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Schaeffer J, Hammer CC, Evlampidou I, Bubba L, Igloi Z, Dub T, Wendland A, Whelan J, Nielsen S, Baidjoe A, Tostmann A. Field Epidemiology and Public Health Microbiology training: capturing the alumni perspectives of the training's impact. Euro Surveill 2023; 28:2300388. [PMID: 37676148 PMCID: PMC10486191 DOI: 10.2807/1560-7917.es.2023.28.36.2300388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
We present the findings from the European Programme for Intervention Epidemiology Training (EPIET) Alumni Network (EAN) Member Survey conducted in October to December 2021. The EAN consists of field epidemiologists (EPIET) and public health microbiologists (European Public Health Microbiology Training Programme (EUPHEM)) who stay connected after their 2-year fellowship. This active alumni network provides opportunities for career development, mentorship, knowledge exchange and sharing of best practices for community members, affiliated professionals and public health organisations in Europe. Overall, 281 of 732 members participated in the survey. Of the 192 European fellowship alumni respondents, 173 (90%) indicated that skills and competencies acquired during their fellowship improved performance in their role compared with their abilities before the fellowship. Reported skills and competencies that could be further strengthened included data management/analysis, communication, mathematical modelling and leadership/team management. The EAN Member Survey provides valuable feedback to the EAN, as well as the fellowship programme offices at the European Centre for Disease Prevention and Control (ECDC) and affiliated field epidemiology programmes. The COVID-19 pandemic was a stark reminder of how essential cross-border collaborations are for continued European health security. Maintaining and increasing the professional, well-trained workforce remains crucial for optimal response to infectious diseases and protection of public health.
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Affiliation(s)
| | - Charlotte Christiane Hammer
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Iro Evlampidou
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
- Médecins sans Frontières, Luxembourg Operational Research, Luxembourg
| | - Laura Bubba
- EPIET Alumni Network Advisory Board, Saint Maurice, France
| | - Zsofia Igloi
- EPIET Alumni Network Advisory Board, Saint Maurice, France
| | - Timothée Dub
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Jane Whelan
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Epismart, Amsterdam, the Netherlands
| | - Stine Nielsen
- EPIET Alumni Network Advisory Board, Saint Maurice, France
| | - Amrish Baidjoe
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
- Médecins sans Frontières, Luxembourg Operational Research, Luxembourg
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alma Tostmann
- EPIET Alumni Network Advisory Board, Saint Maurice, France
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Nijmegen, the Netherlands
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2
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Browne JL, Baidjoe A, Bousema T. [Inequal distribution of cause and effects of climate crisis: a global matter of equity and justice]. Ned Tijdschr Geneeskd 2023; 167:D7487. [PMID: 37289848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The impact of climate change on health in low- and middle-income countries is large and disproportionate to these countries' contribution to total greenhouse gas emissions. These health effects are both direct and indirect through climate change impact on food security, migration and political stability. In this commentary, we argue that a health equity and justice lens should be applied in climate policies.
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Affiliation(s)
- Joyce L Browne
- UMC Utrecht, Julius Centrum voor Eerstelijnszorg en Gezondheidswetenschappen, afd. Global Public Health & Bioethics, Utrecht
- Contact: Joyce L. Browne
| | - Amrish Baidjoe
- Médecins Sans Frontières, Operational Research Unit and Epidemiology Support Unit (LuxOR), Luxemburg, Luxemburg
| | - Teun Bousema
- Radboudumc, afd. Afdeling Medische Microbiologie, Nijmegen
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3
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Blackmore C, Evers ES, Sazed SMA, Baidjoe A, Vilas VDR, Pesigan A, Ofrin R. Perspectives on deployment of humanitarian workers through operational partnerships during the acute emergency health response to the Rohingya refugee crisis in Cox's Bazar. BMC Emerg Med 2022; 22:60. [PMID: 35392811 PMCID: PMC8991559 DOI: 10.1186/s12873-022-00618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background The unprecedented influx of Rohingya refugees into Cox’s Bazar, Bangladesh, in 2017 led to a humanitarian emergency requiring large numbers of humanitarian workers to be deployed to the region. The World Health Organization (WHO) contributed to this effort through well-established deployment mechanisms: the Global Outbreak Alert and Response Network (GOARN) and the Standby Partnerships (SBP). The study captures the views and experiences of those humanitarian workers deployed by WHO through operational partnerships between December 2017 and February 2019 with the purpose of identifying challenges and good practice during the deployment process, and steps to their improvement. Methods A mixed methods design was used. A desktop review was conducted to describe the demographics of the humanitarian workers deployed to Cox’s Bazar and the work that was undertaken. Interviews were conducted with a subset of the respondents to elicit their views relating to their experiences of working as part of the humanitarian response. Thematic analysis was used to identify key themes. Results We identified sixty-five deployments during the study period. Respondents’ previous experience ranged between 3 and 28 years (mean 9.7 years). The duration of deployment ranged from 8 to 278 days (mean 67 days) and there was a higher representation of workers from Western Pacific and European regions. Forty-one interviews were conducted with people who experienced differing aspects of the deployment process. Key themes elicited from interviews related to staffing, the deployment process, the office environment and capacity building. Various issues raised have since been addressed, including the establishment of a sub-office structure, introduction of online training prior to deployment, and a staff wellbeing committee. Conclusions This study identified successes and areas for improvement for deployments during emergencies. The themes and subthemes elicited can be used to inform policy and practice changes, as well as the development of performance indicators. Common findings between this study and previous literature indicate the pivotal role of staff deployments through partnership agreements during health emergency response operations and a need for continuous improvements of processes to ensure maximum effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00618-4.
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Affiliation(s)
- Claire Blackmore
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India.
| | - Egmond Samir Evers
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India.,World Health Organisation, Cox's Bazar Emergency Sub-Office, Sea Palace Hotel, Kolatoli Road, Cox's Bazar, 4700, Bangladesh
| | - S M Asif Sazed
- World Health Organisation, Cox's Bazar Emergency Sub-Office, Sea Palace Hotel, Kolatoli Road, Cox's Bazar, 4700, Bangladesh
| | - Amrish Baidjoe
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India.,Global Outbreak Alert and Response Network (GOARN), WHE/EMO, Office E225, Avenue Appia 20, 1211, Geneva 27, Switzerland.,London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Victor Del Rio Vilas
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India.,Global Outbreak Alert and Response Network (GOARN), WHE/EMO, Office E225, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Art Pesigan
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India
| | - Roderico Ofrin
- World Health Organisation, Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, 110 002, India
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Jeffries R, Abdi H, Ali M, Bhuiyan ATMRH, El Shazly M, Harlass S, Ishtiak A, Mazhar MKA, Prajapati M, Pang QY, Singh B, Tabu F, Baidjoe A. The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh. PLoS One 2021; 16:e0253013. [PMID: 34115800 PMCID: PMC8195412 DOI: 10.1371/journal.pone.0253013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh's district of Cox's Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.
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Affiliation(s)
| | - Hassan Abdi
- United Nations Population Fund, Cox’s Bazar, Bangladesh
| | - Mohammad Ali
- Ministry of Health and Family Welfare Coordination Center, Cox’s Bazar, Bangladesh
| | | | - Mohamed El Shazly
- United Nations High Commissioner for Refugees, Cox’s Bazar, Bangladesh
| | - Sandra Harlass
- United Nations High Commissioner for Refugees, Cox’s Bazar, Bangladesh
| | - Asm Ishtiak
- Ministry of Health and Family Welfare Coordination Center, Cox’s Bazar, Bangladesh
| | | | | | | | | | - Francis Tabu
- International Organisation for Migration Cox’s Bazar, Bangladesh
| | - Amrish Baidjoe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organisation, Regional Office of South East Asia, Delhi, India
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5
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Mazhar MKA, Finger F, Evers ES, Kuehne A, Ivey M, Yesurajan F, Shirin T, Ajim N, Kabir A, Musto J, White K, Baidjoe A, le Polain de Waroux O. An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox's Bazar, Bangladesh: Findings from enhanced epidemiological surveillance. PLoS One 2021; 16:e0250505. [PMID: 33914782 PMCID: PMC8084213 DOI: 10.1371/journal.pone.0250505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/07/2021] [Indexed: 12/20/2022] Open
Abstract
In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population.
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Affiliation(s)
| | - Flavio Finger
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Egmond Samir Evers
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Anna Kuehne
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Public Health England, Letchworth Garden, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, United Kingdom
| | | | - Francis Yesurajan
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Ahammadul Kabir
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | - Jennie Musto
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
| | | | - Amrish Baidjoe
- World Health Organization, Cox’s Bazar Emergency Sub-Office, Cox’s Bazar, Bangladesh
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- International Committee of the Red Cross, Geneva, Switzerland
| | - Olivier le Polain de Waroux
- Global Outbreak Alert and Response Network, Geneva, Switzerland
- Public Health England, Letchworth Garden, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, United Kingdom
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6
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Polonsky JA, Ivey M, Mazhar MKA, Rahman Z, le Polain de Waroux O, Karo B, Jalava K, Vong S, Baidjoe A, Diaz J, Finger F, Habib ZH, Halder CE, Haskew C, Kaiser L, Khan AS, Sangal L, Shirin T, Zaki QA, Salam MA, White K. Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study. PLoS Med 2021; 18:e1003587. [PMID: 33793554 PMCID: PMC8059831 DOI: 10.1371/journal.pmed.1003587] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/21/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. CONCLUSIONS To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises.
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Affiliation(s)
- Jonathan A. Polonsky
- World Health Organization, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Melissa Ivey
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Ziaur Rahman
- Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Olivier le Polain de Waroux
- World Health Organization, Geneva, Switzerland
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Public Health England, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- UK-Public Health Rapid Support Team, London, United Kingdom
| | - Basel Karo
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- Information Centre for International Health Protection (ZIG 1), Robert Koch Institute (RKI), Berlin, Germany
| | - Katri Jalava
- World Health Organization Country Office for Bangladesh, Dhaka, Bangladesh
| | - Sirenda Vong
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Amrish Baidjoe
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
| | - Flavio Finger
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Epicentre, Paris, France
| | - Zakir H. Habib
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - Laurent Kaiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ali S. Khan
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
- College of Public Health, University of Nebraska Medical Center, Nebraska, United States of America
| | - Lucky Sangal
- World Health Organization Country Office for India, New Delhi, India
| | - Tahmina Shirin
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Quazi Ahmed Zaki
- Institute of Epidemiology Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Kate White
- Médecins Sans Frontières, Amsterdam, the Netherlands
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Polonsky JA, Baidjoe A, Kamvar ZN, Cori A, Durski K, Edmunds WJ, Eggo RM, Funk S, Kaiser L, Keating P, de Waroux OLP, Marks M, Moraga P, Morgan O, Nouvellet P, Ratnayake R, Roberts CH, Whitworth J, Jombart T. Outbreak analytics: a developing data science for informing the response to emerging pathogens. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180276. [PMID: 31104603 PMCID: PMC6558557 DOI: 10.1098/rstb.2018.0276] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite continued efforts to improve health systems worldwide, emerging pathogen epidemics remain a major public health concern. Effective response to such outbreaks relies on timely intervention, ideally informed by all available sources of data. The collection, visualization and analysis of outbreak data are becoming increasingly complex, owing to the diversity in types of data, questions and available methods to address them. Recent advances have led to the rise of outbreak analytics, an emerging data science focused on the technological and methodological aspects of the outbreak data pipeline, from collection to analysis, modelling and reporting to inform outbreak response. In this article, we assess the current state of the field. After laying out the context of outbreak response, we critically review the most common analytics components, their inter-dependencies, data requirements and the type of information they can provide to inform operations in real time. We discuss some challenges and opportunities and conclude on the potential role of outbreak analytics for improving our understanding of, and response to outbreaks of emerging pathogens. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control‘. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.
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Affiliation(s)
- Jonathan A Polonsky
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland.,3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Amrish Baidjoe
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Zhian N Kamvar
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Anne Cori
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Kara Durski
- 2 Department of Infectious Hazard Management, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - W John Edmunds
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Rosalind M Eggo
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Sebastian Funk
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Laurent Kaiser
- 3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Patrick Keating
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Olivier le Polain de Waroux
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK.,9 Public Health England , Wellington House, 133-155 Waterloo Road, London SE1 8UG , UK
| | - Michael Marks
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Paula Moraga
- 10 Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster Medical School, Lancaster University , Lancaster LA1 4YW , UK
| | - Oliver Morgan
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - Pierre Nouvellet
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,11 School of Life Sciences, University of Sussex , Sussex House, Brighton BN1 9RH , UK
| | - Ruwan Ratnayake
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Chrissy H Roberts
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Jimmy Whitworth
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Thibaut Jombart
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
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Cook J, Owaga C, Marube E, Baidjoe A, Stresman G, Migiro R, Cox J, Drakeley C, Stevenson JC. Risk factors for Plasmodium falciparum infection in the Kenyan Highlands: a cohort study. Trans R Soc Trop Med Hyg 2020; 113:152-159. [PMID: 30496556 PMCID: PMC6391934 DOI: 10.1093/trstmh/try122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/06/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malaria transmission in African highland areas can be prone to epidemics, with minor fluctuations in temperature or altitude resulting in highly heterogeneous transmission. In the Kenyan Highlands, where malaria prevalence has been increasing, characterising malaria incidence and identifying risk factors for infection is complicated by asymptomatic infection. METHODS This all-age cohort study, one element of the Malaria Transmission Consortium, involved monthly follow-up of 3155 residents of the Kisii and Rachuonyo South districts during June 2009-June 2010. Participants were tested for malaria using rapid diagnostic testing at every visit, regardless of symptoms. RESULTS The incidence of Plasmodium falciparum infection was 0.2 cases per person, although infections were clustered within individuals and over time, with the majority of infections detected in the last month of the cohort study. Overall, incidence was higher in the Rachuonyo district and infections were detected most frequently in 5-10-year-olds. The majority of infections were asymptomatic (58%). Travel away from the study area was a notable risk factor for infection. CONCLUSIONS Identifying risk factors for malaria infection can help to guide targeting of interventions to populations most likely to be exposed to malaria.
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Affiliation(s)
- Jackie Cook
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Chrispin Owaga
- Evidence Action, Ngong Road, Nairobi, Kenya.,Kenya Medical Research Institute (KEMRI), KEMRI-Wellcome Trust Research Programme, Kemri Square, Kilifi, Kenya
| | | | | | - Gillian Stresman
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Robin Migiro
- Kenya Medical Research Institute (KEMRI), KEMRI-Wellcome Trust Research Programme, Kemri Square, Kilifi, Kenya
| | - Jon Cox
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Chris Drakeley
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Jennifer C Stevenson
- Macha Research Trust, Choma, Southern Province, Zambia.,Johns Hopkins Malaria Research Institute, Bloomberg School of Public Health, Baltimore, USA
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Noormal B, Eltayeb E, Al Nsour M, Mohsni E, Khader Y, Salter M, McNabb S, Herrera Guibert D, Rawaf S, Baidjoe A, Ikram A, Longuet C, Al Serouri A, Lami F, Khattabi A, AlMudarra S, Iblan I, Samy S, Bouafif Ép Ben Alaya N, Al-Salihi Q. Innovative Approaches to Improve Public Health Practice in the Eastern Mediterranean Region: Findings From the Sixth Eastern Mediterranean Public Health Network Regional Conference. JMIR Public Health Surveill 2019; 5:e11382. [PMID: 30843869 PMCID: PMC6427103 DOI: 10.2196/11382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022] Open
Abstract
Public health professionals in the Eastern Mediterranean region (EMR) have limited access to continuing education, including workshops and conferences in public health. Held under the theme Innovative Approaches: Adapting to the Current EMR Context, the Eastern Mediterranean Public Health Network (EMPHNET) organized and conducted the Sixth EMPHNET Regional Conference from March 26 to 29, 2018. This paper summarizes the key activities including workshops, roundtable discussions, oral and poster presentations, keynote speeches, and side meetings. Before the opening, 5 preconference workshops were held: “Field Epidemiology Training Program (FETP) Accreditation,” “Innovative Public Health Surveillance,” “Human and Animal Brucellosis,” “Rapid Response Teams,” and “Polio Transition and Routine Immunization.” The conference hosted 6 roundtable discussions: “Consolidation of the FETP Network,” “One Health to Achieve Global Health Security,” “Polio Eradication Efforts and Transition Planning for Measles Elimination,” “Mobile Data Collection and Other Innovative Tools to Enhance Decision Making,” “Confronting Candida auris: An Emerging Multidrug-resistant Global Pathogen,” and “Functioning and Sustainable Country Public Health Emergency Response Operation Framework.” One of the conference’s key objectives was to provide a space for FETP residents, graduates, and public health professionals to showcase achievements. A total of 421 abstracts were submitted and after professional review, 34.9% (147/421) were accepted (111 for oral presentations and 36 for poster presentations) and published by Iproceeding. The conference met the primary objectives of showcasing the public health accomplishments and contributions of the EMR, encouraging the exchange of ideas and coordination among stakeholders, and engaging cross-sectoral workforce in producing recommendations for approaching regional and global health concerns. Moreover, the conference presented a unique opportunity for FETPs and other public health professionals from the Mediterranean region to present their significant scientific work and also facilitated networking among professionals. EMPHNET strives to continue to present similar exchange opportunities for public health professionals in the region.
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Affiliation(s)
| | | | | | | | - Yousef Khader
- Jordan University of Science and Technology, Irbid, Jordan
| | - Mark Salter
- Public Health England, London, United Kingdom
| | - Scott McNabb
- Emory University, Rollins School of Public Health, North Carolina, NC, United States
| | - Dionisio Herrera Guibert
- Training Programs in Epidemiology and Public Health Interventions Network, Decatur, GA, United States
| | | | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Christophe Longuet
- Connecting Organizations for Regional Disease Surveillance, Lyon, France
| | | | - Faris Lami
- Iraq Field Epidemiology Training Program, Baghdad, Iraq
| | | | - Sami AlMudarra
- Saudi Field Epidemiology Training Program, Riyadh, Saudi Arabia
| | | | - Sahar Samy
- Ministry of Health and Population, Cairo, Egypt
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10
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Codrington J, Roosblad J, Baidjoe A, Holband N, Adde A, Kazanji M, Flamand C. Zika virus outbreak in Suriname, a report based on laboratory surveillance data. PLoS Curr 2018; 10:ecurrents.outbreaks.ff0f6190d5431c2a2e824255eaeaf339. [PMID: 29896441 PMCID: PMC5969994 DOI: 10.1371/currents.outbreaks.ff0f6190d5431c2a2e824255eaeaf339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Since the identification of ZIKV in Brazil in May 2015, the virus has spread extensively throughout the Americas. Cases of ZIKV infection have been reported in Suriname since October 2, 2015. METHODS A laboratory-based surveillance system was quickly implemented according to previous experience with the emergence of chikungunya. General practitioners and public health centers located in different districts of Suriname were asked to send blood samples from suspicious cases to Academic Hospital for molecular diagnosis of Zika virus infection. We investigated Zika-related laboratory data collected during surveillance and response activities to provide the first outbreak report in Suriname in terms of time, location and person. RESULTS A total of 791 molecularly confirmed cases were reported during a 48-week interval from October 2015 to August 2016. The majority of ZIKV-positive cases involved women between 20 and 39 years of age, reflecting concern about Zika infection during pregnancy. The outbreak peaked in mid-January and gradually spread from the district of Paramaribo to western coastal areas. DISCUSSION This report provides a simple and comprehensive description of the outbreak in Suriname and demonstrates the utility of laboratory data to highlight the spatiotemporal dynamics of the outbreak in that country.
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Affiliation(s)
| | - Jimmy Roosblad
- Academich Hospital Paramaribo, Clinical Chemistry, Paramaribo, Suriname
| | - Amrish Baidjoe
- Institut Pasteur and EUPHEM fellow at European Centre of Disease Prevention and Control, Institut Pasteur, Paris, France and European Programme for Public Health Microbiology Training (EUPHEM), European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Antoine Adde
- Faculty of Forestry, Geography and Geomatics, Department of Wood and Forest Sciences, Laval University, Québec, Québec, Canada
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11
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Stevenson JC, Stresman GH, Baidjoe A, Okoth A, Oriango R, Owaga C, Marube E, Bousema T, Cox J, Drakeley C. Use of different transmission metrics to describe malaria epidemiology in the highlands of western Kenya. Malar J 2015; 14:418. [PMID: 26502920 PMCID: PMC4624380 DOI: 10.1186/s12936-015-0944-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring and evaluation of malaria programmes may require a combination of approaches to detect any effects of control. This is particularly true at lower transmission levels where detecting both infection and exposure to infection will provide additional evidence of any change. This paper describes use of three transmission metrics to explore the malaria epidemiology in the highlands of western Kenya. METHODS A malariometric survey was conducted in June 2009 in two highland districts, Kisii and Rachuonyo South, Nyanza Province, Kenya using a cluster design. Enumeration areas were used to sample 46 clusters from which 12 compounds were randomly sampled. Individuals provided a finger-blood sample to assess malaria infection (rapid diagnostic test, PCR) and exposure (anti-Plasmodium falciparum MSP-1 antibodies) and a questionnaire was administered to record household factors and assess use of vector control interventions. RESULTS Malaria prevalence infection rates were 3.0 % (95 % CI 2.2-4.2 %) by rapid diagnostic test (RDT) and 8.5 % (95 % CI 7.0-10.4 %) by PCR and these ranged from 0-13.1 to 0-14.8 % between clusters for RDT and PCR, respectively. Seroprevalence was 36.8 % (95 % CI 33.9-39.8) ranging from 18.6 to 65.8 %. Both RDT and PCR prevalences were highest in children aged 5-10 years but the proportion of infections that were sub-patent was highest in those between 15 and 20 years of age (78.1 %, 95 % CI 63.0-93.3 %) and those greater than 20 years (73.3 %, 95 % CI 64.5-81.9 %). Those reporting both indoor residual spraying (IRS) in their home and use of bed nets had lower exposure to malaria compared to those who reported using IRS or bed nets alone. CONCLUSIONS In this highland site in western Kenya malaria transmission was low, but highly heterogeneous. To accurately characterize the true extent of malaria transmission, more sensitive and complementary metrics such as PCR or serology are required in addition to the standard microscopy and/or RDTs that are routinely used. This is likely to be the case in other low endemicity settings.
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Affiliation(s)
- Jennifer C Stevenson
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD, 21205, USA.
| | - Gillian H Stresman
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amrish Baidjoe
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Albert Okoth
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Robin Oriango
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Chrispin Owaga
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Elizabeth Marube
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | - Teun Bousema
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. .,Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Jonathan Cox
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Chris Drakeley
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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12
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Tadesse FG, Pett H, Baidjoe A, Lanke K, Grignard L, Sutherland C, Hall T, Drakeley C, Bousema T, Mamo H. Submicroscopic carriage of Plasmodium falciparum and Plasmodium vivax in a low endemic area in Ethiopia where no parasitaemia was detected by microscopy or rapid diagnostic test. Malar J 2015; 14:303. [PMID: 26242243 PMCID: PMC4524028 DOI: 10.1186/s12936-015-0821-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/23/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Motivated by the success in malaria control that was documented over the last decade Ethiopia is aiming at malaria elimination by 2020 in selected districts. It is currently unknown if asymptomatic, submicroscopic malaria parasite carriage may form a hurdle to achieve elimination. The elimination effort may further be complicated by possible glucose-6 phosphate dehydrogenase (G6PD) deficiency which would hinder the use of 8-aminoquinolines in the elimination efforts. METHOD In February 2014 a community-based cross-sectional survey was conducted in Malo, southwest Ethiopia. Finger-prick blood samples (n = 555) were tested for presence of Plasmodium falciparum and Plasmodium vivax with microscopy, rapid diagnostic test (RDT), and nested polymerase chain reaction (nPCR). Multiplicity of P. falciparum infections was determined based on genotyping the polymorphic merozoite surface protein-2 (MSP-2) gene. Individuals were also genotyped for mutations in the gene that produces G6PD. RESULTS All study participants were malaria infection negative by microscopy and RDT. Nested PCR revealed P. falciparum mono-infection in 5.2% (29/555), P. vivax mono-infection in 4.3% (24/555) and mixed infection in 0.2% (1/555) of individuals. All parasitemic individuals were afebrile (axillary temperature <37.5°C). None of the study participants carried mutations for the G6PD African A-(202GA) and Mediterranean (563CT) variants. All infections, except one, were single-clone infection by MSP-2 genotyping. CONCLUSION The detection of a substantial number of subpatent malaria infections in an apparently asymptomatic population without evidence for malaria transmission by conventional diagnostics raises questions about the path to malaria elimination. It is currently unknown how important these infections are for sustaining malaria transmission in the study sites. The absence of G6PD deficiency indicates that 8-aminoquinolines may be safely deployed to accelerate elimination initiatives.
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Affiliation(s)
- Fitsum G Tadesse
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
- Medical Biotechnology Unit, Institute of Biotechnology, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.
| | - Helmi Pett
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Amrish Baidjoe
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Kjerstin Lanke
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
| | - Lynn Grignard
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Colin Sutherland
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Tom Hall
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Chris Drakeley
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Teun Bousema
- Department of Medical Microbiology, Radboud University Medical Centre, Geert Grooteplein 26-28, 6525GA, Nijmegen, The Netherlands.
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hassen Mamo
- Department of Microbial, Cellular and Molecular Biology, College of Natural Sciences, Addis Ababa University, POBox 1176, Addis Ababa, Ethiopia.
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13
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Schwartz A, Baidjoe A, Rosenthal PJ, Dorsey G, Bousema T, Greenhouse B. The Effect of Storage and Extraction Methods on Amplification of Plasmodium falciparum DNA from Dried Blood Spots. Am J Trop Med Hyg 2015; 92:922-5. [PMID: 25758652 DOI: 10.4269/ajtmh.14-0602] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/27/2015] [Indexed: 11/07/2022] Open
Abstract
Extraction and amplification of DNA from dried blood spots (DBS) collected in field studies is commonly used for detection of Plasmodium falciparum. However, there have been few systematic efforts to determine the effects of storage and extraction methods on the sensitivity of DNA amplification. We investigated the effects of storage conditions, length of storage, and DNA extraction methods on amplification via three PCR-based assays using field samples and laboratory controls. Samples stored as DBS for 2 or more years at ambient temperature showed a significant loss of sensitivity that increased with time; after 10 years only 10% samples with parasite densities > 1,000 parasites/μL were detectable by nested polymerase chain reaction (PCR). Conversely, DBS and extracted DNA stored at -20°C showed no loss of sensitivity with time. Samples with low parasite densities amplified more successfully with saponin/Chelex compared with spin-column-based extraction, though the latter method performed better on samples with higher parasite densities stored for 2 years at ambient temperature. DNA extracted via both methods was stable after 20 freeze-thaw cycles. Our results suggest that DBS should be stored at -20°C or extracted immediately, especially if anticipating 2 or more years of storage.
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Affiliation(s)
- Alanna Schwartz
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amrish Baidjoe
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grant Dorsey
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Greenhouse
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California; Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Stresman GH, Baidjoe A, Stevenson J, Odongo W, Owaga C, Marube E, Osoti V, Makori E, Shagari S, Drakeley C, Cox J, Bousema T. Focal screening and treatment for malaria: defining the sentinel population. Malar J 2014. [PMCID: PMC4179464 DOI: 10.1186/1475-2875-13-s1-p86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Baidjoe A, Stone W, Ploemen I, Shagari S, Grignard L, Osoti V, Makori E, Stevenson J, Kariuki S, Sutherland C, Sauerwein R, Cox J, Drakeley C, Bousema T. Combined DNA extraction and antibody elution from filter papers for the assessment of malaria transmission intensity in epidemiological studies. Malar J 2013; 12:272. [PMID: 23914905 PMCID: PMC3750228 DOI: 10.1186/1475-2875-12-272] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 06/30/2013] [Indexed: 12/26/2022] Open
Abstract
Background Informing and evaluating malaria control efforts relies on knowledge of local transmission dynamics. Serological and molecular tools have demonstrated great sensitivity to quantify transmission intensity in low endemic settings where the sensitivity of traditional methods is limited. Filter paper blood spots are commonly used a source of both DNA and antibodies. To enhance the operational practicability of malaria surveys, a method is presented for combined DNA extraction and antibody elution. Methods Filter paper blood spots were collected as part of a large cross-sectional survey in the Kenyan highlands. DNA was extracted using a saponin/chelex method. The eluate of the first wash during the DNA extraction process was used for antibody detection and compared with previously validated antibody elution procedures. Antibody elution efficiency was assessed by total IgG ELISA for malaria antigens apical membrane antigen-1 (AMA-1) and merozoite-surface protein-1 (MSP-142). The sensitivity of nested 18S rRNA and cytochrome b PCR assays and the impact of doubling filter paper material for PCR sensitivity were determined. The distribution of cell material and antibodies throughout filter paper blood spots were examined using luminescent and fluorescent reporter assays. Results Antibody levels measured after the combined antibody/DNA extraction technique were strongly correlated to those measured after standard antibody elution (p < 0.0001). Antibody levels for both AMA-1 and MSP-142 were generally slightly lower (11.3-21.4%) but age-seroprevalence patterns were indistinguishable. The proportion of parasite positive samples ranged from 12.9% to 19.2% in the different PCR assays. Despite strong agreement between outcomes of different PCR assays, none of the assays detected all parasite-positive individuals. For all assays doubling filter paper material for DNA extraction increased sensitivity. The concentration of cell and antibody material was not homogenously distributed throughout blood spots. Conclusion Combined DNA extraction and antibody elution is an operationally attractive approach for high throughput assessment of cumulative malaria exposure and current infection prevalence in endemic settings. Estimates of antibody prevalence are unaffected by the combined extraction and elution procedure. The choice of target gene and the amount and source of filter paper material for DNA extraction can have a marked impact on PCR sensitivity.
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Affiliation(s)
- Amrish Baidjoe
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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16
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Bousema T, Stevenson J, Baidjoe A, Stresman G, Griffin JT, Kleinschmidt I, Remarque EJ, Vulule J, Bayoh N, Laserson K, Desai M, Sauerwein R, Drakeley C, Cox J. The impact of hotspot-targeted interventions on malaria transmission: study protocol for a cluster-randomized controlled trial. Trials 2013; 14:36. [PMID: 23374910 PMCID: PMC3576332 DOI: 10.1186/1745-6215-14-36] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/16/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Malaria transmission is highly heterogeneous in most settings, resulting in the formation of recognizable malaria hotspots. Targeting these hotspots might represent a highly efficacious way of controlling or eliminating malaria if the hotspots fuel malaria transmission to the wider community. METHODS/DESIGN Hotspots of malaria will be determined based on spatial patterns in age-adjusted prevalence and density of antibodies against malaria antigens apical membrane antigen-1 and merozoite surface protein-1. The community effect of interventions targeted at these hotspots will be determined. The intervention will comprise larviciding, focal screening and treatment of the human population, distribution of long-lasting insecticide-treated nets and indoor residual spraying. The impact of the intervention will be determined inside and up to 500 m outside the targeted hotspots by PCR-based parasite prevalence in cross-sectional surveys, malaria morbidity by passive case detection in selected facilities and entomological monitoring of larval and adult Anopheles populations. DISCUSSION This study aims to provide direct evidence for a community effect of hotspot-targeted interventions. The trial is powered to detect large effects on malaria transmission in the context of ongoing malaria interventions. Follow-up studies will be needed to determine the effect of individual components of the interventions and the cost-effectiveness of a hotspot-targeted approach, where savings made by reducing the number of compounds that need to receive interventions should outweigh the costs of hotspot-detection. TRIAL REGISTRATION NCT01575613. The protocol was registered online on 20 March 2012; the first community was randomized on 26 March 2012.
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Affiliation(s)
- Teun Bousema
- Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Jennifer Stevenson
- Department of Disease Control; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Amrish Baidjoe
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Gillian Stresman
- Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jamie T Griffin
- MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Edmond J Remarque
- Department of Parasitology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - John Vulule
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Nabie Bayoh
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Kayla Laserson
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Meghna Desai
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, GA, USA
| | - Robert Sauerwein
- Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Chris Drakeley
- Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jonathan Cox
- Department of Disease Control; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Veenemans J, Mank T, Ottenhof M, Baidjoe A, Mbugi EV, Demir AY, Wielders JPM, Savelkoul HFJ, Verhoef H. Protection against diarrhea associated with Giardia intestinalis Is lost with multi-nutrient supplementation: a study in Tanzanian children. PLoS Negl Trop Dis 2011. [PMID: 21666789 DOI: 10.137/journal.pntd.0001158.epub] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status. METHODS AND FINDINGS Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n=612; height-for-age z-score <-1.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with ≥3 stools in the last 24 h) and fever without localizing signs, as detected with health-facility based surveillance. Giardia was detected in stool by enzyme-linked immunosorbent assay. Among children who did not receive multi-nutrients, asymptomatic Giardia infection at baseline was associated with a substantial reduction in the rate of diarrhea (HR 0.32; 0.15-0.66) and fever without localizing signs (HR 0.56; 0.36-0.87), whereas no such effect was observed among children who received multi-nutrients (p-values for interaction 0.03 for both outcomes). This interaction was independent of age, HAZ-scores and distance to the research dispensary. There was no evidence that Giardia modified the intervention effect on nutritional status. CONCLUSION Although causality of the Giardia-associated reduction in morbidity cannot be established, multi-nutrient supplementation results in a loss of this protection and thus seems to influence the proliferation or virulence of Giardia or associated intestinal pathogens.
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Affiliation(s)
- Jacobien Veenemans
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
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Veenemans J, Mank T, Ottenhof M, Baidjoe A, Mbugi EV, Demir AY, Wielders JPM, Savelkoul HFJ, Verhoef H. Protection against diarrhea associated with Giardia intestinalis Is lost with multi-nutrient supplementation: a study in Tanzanian children. PLoS Negl Trop Dis 2011; 5:e1158. [PMID: 21666789 PMCID: PMC3110167 DOI: 10.1371/journal.pntd.0001158] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 03/07/2011] [Indexed: 11/19/2022] Open
Abstract
Background Asymptomatic carriage of Giardia intestinalis is highly prevalent among children in developing countries, and evidence regarding its role as a diarrhea-causing agent in these settings is controversial. Impaired linear growth and cognition have been associated with giardiasis, presumably mediated by malabsorption of nutrients. In a prospective cohort study, we aim to compare diarrhea rates in pre-school children with and without Giardia infection. Because the study was conducted in the context of an intervention trial assessing the effects of multi-nutrients on morbidity, we also assessed how supplementation influenced the relationship between Giardia and diarrhoea rates, and to what extent Giardia modifies the intervention effect on nutritional status. Methods and Findings Data were collected in the context of a randomized placebo-controlled efficacy trial with 2×2 factorial design assessing the effects of zinc and/or multi-micronutrients on morbidity (n = 612; height-for-age z-score <−1.5 SD). Outcomes measures were episodes of diarrhea (any reported, or with ≥3 stools in the last 24 h) and fever without localizing signs, as detected with health-facility based surveillance. Giardia was detected in stool by enzyme-linked immunosorbent assay. Among children who did not receive multi-nutrients, asymptomatic Giardia infection at baseline was associated with a substantial reduction in the rate of diarrhea (HR 0.32; 0.15–0.66) and fever without localizing signs (HR 0.56; 0.36–0.87), whereas no such effect was observed among children who received multi-nutrients (p-values for interaction 0.03 for both outcomes). This interaction was independent of age, HAZ-scores and distance to the research dispensary. There was no evidence that Giardia modified the intervention effect on nutritional status. Conclusion Although causality of the Giardia-associated reduction in morbidity cannot be established, multi-nutrient supplementation results in a loss of this protection and thus seems to influence the proliferation or virulence of Giardia or associated intestinal pathogens. Giardia intestinalis is a well-known cause of diarrhea in industrialized countries. In children in developing countries, asymptomatic infections are common and their role as cause of diarrhea has been questioned. In a cohort of rural Tanzanian pre-school children, we assessed the association between the presence of Giardia at baseline and subsequent diarrhea risk. The study was conducted in the context of a randomised trial assessing the effect of supplementation with zinc and other micro-nutrients on malaria, and half of the children daily received a multi-nutrient supplement. Surprisingly, we found that the presence of Giardia at baseline was associated with a substantial reduction in diarrhea risk. Multivariate statistical analysis showed that this protection could not be explained by differences in age or walking distance to the dispensary between children with and without Giardia. Because we cannot exclude that children differed in other (unmeasured) characteristics, we cannot draw firm conclusions about the causality of the observed association, but our findings support the view that the parasite is not an important cause of diarrhea in highly endemic settings. Striking was that the Giardia-associated protection was lost when children received multi-nutrients. Our data do not provide information about the mechanisms involved, but suggest that multi-nutrients may influence the compositionor pathogenicity of intestinal biota.
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Affiliation(s)
- Jacobien Veenemans
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Theo Mank
- Department of Parasitology, Public Health Laboratory, Haarlem, The Netherlands
| | - Maarten Ottenhof
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amrish Baidjoe
- Department of Parasitology, Public Health Laboratory, Haarlem, The Netherlands
| | - Erasto V. Mbugi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayse Y. Demir
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Jos P. M. Wielders
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Huub F. J. Savelkoul
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Hans Verhoef
- Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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