-term global immunodiagnostic use. Here, we set out to isolate nanobodies or single-domain antibodies (sdAbs) with uniform cross-reactivity to the genus Ebolavirus by immunizing a llama with recombinant nucleoprotein (NP) representing the 5 cultivated species to assemble a phage display repertoire for mining. Screening sdAbs for reactivity against the C-terminal domain of NP guided the isolation of clones that could perform as both captor and tracer for polyvalent antigen in sandwich assays. Two promising sdAbs had equivalent reactivities across all 5 species and greatly enhanced the equilibrium concentration at 50% (EC₅₀) for recombinant NP when compared with a differentially cross-reactive nonimmune sdAb isolated previously. Uniform reactivity and enhanced sensitivity were relayed to live virus titrations, resulting in lower limits of detection of 2-5 pfu for the best sdAbs, representing 10-, 20-, and 100-fold improvements for Zaire, Sudan/Reston, and Taï Forest viruses, respectively. Fusions of the sdAbs with ascorbate peroxidase (APEX2) and mNeonGreen generated one-step immunoreagents useful for colorimetric and fluorescent visualization of cellular NP. Both sdAbs were also able to recognize recombinant NPs from the recently discovered Bombali virus, a putative sixth Ebolavirus species unknown at the start of these experiments, validating the forward capabilities of the sdAbs. The simplicity and modularity of these sdAbs should enable advances in antigen-based diagnostic technologies to be retuned toward filoviral detection relatively easily, thereby proactively safeguarding human health.

The Myotis chiloensis Guano Virome: Viral Nucleic Acid Enrichments for High-Resolution Virome Elucidation and Full Alphacoronavirus Genome Assembly

Bats are widespread mammals of the order Chiroptera. They are key for ecosystem functioning, participating in crucial processes. Their unique ability amongst mammals to fly long distances, their frequently large population sizes, and their longevity favor infectious agent persistence and spread. This includes a large variety of viruses, encompassing many important zoonotic ones that cause severe diseases in humans and domestic animals. Despite this, the understanding of the viral ecological diversity residing in bat populations remains unclear, which complicates the determination of the origins of zoonotic viruses. To gain knowledge on the viral community of a widely distributed insectivorous bat species, we characterized the guano virome of a native Chilean bat species (Myotis chiloensis (Waterhouse, 1840)). By applying a novel enrichment strategy, we were able to secure a consequent percentage of viral reads, providing unprecedented resolution for a bat virome. This in turn enabled us to identify and assemble a new bat alphacoronavirus from Chilean bats closely related to PEDV, an important viral pathogen with high mortality rates in suckling piglets. This study highlights the importance of applying and improving high-resolution virome studies in this vital order to ultimately enhance epidemiological surveillance for potentially zoonotic pathogens.

Experience in fostering regional collaboration and Coordination to use data for battling infectious diseases in sub-Saharan Africa

The emergence of COVID-19 highlights globalisation realties, where diseases may emerge from anywhere and rapidly spread globally. Lessons emphasise the necessity for strengthening regional and global collaboration and coordination to allow rapid risk identification, resource mobilisation and joint actions. We report the experience of the Regional Action through Data (RAD) partnership in fostering regional cooperation and collaboration to use data for battling infectious diseases and the effects of COVID-19. The Partnership comprised;BoadReach company, The West African Health Organization (WAHO) and the Intergovernmental Authority on Development (IGAD); Duke University Global Health Centre and the Jembi Health Systems, South Africa.

Comparative Study of Government Response Measures and Epidemic Trends for COVID-19 Global Pandemic

The ongoing novel coronavirus (COVID-19) epidemic has evolved into a full range of challenges that the world is facing. Health and economic threats caused governments to take preventive measures against the spread of the disease. This study aims to provide a correlation analysis of the response measures adopted by countries and epidemic trends since the COVID-19 outbreak. This analysis picks 13 countries for quantitative assessment. We select a trusted model to fit the epidemic trend curves in segments and catch the characteristics based on which we explore the key factors of COVID-19 spread. This review generates a score table of government response measures according to the Likert scale. We use the Delphi method to obtain expert judgments about the government response in the Likert scale. Furthermore, we find a significant negative correlation between the epidemic trend characteristics and the government response measure scores given by experts through correlation analysis. More stringent government response measures correlate with fewer infections and fewer waves in the infection curves. Stringent government response measures curb the spread of COVID-19, limit the number of total infectious cases, and reduce the time to peak of total cases. The clusters of the results categorize the countries into two specific groups. This study will improve our understanding of the prevention of COVID-19 spread and government response.

Mitigating bias in estimating epidemic severity due to heterogeneity of epidemic onset and data aggregation

Outbreaks of infectious diseases, such as influenza, are a major societal burden. Mitigation policies during an outbreak or pandemic are guided by the analysis of data of ongoing or preceding epidemics. The reproduction number, R0, defined as the expected number of secondary infections arising from a single individual in a population of susceptibles is critical to epidemiology. For typical compartmental models such as the Susceptible-Infected-Recovered (SIR) R0 represents the severity of an epidemic. It is an estimate of the early-stage growth rate of an epidemic and is an important threshold parameter used to gain insights into the spread or decay of an outbreak. Models typically use incidence counts as indicators of cases within a single large population; however, epidemic data are the result of a hierarchical aggregation, where incidence counts from spatially separated monitoring sites (or sub-regions) are pooled and used to infer R0. Is this aggregation approach valid when the epidemic has different dynamics across the regions monitored? We characterize bias in the estimation of R0 from a merged data set when the epidemics of the sub-regions, used in the merger, exhibit delays in onset. We propose a method to mitigate this bias, and study its efficacy on synthetic data as well as real-world influenza and COVID-19 data.

Clinicopathologic features among different viral epidemic outbreaks involving the skin

The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks in the last century, and a general warning has been issued on the possibility that coinfections can make the differential diagnosis and treatment difficult, especially in tropical countries. Some reports have noted that the presence of high dengue antibodies can give a false-negative result when testing for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. However, strong clinicopathologic correlation might provide some clues to address differentials. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessment, especially invasive examinations such as biopsy, takes a back seat in severely ill patients. A literature retrieval was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.

Investments for effective functionality of health systems towards Universal Health Coverage in Africa: A scoping review

The health challenges in Africa underscore the importance of effectively investing in health systems. Unfortunately, there is no information on systems investments adequate for an effective functional health system. We aimed to address this by conducting a scoping review of existing evidence following the Joanna Briggs Institute Manual for Evidence Synthesis and preregistered with the Open Science Framework (https://osf.io/bvg4z). We included any empirical research describing interventions that contributed to the functionality of health systems in Africa or any low-income or lower-middle-income regions. We searched Web of Science, MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, and ERIC from their inception, and hand-searched other relevant sources. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. We identified 554 unique reports describing 575 interventions, of which 495 reported evidence of effectiveness. Most interventions were undertaken in Africa (80.9%), covered multiple elements of health systems (median: 3), and focused on service delivery (77.4%) and health workforce (65.6%). Effective interventions contributed to improving single (35.6%) or multiple (64.4%) capacities of health systems: access to essential services (75.6%), quality of care (70.5%), demand for essential services (38.6%), or health systems resilience (13.5%). For example, telemedicine models which covered software (technologies) and hardware (health workers) elements were used as a strategy to address issues of access to essential services. We inventoried these effective interventions for improving health systems functionality in Africa. Further analyses could deepen understanding of how such interventions differ in their incorporation of evidence for potential scale across African countries.

Rethinking Disease Preparedness: Incertitude and the Politics of Knowledge

This paper argues for a rethinking of disease preparedness that puts incertitude and the politics of knowledge at the centre. Through examining the experiences of Ebola, Nipah, cholera and COVID-19 across multiple settings, the limitations of current approaches are highlighted. Conventional approaches assume a controllable, predictable future, which is responded to by a range of standard interventions. Such emergency preparedness planning approaches assume risk - where future outcomes can be predicted - and fail to address uncertainty, ambiguity and ignorance - where outcomes or their probabilities are unknown. Through examining the experiences of outbreak planning and response across the four cases, the paper argues for an approach that highlights the politics of knowledge, the constructions of time and space, the requirements for institutions and administrations and the challenges of ethics and justice. Embracing incertitude in disease preparedness responses therefore means making contextual social, political and cultural dimensions central.

SARS-CoV-2 at the human-animal interphase: A review

Since its emergence in China in December 2019, COVID-19 remains the recent leading disease of concern drawing the public health attention globally. The disease is known of viral origin and zoonotic nature originating from animals. However, to date neither the source of the spillover nor the intermediate hosts are identified. Moreover, the public health situation is intermittently aggravated by identification of new animals susceptible to the SARS-CoV-2 infection, potentially replicating the virus and maintaining intra and interspecies spread of the disease. Although the role of a given animal and/or its produce is important to map the disease pattern, continuous efforts should be undertaken to further understand the epidemiology of SARS-CoV-2, a vital step to establish effective disease prevention and control strategy. This manuscript attempted to review updates regarding SARS-CoV-2 infection at the human-animal interface with consideration to postulations on the genetic relatedness and origin of the different SARS-CoV-2 variants isolated from different animal species. Also, the review addresses the possible role of different animal species and their produce in transmission of the disease. Also, the manuscript discussed the contamination potentiality of the virus and its environmental stability. Finally, we reviewed the currently instituted measures to prevent and manage the spread of SARS-CoV-2 infection. The manuscript suggested the One Health based control measures that could prove of value for the near future.

Applications of Healthcare Robots in Combating the COVID-19 Pandemic

Due to the increasing number of COVID-19 cases, there is a remarkable demand for robots, especially in the clinical sector. SARS-CoV-2 mainly propagates due to close human interactions and contaminated surfaces, and hence, maintaining social distancing has become a mandatory preventive measure. This generates the need to treat patients with minimal doctor-patient interaction. Introducing robots in the healthcare sector protects the frontline healthcare workers from getting exposed to the coronavirus as well as decreases the need for medical personnel as robots can partially take over some medical roles. The aim of this paper is to highlight the emerging role of robotic applications in the healthcare sector and allied areas. To this end, a systematic review was conducted regarding the various robots that have been implemented worldwide during the COVID-19 pandemic to attenuate and contain the virus. The results obtained from this study reveal that the implementation of robotics into the healthcare field has a substantial effect in controlling the spread of SARS-CoV-2, as it blocks coronavirus propagation between patients and healthcare workers, along with other advantages such as disinfection or cleaning.

Implications of Glycosaminoglycans on Viral Zoonotic Diseases

Zoonotic diseases are infectious diseases that pass from animals to humans. These include diseases caused by viruses, bacteria, fungi, and parasites and can be transmitted through close contact or through an intermediate insect vector. Many of the world's most problematic zoonotic diseases are viral diseases originating from animal spillovers. The Spanish influenza pandemic, Ebola outbreaks in Africa, and the current SARS-CoV-2 pandemic are thought to have started with humans interacting closely with infected animals. As the human population grows and encroaches on more and more natural habitats, these incidents will only increase in frequency. Because of this trend, new treatments and prevention strategies are being explored. Glycosaminoglycans (GAGs) are complex linear polysaccharides that are ubiquitously present on the surfaces of most human and animal cells. In many infectious diseases, the interactions between GAGs and zoonotic pathogens correspond to the first contact that results in the infection of host cells. In recent years, researchers have made progress in understanding the extraordinary roles of GAGs in the pathogenesis of zoonotic diseases, suggesting potential therapeutic avenues for using GAGs in the treatment of these diseases. This review examines the role of GAGs in the progression, prevention, and treatment of different zoonotic diseases caused by viruses.

The Epidemic Failure Cycle hypothesis: Towards understanding the global community's recent failures in responding to an epidemic

BACKGROUND

Within a few years, the global community has failed twice in responding to large viral infection outbreaks: the Ebola epidemic in 2014 and the SARS-Cov-2 pandemic in 2020. There is, however, no systematic approach or research available that analyses the repeated failures with regard to an adequate response to an epidemic.

METHODS

For a better understanding of failing societal responses, we have analysed the available research literature on societal responses to epidemics and we propose a framework called the 'Epidemic Failure Cycle' (EFC).

RESULTS

The EFC consists of four phases: Negligence, Arrogance/Denial, Panic and Analysis/Self-criticism. These phases fit largely with the current World Health Organization pandemic influenza phases: Interpandemic, Alert, Pandemic, Transition. By utilizing the Ebola epidemic and the SARS-Cov-2 pandemic as case studies, we show striking similarities in the response to these outbreaks during both crises. Finally, we suggest three major areas to be of utmost importance for triggering and maintaining the EFC. In terms of ecology, zoonoses, supposed to be the main biological origin for virus epidemics, have been largely neglected by politicians, the media and the scientific community. Socioeconomic and cultural conditions such as harsh living and working conditions as well as conspiracy theories hinder effective preventive and counter measures against epidemics. Lastly, in terms of epistemology, the reliance on knowledge about previous outbreaks has led to slow and inadequate decisions.

CONCLUSIONS

We conclude that any current society has to be aware of the risks of repeating responses to epidemics that will fail. Being aware of the societal mechanisms that trigger inadequate responses may help to get to more appropriate decisions in the face of an epidemic.

Acute and post-acute neurological manifestations of COVID-19: present findings, critical appraisal, and future directions

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.

Establishment of Intestinal Organoid from Rousettus leschenaultii and the Susceptibility to Bat-Associated Viruses, SARS-CoV-2 and Pteropine Orthoreovirus

Various pathogens, such as Ebola virus, Marburg virus, Nipah virus, Hendra virus, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and SARS-CoV-2, are threatening human health worldwide. The natural hosts of these pathogens are thought to be bats. The rousette bat, a megabat, is thought to be a natural reservoir of filoviruses, including Ebola and Marburg viruses. Additionally, the rousette bat showed a transient infection in the experimental inoculation of SARS-CoV-2. In the current study, we established and characterized intestinal organoids from Leschenault’s rousette, Rousettus leschenaultii. The established organoids successfully recapitulated the characteristics of intestinal epithelial structure and morphology, and the appropriate supplements necessary for long-term stable culture were identified. The organoid showed susceptibility to Pteropine orthoreovirus (PRV) but not to SARS-CoV-2 in experimental inoculation. This is the first report of the establishment of an expandable organoid culture system of the rousette bat intestinal organoid and its sensitivity to bat-associated viruses, PRV and SARS-CoV-2. This organoid is a useful tool for the elucidation of tolerance mechanisms of the emerging rousette bat-associated viruses such as Ebola and Marburg virus.

Critical country-level determinants of death rate during Covid-19 pandemic

The COVID-19 pandemic has already led to over 94 million confirmed cases and over 2 million deaths globally (John Hopkins CSSE, 2021). Due to the magnitude of the socio-economic damage of COVID-19 all over the world, we analyzed the critical country-level determinants of the death rate during the COVID-19 pandemic. We have examined the effects of GDP (allocated to pandemics and health), education, gender, cultural factors, number of physicians (per 1000 of the population) on the death rate. A correlation between the death rate and socio-economic conditions has been observed. The finding shows that power distance, individualism, gender, and age affect the death rate more than other socio-economic factors we use. We have also performed the same analysis by using Lockdown levels as a moderator. Lockdown levels have a more significant moderating effect on cultural factors rather than the other socio-economic factors. However, due to the topic's sensitivity, we still need to pay attention to the socio-economic factors that may have lower levels of significant relationship with the death rate, since even 0.1 % of changes in coefficients of our other socio-economic variables could mean thousands of lives. The study results will help health organizations, administration, and policymakers take the necessary steps to combat and manage the pandemic.

Vaccine Hesitancy: Drivers and How the Allergy Community Can Help

Vaccine hesitancy-defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccines despite availability of vaccination services"-is not a recent phenomenon. Historical records indicate that vaccine hesitancy existed by the 18th century in Europe and even resulted in violent riots. The drivers of vaccine hesitancy have evolved over the last 200 years but not, perhaps, as much as one might expect. More problematic are the means by which concerns over vaccine hesitancy are communicated by a new landscape of digital communication, generating what has been described as an "infodemic" in which an overabundance of information-both factual and misinformation-contributes to hesitancy. In this review, we discuss the background and current drivers of vaccine hesitancy and the evidence base for strategies to combat this. We highlight the important role the allergy/immunology community could have in working to mitigate vaccine hesitancy, particularly with respect to the current coronavirus disease 2019 (COVID-19) pandemic.

Heterologous prime-boost regimens with HAdV-5 and NDV vectors elicit stronger immune responses to Ebola virus than homologous regimens in mice

The 2014 Ebola outbreak in West Africa resulted in more than 11,000 deaths, highlighting the need for a vaccine. A phase I clinical trial of a human adenovirus type 5 vector-based Ebola virus (EBOV) vaccine (HAdV-5-MakGP) showed that a homologous prime-boost regimen with HAdV-5 vaccine elicited a robust humoral response but a weak cellular immune response. Due to pre-existing anti-vector immunity, boosting with the same vaccine did not increase the magnitude of the cellular immune response, which contributes significantly to protection against EBOV infection. Here, we generated a recombinant Newcastle disease virus (NDV), based on the LaSota vaccine strain, expressing the GP protein of the EBOV variant Makona (rLS/EB-GP) using reverse genetics technology. The humoral and cellular immune responses to this vaccine candidate in mice immunized using a homologous prime-boost regimen or a heterologous prime-boost regimen with the HAdV-5-vectored Ebola vaccine were assessed using ELISA and ELISPOT assays. The ELISA and ELISPOT results showed that mice primed with rLS/EB-GP and boosted with HAdV-5-MakGP (NDV+HAdV-5) or, reversed, primed with HAdV-5-MakGP and boosted with rLS/EB-GP (HAdV-5+NDV) exhibited more-potent EBOV GP-specific antibody and cellular immune responses than those receiving the same vaccine twice. The most robust EBOV GP-specific antibody and T-cell responses were detected in the HAdV-5-MakGP-primed and rLS/EB-GP-boosted (HAdV-5+NDV) mice. These results suggest that the HAdV-5 prime-NDV boost regimen is more effective in stimulating EBOV-specific immunity than homologous regimens alone, indicating the potential boosting ability of the NDV vector in human vaccine use.

Clinicopathologic features between different viral epidemic outbreaks involving the skin

The current coronavirus disease 2019 pandemic has exceeded any epidemiologic prevision, but increasing information suggests some analogies with the major viral outbreaks of the last century. A general warning has been issued on the possibility that coinfections can make differential diagnosis and treatment difficult, especially in tropical countries. Some reports have pointed out that the presence of high Dengue antibodies can give a false-negative result for severe acute respiratory syndrome coronavirus 2. Mucocutaneous manifestations are very frequent, with an apparent overlap among different pathogens. A strong clinicopathologic correlation, however, may provide some clues to address the differential. Waiting for laboratory and instrumental results, the timing and distribution of skin lesions is often pathognomonic. Histopathologic findings characterize certain reaction patterns and provide insights on pathogenetic mechanisms. Unfortunately, skin assessments, especially invasive exams such as biopsy, are less important in severely ill patients. A literature review was performed to collect information from other epidemics to counteract what has become the most frightening disease of our time.

The first eight months of COVID-19 pandemic in three West African countries: leveraging lessons learned from responses to the 2014-2016 Ebola virus disease outbreak

Experience gained from responding to major outbreaks may have influenced the early coronavirus disease-2019 (COVID-19) pandemic response in several countries across Africa. We retrospectively assessed whether Guinea, Liberia and Sierra Leone, the three West African countries at the epicentre of the 2014–2016 Ebola virus disease outbreak, leveraged the lessons learned in responding to COVID-19 following the World Health Organization's (WHO) declaration of a public health emergency of international concern (PHEIC). We found relatively lower incidence rates across the three countries compared to many parts of the globe. Time to case reporting and laboratory confirmation also varied, with Guinea and Liberia reporting significant delays compared to Sierra Leone. Most of the selected readiness measures were instituted before confirmation of the first case and response measures were initiated rapidly after the outbreak confirmation. We conclude that the rapid readiness and response measures instituted by the three countries can be attributed to their lessons learned from the devastating Ebola outbreak, although persistent health systems weaknesses and the unique nature of COVID-19 continue to challenge control efforts.

AutoVEM2: A flexible automated tool to analyze candidate key mutations and epidemic trends for virus

In our previous work, we developed an automated tool, AutoVEM, for real-time monitoring the candidate key mutations and epidemic trends of SARS-CoV-2. In this research, we further developed AutoVEM into AutoVEM2. AutoVEM2 is composed of three modules, including call module, analysis module, and plot module, which can be used modularly or as a whole for any virus, as long as the corresponding reference genome is provided. Therefore, it's much more flexible than AutoVEM. Here, we analyzed three existing viruses by AutoVEM2, including SARS-CoV-2, HBV and HPV-16, to show the functions, effectiveness and flexibility of AutoVEM2. We found that the N501Y locus was almost completely linked to the other 16 loci in SARS-CoV-2 genomes from the UK and Europe. Among the 17 loci, 5 loci were on the S protein and all of the five mutations cause amino acid changes, which may influence the epidemic traits of SARS-CoV-2. And some candidate key mutations of HBV and HPV-16, including T350G of HPV-16 and C659T of HBV, were detected. In brief, we developed a flexible automated tool to analyze candidate key mutations and epidemic trends for any virus, which would become a standard process for virus analysis based on genome sequences in the future.

Structural Basis for a Neutralizing Antibody Response Elicited by a Recombinant Hantaan Virus Gn Immunogen

Hantaviruses are a group of emerging pathogens capable of causing severe disease upon zoonotic transmission to humans. The mature hantavirus surface presents higher-order tetrameric assemblies of two glycoproteins, Gn and Gc, which are responsible for negotiating host cell entry and constitute key therapeutic targets. Here, we demonstrate that recombinantly derived Gn from Hantaan virus (HTNV) elicits a neutralizing antibody response (serum dilution that inhibits 50% infection [ID₅₀], 1:200 to 1:850) in an animal model. Using antigen-specific B cell sorting, we isolated monoclonal antibodies (mAbs) exhibiting neutralizing and non-neutralizing activity, termed mAb HTN-Gn1 and mAb nnHTN-Gn2, respectively. Crystallographic analysis reveals that these mAbs target spatially distinct epitopes at disparate sites of the N-terminal region of the HTNV Gn ectodomain. Epitope mapping onto a model of the higher order (Gn-Gc)₄ spike supports the immune accessibility of the mAb HTN-Gn1 epitope, a hypothesis confirmed by electron cryo-tomography of the antibody with virus-like particles. These data define natively exposed regions of the hantaviral Gn that can be targeted in immunogen design. IMPORTANCE The spillover of pathogenic hantaviruses from rodent reservoirs into the human population poses a continued threat to human health. Here, we show that a recombinant form of the Hantaan virus (HTNV) surface-displayed glycoprotein, Gn, elicits a neutralizing antibody response in rabbits. We isolated a neutralizing (HTN-Gn1) and a non-neutralizing (nnHTN-Gn2) monoclonal antibody and provide the first molecular-level insights into how the Gn glycoprotein may be targeted by the antibody-mediated immune response. These findings may guide rational vaccine design approaches focused on targeting the hantavirus glycoprotein envelope.

Low mammalian species richness is associated with Kyasanur Forest disease outbreak risk in deforested landscapes in the Western Ghats, India

Kyasanur forest disease virus (KFDV) is a rapidly expanding tick-borne zoonotic virus with natural foci in the forested region of the Western Ghats of South India. The Western Ghats is one of the world's most important biodiversity hotspots and, like many such areas of high biodiversity, is under significant pressure from anthropogenic landscape change. The current study sought to quantify mammalian species richness using ensemble models of the distributions of a sample of species extant in the Western Ghats and to explore its association with KFDV outbreaks, as well as the modifying effects of deforestation on this association. Species richness was quantified as a composite of individual species' distributions, as derived from ensembles of boosted regression tree, random forest, and generalised additive models. Species richness was further adjusted for the potential biotic constraints of sympatric species. Both species richness and forest loss demonstrated strong positive associations with KFDV outbreaks, however forest loss substantially modified the association between species richness and outbreaks. High species richness was associated with increased KFDV risk but only in areas of low forest loss. In contrast, lower species richness was associated with increased KFDV risk in areas of greater forest loss. This relationship persisted when species richness was adjusted for biotic constraints at the taluk-level. In addition, the taluk-level species abundances of three monkey species (Macaca radiata, Semnopithecus hypoleucus, and Semnopithecus priam) were also associated with outbreaks. These results suggest that increased monitoring of wildlife in areas of significant habitat fragmentation may add considerably to critical knowledge gaps in KFDV epidemiology and infection ecology and should be incorporated into novel One Health surveillance development for the region. In addition, the inclusion of some primate species as sentinels of KFDV circulation into general wildlife surveillance architecture may add further value.

Design and development of a mobile-based patient management and information system for infectious disease outbreaks in low resource environments

BACKGROUND

The design of Patient Management and Information Systems during outbreaks of highly infectious diseases in low resource environments poses special challenges. Such systems necessitate special functional and design requirements to support patient care under austere conditions. A primary concern is to minimize spread of the disease to caregivers and non-infected individuals. Patient management in these conditions requires the design and development of systems customized for complex patient and caregiver workflows.

OBJECTIVE

Design and develop a Patient Management and Information System for healthcare facilities on the frontlines of outbreaks of highly infectious diseases in low resource environments.

METHODS

A team composed of clinicians with experience in Ebola care in affected areas of Africa and informaticians developed detailed hardware, software and functionality requirements. These were translated into hardware designs, software architectures, screen and interface designs and implemented using Common Off-The-Shelf hardware. An experimental app development system was used to develop mHealth software modules.

RESULTS

The system was developed and implemented as a proof of concept. Acceptance testing showed that the system met functionality requirements.

CONCLUSION

Useful Patient Management and Information systems can be developed and implemented for frontline use in low-resource environments during outbreaks of highly infectious diseases.

Nanoscience and quantum science-led biocidal and antiviral strategies

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) caused the COVID-19 pandemic. According to the World Health Organization, this pandemic continues to be a serious threat to public health due to the worldwide spread of variants and their higher rate of transmissibility. A range of measures are necessary to slow the pandemic and save lives, which include constant evaluation and the careful adjustment of public-health responses augmented by medical treatments, vaccines and protective gear. It is hypothesized that nanostructured particulates underpinned by nanoscience and quantum science yield high-performing antiviral strategies, which can be applied in preventive, diagnostic, and therapeutic applications such as face masks, respirators, COVID test kits, vaccines, and drugs. This review is aimed at providing comprehensive and cohesive perspectives on various nanostructures that are suited to intensifying and amplifying the effectiveness of antiviral strategies. Growing scientific literature over the past eighteen months indicates that quantum dots, iron oxide, silicon oxide, polymeric and metallic nanoparticles have been employed in COVID-19 diagnostic assays, vaccines, and personal protective equipment (PPE). Quantum dots have displayed their suitability as more sensitive imaging probes in diagnostics and prognostics, and as controlled drug-release carriers that target the virus. Nanoscience and quantum science have assisted the design of advanced vaccine delivery since nanostructured materials are suited for antigen delivery, as mimics of viral structures and as adjuvants. Furthermore, the quantum science- and nanoscience-supported tailored functionalization of nanostructured materials offers insight and pathways to deal with future pandemics. This review seeks to illustrate several examples, and to explain the underpinning quantum science and nanoscience phenomena, which include wave functions, electrostatic interactions, van der Waals forces, thermal and electrodynamic fluctuations, dispersion forces, local field-enhancement effects, and the generation of reactive oxygen species (ROS). This review discusses how nanostructured materials are helpful in the detection, prevention, and treatment of the SARS-CoV-2 infection, other known viral infection diseases, and future pandemics.

Biodefence research two decades on: worth the investment?

For the past 20 years, the notion of bioterror has been a source of considerable fear and panic worldwide. In response to the terror attacks of 2001 in the USA, extensive research funding was awarded to investigate bioterror-related pathogens. The global scientific legacy of this funding has extended into the present day, highlighted by the ongoing COVID-19 pandemic. Unsurprisingly, the surge in biodefence-related research and preparedness has been met with considerable apprehension and opposition. Here, we briefly outline the history of modern bioterror threats and biodefence research, describe the scientific legacy of biodefence research by highlighting advances pertaining to specific bacterial and viral pathogens, and summarise the future of biodefence research and its relevance today. We sought to address the sizeable question: have the past 20 years of investment into biodefence research and preparedness been worth it? The legacy of modern biodefence funding includes advancements in biosecurity, biosurveillence, diagnostics, medical countermeasures, and vaccines. In summary, we feel that these advances justify the substantial biodefence funding trend of the past two decades and set a precedent for future funding.

The HCT Index: a typology and index of health conspiracy theories with examples of use

Background: Conspiracy theories regarding vaccination programmes, medical side effects, and cover-ups by governments or pharmaceutical companies are prevalent in many countries and have highly detrimental and far-reaching effects on people’s wellbeing. For research and policymaking in public health, it is vital to understand the nature, construction and dissemination of these health conspiracy theories (HCTs). Inspired by tale typologies developed in folkloristics, this paper presents a typology and index of international HCTs as a tool for researchers to identify and categorise the HCTs they come across, and to provide a pool of examples of HCTs which could be used in various fields of research. To illustrate this, two studies are also presented (Study 1 and Study 2). Methods: HCTs were collected from relevant academic literature, news journalism, a survey of known health-related, general conspiracy theorist websites, and web searches based around known HCTs. From this, 14 core types were identified, and a numbered index was constructed with brief descriptions, examples, and motifs. Study 1 is a survey of HCT exposure and belief in the UK. Study 2 is a focus group discussion of health rumours in rural Sri Lanka including discussion of HCTs. Results: The HCT Index provides valuable insights into the international dissemination of HCTs. Study 1 found that familiarity with and belief in HCTs were high: 97% of Britons are familiar with at least one HCT and 49% of Britons believed that at least one HCT was likely to be true. Study 2 highlighted concerns over threats to fertility and about how to verify information that falls outside of typical experience. Conclusions: The HCT Index provides a useful framework for future cross-cultural research. As a typology it encompasses a wide range of beliefs which can be more effectively categorized and compared and, ultimately, challenged.

Conspiracy Theories: A Public Health Concern and How to Address It

The SARS-CoV-2 pandemic was characterized by a significant increase in the endorsement of conspiracy theories. Conspiracy theories are narratives that can enable and accentuate distrust toward health professionals and authorities. As such, they can lead to violent radicalization and should be considered a public health issue. This perspective article aims to further the understanding of professionals on conspiracy theories via the 3N model of radicalization and self-determination theory. Based on empirical research, theory, and existing interventions, potential initiatives intended to tackle the issue of conspiracy theories during pandemics are also presented.

Mapping the global research output on Ebola vaccine from research indexed in web of science and scopus: a comprehensive bibliometric analysis

Introduction: The Ebola Virus outbreak in Africa is believed to be one of the deadliest viral infections that causes severe hemorrhagic fever in human and nonhuman primates, which has resulted in increased mortality rates in the affected African countries. Thus, the current study mapped and quantified global research output and trends in the EBOV vaccine publications via a bibliometric analysis.Methods: Publications about the Ebola virus vaccine were extracted from the Web of Science and Scopus databases. HistCite, Bibliometrix, an R package, and VOSviewer.Var1.6.6 were used for data mapping and analysis.Results: A total of 541 (WoS) and 511 (Scopus) documents were included, with a cumulation of 24,611 citations in both databases. These documents were published in 141 journals in the Wos and 185 in Scopus. The USA was the most productive country with 206 (38.08%) publications in the Wos. Although the top-cited authors are from the USA, the United Kingdom, and Canada, only one author from Africa "Samai M" from the University of Sierra Leone contributed 13 publications. Meanwhile, the Journal of Infectious Diseases was the most productive (45, 8.32%) in this field.Conclusion: The study provides insight for researchers and health policy on the trends and progress of the EBOV vaccine research and development, focusing on the hot topics, research collaboration, and research dearth that requires urgent redress to fast-track an all-inclusive EBOV vaccine development.

Distinct transcriptional responses to fatal Ebola virus infection in cynomolgus and rhesus macaques suggest species-specific immune responses

Ebola virus (EBOV) is a negative single-stranded RNA virus within the Filoviridae family and the causative agent of Ebola virus disease (EVD). Nonhuman primates (NHPs), including cynomolgus and rhesus macaques, are considered the gold standard animal model to interrogate mechanisms of EBOV pathogenesis. However, despite significant genetic similarity (>90%), NHP species display different clinical presentation following EBOV infection, notably a ∼1-2 days delay in disease progression. Consequently, evaluation of therapeutics is generally conducted in rhesus macaques, whereas cynomolgus macaques are utilized to determine efficacy of preventative treatments, notably vaccines. This observation is in line with reported differences in disease severity and host responses between these two NHP following infection with simian varicella virus, influenza A and SARS-CoV-2. However, the molecular underpinnings of these differential outcomes following viral infections remain poorly defined. In this study, we compared published transcriptional profiles obtained from cynomolgus and rhesus macaques infected with the EBOV-Makona Guinea C07 using bivariate and regression analyses to elucidate differences in host responses. We report the presence of a shared core of differentially expressed genes (DEGs) reflecting EVD pathology, including aberrant inflammation, lymphopenia, and coagulopathy. However, the magnitudes of change differed between the two macaque species. These findings suggest that the differential clinical presentation of EVD in these two species is mediated by altered transcriptional responses.

PTSD, depression and anxiety in Ebola virus disease survivors in Beni town, Democratic Republic of the Congo

BACKGROUND

Ebola Virus Disease (EVD) is a deadly and feared infectious disease, which can be responsible of debilitating physical and psychological sequelae in survivors including depression and anxiety disorders. Unfortunately, there are scarce data on survivor sequelae in Democratic Republic of the Congo. So this study assessed PTSD, depression and anxiety symptoms among EVD survivors enrolled in the follow-up program of the psychosocial care team of Beni town's general hospital.

METHODS

A cross-sectional study used consecutive sampling to recruit 144 Ebola virus disease survivors who came for follow up from October 23 to November 13; 2019. Basic socio-demographic data, presence of headache and short-term memory function were assessed. The Post-traumatic Checklist Scale and Hospital Anxiety and Depression Scale were used to assess psychological burden among participants. Descriptive statistics were used to summarized data and Pearson's or likelihood chi-square were used to test association between psychiatric disorders and associated factors.

RESULTS

The prevalence of PTSD, depression and anxiety was 24.3, 24.3 and 33.3% respectively. Being male (OR = 0.42, 95% CI: 0.16, 0.95, p = 0.049), suffering from persistent headache (OR = 2.62, 95% CI: 1.12, 6.14, p = 0.014), losing a loved one because of EVD (OR: 2.60, 95% CI: 1.11, 6.15, p = 0. 015) and being young - 18-24 years - (OR: 0. 261, 95% CI: 0. 08, 0.82, p = 0,026) were statistically associated with PTSD diagnosis. Having short-term memory impairment and suffering from persistent headache were statistically associated with depression and anxiety diagnoses (OR = 2.44, 95% CI: 1.03, 5.82, p = 0.026); (OR = 2.24, 95% CI: 1.04, 4.85, p = 0.025); (OR = 2.62, 95% CI: 1.12, 6.14, p = 0.014); (OR = 2.31, 95% CI: 1.06, 5.01, p = 0.020).

CONCLUSION

The prevalence of PTSD, depression and anxiety is high among EVD survivors. Development of specialized psychiatric services to sustain psychiatric and psychological health amongst survivors in the cultural context of the Eastern part of the DRC should be considered by the teams fighting against EVD in the DRC.

Food Security, Environmental Health, and the Economy in Mexico: Lessons Learned with the COVID-19

The COVID-19 pandemic showed an impact mainly on the health of people and the economy of households. The levels of food security in the world’s households, especially in Mexico, have decreased. When people do not have food security, their health is compromised and they have financial problems; on the other hand, environmental deterioration has a link with food security. The purpose of this review is to analysis of the current situation in Mexico of food security, environmental health and economy, the main lessons learned in these areas and their proposals integrating public policies. A review was carried out in the main databases (MEDLINE, Embase, CINAHL Plus, Web of Science, CAB Abstracts y PAIS Index) with the following keywords and according to the MeSH terms: Food security, food insecurity, environmental health, public policies, environmental, production, integrating the word COVID-19 in English and Spanish. Only 44.5% of Mexican households presented food security. For food insecurity, 22.6% had moderate and severe food insecurity, while 32.9% had mild insecurity. Food insecurity and the health impacts of environmental origin (waste management during the coronavirus pandemic, water contaminated by bacteria, viruses, and toxins; air pollution) generates impacts on economic activity by not offering food that meets health regulations. Without the application of cost-effective measures and interventions for the prevention and control of patients with obesity, the direct costs for 2023 will amount to 9 million dollars, which worsens the household economy. Despite having laws and policies on the right to food, a healthy environment (water), and opportunities for economic growth, these human rights are not fulfilled. The conclusion is that it is necessary to use a health and agroecological model to promote public policies (health, environment, and economy) that aims to prevent the discussed issues, with multidisciplinary and intersectoral interventions (government, academia, researchers, civil society organizations, industry, and population). This upholds the human right that all people should enjoy an adequate, healthy environment and have access to high-quality food.

From Protein to Pandemic: The Transdisciplinary Approach Needed to Prevent Spillover and the Next Pandemic

Pandemics are a consequence of a series of processes that span scales from viral biology at 10-9 m to global transmission at 106 m. The pathogen passes from one host species to another through a sequence of events that starts with an infected reservoir host and entails interspecific contact, innate immune responses, receptor protein structure within the potential host, and the global spread of the novel pathogen through the naive host population. Each event presents a potential barrier to the onward passage of the virus and should be characterized with an integrated transdisciplinary approach. Epidemic control is based on the prevention of exposure, infection, and disease. However, the ultimate pandemic prevention is prevention of the spillover event itself. Here, we focus on the potential for preventing the spillover of henipaviruses, a group of viruses derived from bats that frequently cross species barriers, incur high human mortality, and are transmitted among humans via stuttering chains. We outline the transdisciplinary approach needed to prevent the spillover process and, therefore, future pandemics.

Flashback and lessons learnt from history of pandemics before COVID-19

With an increasing frequency of infectious disease outbreaks, the COVID-19 pandemic causing mortality around the world and the threat of similar future events looming large, mankind is faced with the herculean task of counteracting such threats with the best possible strategies and public health decisions. It is key that such decisions should be guided by previous examples of similar health emergencies. Here we review some of the significant infectious disease outbreaks, including epidemics and pandemics occurring worldwide in the past including their impact at population and global levels, unique challenges presented by each and the measures taken by authorities worldwide as well as the crucial lessons each epidemic or pandemic provided. This review highlights that throughout history measures such as contact tracing, quarantine and isolation have been incredibly effective in limiting an outbreak in its severity, thus ensuring accurate information flow to the public is as essential as limiting the spread of misinformation. With global populations rising, surveillance for emerging and re-emerging pathogens will play an immense role in preventing future epidemics or pandemics. And finally that even though for novel strains or pathogens, although vaccines are thought to be an irreplaceable defense, but their development and distribution in time to curb an epidemic has seldom been witnessed and remains an important challenge for the future. Hence, we conclude that looking at these past examples not only highlights the important knowledge gained for the strategies to devise, but also the mistakes that can be avoided in the way forward.

Culturally sensitive palliative care in humanitarian action: Lessons from a critical interpretive synthesis of culture in palliative care literature

OBJECTIVE

There is growing recognition of the importance of increasing preparedness for and the provision of palliative care in humanitarian crises. The primary objective of this review is to interpret the existing literature on culture and palliative care to query the recommendation that humanitarian healthcare providers, teams, and organizations integrate palliative care into their practice in ways that are attentive to and respectful of cultural differences.

METHODS

A critical interpretive synthesis was applied to a systematic literature review guided by the PRISMA framework. Analysis was based on directed data extraction and was team based, to ensure rigor and consistency.

RESULTS

In total, 112 articles covering 51 countries and 9 major worldviews met inclusion criteria. This literature describes culture as it influences perspectives on death and dying, expectations of palliative care, and challenges to providing culturally sensitive care. A key pattern highlighted in articles with respect to the culture and palliative care literature is that culture is invoked in this literature as a sort of catch-all for non-white, non-Christian, indigenous practices, and preferences for palliative care. It is important that humanitarian healthcare providers and organizations aiming to enact their commitment of respect for all persons through attention to potential culturally specific approaches to pain management, suffering, and dying in specific crisis settings do so without reproducing Othering and reductionistic understandings of what culturally sensitive care in humanitarian crises settings involves.

SIGNIFICANCE OF RESULTS

This paper clarifies and unpacks the diverse influences of culture in palliative care with the goal of supporting the preparedness and capacity of humanitarian healthcare providers to provide palliative care. In doing so, it aids in thinking through what constitutes culturally sensitive practice when it comes to palliative care needs in humanitarian crises. Providing such care is particularly challenging but also tremendously important given that healthcare providers from diverse cultures are brought together under high stress conditions.

The 2013-2016 Ebola epidemic: evaluating communication strategies between two affected countries in West Africa

BACKGROUND

Ebola is a haemorrhagic disease with high fatality rates between 25 and 90%. The 2013-16 Ebola outbreak in West Africa was the largest to date with >28 000 cases and >11 000 fatalities. This outbreak exposed inadequacies in public health agencies and has spurred health officials to re-evaluate the way Ebola virus disease (EVD) epidemics are co-ordinated and communicated.

METHODS

This project compares, using the systematic review method, differences in the communication of EVD in Nigeria and Liberia with data from selected articles analyzed using thematic analysis.

RESULTS

The most successful communication strategies were community engagement and targeted health-communication to the most at-risk groups. We also highlight the importance of a multi-modal strategy to effectively communicate prevention and management of EVD to affected communities. Secondary to these findings included the relevance of the media, particularly social media tools in managing such serious outbreak situations.

CONCLUSION

This study provides the basis for the development of a theory-based framework to effectively communicate EVD and reduce the negative outcomes observed during the 2013-16 EVD outbreak.