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Adachi M, Taniguchi K, Hori H, Mizutani T, Ishizaka A, Ishikawa K, Matano T, Opare D, Arhin D, Asiedu FB, Ampofo WK, Yeboah DM, Koram KA, Anang AK, Kiyono H. Strengthening surveillance in Ghana against public health emergencies of international concern. Trop Med Health 2022; 50:81. [PMID: 36307880 DOI: 10.1186/s41182-022-00473-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Among western African countries, the Republic of Ghana has maintained an economic growth rate of 5% since the 1980s and is now categorized as a middle-income country. However, as with other developing countries, Ghana still has challenges in the effective implementation of surveillance for infectious diseases. Facing public health emergencies of international concern (PHEIC), it is crucial to establish a reliable sample transportation system to the referral laboratory. Previously, surveillance capacity in Ghana was limited based on Integrated Disease Surveillance and Response, and therefore the "Surveillance and Laboratory Support for Emerging Pathogens of Public Health Importance in Ghana (SLEP)" was introduced to strengthen diarrhea surveillance. The SLEP project started with a sentinel diarrhea survey supported by SATREPS/JICA in collaboration with National Public Health Reference Laboratory (NHPRL) and Noguchi Memorial Institute of Medicine (NMIMR). The base-line survey revealed the limited capacity to detect diarrhea pathogens and to transfer samples from health centers to NHPRL. The involvement of private clinic/hospital facilities into the surveillance network is also crucial to strengthen surveillance in Ghana. The strong and interactive relationship between the two top referral laboratories, NHPRL under the Ministry of Health NMIMR and under the Ministry of Education, enables Ghana Health Services and is critical for the rapid response against PHEIC. In future, we hope that the outcome of the SLEP surveillance project could contribute to building a surveillance network with more timely investigation and transfer of samples to referral labs.
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Affiliation(s)
- Motoi Adachi
- St Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
| | | | | | - Taketoshi Mizutani
- Graduate School of Frontier Science, The University of Tokyo, Tokyo, Japan
| | - Aya Ishizaka
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Koichi Ishikawa
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tetsuro Matano
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,AIDS Research Centre, National Institute of Infectious Diseases, Tokyo, Japan.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | - Dorothy Manu Yeboah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwadwo Ansah Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Hiroshi Kiyono
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.,Institute for Global Prominent Research, Graduate School of Medicine, Chiba University, Chiba, Japan.,CU-UCSD Center for Mucosal Immunology, Allergy and Vaccines (cMAV), Department of Medicine, University of California San Diego, San Diego, CA, USA
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2
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Afum T, Asandem DA, Asare P, Asante-Poku A, Mensah GI, Musah AB, Opare D, Taniguchi K, Guinko NM, Aphour T, Arhin D, Ishikawa K, Matano T, Mizutani T, Asiedu-Bekoe F, Kiyono H, Anang AK, Koram KA, Yeboah-Manu D. Diarrhea-Causing Bacteria and Their Antibiotic Resistance Patterns Among Diarrhea Patients From Ghana. Front Microbiol 2022; 13:894319. [PMID: 35663873 PMCID: PMC9161929 DOI: 10.3389/fmicb.2022.894319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/11/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Diarrheal disease remains a major global health problem particularly in children under 5 years and the emergence of antibiotic-resistant strains of causative pathogens could slow control efforts, particularly in settings where treatment options are limited. This surveillance study conducted in Ghana aimed to determine the prevalence and antimicrobial susceptibility profile of diarrhea-causing bacteria. This was a cross-sectional study carried out in five health facilities in the Ga West Municipality of Ghana between 2017 and 2021. Diarrheic stool samples from patients were collected and cultured on standard differential/selective media and isolates identified by standard biochemical tests, MALDI-TOF assay, and serological analysis. The antibiogram was determined using Kirby-Bauer disk diffusion and Microscan autoScan4 MIC panels which were used for extended-spectrum beta-lactamase (ESBL) detection. Bacteria were isolated from 97.5% (772/792) of stool samples, and 167 of the isolates were diarrheagenic and met our inclusion criteria for antimicrobial resistance (AMR) analysis. These included Escherichia coli (49.1%, 82/167), Salmonella species (23.9%, 40/167), Vibrio species (16.8%, 28/167), and Shigella species (10.2%, 17/167). Among 24 Vibrio species, we observed resistances to cefotaxime (21/24, 87.5%), ceftriaxone (20/24, 83.3%), and ciprofloxacin (6/24, 25%), including four multi-drug resistant isolates. All 13 Vibrio parahaemolyticus isolates were resistant to cefazolin. All 17 Shigella isolates were resistant to tetracycline with resistance to shigellosis drugs such as norfloxacin and ciprofloxacin. Salmonella isolates were highly susceptible to norfloxacin (40/40, 100%) and tetracycline (12/34, 35%). Two ESBL-producing E. coli were also identified with marked susceptibility to gentamicin (66/72, 91.7%) and amikacin (57/72, 79.2%) prescribed in the treatment of E. coli infections. This study showed the different bacteria implicated in diarrhea cases in Ghana and the need for differential diagnoses for better treatment outcomes. Escherichia coli, Shigella, Salmonella, and Vibrio have all been implicated in diarrhea cases in Ghana. The highest prevalence was E. coli and Salmonella with Shigella the least prevalent. Resistance to commonly used drugs found in these isolates may render bacteria infection treatment in the near future nearly impossible. Routine antimicrobial susceptibility testing, effective monitoring, and nationwide surveillance of AMR pathogens should be implemented to curb the increase of antimicrobial resistance in Ghana.
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Affiliation(s)
- Theophilus Afum
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Diana Asema Asandem
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Prince Asare
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Gloria Ivy Mensah
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Abdul Basit Musah
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kiyosi Taniguchi
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, Institute for Global Prominent Research, Chiba University, Chiba, Japan
| | | | | | | | - Koichi Ishikawa
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Tetsuro Matano
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | | | | | - Hiroshi Kiyono
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Graduate School of Medicine, Institute for Global Prominent Research, Chiba University, Chiba, Japan
- Department of Medicine, CU-UCSD Center for Mucosal Immunology, Allergy and Vaccines (cMAV), University of California San Diego, San Diego, CA, United States
| | - Abraham Kwabena Anang
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwadwo Ansah Koram
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Dorothy Yeboah-Manu
- College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- *Correspondence: Dorothy Yeboah-Manu,
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3
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Owusu M, Nkrumah B, Mensah EK, Lamptey J, Acheampong G, Sambian D, Sylverken A, Emery S, Robinson LM, Sefa SA, Amoako E, Amedzro I, Chinbuah S, Asante K, Adu-Sarkodie Y, Opare D. Surveillance and laboratory collaboration in response to an outbreak of Vibrio parahaemolyticus, Plesiomonas shigelloides, and Aeromonas hydrophila in Sekondi-Takoradi, Ghana: a case series. J Med Case Rep 2022; 16:53. [PMID: 35086562 PMCID: PMC8792525 DOI: 10.1186/s13256-021-03243-0] [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: 09/25/2020] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The detection of epidemic-prone pathogens is important in strengthening global health security. Effective public health laboratories are critical for reliable, accurate, and timely testing results in outbreak situations. Ghana received funding as one of the high-risk non-Ebola affected countries to build and strengthen public health infrastructure to meet International Health Regulation core capacities. A key objective was to build laboratory capacities to detect epidemic-prone diseases. Case presentation In June 2018, a local hospital received eight patients who presented with acute diarrhea. A sample referral system for Ghana has not been established, but the Sekondi Zonal Public Health Laboratory staff and mentors collaborated with Disease Surveillance Officers (DSOs) to collect, package, and transport stool specimens from the outbreak hospital to the Public Health Laboratory for laboratory testing. The patients included seven females and one male, of Fante ethnicity from the Fijai township of Sekondi-Takoradi Municipality. The median age of the patients was 20 years (interquartile range: 20–29 years). Vibrio parahaemolyticus was identified within 48 hours from four patients, Plesiomonas shigelloides from one patient, and Aeromonas hydrophila from another patient. There was no bacteria growth from the samples from the two other patients. All patients were successfully treated and discharged. Conclusion This is the first time these isolates have been identified at the Sekondi Zonal Public Health Laboratory, demonstrating how rapid response, specimen transportation, laboratory resourcing, and public health coordination are important in building capacity towards achieving health security. This capacity building was part of the United States Centers for Disease Control and Prevention engagement of international and local partners to support public health laboratories with supplies, diagnostic equipment, reagents, and logistics.
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Affiliation(s)
- Michael Owusu
- Centre for Health System Strengthening, Kumasi, Ghana. .,Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | | | - Jones Lamptey
- Centre for Health System Strengthening, Kumasi, Ghana
| | | | - David Sambian
- Centre for Health System Strengthening, Kumasi, Ghana
| | - Augustina Sylverken
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Shannon Emery
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | | | | | - Eric Amoako
- Sekondi Public Health Laboratory, Ghana Health Service, Sekondi, Ghana
| | - Irene Amedzro
- Sekondi Public Health Laboratory, Ghana Health Service, Sekondi, Ghana
| | | | - Kwame Asante
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Opare
- National Public Health and Reference Laboratory, Ghana Health Service, Accra, Ghana
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4
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Opintan JA, Will RC, Kuma GK, Osei M, Akumwena A, Boateng G, Owusu-Okyere G, Antwi L, Opare D, Pragasam AK, Vasudevan K, Srivastava SK, Balaji V, Newman MJ, Dougan G, Mutreja A. Phylogenetic and antimicrobial drug resistance analysis of Vibrio cholerae O1 isolates from Ghana. Microb Genom 2021; 7. [PMID: 34714228 PMCID: PMC8627208 DOI: 10.1099/mgen.0.000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/18/2022] Open
Abstract
We investigated the evolution, phylogeny and antimicrobial resistance of Vibrio cholerae O1 isolates (VCO1) from Ghana. Outbreak and environmental sources of VCO1 were characterized, whole-genome sequenced and compared to globally available seventh pandemic (7P) strains of V. cholerae at SNP resolution. Final analyses included 636 isolates. Novel Ghanaian isolates clustered into three distinct clades (clades 1, 2 and 3) in wave 3 of the 7P lineage. The closest relatives of our novel Ghanaian isolates were from Benin, Cameroon, Togo, Niger and Nigeria. All novel Ghanaian isolates were multi-drug resistant. Environmental isolates clustered into clade 2, despite being isolated years later, showing the possibility of persistence and re-emergence of older clades. A lag phase of several years from estimated introduction to reported cases suggests pathogen persistence in the absence of reported cholera cases. These results highlight the importance of deeper surveillance for understanding transmission routes between bordering countries and planning tailored vaccination campaigns in an effort to eradicate cholera.
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Affiliation(s)
- Japheth A Opintan
- Medical Microbiology Department, University of Ghana Medical School, Accra, Ghana.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert C Will
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, UK
| | - George K Kuma
- Laboratory Department, Brong Ahafo Regional Hospital, Sunyani, Ghana
| | - Mary Osei
- Medical Microbiology Department, University of Ghana Medical School, Accra, Ghana
| | - Amos Akumwena
- Medical Microbiology Department, University of Ghana Medical School, Accra, Ghana
| | - Gifty Boateng
- National Public Health Reference Laboratory, Accra, Ghana
| | | | - Lorreta Antwi
- National Public Health Reference Laboratory, Accra, Ghana
| | - David Opare
- National Public Health Reference Laboratory, Accra, Ghana
| | | | - Karthick Vasudevan
- Christian Medical College, Vellore, Tamil Nadu, India.,Department of Biotechnology, School of Applied Sciences, REVA University, Bangalore, India
| | | | | | - Mercy J Newman
- Medical Microbiology Department, University of Ghana Medical School, Accra, Ghana
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ankur Mutreja
- Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, UK.,Translational Health Science and Technology Institute, Faridabad, India
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5
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Dongdem AZ, Alhassan E, Opare D, Boateng G, Bonsu G, Amponsa-Achiano K, Sarkodie B, Dzotsi E, Adjabeng M, Afagbedzi S, Alhassan Y, Agyabeng K, Asiedu-Bekoe F. An 11-year trend of rubella incidence cases reported in the measles case-based surveillance system, Ghana. Pan Afr Med J 2021; 39:132. [PMID: 34527148 PMCID: PMC8418178 DOI: 10.11604/pamj.2021.39.132.23297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/04/2020] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction rubella is vaccine-preventable and vaccination is the most cost-effective approach to control the disease and avoid the management of congenital rubella syndrome cases. Ghana introduced the rubella vaccine into the routine immunization program in 2013. Since then there have not been any evaluation of the epidemiology of rubella. We determined the disease trends and the population demographics of rubella cases, in the Ghana national measles case-based surveillance system. Methods we reviewed the measles case-based surveillance data from 2007 to 2017. Descriptive data statistics was done and expressed as frequencies and proportions. Chi-square test was used to establish associations. Results a total of 11,483 suspected cases for measles received and tested for measles IgM antibodies and 1,137(12.98%) confirmed positive for the period. Of these 10,077 were negative and 250 indeterminate for measles and tested for rubella and 2,090 (20.23%) confirmed positive for rubella IgM antibodies. More females (21.45%) were affected than males (19.48%). Majority of the confirmed positives were recorded in the urban areas. Children aged 15 years or less were mostly affected. There was a statistical difference between incidence cases and sex (χ2=6.03, p-value = 0.014), or age (χ2=283.56, p-value < 0.001) or area (χ2= 6.17, p-value = 0.013). Most infections occurred during the dry season. Conclusion children less than 15 years were mostly affected with majority being females. The highest incidence of cases was before the rains and occurred mostly in urban areas. The incidence of cases has declined significantly with the introduction of the rubella vaccine.
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Affiliation(s)
- Anthony Zunuo Dongdem
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - David Opare
- National Public Health and Reference Laboratory, Ghana Health Service, Accra, Ghana
| | - Gifty Boateng
- National Public Health and Reference Laboratory, Ghana Health Service, Accra, Ghana
| | - George Bonsu
- Expanded Programme on Immunization, Ghana Health Service, Accra, Ghana
| | | | - Badu Sarkodie
- Public Health Division, Ghana Health Service, Accra, Ghana
| | - Emmanuel Dzotsi
- Oti Regional Health Directorate, Ghana Health Service, Dambai, Ghana
| | | | - Seth Afagbedzi
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Yakubu Alhassan
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
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6
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Mizutani T, Aboagye SY, Ishizaka A, Afum T, Mensah GI, Asante-Poku A, Asandem DA, Parbie PK, Abana CZY, Kushitor D, Bonney EY, Adachi M, Hori H, Ishikawa K, Matano T, Taniguchi K, Opare D, Arhin D, Asiedu-Bekoe F, Ampofo WK, Yeboah-Manu D, Koram KA, Anang AK, Kiyono H. Gut microbiota signature of pathogen-dependent dysbiosis in viral gastroenteritis. Sci Rep 2021; 11:13945. [PMID: 34230563 PMCID: PMC8260788 DOI: 10.1038/s41598-021-93345-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/27/2020] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
Acute gastroenteritis associated with diarrhea is considered a serious disease in Africa and South Asia. In this study, we examined the trends in the causative pathogens of diarrhea and the corresponding gut microbiota in Ghana using microbiome analysis performed on diarrheic stools via 16S rRNA sequencing. In total, 80 patients with diarrhea and 34 healthy adults as controls, from 2017 to 2018, were enrolled in the study. Among the patients with diarrhea, 39 were norovirus-positive and 18 were rotavirus-positive. The analysis of species richness (Chao1) was lower in patients with diarrhea than that in controls. Beta-diversity analysis revealed significant differences between the two groups. Several diarrhea-related pathogens (e.g., Escherichia-Shigella, Klebsiella and Campylobacter) were detected in patients with diarrhea. Furthermore, co-infection with these pathogens and enteroviruses (e.g., norovirus and rotavirus) was observed in several cases. Levels of both Erysipelotrichaceae and Staphylococcaceae family markedly differed between norovirus-positive and -negative diarrheic stools, and the 10 predicted metabolic pathways, including the carbohydrate metabolism pathway, showed significant differences between rotavirus-positive patients with diarrhea and controls. This comparative study of diarrheal pathogens in Ghana revealed specific trends in the gut microbiota signature associated with diarrhea and that pathogen-dependent dysbiosis occurred in viral gastroenteritis.
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Affiliation(s)
- Taketoshi Mizutani
- The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Samuel Yaw Aboagye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Aya Ishizaka
- The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Theophillus Afum
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Gloria Ivy Mensah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Diana Asema Asandem
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Prince Kofi Parbie
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Dennis Kushitor
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Evelyn Yayra Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Koichi Ishikawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tetsuro Matano
- The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | | | | | | | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwadwo Ansah Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Hiroshi Kiyono
- The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
- Institute for Global Prominent Research, Graduate School of Medicine, Chiba University, Chiba, Japan
- CU-UCSD Center for Mucosal Immunology, Allergy and Vaccines (cMAV), Department of Medicine, University of California San Diego, San Diego, CA, USA
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7
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Johnson BW, Demanou M, Fall G, Betoulle JL, Obiekea C, Basile AJ, Domingo C, Goodman C, Mossel E, Reusken C, Staples E, de Morais JFM, Neto Z, Paixão P, Denon YE, Glitho M, Mahinou J, Kagone T, Nakoune E, Gamougam K, Simbu EP, Ahuka S, Mombouli JV, Goma-Nkoua C, Adjogoua EV, Tayachew A, Beyene B, Sanneh B, Jarju ML, Mendy A, Amelor DK, Ofosu-Appiah L, Opare D, Antwi L, Adade R, Magassouba N, Gomes SF, Limbaso S, Lutomiah J, Gbelee B, Dogba J, Cisse I, Idde Z, Ihekweazu C, Mba N, Faye O, Faye O, Sall AA, Koroma Z, Juma MA, Maror JA, Eldigail M, Elduma AH, Elageb R, Badziklou K, Komla KA, Kayiwa J, Lutwama JJ, Hampton L, Mulders MN. Laboratory capacity assessments in 25 African countries at high risk of yellow fever, August-December 2018. Pan Afr Med J 2021; 38:402. [PMID: 34381546 PMCID: PMC8325472 DOI: 10.11604/pamj.2021.38.402.28886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/15/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction accurate and timely laboratory diagnosis of yellow fever (YF) is critical to the Eliminate Yellow Fever Epidemics (EYE) strategy. Gavi, the Vaccine Alliance recognized the need to support and build capacity in the national and regional laboratories in the Global YF Laboratory Network (GYFLN) as part of this strategy. Methods to better understand current capacity, gaps and needs of the GYFLN laboratories in Africa, assessments were carried out in national and regional reference laboratories in the 25 African countries at high risk for YF outbreaks that were eligible for new financial support from Gavi. Results the assessments found that the GYFLN in Africa has high capacity but 21% of specimens were not tested due to lack of testing kits or reagents and approximately 50% of presumptive YF cases were not confirmed at the regional reference laboratory due to problems with shipping. Conclusion the laboratory assessments helped to document the baseline capacities of these laboratories prior to Gavi funding to support strengthening YF laboratories.
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Affiliation(s)
| | - Maurice Demanou
- World Health Organization African Region Yellow Fever Laboratory, Ouagadougou, Burkina Faso.,Centre Pasteur Cameroon, Yaoundé, Cameroon
| | | | | | - Celestina Obiekea
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Alison Jane Basile
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, Fort Collins, Colorado, United States of America
| | | | - Christin Goodman
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, Fort Collins, Colorado, United States of America
| | - Eric Mossel
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, Fort Collins, Colorado, United States of America
| | - Chantal Reusken
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Erin Staples
- Centers for Disease Control and Prevention, Division of Vector-borne Diseases, Fort Collins, Colorado, United States of America
| | | | - Zoraima Neto
- Instituto Nacional de Investigacao em Saude, Luanda, Angola
| | - Paula Paixão
- Instituto Nacional de Investigacao em Saude, Luanda, Angola
| | | | | | - José Mahinou
- National Public Health Laboratory, Cotonou, Benin
| | - Therese Kagone
- Scientific Laboratory Consulting, Laporte, Colorado, United States of America.,World Health Organization African Region Yellow Fever Laboratory, Ouagadougou, Burkina Faso
| | | | | | | | - Steve Ahuka
- National Institute for Biomedical Research, Kinshasha, Democratic Republic of Congo
| | | | | | | | - Adamu Tayachew
- Ethiopian Public Health Institute, Virology and Rickettsiology Unit, Addis Ababa, Ethiopia
| | | | - Bakary Sanneh
- National Health Laboratory Services, Royal Victoria Teaching Hospital, Banjul, The Gambia
| | - Modou Lamin Jarju
- National Health Laboratory Services, Royal Victoria Teaching Hospital, Banjul, The Gambia
| | - Alphonse Mendy
- National Health Laboratory Services, Royal Victoria Teaching Hospital, Banjul, The Gambia
| | - Dodzi Kofi Amelor
- National Public Health and Reference Laboratory, Public Health Division, Ghana Health Service, Korle-Bu, Accra, Ghana
| | - Lawrence Ofosu-Appiah
- National Public Health and Reference Laboratory, Public Health Division, Ghana Health Service, Korle-Bu, Accra, Ghana
| | - David Opare
- National Public Health and Reference Laboratory, Public Health Division, Ghana Health Service, Korle-Bu, Accra, Ghana
| | - Lorreta Antwi
- National Public Health and Reference Laboratory, Public Health Division, Ghana Health Service, Korle-Bu, Accra, Ghana
| | - Rexford Adade
- National Public Health and Reference Laboratory, Public Health Division, Ghana Health Service, Korle-Bu, Accra, Ghana
| | | | | | - Samson Limbaso
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joel Lutomiah
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Burgess Gbelee
- National Public Health Reference Laboratory, National Public Health Institute of Liberia, Charlesville, Liberia
| | - John Dogba
- National Public Health Reference Laboratory, National Public Health Institute of Liberia, Charlesville, Liberia
| | - Issa Cisse
- Institut National de Santé Publique Laboratoire de Fièvre Jaune, Bamako, Mali
| | | | - Chikwe Ihekweazu
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Nwando Mba
- National Reference Laboratory, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | - Zikan Koroma
- National Public Health Laboratory, Lakka, Sierra Leone
| | | | | | | | | | | | - Kossi Badziklou
- Laboratoire de Sérologie, Institut National d'Hygiène, Lomé, Togo
| | | | - John Kayiwa
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Mick Norman Mulders
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Owusu M, Nkrumah B, Acheampong G, Mensah EK, Komei AAK, Sroda FK, David S, Emery S, Robinson LM, Asante K, Opare D. Improved detection of microbiological pathogens: role of partner and non-governmental organizations. BMC Infect Dis 2021; 21:303. [PMID: 33765944 PMCID: PMC7993523 DOI: 10.1186/s12879-021-05999-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/23/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proper detection of disease-causing organisms is very critical in controlling the course of outbreaks and avoiding large-scale epidemics. Nonetheless, availability of resources to address these gaps have been difficult due to limited funding. This report sought to highlight the importance of in-country partners and non-governmental organizations in improving detection of microbiological organisms in Ghanaian Public Health Laboratories (PHLs). METHODS/CONTEXT This study was conducted between June, 2018 to August, 2019. U. S CDC engaged the Centre for Health Systems Strengthening (CfHSS) through the Association of Public Health Laboratories to design and implement strategies for strengthening three PHLs in Ghana. An assessment of the three PHLs was done using the WHO/CDS/CSR/ISR/2001.2 assessment tool. Based on findings from the assessments, partner organizations (CfHSS/APHL/CDC) serviced and procured microbiological equipment, laboratory reagents and logistics. CfHSS provided in-house mentoring and consultants to assist with capacity building in detection of epidemic-prone infectious pathogens by performing microbiological cultures and antimicrobial susceptibility tests. RESULTS A total of 3902 samples were tested: blood (1107), urine (1742), stool (249) and cerebrospinal fluid (CSF) (804). All-inclusive, 593 pathogenic bacteria were isolated from blood cultures (70; 11.8%); urine cultures (356; 60%); stool cultures (19; 3.2%) and from CSF samples (148; 25%). The most predominant pathogens isolated from blood, urine and stool were Staphylococcus aureus (22/70; 31%), Escherichia coli (153/356; 43%) and Vibrio parahaemolyticus (5/19; 26.3%), respectively. In CSF samples, Streptococcus pneumoniae was the most frequent pathogen detected (80/148; 54.1%). New bacterial species such as Pastuerella pneumotropica, Klebsiella oxytoca, Vibrio parahaemolyticus, and Halfnia alvei were also identified with the aid of Analytical Profile Index (API) kits that were introduced as part of this implementation. Streptococcus pneumoniae and Neisseria meningitidis detections in CSF were highest during the hot dry season. Antimicrobial susceptibility test revealed high rate of S. aureus, K. pneumoniae and E. coli resistance to gentamicin (35-55%). In urine, E. coli was highly resistant to ciprofloxacin (39.2%) and ampicillin (34%). CONCLUSION Detection of epidemic-prone pathogens can be greatly improved if laboratory capacity is strengthened. In-country partner organizations are encouraged to support this move to ensure accurate diagnosis of diseases and correct antimicrobial testing.
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Affiliation(s)
- Michael Owusu
- Centre for Health Systems Strengthening, Kumasi, Ghana.
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | | | | | | | - Festus Kofi Sroda
- Kumasi Public Health Laboratory, Ghana Health Service, Kumasi, Ghana
| | - Sambian David
- Centre for Health Systems Strengthening, Kumasi, Ghana
| | - Shannon Emery
- Association of Public Health Laboratories, Silver Springs, MD, USA
| | | | - Kwame Asante
- Association of Public Health Laboratories, Silver Springs, MD, USA
| | - David Opare
- National Public Health and Reference Laboratory, Accra, Ghana
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Danso EK, Asare P, Otchere ID, Akyeh LM, Asante-Poku A, Aboagye SY, Osei-Wusu S, Opare D, Ntoumi F, Zumla A, Duodu S, Yeboah-Manu D. A molecular and epidemiological study of Vibrio cholerae isolates from cholera outbreaks in southern Ghana. PLoS One 2020; 15:e0236016. [PMID: 32649692 PMCID: PMC7351161 DOI: 10.1371/journal.pone.0236016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/23/2019] [Accepted: 06/27/2020] [Indexed: 11/18/2022] Open
Abstract
Cholera remains a major global public health threat and continuous emergence of new Vibrio cholerae strains is of major concern. We conducted a molecular epidemiological study to detect virulence markers and antimicrobial resistance patterns of V. cholerae isolates obtained from the 2012–2015 cholera outbreaks in Ghana. Archived clinical isolates obtained from the 2012, 2014 and 2015 cholera outbreaks in Ghana were revived by culture and subjected to microscopy, biochemical identification, serotyping, antibiotic susceptibility testing, molecular detection of distinct virulence factors and Multi-Locus Variable-Number of Tandem-Repeat Analysis (MLVA). Of 277 isolates analysed, 168 (60.6%) were confirmed to be V. cholerae and 109 (39.4%) isolates constituted other bacteria (Escherichia coli, Aeromonas sobria, Pseudomonas aeruginosa, Enterobacter cloacae and Enterococci faecalis). Serotyping the V. cholerae isolates identified 151 (89.9%) as Ogawa, 3 (1.8%) as Inaba and 14 (8.3%) as non-O1/O139 serogroup. The O1 serogroup isolates (154/168, 91.7%) carried the cholera toxin ctxB gene as detected by PCR. Additional virulence genes detected include zot, tcpA, ace, rtxC, toxR, rtxA, tcpP, hlyA and tagA. The most common and rare virulence factors detected among the isolates were rtxC (165 isolates) and tcpP (50 isolates) respectively. All isolates from 2014 and 2015 were multidrug resistant against the selected antibiotics. MLVA differentiated the isolates into 2 large unique clones A and B, with each predominating in a particular year. Spatial analysis showed clustering of most isolates at Ablekuma sub-district. Identification of several virulence genes among the two different genotypes of V. cholerae isolates and resistance to first- and second-line antibiotics, calls for scaleup of preventive strategies to reduce transmission, and strengthening of public health laboratories for rapid antimicrobial susceptibility testing to guide accurate treatment. Our findings support the current WHO licensed cholera vaccines which include both O1 Inaba and Ogawa serotypes.
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Affiliation(s)
- Emelia Konadu Danso
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana Legon, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Prince Asare
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Isaac Darko Otchere
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Lorenzo Moses Akyeh
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Yaw Aboagye
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Institute for Environment and Sanitation Studies, University of Ghana, Legon, Accra, Ghana
| | - Stephen Osei-Wusu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - David Opare
- National Public Health and Reference Laboratory, Accra, Ghana
| | - Francine Ntoumi
- Université Marien NGouabi, Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo
- Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, England, United Kingdom
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana Legon, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Accra, Ghana
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana Legon, Legon, Accra, Ghana
- * E-mail:
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Bozio CH, Abdul-Karim A, Abenyeri J, Abubakari B, Ofosu W, Zoya J, Ouattara M, Srinivasan V, Vuong JT, Opare D, Asiedu-Bekoe F, Lessa FC. Continued occurrence of serotype 1 pneumococcal meningitis in two regions located in the meningitis belt in Ghana five years after introduction of 13-valent pneumococcal conjugate vaccine. PLoS One 2018; 13:e0203205. [PMID: 30192772 PMCID: PMC6128537 DOI: 10.1371/journal.pone.0203205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 05/23/2018] [Accepted: 08/16/2018] [Indexed: 01/07/2023] Open
Abstract
Background Increases in pneumococcal meningitis were reported from Ghanaian regions that lie in the meningitis belt in 2016–2017, despite introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in 2012 using a 3-dose schedule (6, 10, and 14 weeks). We describe pneumococcal meningitis epidemiology in the Ghanaian Northern and Upper West regions across two meningitis seasons. Methods Suspected meningitis cases were identified using World Health Organization standard definitions. Pneumococcal meningitis was confirmed if pneumococcus was the sole pathogen detected by polymerase chain reaction, culture, or latex agglutination in cerebrospinal fluid collected from a person with suspected meningitis during December 2015-March 2017. Pneumococcal serotyping was done using PCR. Annual age-specific pneumococcal meningitis incidence (cases per 100,000 population) was calculated, adjusting for suspected meningitis cases lacking confirmatory testing. Findings Among 153 pneumococcal meningitis cases, 137 (89.5%) were serotyped; 100 (73.0%) were PCV13-type, including 85 (62.0%) that were serotype 1, a PCV13-targeted serotype. Persons aged ≥5 years accounted for 96.7% (148/153) of cases. Comparing 2015–2016 and 2016–2017 seasons, the proportion of non-serotype 1 PCV13-type cases decreased from 20.0% (9/45) to 4.1% (3/74) (p = 0.008), whereas the proportion that was serotype 1 was stable (71.1% (32/45) vs. 58.1% (43/74); p = 0.16). Estimated adjusted pneumococcal meningitis incidence was 1.8 in children aged <5 years and ranged from 6.8–10.5 in older children and adults. Conclusions High pneumococcal meningitis incidence with a large proportion of serotype 1 disease in older children and adults suggests infant PCV13 vaccination has not induced herd protection with this schedule in this high-transmission setting.
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Affiliation(s)
- Catherine H. Bozio
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | | | | | | | | | | | - Mahamoudou Ouattara
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Velusamy Srinivasan
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jeni T. Vuong
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - David Opare
- National Public Health Reference Laboratory, Ghana Health Service, Accra, Ghana
| | | | - Fernanda C. Lessa
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Ogee-Nwankwo A, Opare D, Boateng G, Nyaku M, Haynes LM, Balajee SA, Conklin L, Icenogle JP, Rota PA, Waku-Kouomou D. Assessment of National Public Health and Reference Laboratory, Accra, Ghana, within Framework of Global Health Security. Emerg Infect Dis 2018; 23. [PMID: 29155650 PMCID: PMC5711297 DOI: 10.3201/eid2313.170372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Second Year of Life project of the Global Health Security Agenda aims to improve immunization systems and strengthen measles and rubella surveillance, including building laboratory capacity. A new laboratory assessment tool was developed by the Centers for Disease Control and Prevention to assess the national laboratory in Ghana to improve molecular surveillance for measles and rubella. Results for the tool showed that the laboratory is well organized, has a good capacity for handling specimens, has a good biosafety system, and is proficient for diagnosis of measles and rubella by serologic analysis. However, there was little knowledge about molecular biology and virology activities (i.e., virus isolation on tissue culture was not available). Recommendations included training of technical personnel for molecular techniques and advocacy for funding for laboratory equipment, reagents, and supplies.
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12
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Aku FY, Lessa FC, Asiedu-Bekoe F, Balagumyetime P, Ofosu W, Farrar J, Ouattara M, Vuong JT, Issah K, Opare J, Ohene SA, Okot C, Kenu E, Ameme DK, Opare D, Abdul-Karim A. Meningitis Outbreak Caused by Vaccine-Preventable Bacterial Pathogens - Northern Ghana, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:806-810. [PMID: 28771457 PMCID: PMC5720875 DOI: 10.15585/mmwr.mm6630a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Kwarteng A, Amuasi J, Annan A, Ahuno S, Opare D, Nagel M, Vinnemeier C, May J, Owusu-Dabo E. Current meningitis outbreak in Ghana: Historical perspectives and the importance of diagnostics. Acta Trop 2017; 169:51-56. [PMID: 28122199 DOI: 10.1016/j.actatropica.2017.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 01/07/2023]
Abstract
Bacterial meningitis continues to be one of the most dreaded infections in sub-Saharan Africa and other countries that fall in the "meningitis belt" due to recurrent nature of the infection and the sequel of deliberating effects among survivors even after treatment. Ghana has had recurrent epidemics in the past but has been free from high mortality levels. Whereas reasons for the low reported number of deaths in the past are unclear, we hypothesize that it may be due to increased vaccination from expanded program on immunization (EPI) and consequent herd immunity of the general population. As at the end of February, 2016, 100 individuals were reported to have died out of 500 recorded cases. The infection may cause severe brain damage and kills at least 1 out of 10 individuals if quick interventions are not provided. The Ghana Health Service (GHS) and the Ministry of Health (MoH), together with other local and international stakeholders are working intensely to control the spread of the infection in affected communities with treatment and other health management programmes. This review presents a quick overview of meningitis in Ghana with emphasis on S. pneumoniae (responsible for about 70% of cases in the recent epidemic) together with some recommendations aimed at ensuring a "meningitis-free Ghana".
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14
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Kwambana-Adams BA, Asiedu-Bekoe F, Sarkodie B, Afreh OK, Kuma GK, Owusu-Okyere G, Foster-Nyarko E, Ohene SA, Okot C, Worwui AK, Okoi C, Senghore M, Otu JK, Ebruke C, Bannerman R, Amponsa-Achiano K, Opare D, Kay G, Letsa T, Kaluwa O, Appiah-Denkyira E, Bampoe V, Zaman SMA, Pallen MJ, D'Alessandro U, Mwenda JM, Antonio M. An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana. BMC Infect Dis 2016; 16:575. [PMID: 27756235 PMCID: PMC5070171 DOI: 10.1186/s12879-016-1914-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 06/17/2016] [Accepted: 10/11/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). METHODS Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. RESULTS Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. CONCLUSION The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.
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Affiliation(s)
- Brenda Anna Kwambana-Adams
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | | | | | | | - Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | | | | | - Archibald Kwame Worwui
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Catherine Okoi
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Madikay Senghore
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Jacob Kweku Otu
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Chinelo Ebruke
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia
| | - Richard Bannerman
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | - David Opare
- National Public Health Reference Laboratory, Ghana Health Service, Accra, Ghana
| | - Gemma Kay
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Timothy Letsa
- Brong Ahafo Regional Health Directorate, Sunyani, Brong Ahafo, Ghana
| | | | | | | | - Syed M A Zaman
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Mark J Pallen
- Microbiology and Infection Unit, Warwick Medical School, Warwick, UK
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Martin Antonio
- Vaccines and Immunity Theme, The Medical Research Council Unit The Gambia, P.O Box 273, Banjul, Fajara, The Gambia. .,Microbiology and Infection Unit, Warwick Medical School, Warwick, UK. .,London School of Hygiene and Tropical Medicine, London, UK.
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Eibach D, Herrera-León S, Gil H, Hogan B, Ehlkes L, Adjabeng M, Kreuels B, Nagel M, Opare D, Fobil JN, May J. Molecular Epidemiology and Antibiotic Susceptibility of Vibrio cholerae Associated with a Large Cholera Outbreak in Ghana in 2014. PLoS Negl Trop Dis 2016; 10:e0004751. [PMID: 27232338 PMCID: PMC4883745 DOI: 10.1371/journal.pntd.0004751] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 01/26/2016] [Accepted: 05/11/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ghana is affected by regular cholera epidemics and an annual average of 3,066 cases since 2000. In 2014, Ghana experienced one of its largest cholera outbreaks within a decade with more than 20,000 notified infections. In order to attribute this rise in cases to a newly emerging strain or to multiple simultaneous outbreaks involving multi-clonal strains, outbreak isolates were characterized, subtyped and compared to previous epidemics in 2011 and 2012. METHODOLOGY/PRINCIPAL FINDINGS Serotypes, biotypes, antibiotic susceptibilities were determined for 92 Vibrio cholerae isolates collected in 2011, 2012 and 2014 from Southern Ghana. For a subgroup of 45 isolates pulsed-field gel electrophoresis, multilocus sequence typing and multilocus-variable tandem repeat analysis (MLVA) were performed. Eighty-nine isolates (97%) were identified as ctxB (classical type) positive V. cholerae O1 biotype El Tor and three (3%) isolates were cholera toxin negative non-O1/non-O139 V. cholerae. Among the selected isolates only sulfamethoxazole/trimethoprim resistance was detectable in 2011, while 95% of all 2014 isolates showed resistance towards sulfamethoxazole/trimethoprim, ampicillin and reduced susceptibility to ciprofloxacin. MLVA achieved the highest subtype discrimination, revealing 22 genotypes with one major outbreak cluster in each of the three outbreak years. Apart from those clusters genetically distant genotypes circulate during each annual epidemic. CONCLUSIONS/SIGNIFICANCE This analysis suggests different endemic reservoirs of V. cholerae in Ghana with distinct annual outbreak clusters accompanied by the occurrence of genetically distant genotypes. Preventive measures for cholera transmission should focus on aquatic reservoirs. Rapidly emerging multidrug resistance must be monitored closely.
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Affiliation(s)
- Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- * E-mail:
| | - Silvia Herrera-León
- National Center of Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Horacio Gil
- National Center of Microbiology, Institute of Health Carlos III, Madrid, Spain
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Benedikt Hogan
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany
| | - Lutz Ehlkes
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany
| | - Michael Adjabeng
- Ghana Health Service, Disease Surveillance Service, Accra, Ghana
| | - Benno Kreuels
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany
- University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Nagel
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - David Opare
- Ghana Health Service, National Public Health and Reference Laboratory (NPHRL), Accra, Ghana
| | - Julius N Fobil
- Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Borstel-Lübeck, Germany
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Kuma G, Opintan J, Sackey S, Opare D, Dongdem A, Aryee E, Antwi L, Ofosu-Appiah L, Owusu-Okyere G. Antibiotic resistant patterns amongst clinical Vibrio cholerae O1 isolates from the Greater Accra Region, Ghana-2013. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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17
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Torondel B, Opare D, Brandberg B, Cobb E, Cairncross S. Efficacy of Moringa oleifera leaf powder as a hand-washing product: a crossover controlled study among healthy volunteers. Altern Ther Health Med 2014; 14:57. [PMID: 24528477 PMCID: PMC3930822 DOI: 10.1186/1472-6882-14-57] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Moringa oleifera is a plant found in many tropical and subtropical countries. Many different uses and properties have been attributed to this plant, mainly as a nutritional supplement and as a water purifier. Its antibacterial activity against different pathogens has been described in different in vitro settings. However the potential effect of this plant leaf as a hand washing product has never been studied. The aim of this study is to test the efficacy of this product using an in vivo design with healthy volunteers. METHODS The hands of fifteen volunteers were artificially contaminated with Escherichia coli. Moringa oleifera leaf powder was tested as a hand washing product and was compared with reference non-medicated liquid soap using a cross over design following an adaptation of the European Committee for Standardization protocol (EN 1499). In a second part of tests, the efficacy of the established amount of Moringa oleifera leaf powder was compared with an inert powder using the same protocol. RESULTS Application of 2 and 3 g of dried Moringa oleifera leaf powder (mean log10-reduction: 2.44 ± 0.41 and 2.58 ± 0.34, respectively) was significantly less effective than the reference soap (3.00 ± 0.27 and 2.99 ± 0.26, respectively; p < 0.001). Application of the same amounts of Moringa oleifera (2 and 3 g) but using a wet preparation, was also significantly less effective than reference soap (p < 0.003 and p < 0.02, respectively). However there was no significant difference when using 4 g of Moringa oleifera powder in dried or wet preparation (mean log10-reduction: 2.70 ± 0.27 and 2.91 ± 0.11, respectively) compared with reference soap (2.97 ± 0.28). Application of calcium sulphate inert powder was significantly less effective than the 4 g of Moringa oleifera powder (p < 0.01). CONCLUSION Four grams of Moringa oleifera powder in dried and wet application had the same effect as non-medicated soap when used for hand washing. Efficacious and available hand washing products could be useful in developing countries in controlling pathogenic organisms that are transmitted through contaminated hands.
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