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Hedtke SM, Kode A, Ukety TO, Mande JL, Abhafule GM, Raciu AA, Uvon CB, Jada SR, Hotterbeekx A, Siewe Fodjo JN, Mitreva M, Sebit W, Colebunders R, Grant WN, Kuesel AC. Procedure for Handling and Storage of Onchocerca volvulus Microfilariae Obtained from Skin Snips for Downstream Genetic Work. Trop Med Infect Dis 2023; 8:445. [PMID: 37755906 PMCID: PMC10536066 DOI: 10.3390/tropicalmed8090445] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
WHO and endemic countries target elimination of transmission of Onchocerca volvulus, the parasite causing onchocerciasis. Population genetic analysis of O. volvulus may provide data to improve the evidence base for decisions on when, where, and for how long to deploy which interventions and post-intervention surveillance to achieve elimination. Development of necessary methods and tools requires parasites suitable for genetic analysis. Based on our experience with microfilariae obtained from different collaborators, we developed a microfilariae transfer procedure for large-scale studies in the Democratic Republic of Congo (DRC) comparing safety and efficacy of ivermectin, the mainstay of current onchocerciasis elimination strategies, and moxidectin, a new drug. This procedure is designed to increase the percentage of microfilariae in skin snips suitable for genetic analysis, improve assignment to metadata, and minimize time and materials needed by the researchers collecting the microfilariae. Among 664 microfilariae from South Sudan, 35.7% and 39.5% failed the mitochondrial and nuclear qPCR assay. Among the 576 microfilariae from DRC, 16.0% and 16.7% failed these assays, respectively. This difference may not only be related to the microfilariae transfer procedure but also to other factors, notably the ethanol concentration in the tubes in which microfilariae were stored (64% vs. ≥75%).
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Affiliation(s)
- Shannon M Hedtke
- Department of Environment and Genetics, La Trobe University, Bundoora, VIC 3086, Australia
| | - Anusha Kode
- Department of Environment and Genetics, La Trobe University, Bundoora, VIC 3086, Australia
| | - Tony O Ukety
- Centre de Recherche en Maladies Tropicales (CRMT), Bunia P.O. Box 143, Democratic Republic of the Congo
| | - Jöel L Mande
- Centre de Recherche en Maladies Tropicales (CRMT), Bunia P.O. Box 143, Democratic Republic of the Congo
| | - Germain M Abhafule
- Centre de Recherche en Maladies Tropicales (CRMT), Bunia P.O. Box 143, Democratic Republic of the Congo
| | - Anuarite A Raciu
- Centre de Recherche en Maladies Tropicales (CRMT), Bunia P.O. Box 143, Democratic Republic of the Congo
| | - Claude B Uvon
- Centre de Recherche en Maladies Tropicales (CRMT), Bunia P.O. Box 143, Democratic Republic of the Congo
| | | | - An Hotterbeekx
- Global Health Institute, University of Antwerp, 2610 Antwerp, Belgium
| | | | - Makedonka Mitreva
- Department of Medicine, Washington University in St. Louis and McDonnell Genome Institute, St. Louis, MO 63108, USA
| | - Wilson Sebit
- National Public Health Laboratory, Juba P.O. Box 88, South Sudan
| | | | - Warwick N Grant
- Department of Environment and Genetics, La Trobe University, Bundoora, VIC 3086, Australia
| | - Annette C Kuesel
- UNICEF/UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, CH-1211 Geneva, Switzerland
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Sanders AM, Makoy S, Deathe AR, Ohidor S, Jesudason TC, Nute AW, Odongi P, Boniface L, Abuba S, Delahaut AS, Sebit W, Niquette J, Callahan EK, Walker DG, Nash SD. Cost and community acceptability of enhanced antibiotic distribution approaches for trachoma in the Republic of South Sudan: enhancing the A in SAFE (ETAS) study protocol. BMC Ophthalmol 2023; 23:51. [PMID: 36747194 PMCID: PMC9900535 DOI: 10.1186/s12886-023-02783-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The World Health Organization targeted trachoma for global elimination as a public health problem by 2030. Reaching elimination thresholds by the year 2030 in the Republic of South Sudan will be a considerable challenge, as the country currently has many counties considered hyper-endemic (> 30% trachomatous inflammation-follicular [TF]) that have yet to receive interventions. Evidence from randomized trials, modeling, and population-based surveys suggests that enhancements may be needed to the standard-of-care annual mass drug administration (MDA) to reach elimination thresholds in a timely manner within highly endemic areas. We describe a protocol for a study to determine the cost and community acceptability of enhanced antibiotic strategies for trachoma in South Sudan. METHODS The Enhancing the A in SAFE (ETAS) study is a community randomized intervention costing and community acceptability study. Following a population-based trachoma prevalence survey in 1 county, 30 communities will be randomized 1:1 to receive 1 of 2 enhanced MDA interventions, with the remaining communities receiving standard-of-care annual MDA. The first intervention strategy will consist of a community-wide MDA followed by 2 rounds of targeted treatment to children ages 6 months to 9 years, 2 weeks and 4 weeks after the community MDA. The second strategy will consist of a community-wide biannual MDA approximately 6 to 8 months apart. The costing analysis will use a payer perspective and identify the total cost of the enhanced interventions and annual MDA. Community acceptability will be assessed through MDA coverage monitoring and mixed-methods research involving community stakeholders. A second trachoma-specific survey will be conducted 12 months following the original survey. DISCUSSION ETAS has received ethical clearance and is expected to be conducted between 2022 and 2023. Results will be shared through subsequent manuscripts. The study's results will provide information to trachoma programs on whether enhanced interventions are affordable and acceptable to communities. These results will further help in the design of future trachoma-specific antibiotic efficacy trials. Enhanced MDA approaches could help countries recover from delays caused by conflict or humanitarian emergencies and could also assist countries such as South Sudan in reaching trachoma elimination as a public health problem by 2030. TRIAL REGISTRATION This trial was registered on December 1st, 2022 (clinicaltrails.org: NCT05634759).
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Affiliation(s)
| | - Samuel Makoy
- Ministry of Health, Juba, Republic of South Sudan
| | - Andrew R. Deathe
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Andrew W. Nute
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
| | | | | | - Stella Abuba
- The Carter Center, Juba, Republic of South Sudan
| | | | - Wilson Sebit
- Ministry of Health, Juba, Republic of South Sudan
| | | | | | | | - Scott D. Nash
- grid.418694.60000 0001 2291 4696The Carter Center, Atlanta, GA USA
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Hotterbeekx A, Raimon S, Abd-Elfarag G, Carter JY, Sebit W, Suliman A, Siewe Fodjo JN, De Witte P, Logora MY, Colebunders R, Kumar-Singh S. Onchocerca volvulus is not detected in the cerebrospinal fluid of persons with onchocerciasis-associated epilepsy. Int J Infect Dis 2019; 91:119-123. [PMID: 31786246 PMCID: PMC6996151 DOI: 10.1016/j.ijid.2019.11.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 10/23/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Epidemiological evidence links onchocerciasis with the development of epilepsy. The aim of this study was to detect Onchocerca volvulus microfilariae or its bacterial endosymbiont, Wolbachia, in the cerebrospinal fluid (CSF) of persons with onchocerciasis-associated epilepsy (OAE). METHODS Thirteen persons with OAE and O. volvulus skin snip densities of >80 microfilariae were recruited in Maridi County (South Sudan) and their CSF obtained. Cytospin centrifuged preparations of CSF were examined by light microscopy for the presence of O. volvulus microfilariae. DNA was extracted from CSF to detect O. volvulus (O-150 repeat) by quantitative real-time PCR, and Wolbachia (FtsZ gene) by standard PCR. To further investigate whether CSF from onchocerciasis-infected participants could induce seizures, 3- and 7-day old zebrafish larvae were injected with the CSF intracardially and intraperitoneally, respectively. For other zebrafish larvae, CSF was added directly to the larval medium. RESULTS No microfilariae, parasite DNA, or Wolbachia DNA were detected in any of the CSF samples by light microscopy or PCR. All zebrafish survived the procedures and none developed seizures. CONCLUSIONS The absence of O. volvulus in the CSF suggests that OAE is likely not caused by direct parasite invasion into the central nervous system, but by another phenomenon triggered by O. volvulus infection.
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Affiliation(s)
- An Hotterbeekx
- Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | | | - Gasim Abd-Elfarag
- Global Child Health Group, Department of Paediatrics and Department of Global Health, Academic Medical Center, University of Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
| | | | - Wilson Sebit
- National Public Health Laboratory, Juba, South Sudan.
| | | | | | - Peter De Witte
- Moleculaire bio-ontdekking, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Makoy Yibi Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Juba, South Sudan.
| | | | - Samir Kumar-Singh
- Molecular Pathology Group, Laboratory of Cell Biology and Histology, Faculty of Medical and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Bukachi SA, Mumbo AA, Alak ACD, Sebit W, Rumunu J, Biéler S, Ndung'u JM. Knowledge, attitudes and practices about human African trypanosomiasis and their implications in designing intervention strategies for Yei county, South Sudan. PLoS Negl Trop Dis 2018; 12:e0006826. [PMID: 30273342 PMCID: PMC6181432 DOI: 10.1371/journal.pntd.0006826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 11/14/2017] [Revised: 10/11/2018] [Accepted: 09/11/2018] [Indexed: 02/01/2023] Open
Abstract
Background A clear understanding of the knowledge, attitudes and practices (KAP) of a particular community is necessary in order to improve control of human African trypanosomiasis (HAT).New screening and diagnostic tools and strategies were introduced into South Sudan, as part of integrated delivery of primary healthcare. Knowledge and awareness on HAT, its new/improved screening and diagnostic tools, the places and processes of getting a confirmatory diagnosis and treatment are crucial to the success of this strategy. Methodology A KAP survey was carried out in Yei County, South Sudan, to identify gaps in community KAP and determine the preferred channels and sources of information on the disease. The cross-sectional KAP survey utilized questionnaires, complemented with key informant interviews and a focus group discussion to elicit communal as well as individual KAP on HAT. Findings Most (90%) of the respondents had general knowledge on HAT. Lower levels of education, gender and geographic locations without a history of HAT interventions were associated with incorrect knowledge and/or negative perceptions about the treatability of HAT. Symptoms appearing in the late stage were best known. A majority (97.2%) would seek treatment for HAT only in a health centre. However, qualitative data indicates that existing myths circulating in the popular imagination could influence people’s practices. Seventy-one percent of the respondents said they would offer social support to patients with HAT but qualitative data highlights that stigma still exists. Misconceptions and stigma can negatively influence the health seeking behaviour of HAT cases. In relation to communication, the top preferred and effective source of communication was radio (24%). Conclusion Gaps in relation to KAP on HAT still exist in the community. Perceptions on HAT, specifically myths and stigma, were key gaps that need to be bridged through effective education and communication strategies for HAT control alongside other interventions. Misconceptions about sleeping sickness, a neglected tropical disease transmitted by tsetse flies, can be a hindrance to effective implementation of control interventions especially in the face of accelerating work to eliminate the disease. Understanding community knowledge, attitudes and practices about sleeping sickness is important in developing appropriate material for educating and sensitizing communities at risk of the disease. We conducted a study to establish community knowledge, attitudes and practices, including preferred channels of disseminating sleeping sickness information. Despite the fact that the community in Yei County knew about the disease, existing myths and stigma have the potential of influencing their health seeking behaviour. The radio, community health workers and village elders were the most preferred sources of sharing information with the community. There is need to develop education and awareness material to address issues of existing myths, potential stigma, treat ability of HAT, importance of testing and treatment, as well as provide information on the new/improved testing and treatment approaches for HAT. In addition, this should be provided through use of preferred and trusted sources of information dissemination, which is critical in uptake of HAT control, management and prevention activities.
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Affiliation(s)
- Salome A. Bukachi
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya
- Research and Development, Passion Africa Limited, Nairobi, Kenya
- * E-mail:
| | - Angeline A. Mumbo
- South Sudan Coordination Office, Malteser International, Juba, Republic of South Sudan
| | - Ayak C. D. Alak
- Preventive Health Services, Ministry of Health, Juba, Republic of South Sudan
| | - Wilson Sebit
- Preventive Health Services, Ministry of Health, Juba, Republic of South Sudan
| | - John Rumunu
- Preventive Health Services, Ministry of Health, Juba, Republic of South Sudan
| | - Sylvain Biéler
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Joseph M. Ndung'u
- Neglected Tropical Diseases, Foundation for Innovative New Diagnostics, Geneva, Switzerland
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