The rising incidence of African swine fever during the COVID-19 pandemic in Africa: Efforts, challenges and recommendations

A multi-state survey of farm-level preparedness towards African swine fever outbreak in Nigeria

Outbreaks of African Swine Fever (ASF) have severe economic implications for Nigeria and result in significant loss of livelihoods. The non-availability of vaccines makes biosecurity the reliable key to reducing ASF outbreaks. This study evaluated preparedness for ASF outbreaks at the farm level among 247 pig farmers randomly selected from Abia, Akwa-Ibom, Edo, Kwara, and Oyo states. We categorized each pig farmer's ASF preparedness rating (ASF - PR) as "poor", "moderate", and "satisfactory" based on their score on an 11-item scale. Finally, a multivariable logistic regression analysis was conducted to assess the association between the socio-demographic variables and farm-level ASF preparedness. The awareness of ASF among pig farmers was very high (87.9%, n = 217). Most farmers knew the clinical signs of the disease, the modes of transmission of ASF, and correctly identified the risk factors. They also considered the need for thorough cleaning and disinfection of piggeries (87.1%, n = 189), tightened biosecurity (85.7%, n = 186), culling all ASF-affected pigs (77.9%, n = 169) as well as the ban on the transport of pigs and their products (49.8%, n = 108) as very important in ASF control. Conversely, 27.6%, (n = 60) of the farmers thought ASF could affect humans, 12% (n = 27) of them openly discarded the carcasses of dead pigs, and there was a high antibiotic usage. Most of the pig farmers used antibiotics as prophylaxis (63.6%, n = 157), chemotherapeutics (66.4%, n = 164), growth promoters (15.4%, n = 38), and wrongly so, 13% (n = 32) of them thought that antibiotics could be used to prevent and treat ASF. At the farm level, two-thirds (68.8%, n = 170) of the farmers had strict movement restrictions, and 48.6% (n = 120) routinely quarantine new pigs before introduction into their herd. Across the five states, 36% (n = 89) of the farmers had witnessed sudden death with signs consistent with ASF amongst their pigs and only 10.1% (n = 27) had confirmatory ASF diagnosis. The mean score for the farm-level ASF-PR was 6.95 ± 2.7. Approximately one-quarter of the 247 pig farmers had satisfactory ASF - PR that might help to prevent the incursion of ASF into their farms. Most farmers had moderate ASF - PR (59.5%, n = 147) whereas 17% (n = 42) had very poor ASF-PR and were most prone to an ASF outbreak. Of the sociodemographic variables, only age was significantly associated with farm-level ASF preparedness as older pig farmers especially those aged between 50 and 59 years (OR: 4.83; 95% CI: 1.10, 21.22; p = 0.037) were more likely to have satisfactory ASF - PR than the others. Our findings showed pig farmers were not adequately prepared and the next ASF outbreak could pose more significant threat to pig populations across Nigeria. Government should urgently establish minimum biosecurity measures and improve its ASF surveillance mechanisms for commercial and backyard pig production.

Recent advances in the diagnosis and management of typhoid fever in Africa: A review

Typhoid fever, a classical disease of enteric origin caused by Salmonella species of bacteria, is among the most important diseases threatening public health in Africa. The African continent is a marker for both low resources within the healthcare system and poor disease control policy formulations in managing endemic infectious diseases. Since the colonial era, the Widal serological test has been used to confirm typhoid fever in Africa, however recent studies recommend blood culture, and when blood culture cannot be obtained, clinical findings, laboratory Widal test confirmation, and ruling out other febrile illnesses as confirmatory pathway to diagnose typhoid fever in Africa. Managing typhoid fever relies on antimicrobials. In 1980s chloramphenicol was the medication of choice. Years later, amoxicillin and co-trimoxazole were adopted. However, the instantaneous rise of resistant strains of Salmonella enterica confers an important challenge to treat the burdensome enteric fever. The current treatment algorithm of typhoid fever in Africa relies significantly on the use of fluoroquinolones, macrolides, and cephalosporins. Developed nations have successfully addressed and controlled typhoid fever via improvement in accessing safe water and food, better sanitary and hygienic behaviours, and vaccines development. Nevertheless, there is significant evidence to infer improvement in the diagnosis management of typhoid fever over the last few decades, and efforts are underway to control the disease spread in Africa. This review aims to provide an overview of the latest developments in typhoid fever diagnosis and management in Africa and provide key recommendations for a coordinated approach to mitigate typhoid in the continent.

Cross-protection against African swine fever virus upon intranasal vaccination is associated with an adaptive-innate immune crosstalk

African swine fever virus (ASFV) is causing a worldwide pandemic affecting the porcine industry and leading to important global economic consequences. The virus causes a highly lethal hemorrhagic disease in wild boars and domestic pigs. Lack of effective vaccines hampers the control of virus spread, thus increasing the pressure on the scientific community for urgent solutions. However, knowledge on the immune components associated with protection is very limited. Here we characterized the in vitro recall response induced by immune cells from pigs intranasally vaccinated with the BA71ΔCD2 deletion mutant virus. Vaccination conferred dose-dependent cross-protection associated with both ASFV-specific antibodies and IFNγ-secreting cells. Importantly, bulk and single-cell transcriptomics of blood and lymph node cells from vaccinated pigs revealed a positive feedback from adaptive to innate immunity. Indeed, activation of Th1 and cytotoxic T cells was concomitant with a rapid IFNγ-dependent triggering of an inflammatory response characterized by TNF-producing macrophages, as well as CXCL10-expressing lymphocytes and cross-presenting dendritic cells. Altogether, this study provides a detailed phenotypic characterization of the immune cell subsets involved in cross-protection against ASFV, and highlights key functional immune mechanisms to be considered for the development of an effective ASF vaccine.

African swine fever (ASF) pandemic is currently the number one threat for the porcine industry worldwide. Lack of treatments hampers its control, and the insufficient knowledge regarding the immune effector mechanisms required for protection hinders rational vaccine design. Here we present the first comprehensive study characterizing the complex cellular immune response involved in cross-protection against ASF. We show that, upon in vitro reactivation, cells from immune pigs induce a Th1-biased recall response that in turn enhances the antiviral innate response. Our results suggest that this positive feedback regulation of innate immunity plays a key role in the early control of ASF virus infection. Altogether, this work represents a step forward in the understanding of ASF immunology and provide critical immune components that should be considered to more rationally design future ASF vaccines.

Poliovirus returns to the UK after nearly 40 years: current efforts and future recommendations

On 22 June 2022, the UK Health Security Agency declared a 'rare national incidence' after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public's risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm. This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.

Anthrax outbreak amidst the COVID-19 pandemic in Africa: Challenges and possible solutions

Anthrax and coronavirus disease 2019 (COVID-19) are both notable zoonoses that have high morbidity and mortality, not to mention adverse socio-economic and health consequences on the communities they ravage. Anthrax wreaks disease amongst mammalian species worldwide and has an endemic distribution in Africa and Asia. Kenya, for example, records an average of 10 outbreaks annually. In 2014 and 2017, it held anthrax attack rates of 15% and 29%, respectively, and case fatality rates of 1–5%. As with COVID-19, effective surveillance, containment, and vaccination programs are crucial in the fight against anthrax. While there is no evidence of direct, human-to-human transmission of anthrax currently, Bacillus anthracis remains a disease of public health concern that serves to fuel the devastating effects of SARS-CoV-2 in African communities. In this commentary, we examine anthrax spread in Africa amidst COVID-19, the challenges faced by these simultaneous zoonoses, and the efforts put to combat both equally.

Challenges of addressing neglected tropical diseases amidst the COVID-19 pandemic in Africa: A case of Chagas Disease

Chagas Disease (CD) is an infectious, neglected tropical disease (NTD) that has affected over 1.7 billion people worldwide. Unfortunately, most countries usually put little effort into mitigating the spread of NTDs, having weak public health approaches, diagnostic delays, and ineffective clinical management guidelines and resources. However, the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the coronavirus SARS-CoV-2, exacerbates the impact of NTDs. In this review, we examine the subsequent changes that have been imposed on CD prevention and treatment. Articles from Google Scholar and PubMed were extracted which satisfied our inclusion criteria. From our data, we gather that COVID-19 has — from preventive measures to treating patients — greatly affected every stage in the fight against CD. For instance, co-infection of CD and COVID-19 puts patients at higher risk for cardiomyopathy (i.e., atrial fibrillation, chronic heart failure), yet no clinical guidelines were established for co-infected patients. To mitigate the spread of CD during the COVID-19 pandemic, further investigations on the impacts of co-infections and vaccines that can be developed to treat such conditions are warranted.

A review on acute, severe hepatitis of unknown origin in children: A call for concern

Hepatitis is defined as the inflammatory reaction of the liver parenchyma. It is either acute, which resolves within six months or may be chronic. An outbreak of severe, acute hepatitis of unknown origin in children was reported in nearly all World Health Organisation (WHO) regions except in the Africa. As per the recent update on the 26th of May, approximately 650 cases have met the WHO's probable criteria. While some are yet to be confirmed, the WHO warns that the figure may be underestimating the real situation. The observed clinical presentation includes outstanding immoderate levels of transaminases, vomiting from the previous presentation, pale/mild stools, and jaundice. So far, the viruses which can cause viral hepatitides, like Hepatitis A, B, C, D, and E, have not been detected in any of the identified cases. Some literature reported human enteric adenovirus type 41F in the majority of cases aged sixteen or younger, with few cases of co-infection with SARS-CoV-2. Currently, only several hypotheses have discussed the causality of the outbreak. However, no consensus has been reached. During this outbreak, it is important to adhere to both hand and body hygiene, general infection and control prevention strategies, and lastly, case presentation matching the criteria of case definition set by the WHO. Said identified cases should be reported to concerned health authorities on an urgent basis and must be kept under proper surveillance.

•

Hepatitis is defined as the inflammatory reaction of the liver parenchyma. It is either acute, which resolves within six months or may be chronic.

•

An outbreak of severe, acute hepatitis of unknown origin in children was reported in nearly all World Health Organisation (WHO) regions except in the Africa.

•

Although extensive research has not been conducted on the rapidly-progressing AHUO in children, current literature has reported human enteric adenovirus type-41F in most cases aged sixteen or younger.

•

Potential confounding coronavirus infection is one of several theories currently being considered in acute non-hepatitis A–E viral hepatitis origin.

•

During this outbreak, it is important to adhere to both hand and body hygiene, general infection and control prevention strategies, and lastly, case presentation matching the criteria of case definition set by the WHO.

Leptospirosis outbreak in Tanzania: An alarming situation

On July 5, 2022, the Tanzanian Ministry of Health (MoH) announced the re-emergence of leptospirosis after reporting 20 confirmed symptomatic cases and 3 mortalities. Leptospirosis is caused by a spirochete bacterium that lives in an animal's renal tubule and spreads to individuals through contact with contaminated animal urine. Unsupervised agricultural practices, urban development, wildlife infiltration, and a lack of sanitation have all been proposed as potential environmental causes of the present outbreak. The MoH is taking the necessary steps to halt the spread of said outbreak with assistance from the World Health Organization (WHO).

This article examines the risk factors, etiology, number of confirmed cases, and subsequent case index to analyse the epidemiology of the current leptospirosis outbreak in Tanzania's southern Linda region. In light of these findings, this research further details recent recommendations made by the WHO, Centers for Disease Control and Prevention, and MoH to mitigate such an alarming situation. These recommendations include early detection and isolation, contact tracing, and chemoprophylaxis using doxycycline. The article concludes by outlining suggestions for individuals and governments, including the launch of public awareness campaigns, immunisation, increased surveillance, rapid detection testing, and the installation of suitable purification systems, to help contain future leptospirosis outbreaks.

Leishmaniasis control in the light of the COVID-19 pandemic in Africa

Leishmaniasis is a parasitic disease, endemic to Africa, Asia, and South America due to inadequate access to medication and underreporting of leishmaniasis cases. Leishmaniasis has two forms: cutaneous and visceral. The fight against leishmaniasis has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic that impacted resource distribution and access to medication. Continuous effort in vaccine development and affordable therapeutics are necessary to eliminate leishmaniasis in low-income countries. Further research is necessary to determine molecular drug resistance markers in leishmaniasis patients. In this analysis, we focus on the effect of COVID-19 on leishmaniasis in Africa.

The burden of monkeypox virus amidst the Covid-19 pandemic in Africa: A double battle for Africa

The Coronavirus Disease - 19 (COVID-19) pandemic has put additional strain on Africa's fragile healthcare systems and has impacted the rise of emerging and re-emerging infectious diseases. Currently, there is a rise in cases of Monkeypox Disease, a zoonotic viral disease caused by the Monkeypox virus, which was first documented in 1970 in the Democratic Republic of the Congo. Most of the clinical symptoms of Monkeypox resemble that of smallpox, whose virus also belongs to the same genus. Initial symptoms include headache, fever, and fatigue, followed by lymphadenopathy and a rash. This study aims to provide more insight into Monkeypox by exposing its current burden and efforts to combat it amidst COVID-19 in Africa. Since Monkeypox disease is re-emerging and is less contagious than COVID-19, prevention and treatment are much more manageable. Still, African countries face several crucial challenges in responding to the Monkeypox in times of the covid-19 pandemic. These include lack of a well-functioning surveillance system for early detection of the disease, lack of awareness and knowledge of the monkeypox disease across the general population, lack of healthcare facilities already burdened by COVID-19 cases, and shortage of trained healthcare professionals. On the other hand, one significant factor contributing to the minimized risk in Africa was the smallpox vaccination done before 1980. However, a declining cross-protective immunity is seen in those inoculated with the smallpox vaccine and the ever-increasing risk to the unvaccinated population. Thus, focusing on vaccination and disease surveillance operations and diligent monitoring, as well as cross-border collaborations with international sectors, including One Health, FOA, OIE, and WHO is critical to achieving the ultimate eradication of monkeypox in Africa.

Ukraine - Russia crisis and its impacts on the mental health of Ukrainian young people during the COVID-19 pandemic

The Russia-Ukraine crisis has been at the center of international talks since early 2022. This conflict, bursting after the sanitary crisis of the covid 19 pandemic, creates an atmosphere of uncertainty and instability, which negatively impacts many aspects, including mental health. Young Ukrainians have been suffering from socio-political instability for decades, and the current war, together with the Covid 19 pandemic, shatters hopes of brighter days. This commentary covers the challenges facing the younger generation in Ukraine and the impact of this situation on their mental health.

Nigeria in the COVID era: Health system strengthening for national security and prosperity

The coronavirus disease-19 pandemic has spread to all parts of the world. As of 20 May 2022, over 500 million confirmed cases have occurred with over 6 million deaths. In Nigeria, over 255,000 cases have occurred with more than 3000 deaths. The pandemic has adversely affected virtually all aspects of human endeavour, with a severe impact on the health system. The Nigerian health system was ill prepared for the pandemic, and this further weakened it. The impacts of the pandemic on the health system include disruption of health services, low motivation of the health workforce, unresponsive leadership and poor funding. The national response, though initially weak, was ramped up to expand capacity building, testing, public enlightenment, creation of isolation and treatment centres and research. The funding for the national response was from the government, private sector and multilateral donors. Nigeria must comprehensively strengthen its health system through motivating and building the capacity of its human resources for health, improved service delivery and provision of adequate funding, to be better prepared against future pandemics.

Prospect of acute hepatitis E virus outbreak in the context of the COVID-19 Pandemic in Africa: A contingency plan

Hepatitis E virus (HEV) is the primary cause of acute viral hepatitis in Sub-Saharan Africa (SSA). It is transmitted by oral-faecal route via contaminated water or animal products, which is more pronounced in SSA, where inadequate hygiene measures, low socioeconomic situation, and frail healthcare system increase HEV susceptibility. During the coronavirus disease-19 (COVID-19), numerous initiatives concerning viral hepatitis relief in SSA are implemented. However, national programs do not support most services and are neglected when national and local attention rests on the COVID-19 pandemic. Furthermore, during the COVID-19 pandemic, hepatitis E prevention and control programs were affected in low-income countries due to economic losses. Therefore, an interdisciplinary approach should be adopted to mitigate HEV infections during COVID-19.

Poliomyelitis amidst the COVID-19 pandemic in Africa: Efforts, challenges and recommendations

Poliomyelitis is the leading infectious cause of acute flaccid paralysis among children under five years of age, caused by the Wild Poliovirus, with no medical cure other than prevention through vaccination. The advent of mass vaccination campaigns against polio disease worldwide has greatly decreased the number of global cases and limited the rate of transmission. However, the emergence of Vaccine-derived Poliovirus due to genetic reversions in the live attenuated oral polio vaccine has posed a significant impediment to global polio eradication efforts. Therefore, There is a need to modify the vaccination regimen by utilizing more doses of inactivated poliovirus vaccine or adopting the bivalent oral polio vaccine in order to eliminate the transmission of Vaccine-derived Poliovirus. In addition, collective efforts from governments, health policymakers, vaccination groups and health-related bodies are required to improve vaccine coverage and suppress the circulation of Vaccine-derived Poliovirus.

Has the Spread of African Swine Fever in the European Union Been Impacted by COVID-19 Pandemic?

African Swine Fever (ASF) is a contagious viral disease of domestic and wild pigs, listed as notifiable by the World Organization for Animal Health (OIE). It causes substantial economic losses to pig farming in the affected countries, with consequent enormous damage to livestock production due to mortality of the animals, and to the restrictions on national and international trade in pigs and derivative products that the presence of the infection implies. To prevent or reduce the risk of ASF introduction, the World Trade Organization (WTO) and the OIE recommend preventive and control measures, such as the ban of live swine and their products traded from ASF-affected to ASF-free countries or zones. The current spread of ASF into Europe poses a serious risk to the industrialized and small-scale pig sector, as demonstrated by observed cases in different EU areas. In this paper the authors discuss the impact of the COVID-19 pandemic on ASF, and the indirect effects including the impact on animal health and disease management. They suggest that the COVID-19 pandemic has severely affected animal disease surveillance control. ASF requires rapid responses and continuous monitoring to identify outbreaks and prevent their spread, and both aspects may have been greatly reduced during the COVID-19 pandemic.

Rift Valley fever during the COVID-19 pandemic in Africa: A double burden for Africa's healthcare system

A new rising incidence of Rift Valley fever (RVF) among livestock and humans in the African continent during the COVID‐19 pandemic has become of increasing concern. We analyzed the different ways COVID‐19 has contributed to the increase in RVF cases and how it has impacted the interventions allocated to the disease by comparing it with the status of the disease before the pandemic. There is enough evidence to conclude that the COVID‐19 pandemic has impacted the efforts being taken to prevent outbreaks of RVF. Therefore, with no definitive treatment in place and inadequate preventive measures and disease control, RVF may potentially lead to a future epidemic unless addressed urgently.