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Hangi S. Crisis of Ebola virus disease in Democratic Republic of the Congo, A call to action. New Microbes New Infect 2024; 60-61:101426. [PMID: 38770232 PMCID: PMC11103947 DOI: 10.1016/j.nmni.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Samson Hangi
- Faculty of Medicine, La Sapientia Catholic University, Goma, DR Congo
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR Congo
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2
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Fongwen NT, Nchafack A, Tetuh KM, Ong JJ, Tucker JD, Hughes G, Peeling R. Telephone hotlines for infectious disease outbreaks in Africa: A review and qualitative study. J Public Health Afr 2024; 15:608. [PMID: 39145288 PMCID: PMC11321129 DOI: 10.4102/jphia.v15i1.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024] Open
Abstract
Background Mobile health interventions like telephone hotlines face challenges that may threaten their use, adoption and sustainability in Africa. Aim We sought to understand the barriers and facilitators for sustainability of telephone hotlines used in infectious disease outbreaks in Africa using a scoping review and a qualitative study. Setting Participants form 12 African countries and Database searches. Methods Databases were searched for articles on the barriers and/or facilitators in operating telephone hotlines for outbreaks in Africa. One-on-one interviews and focus group discussions with 30 participants from 12 African countries were also conducted. Emerging themes from the review and interviews were identified and synthesised to focus on barriers and facilitators for the sustainability of the hotlines. Results The search identified 1153 citations, and 25 studies were finally included. The articles were from 20 African countries. The government was the main source of funding in four countries. Barriers with calls and data management were the most frequent. Human resource barriers such as limited staff, high staff turnover, a lack of incentives and motivation were also significant. Financial barriers were the high cost of operation and huge dependence on external funders. Technological and infrastructural hurdles included limited Internet and phone coverage, malfunction and a lack of interoperability of software. Transitioning to either complete or shared government ownership with diversification and integration of the hotline into routine use was the main facilitator for sustainability. Conclusion Strengthening technical capacity in telephone hotlines and ensuring financial sustainability are critical. Increased government support is needed. Contribution More studies on costing will help in developing financial sustainability models for Africa.
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Affiliation(s)
- Noah T Fongwen
- Department of Diagnostics Access, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Almighty Nchafack
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kyeng M Tetuh
- Department of Surveillance, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
| | - Joseph D Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, United States of America
| | - Gwenda Hughes
- UK Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosanna Peeling
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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3
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Ceruti A, Faye M, Diagne MM, Kobialka RM, Makiala-Mandanda S, Faye O, Faye O, El Wahed AA, Weidmann M. Rapid detection of Ebolavirus using isothermal recombinase-aided amplification. J Med Virol 2024; 96:e29744. [PMID: 38874258 DOI: 10.1002/jmv.29744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
Ebolavirus disease (EVD) is an often-lethal disease caused by the genus Ebolavirus (EBOV). Although vaccines are being developed and recently used, outbreak control still relies on a combination of various factors, including rapid identification of EVD cases. This allows rapid patient isolation and control measure implementation. Ebolavirus diagnosis is performed in treatment centers or reference laboratories, which usually takes a few hours to days to confirm the outbreak or deliver a clear result. A fast and field-deployable molecular detection method, such as the isothermal amplification recombinase-aided amplification (RAA), could significantly reduce sample-to-result time. In this study, a RT-RAA assay was evaluated for EBOV detection. Various primer and probe combinations were screened; analytical sensitivity and cross-specificity were tested. A total of 40 archived samples from the 2014 to 2016 Ebola outbreak in West Africa were tested with both the reference method real-time RT-PCR and the established RT-RAA assay. The assay could detect down to 22.6 molecular copies per microliter. No other pathogens were detected with the Ebolavirus RT-RAA assay. Testing 40 samples yield clinical sensitivity and specificity of 100% each. This rapid isothermal RT-RAA assay can replace the previous RT-RPA and continue to offer rapid EBOV diagnostics.
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Affiliation(s)
- Arianna Ceruti
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
| | - Martin Faye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Moussa M Diagne
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Rea M Kobialka
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
| | - Sheila Makiala-Mandanda
- Department of Virology at the Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo
- Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ousmane Faye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Oumar Faye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Ahmed A El Wahed
- Institute of Animal Hygiene and Veterinary Public Health, Leipzig University, Leipzig, Germany
| | - Manfred Weidmann
- Institute of Microbiology and Virology, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
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4
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Fongwen NT, Nchafack A, Rohan H, Ong JJ, Tucker JD, Beckmann N, Hughes G, Peeling RW. Role and effectiveness of telephone hotlines in outbreak response in Africa: A systematic review and meta-analysis. PLoS One 2023; 18:e0292085. [PMID: 38019849 PMCID: PMC10686465 DOI: 10.1371/journal.pone.0292085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa. METHOD We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively. RESULTS Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24-52%). The sensitivity was 41% (95% CI: 24-59%) for local hotlines and 26%(95%CI:5-47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size. CONCLUSION These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas.
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Affiliation(s)
- Noah T. Fongwen
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Laboratory Systems and Networks, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Almighty Nchafack
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hana Rohan
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jason J. Ong
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Joseph D. Tucker
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of North Carolina Institute of Global Health and Infectious Diseases, Chapel Hill, North Carolina, United States of America
| | - Nadine Beckmann
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- United Kingdom Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosanna W. Peeling
- Faculty of Infectious and Tropical Diseases, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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Tshomba AO, Mukadi-Bamuleka D, De Weggheleire A, Tshiani OM, Kayembe CT, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Chenge FM, Jacobs BKM, Mumba DN, Tshala-Katumbay DD, Mulangu S. Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model. PLoS One 2023; 18:e0293077. [PMID: 37847703 PMCID: PMC10581462 DOI: 10.1371/journal.pone.0293077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists. OBJECTIVE To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak. METHODS We collected data on rapid diagnostic tests (RDTs) and prediction scores' accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi™-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi™-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi™-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi™-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings. RESULTS Our analysis found dual ECPS as a conditional test with the QuickNavi™-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi™-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi™-Ebola RDT. CONCLUSIONS Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi™-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.
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Affiliation(s)
- Antoine Oloma Tshomba
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- National Institute for Biomedical Research, Kinshasa, DRC
| | - Daniel Mukadi-Bamuleka
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | | | - Olivier M. Tshiani
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Charles T. Kayembe
- Department of Internal Medicine, University of Kisangani, Kisangani, DRC
| | - Placide Mbala-Kingebeni
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Faustin M. Chenge
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- School of Public Health, University of Lubumbashi, Lubumbashi, RDC
| | - Bart Karl M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dieudonné N. Mumba
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, DRC
| | - Désiré D. Tshala-Katumbay
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Neurology, University of Kinshasa, Kinshasa, DRC
| | - Sabue Mulangu
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
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6
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Jain S, Khaiboullina S, Martynova E, Morzunov S, Baranwal M. Epidemiology of Ebolaviruses from an Etiological Perspective. Pathogens 2023; 12:pathogens12020248. [PMID: 36839520 PMCID: PMC9963726 DOI: 10.3390/pathogens12020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Since the inception of the ebolavirus in 1976, 32 outbreaks have resulted in nearly 15,350 deaths in more than ten countries of the African continent. In the last decade, the largest (2013-2016) and second largest (2018-2020) ebolavirus outbreaks have occurred in West Africa (mainly Guinea, Liberia, and Sierra Leone) and the Democratic Republic of the Congo, respectively. The 2013-2016 outbreak indicated an alarming geographical spread of the virus and was the first to qualify as an epidemic. Hence, it is imperative to halt ebolavirus progression and develop effective countermeasures. Despite several research efforts, ebolaviruses' natural hosts and secondary reservoirs still elude the scientific world. The primary source responsible for infecting the index case is also unknown for most outbreaks. In this review, we summarize the history of ebolavirus outbreaks with a focus on etiology, natural hosts, zoonotic reservoirs, and transmission mechanisms. We also discuss the reasons why the African continent is the most affected region and identify steps to contain this virus.
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Affiliation(s)
- Sahil Jain
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, Punjab, India
- Department of Biochemistry and Molecular Biology, Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Svetlana Khaiboullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Tatarstan, Russia
| | - Ekaterina Martynova
- Institute of Fundamental Medicine and Biology, Kazan Federal University, 420008 Kazan, Tatarstan, Russia
| | - Sergey Morzunov
- Department of Pathology, School of Medicine, University of Nevada, Reno, NV 89557, USA
- Correspondence: (S.M.); or (M.B.); Tel.: +1-775-682-6230 (S.M.); +91-175-2393118 (M.B.); Fax: +91-175-2364498 (M.B.)
| | - Manoj Baranwal
- Department of Biotechnology, Thapar Institute of Engineering and Technology, Patiala 147004, Punjab, India
- Correspondence: (S.M.); or (M.B.); Tel.: +1-775-682-6230 (S.M.); +91-175-2393118 (M.B.); Fax: +91-175-2364498 (M.B.)
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7
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Keita M, Talisuna A, Chamla D, Burmen B, Cherif MS, Polonsky JA, Boland S, Barry B, Mesfin S, Traoré FA, Traoré J, Kimenyi JP, Diallo AB, Godjedo TP, Traore T, Delamou A, Ki-Zerbo GA, Dagron S, Keiser O, Gueye AS. Investing in preparedness for rapid detection and control of epidemics: analysis of health system reforms and their effect on 2021 Ebola virus disease epidemic response in Guinea. BMJ Glob Health 2023; 8:bmjgh-2022-010984. [PMID: 36599498 DOI: 10.1136/bmjgh-2022-010984] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023] Open
Abstract
The 2014-2016 West Africa Ebola Virus Disease (EVD) Epidemic devastated Guinea's health system and constituted a public health emergency of international concern. Following the crisis, Guinea invested in the establishment of basic health system reforms and crucial legal instruments for strengthening national health security in line with the WHO's recommendations for ensuring better preparedness for (and, therefore, a response to) health emergencies. The investments included the scaling up of Integrated Disease Surveillance and Response; Joint External Evaluation of International Health Regulation capacities; National Action Plan for Health Security; Simulation Exercises; One Health platforms; creation of decentralised structures such as regional and prefectural Emergency Operation Centres; Risk assessment and hazard identification; Expanding human resources capacity; Early Warning Alert System and community preparedness. These investments were tested in the subsequent 2021 EVD outbreak and other epidemics. In this case, there was a timely declaration and response to the 2021 EVD epidemic, a lower-case burden and mortality rate, a shorter duration of the epidemic and a significant reduction in the cost of the response. Similarly, there was timely detection, response and containment of other epidemics including Lassa fever and Marburg virus disease. Findings suggest the utility of the preparedness activities for the early detection and efficient containment of outbreaks, which, therefore, underlines the need for all countries at risk of infectious disease epidemics to invest in similar reforms. Doing so promises to be not only cost-effective but also lifesaving.
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Affiliation(s)
- Mory Keita
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo .,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ambrose Talisuna
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Dick Chamla
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Barbara Burmen
- Health Security Preparedness, World Health Organization, Geneva, Switzerland
| | - Mahamoud Sama Cherif
- Faculty of Sciences and Health Technics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Jonathan A Polonsky
- Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Emergency Response, World Health Organization, Geneva, Switzerland
| | - Samuel Boland
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Boubacar Barry
- Emergency Response, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Emergency Response, World Health Organization, Geneva, Switzerland
| | - Fodé Amara Traoré
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | - Jean Traoré
- National Agency for Health Security, Ministry of Health, Conakry, Guinea
| | - Jean Paul Kimenyi
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Amadou Bailo Diallo
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Togbemabou Primous Godjedo
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Tieble Traore
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Alexandre Delamou
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Georges Alfred Ki-Zerbo
- Office at the African Union (AU) and Un Economic Commission for Africa (UNECA), World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Stephanie Dagron
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Abdou Salam Gueye
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
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Keita M, Polonsky J, Finci I, Mbala-Kingebeni P, Ilumbulumbu MK, Dakissaga A, Ngwama JK, Tosalisana MK, Ahuka-Mundeke S, Gueye AS, Dagron S, Keiser O, Fall IS. Investigation of and Strategies to Control the Final Cluster of the 2018-2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo. Open Forum Infect Dis 2022; 9:ofac329. [PMID: 36168547 PMCID: PMC9499850 DOI: 10.1093/ofid/ofac329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Mory Keita
- Regional Office for Africa, World Health Organization, Brazzaville, Congo.,Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jonathan Polonsky
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.,World Health Organization, Geneva, Switzerland
| | - Iris Finci
- European Program for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Michel Kalongo Ilumbulumbu
- Division Provinciale de la Santé du Nord-Kivu, Ministère de la Santé, Goma, Democratic Republic of Congo
| | - Adama Dakissaga
- Ministère de la Santé, Direction Régionale de la Santé du Plateau central, Ziniaré, Burkina Faso
| | - John Kombe Ngwama
- Direction Générale de la Lutte contre la Maladie, Ministère de la Santé, Kinshasa, Democratic Republic of Congo
| | - Michel Kasereka Tosalisana
- Division Provinciale de la Santé du Nord-Kivu, Ministère de la Santé, Goma, Democratic Republic of Congo
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
| | - Abdou Salam Gueye
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Stephanie Dagron
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Olivia Keiser
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
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9
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Hardhantyo M, Djasri H, Nursetyo AA, Yulianti A, Adipradipta BR, Hawley W, Mika J, Praptiningsih CY, Mangiri A, Prasetyowati EB, Brye L. Quality of National Disease Surveillance Reporting before and during COVID-19: A Mixed-Method Study in Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052728. [PMID: 35270431 PMCID: PMC8910184 DOI: 10.3390/ijerph19052728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early Warning and Response Alert System (EWARS) for disease surveillance and to measure the burden of disease surveillance reporting quality before and during the COVID-19 epidemic in Indonesia. Methods: A mixed-method approach was used. A total of 38 informants from regional health offices participated in Focus Group Discussion (FGD) and In-Depth Interview (IDI) for informants from Ministry of Health. The FGD and IDI were conducted using online video communication. Yearly completeness and timeliness of reporting of 34 provinces were collected from the application. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Results: Major implementation gaps were found in poorly distributed human resources and regional infrastructure inequity. National reporting from 2017–2019 showed an increasing trend of completeness (55%, 64%, and 75%, respectively) and timeliness (55%, 64%, and 75%, respectively). However, the quality of the reporting dropped to 53% and 34% in 2020 concomitant with the SARS-CoV2 epidemic. Conclusions: Report completeness and timeliness are likely related to regional infrastructure inequity and the COVID-19 epidemic. It is recommended to increase report capacities with an automatic EWARS application linked systems in hospitals and laboratories.
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Affiliation(s)
- Muhammad Hardhantyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
- Faculty of Health Science, Universitas Respati Yogyakarta, Yogyakarta 55281, Indonesia
- Correspondence:
| | - Hanevi Djasri
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Aldilas Achmad Nursetyo
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Andriani Yulianti
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - Bernadeta Rachela Adipradipta
- Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia; (H.D.); (A.A.N.); (A.Y.); (B.R.A.)
| | - William Hawley
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Jennifer Mika
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Catharina Yekti Praptiningsih
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
| | - Amalya Mangiri
- Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA 30329, USA; (W.H.); (J.M.); (C.Y.P.); (A.M.)
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