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

Threat of resurgence or hope for global eradication of poliovirus?

PURPOSE OF REVIEW

Recent outbreaks of poliomyelitis in countries that have been free of cases for decades highlight the challenges of eradicating polio in a globalized interconnected world beset with a novel viral pandemic. We provide an epidemiological update, advancements in vaccines, and amendments in public health strategy of poliomyelitis in this review.

RECENT FINDINGS

Last year, new cases of wild poliovirus type 1 (WPV1) were documented in regions previously documented to have eradicated WPV1 and reports of circulating vaccine-derived poliovirus type 2 (cVDPV2) and 3 (cVDPV3) in New York and Jerusalem made international headlines. Sequencing of wastewater samples from environmental surveillance revealed that the WPV1 strains were related to WPV1 lineages from endemic countries and the cVDPV2 strains from New York and Jerusalem were not only related to each other but also to environmental isolates found in London. The evidence of importation of WPV1 cases from endemic countries, and global transmission of cVDPVs justifies renewed efforts in routine vaccination programs and outbreak control measures that were interrupted by the COVID-19 pandemic. After the novel oral poliovirus vaccine type 2 (nOPV2) received emergency authorization for containment of cVDPV2 outbreaks in 2021, subsequent reduced incidence, transmission rates, and vaccine adverse events, alongside increased genetic stability of viral isolates substantiates the safety and efficacy of nOPV2. The nOPV1 and nOPV3 vaccines, against type 1 and 3 cVDPVs, and measures to increase accessibility and efficacy of inactivated poliovirus vaccine (IPV) are in development.

SUMMARY

A revised strategy utilizing more genetically stable vaccine formulations, with uninterrupted vaccination programs and continued active surveillance optimizes the prospect of global poliomyelitis eradication.

Polio-philanthropy in Africa: A narrative review

Background and Aim

Polio eradication efforts including polio-philanthropy have been coordinated and sustained since 1988, with the introduction of the Global Polio Eradication Initiative (GPEI). The polio fight is sustained in the name of evidence-based benevolence or beneficent philanthropy from which Africa has benefited immensely. With the recorded polio cases as of 2023, more efforts and funds are required to eradicate polio. Hence, it is not yet "Uhuru." Using the Mertonian lens, this study examines polio-philanthropy in Africa, its unintended consequences, and crucial dilemmas, which could impact the polio fight and polio-philanthropy.

Methods

This is a narrative review that relies on secondary sources obtained through a thorough literature search. Only studies published in English were utilized. The study synthesized relevant literature in line with the study objective. The following databases were consulted: PubMed, philosopher's index, web of knowledge, Google Scholar, and Sociological Abstracts. Both empirical and theoretical studies were utilized for the study.

Results

Despite significant achievements, the global initiative has shortcomings when examined through the Mertonian lens of manifest and latent functions. The GPEI sets a unilinear goal within multiple challenges. The activities of the philanthropic giants manifest in disempowering rigor, multisectoral neglect, and parallel (health) systems, sometimes, inimical to the national health system. Most philanthropic giants often operate vertically. It is observed that, apart from funding, the last phase of polio-philanthropy will be defined by some crucial factors, the 4Cs: Communicable disease outbreaks, Conflict, Climate-related disasters, and Conspiracy theory, which could impact the prevalence or resurgence of polio.

Conclusion

The polio fight will benefit from the persistent drive to reach the finish line as scheduled. The latent consequences or dysfunctions are general lessons for GPEI and other global health initiatives. Therefore, decision-makers should calculate the net balance of consequences within global health philanthropy for appropriate mitigation.

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.

Yellow fever outbreak in Kenya: A review

Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family. The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya. In early 2022, the viral acute illness resurfaced and hit Kenya. On January 12, 2022, the first case was discovered, with over 14 patients suffering from fever, jaundice, and joint and muscle pains. On March 4, 2022, a yellow fever outbreak re-emerged in Kenya, affecting 11 wards in Isiolo County. The fatality rate recorded was 11.3% (six deaths), with Chari accounting for 39.6% of the total 21 cases, Cherab 14 (26.4%), and 5 Garba Tulla (9.4%).

This has the potential to further endanger the nation's economic growth while also negatively impacting people's daily lives in a part of the world that is already dealing with the catastrophic impacts of the coronavirus pandemic. However, there is no curative therapy for yellow fever. The only options for curbing its spread are through vaccination and preventive measures.

Hence, Kenya's government must take responsibility for requiring vaccination of its citizens, implement an active national disease surveillance protocol, and set up anti-yellow fever campaigns in the country.

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Yellow fever (YF) is a viral acute hemorrhagic illness caused by infected mosquitoes of the flavivirus family.

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The first yellow fever outbreak in Kenya was in 1992. Similar outbreaks were recorded in the western part of the country in 1993, 1995, and 2011, particularly in the Rift Valley province of Kenya.

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In 2022, a yellow fever outbreak re-emerged in Kenya.

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The only options for curbing its spread are through vaccination and preventive measures.

Prospects of malaria vaccination in Nigeria: Anticipated challenges and lessons from previous vaccination campaigns

Malaria is a severe public health issue in Nigeria, with higher morbidity and mortality rates than any other country. An estimated 100 million malaria cases and over 300,000 deaths are recorded yearly in Nigeria. Vaccination is an effective strategy in combating and eliminating infectious diseases such as malaria, thus, the deployment of a prospective malaria vaccine in Nigeria offers hope to the country's health sector. However, vaccination programmes face challenges, particularly in communities that are difficult to reach geographically or culturally, and these obstacles can only be overcome through continued international, national, and individual commitment. There is a need for expanded and continuous public health information, education, and communication particularly on contemporary health issues such as malaria and vaccination hesitancy. This will enable easier implementation and compliance to strategies for the sustainable control and eventual elimination of malaria. This article highlights some of the lessons learned from previous vaccination programs in Nigeria and how the insight gotten can be pivotal in ensuring the success of a prospective malaria vaccination programme in Nigeria.

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Nigeria has the highest malaria burden worldwide, and the high costs of continued malaria treatment has created an economic burden for the Nigerian health sector.

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Malaria vaccines undergoing clinical trials have shown great promise and will help to curb the adverse health and socioeconomic effects of the disease.

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.

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.