#Effects of #Response to 2014–2015 #Ebola #Outbreak on #Deaths from #Malaria, #HIV/AIDS, and #Tuberculosis, West #Africa (@CDC_EIDjournal, abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 22, Number 3—March 2016  / Research

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa  [      ]

Alyssa S. Parpia, Martial L. Ndeffo-Mbah, Natasha S. Wenzel, and Alison P. Galvani

Author affiliations: Yale School of Public Health, New Haven, Connecticut, USA

 

Abstract

Response to the 2014–2015 Ebola outbreak in West Africa overwhelmed the healthcare systems of Guinea, Liberia, and Sierra Leone, reducing access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS, and tuberculosis. To estimate the repercussions of the Ebola outbreak on the populations at risk for these diseases, we developed computational models for disease transmission and infection progression. We estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 (2,564–12,407) in Guinea; 1,535 (522–2,8780) in Liberia; and 2,819 (844–4,844) in Sierra Leone. The 2014–2015 Ebola outbreak was catastrophic in these countries, and its indirect impact of increasing the mortality rates of other diseases was also substantial.

Keywords: Research; Abstracts; Ebola; African Region.

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Reconstruction of the #Evolutionary #History and Dispersal of #Usutu #Virus, a Neglected Emerging #Arbovirus in #Europe and #Africa (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

Reconstruction of the Evolutionary History and Dispersal of Usutu Virus, a Neglected Emerging Arbovirus in Europe and Africa [      ]

Dimitri Engel a, Hanna Jöst a, Michael Wink b, Jessica Börstler a, Stefan Boschc, Mutien-Marie Garigliany d, Artur Jöst e, Christina Czajka a,e, Renke Lühken a, Ute Ziegler f, Martin H. Groschup f, Martin Pfeffer g, Norbert Becker e, Daniel Cadar a, Jonas Schmidt-Chanasit a,h

Author Affiliations: aBernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Hemorrhagic Fever Reference and Research, Hamburg, Germany bInstitute of Pharmacy and Molecular Biotechnology, Heidelberg University, Heidelberg, Germany cNature and Biodiversity Conservation Union (NABU), Stuttgart, Germany dDepartment of Veterinary Pathology, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium eGerman Mosquito Control Association (KABSeV), Speyer, Germany fFriedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Novel and Emerging Infectious Diseases, Greifswald-Insel Riems, Germany gFaculty of Veterinary Medicine, Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany hGerman Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany

Address correspondence to Daniel Cadar, danielcadar@gmail.com.

D.E., H.J., D.C., and J.S.-C. contributed equally to this article.

Editor Xiang-Jin Meng, Virginia Polytechnic Institute and State University

 

ABSTRACT

Usutu virus (USUV), one of the most neglected Old World encephalitic flaviviruses, causes epizootics among wild and captive birds and sporadic infection in humans. The dynamics of USUV spread and evolution in its natural hosts are unknown. Here, we present the phylogeny and evolutionary history of all available USUV strains, including 77 newly sequenced complete genomes from a variety of host species at a temporal and spatial scaled resolution. The results showed that USUV can be classified into six distinct lineages and that the most recent common ancestor of the recent European epizootics emerged in Africa at least 500 years ago. We demonstrated that USUV was introduced regularly from Africa into Europe in the last 50 years, and the genetic diversity of European lineages is shaped primarily by in situ evolution, while the African lineages have been driven by extensive gene flow. Most of the amino acid changes are deleterious polymorphisms removed by purifying selection, with adaptive evolution restricted to the NS5 gene and several others evolving under episodic directional selection, indicating that the ecological or immunological factors were mostly the key determinants of USUV dispersal and outbreaks. Host-specific mutations have been detected, while the host transition analysis identified mosquitoes as the most likely origin of the common ancestor and birds as the source of the recent European USUV lineages. Our results suggest that the major migratory bird flyways could predict the continental and intercontinental dispersal patterns of USUV and that migratory birds might act as potential long-distance dispersal vehicles.

 

IMPORTANCE

Usutu virus (USUV), a mosquito-borne flavivirus of the Japanese encephalitis virus antigenic group, caused massive bird die-offs, mostly in Europe. There is increasing evidence that USUV appears to be pathogenic for humans, becoming a potential public health problem. The emergence of USUV in Europe allows us to understand how an arbovirus spreads, adapts, and evolves in a naive environment. Thus, understanding the epidemiological and evolutionary processes that contribute to the emergence, maintenance, and further spread of viral diseases is the sine qua non to develop and implement surveillance strategies for their control. In this work, we performed an expansive phylogeographic and evolutionary analysis of USUV using all published sequences and those generated during this study. Subsequently, we described the genetic traits, reconstructed the potential pattern of geographic spread between continents/countries of the identified viral lineages and the drivers of viral migration, and traced the origin of outbreaks and transition events between different hosts.

 

Footnotes

Citation Engel D, Jöst H, Wink M, Börstler J, Bosch S, Garigliany M, Jöst A, Czajka C, Lühken R, Ziegler U, Groschup MH, Pfeffer M, Becker N, Cadar D, Schmidt-Chanasit J. 2016. Reconstruction of the evolutionary history and dispersal of Usutu virus, a neglected emerging arbovirus in Europe and Africa. mBio 7(1):e01938-15. doi:10.1128/mBio.01938-15.

Received 6 November 2015 – Accepted 28 December 2015 – Published 2 February 2016

Copyright © 2016 Engel et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-ShareAlike 3.0 Unported license, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Keywords: Research; Abstracts; Usutu Virus; Arbovirus; Flavivirus; Africa; Europe.

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#Residency #Training at the Front of the West African #Ebola #Outbreak: Adapting for a Rare Opportunity (Plos Curr Outbreaks, abstract)

[Source: PLoS Currents Outbreaks, full page: (LINK). Abstract, edited.]

Residency Training at the Front of the West African Ebola Outbreak: Adapting for a Rare Opportunity [      ]

February 2, 2016 · Discussion

Citation: Mo Y, Archuleta S, Salmon S, Fisher D. Residency Training at the Front of the West African Ebola Outbreak: Adapting for a Rare Opportunity. PLOS Currents Outbreaks. 2016 Feb 2 . Edition 1. doi: 10.1371/currents.outbreaks.2ccbcab30e96d3fe28d3896d258b818e.

 

Abstract

Medical trainees face multiple barriers to participation in major outbreak responses such as that required for Ebola Virus Disease through 2014-2015 in West Africa. Hurdles include fear of contracting and importing the disease, residency requirements, scheduling conflicts, family obligations and lack of experience and maturity. We describe the successful four-week deployment to Liberia of a first year infectious diseases trainee through the mechanism of the Global Outbreak Alert and Response Network of the World Health Organization. The posting received prospective approval from the residency supervisory committees and employing hospital management and was designed with components fulfilling the Accreditation Council for Graduate Medical Education (ACGME) core competencies. It mirrored conventional training with regards to learning objectives, supervisory framework and assessment methods. Together with Centers for Disease Control and Prevention and many other partners, the team joined the infection prevention and control efforts in Monrovia. Contributions were made to a ‘ring fencing’ infection control approach that was being introduced, including enhancement of triage, training and providing supplies in high priority health-care facilities in the capital and border zones. In addition the fellow produced an electronic database that enabled monitoring infection control standards in health facilities. This successful elective posting illustrates that quality training can be achieved, even in the most challenging environments, with support from the pedagogic and sponsoring institutions. Such experiential learning opportunities benefit both the outbreak response and the trainee, and if scaled up would contribute towards building a global health emergency workforce. More should be done from residency accreditation bodies in facilitating postings in outbreak settings.

Funding Statement

There is no funding for this commentary article.

Keywords: Research; Abstracts; Ebola; Africa Region.

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#Historical #Parallels, #Ebola Virus Disease and #Cholera: Understanding #Community #Distrust and #Social #Violence with #Epidemics (PLoS Currents Outbreaks, abstract)

[Source: PLoS Currents Outbreaks, full page: (LINK). Abstract, edited.]

Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics [      ]

January 26, 2016

Citation: Cohn S, Kutalek R. Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics. PLOS Currents Outbreaks. 2016 Jan 26 . Edition 1. doi: 10.1371/currents.outbreaks.aa1f2b60e8d43939b43fbd93e1a63a94.

 

Abstract

In the three West African countries most affected by the recent Ebola virus disease (EVD) outbreak, resistance to public health measures contributed to the startling speed and persistence of this epidemic in the region. But how do we explain this resistance, and how have people in these communities understood their actions? By comparing these recent events to historical precedents during Cholera outbreaks in Europe in the 19th century we show that these events have not been new to history or unique to Africa. Community resistance must be analysed in context and go beyond simple single-variable determinants. Knowledge and respect of the cultures and beliefs of the afflicted is essential for dealing with threatening disease outbreaks and their potential social violence.

 

Funding Statement

SC is funded by a ‘Major Research Fellowship’ from the Leverhulme Trust, from 1 September 2014 to 31 August 2017, MRF-2013-068; http://www.leverhulme.ac.uk. Both authors would like to acknowledge the funding of The Rockefeller Foundation for the conference “Fear of the Foreign: Pandemics and Xenophobia”, Bellagio Center, Italy, June 24, 2015, in which both authors were invited to participate. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Keywords: Research; Abstracts; Ebola; Africa Region.

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#Ebola #virus #disease #outbreak; the role of #field #epidemiology #training programme in the fight against the epidemic, #Liberia, 2014 (Pan Afr Med J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pan Afr Med J. 2015 Oct 10;22(Suppl 1):5.

Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014. [      ]

Lubogo M 1, Donewell B 2, Godbless L 3, Shabani S 3, Maeda J 3, Temba H 3, Malibiche TC 3, Berhanu N 4.

Author information: 1Field Epidemiology & Laboratory Training Program, Uganda. 2Field Epidemiology & Laboratory Training Program, Zimbabwe. 3Field Epidemiology & Laboratory Training Program, Tanzania. 4Field Epidemiology & Laboratory Training Program Ethiopia.

 

Abstract

The African Field Epidemiology Network (AFENET) is a public health network established in 2005 as a non-profit networking alliance of Field Epidemiology and Laboratory Training Programs (FELTPs) and Field Epidemiology Training Programs (FETPs) in Africa. AFENET is dedicated to supporting Ministries of Health in Africa build strong, effective and sustainable programs and capacity to improve public health systems by partnering with global public health experts. The Network’s goal is to strengthen field epidemiology and public health laboratory capacity to contribute effectively to addressing epidemics and other major public health problems in Africa. The goal for the establishment of FETP and FELTP was and still is to produce highly competent multi-disciplinary public health professionals who would assume influential posts in the public health structures and tackle emerging and re-emerging communicable and non-communicable diseases. AFENET currently networks 12 FELTPs and FETPs in sub-Saharan Africa with operations in 20 countries. During the Ebola Virus Disease (EVD) outbreak in West Africa, African Union Support for the Ebola Outbreak in West Africa (ASEOWA) supported FETP graduates from Uganda, Zimbabwe, Ethiopia and Tanzania for the investigation and control of the EVD outbreak in Liberia. The graduates were posted in different counties in Liberia where they lead teams of other experts conduct EVD outbreak investigations, Infection Control and Prevention trainings among health workers and communities, Strengthening integrated disease surveillance, developing Standard Operating Procedures for infection control and case notification in the Liberian setting as well as building capacity of local surveillance officers’ conduct outbreak investigation and contact tracing. The team was also responsible for EVD data management at the different Counties in Liberia. The FETP graduates have been instrumental in the earlier successes registered in various counties in Liberia in the control of the Ebola virus disease. Such efforts should be sustained by supporting local authorities develop strong health systems that are able to respond to epidemic of such magnitude in the near future.

KEYWORDS: EVD; Ebola; FETP; Liberia

PMID: 26779298 [PubMed – as supplied by publisher]

Keywords: Research; Abstracts; Ebola; Africa Region.

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Spatiotemporal #Evolution of #Ebola Virus #Disease at Sub-National Level during the 2014 West #Africa #Epidemic: Model Scrutiny and Data Meagreness (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

Open Access / Peer-reviewed / Research Article

Spatiotemporal Evolution of Ebola Virus Disease at Sub-National Level during the 2014 West Africa Epidemic: Model Scrutiny and Data Meagreness [      ]

Eva Santermans,  Emmanuel Robesyn,  Tapiwa Ganyani,  Bertrand Sudre,  Christel Faes,  Chantal Quinten,  Wim Van Bortel,  Tom Haber,  … Thomas Kovac,  Frank Van Reeth

Published: January 15, 2016  / DOI: 10.1371/journal.pone.0147172

 

Abstract

Background

The Ebola outbreak in West Africa has infected at least 27,443 individuals and killed 11,207, based on data until 24 June, 2015, released by the World Health Organization (WHO). This outbreak has been characterised by extensive geographic spread across the affected countries Guinea, Liberia and Sierra Leone, and by localized hotspots within these countries. The rapid recognition and quantitative assessment of localised areas of higher transmission can inform the optimal deployment of public health resources.

Methods

A variety of mathematical models have been used to estimate the evolution of this epidemic, and some have pointed out the importance of the spatial heterogeneity apparent from incidence maps. However, little is known about the district-level transmission. Given that many response decisions are taken at sub-national level, the current study aimed to investigate the spatial heterogeneity by using a different modelling framework, built on publicly available data at district level. Furthermore, we assessed whether this model could quantify the effect of intervention measures and provide predictions at a local level to guide public health action. We used a two-stage modelling approach: a) a flexible spatiotemporal growth model across all affected districts and b) a deterministic SEIR compartmental model per district whenever deemed appropriate.

Findings

Our estimates show substantial differences in the evolution of the outbreak in the various regions of Guinea, Liberia and Sierra Leone, illustrating the importance of monitoring the outbreak at district level. We also provide an estimate of the time-dependent district-specific effective reproduction number, as a quantitative measure to compare transmission between different districts and give input for informed decisions on control measures and resource allocation. Prediction and assessing the impact of control measures proved to be difficult without more accurate data. In conclusion, this study provides us a useful tool at district level for public health, and illustrates the importance of collecting and sharing data.

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Citation: Santermans E, Robesyn E, Ganyani T, Sudre B, Faes C, Quinten C, et al. (2016) Spatiotemporal Evolution of Ebola Virus Disease at Sub-National Level during the 2014 West Africa Epidemic: Model Scrutiny and Data Meagreness. PLoS ONE 11(1): e0147172. doi:10.1371/journal.pone.0147172

Editor: Luzia Helena Carvalho, Centro de Pesquisa Rene Rachou/Fundação Oswaldo Cruz (Fiocruz-Minas), BRAZIL

Received: August 25, 2015; Accepted: December 30, 2015; Published: January 15, 2016

Copyright: © 2016 Santermans et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All compiled data and code are available from a Github repository (DOI 10.5281/zenodo.33126).

Funding: ES acknowledges support from a Methusalem research grant from the Flemish government awarded to Herman Goossens (Antwerpen University) en Geert Molenberghs (Hasselt University). NH acknowledges support from the Antwerp University scientific chair in Evidence-Based Vaccinology, financed in 2009–2015 by an unrestricted gift from Pfizer. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have read the journal’s policy and have the following competing interests: Co-author Niel Hens received support from the University of Antwerp scientific chair in Evidence-Based Vaccinology, financed in 2009–2014 by a gift from Pfizer. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Keywords: Research; Abstracts; Ebola; African Region.

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#Ebola #Virus #Disease among #Male and #Female Persons in West #Africa (N Engl J Med., extract)

[Source: The New England Journal of Medicine, full page: (LINK). Extract, edited.]

Correspondence

Ebola Virus Disease among Male and Female Persons in West Africa [      ]

N Engl J Med 2016; 374:96-98 / January 7, 2016 / DOI: 10.1056/NEJMc1510305

______

To the Editor:

From December 2013 to August 11, 2015, a total of 20,035 confirmed and probable cases of Ebola virus disease (EVD) were reported in Guinea, Liberia, and Sierra Leone. There have been concerns that the different cultural roles or physiology of male and female persons may have resulted in the sexes being differently affected during this outbreak.1,2

(…)

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WHO Ebola Response Team

The study was conducted in support of the response to the Ebola outbreak in Guinea, Liberia, and Sierra Leone and is based on data routinely collected by national and international staff in conjunction with WHO.

Supported by the Medical Research Council, the Bill and Melinda Gates Foundation, the Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences (National Institutes of Health), the Health Protection Research Units of the National Institute for Health Research, the European Union PREDEMICS consortium, the Wellcome Trust, and Fogarty International Center.

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

The authors (members of the WHO Ebola Response Team who contributed to this letter, in alphabetical order) are as follows: Junerlyn Agua-Agum, M.P.H., Archchun Ariyarajah, M.Sc., Isobel M. Blake, Ph.D., Anne Cori, Ph.D., Christl A. Donnelly, Sc.D., Ilaria Dorigatti, Ph.D., Christopher Dye, D.Phil., Tim Eckmanns, M.D., Neil M. Ferguson, D.Phil., Christophe Fraser, Ph.D., Tini Garske, Ph.D., Wes Hinsley, Ph.D., Thibaut Jombart, Ph.D., Harriet L. Mills, Ph.D., Gemma Nedjati-Gilani, Ph.D., Emily Newton, B.Sc., Pierre Nouvellet, Ph.D., Devin Perkins, B.A., Steven Riley, D.Phil., Dirk Schumacher, M.Sc., Anita Shah, M.Sc., Lisa J. Thomas, M.D., and Maria D. Van Kerkhove, Ph.D.

The authors’ affiliations are as follows: Imperial College London, London (I.M.B., A.C., C.A.D., I.D., N.M.F., C.F., T.G., W.H., T.J., H.L.M., G.N.-G., P.N., S.R., M.D.V.K.); World Health Organization (WHO), Geneva (J.A.-A., A.A., C.D., T.E., E.N., D.P., D.S., A.S., L.J.T.); Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin (T.E.); and Center for Global Health, Institut Pasteur, Paris (M.D.V.K.).

 

Source Information

Address reprint requests to Dr. Donnelly (c.donnelly@imperial.ac.uk), Dr. Dye (dyec@who.int), or Dr. Ferguson (neil.ferguson@imperial.ac.uk).

Keywords: Research; Abstracts; Ebola; African Region.

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#Detection of #pandemic #strain of #influenza virus #H1N1pdm09 in #pigs, West #Africa: implications and #considerations for #prevention of future influenza pandemics at the source (Infect Ecol Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infect Ecol Epidemiol. 2015 Dec 28;5:30227. doi: 10.3402/iee.v5.30227. eCollection 2015.

Detection of pandemic strain of influenza virus (A/H1N1/pdm09) in pigs, West Africa: implications and considerations for prevention of future influenza pandemics at the source. [      ]

Adeola OA1,2, Olugasa BO1,3, Emikpe BO1,4,5.

Author information: 1Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Nigeria. 2Department of Medical Microbiology and Parasitology, College of Medicine, Bingham University, Karu, via Abuja, Nigeria; phamo2@yahoo.co.nz. 3Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria. 4Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Nigeria. 5Department of Veterinary Pathobiology, School of Veterinary Medicine, College of Health Sciences, Kwame Nkruma University of Science and Technology, Kumasi, Ghana.

 

Abstract

BACKGROUND:

Human and animal influenza are inextricably linked. In particular, the pig is uniquely important as a mixing vessel for genetic reassortment of influenza viruses, leading to emergence of novel strains which may cause human pandemics. Significant reduction in transmission of influenza viruses from humans, and other animals, to swine may therefore be crucial for preventing future influenza pandemics. This study investigated the presence of the 2009 pandemic influenza A/H1N1 virus, A(H1N1)pdm09, in Nigerian and Ghanaian pigs, and also determined levels of acceptance of preventive measures which could significantly reduce the transmission of this virus from humans to pigs.

METHODS:

Nasal swab specimens from 125 pigs in Ibadan, Nigeria, and Kumasi, Ghana, were tested for the presence of influenza A/California/04/2009 (H1N1) by quantitative antigen-detection ELISA. A semi-structured questionnaire was also administered to pig handlers in the two study areas and responses were analyzed to evaluate their compliance with seven measures for preventing human-to-swine transmission of influenza viruses.

RESULTS:

The virus was detected among pigs in the two cities, with prevalence of 8% in Ibadan and 10% in Kumasi. Levels of compliance of pig handlers with relevant preventive measures were also found to be mostly below 25 and 40% in Ibadan and Kumasi, respectively.

CONCLUSION:

Detection of influenza A(H1N1)pdm09 among pigs tested suggests the possibility of human-to-swine transmission, which may proceed even more rapidly, considering the very poor acceptance of basic preventive measures observed in this study. This is also the first report on detection of influenza A(H1N1)pdm09 in Ghanaian pigs. We recommend improvement on personal hygiene among pig handlers, enforcement of sick leave particularly during the first few days of influenza-like illnesses, and training of pig handlers on recognition of influenza-like signs in humans and pigs. These could be crucial for prevention of future influenza pandemics.

KEYWORDS:

Ghana; Nigeria; West Africa; human strain; influenza A(H1N1)pdm09; influenza pandemics; pigs; preventive measures; reverse zoonotic transmission

PMID: 26715380 [PubMed]

Keywords: Research; Abstracts; Seasonal Influenza; H1N1pdm09; Pigs; African Region.

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Preventive #malaria #treatment for #contacts of #patients with #Ebola virus disease in the context of the west #Africa 2014–15 Ebola virus disease response: an economic analysis (The Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Articles

Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014–15 Ebola virus disease response: an economic analysis [      ]

Cristina Carias, Bradford Greening, Caresse G Campbell, Martin I Meltzer, Mary J Hamel

Published Online: 16 December 2015 / Publication stage: In Press Corrected Proof / DOI: http://dx.doi.org/10.1016/S1473-3099(15)00465-X

© 2015 Elsevier Ltd. All rights reserved.

 

Summary

Background

After the detection of an Ebola virus disease outbreak in west Africa in 2014, one of the elements of the response was to contact trace and isolate patients in specialised Ebola treatment units (ETUs) at onset of fever. We aimed to assess the economic feasibility of administering preventive malaria treatment to all contacts of patients with Ebola virus disease, to prevent the onset of febrile malaria and subsequent admission to ETUs.

Methods

We used a decision tree model to analyse the costs of preventive malaria treatment (artemisinin-based combination treatment [ACT]) for all contacts of patients with Ebola virus disease (in terms of administration and averted ETU-stay costs) and benefits (in terms of averted ETU admissions) in west Africa, from a health-care provider perspective. The period of analyses was 1 year, which is roughly similar to the duration of the 2014–15 west Africa Ebola outbreak response. We calculated the intervention’s cost per ETU admission averted (average cost-effectiveness ratio) by season (wet and dry), country (Liberia, Sierra Leone, and Guinea), and age of contact (<5 years, 5–14 years, and ≥15 years). We did sensitivity analyses to assess how results varied with malaria parasite prevalence (in children aged 2–10 years), daily cost of ETU stay (for Liberian malaria incidence levels), and compliance and effectiveness of preventive malaria treatment.

Findings

Administration of ACTs to contacts of patients with Ebola virus disease was cost saving for contacts of all ages in Liberia, Sierra Leone, and Guinea, in both seasons, from a health-care provider perspective. In the wet season, preventive malaria treatment was estimated to reduce the probability of a contact being admitted to an ETU by a maximum of 36% (in Guinea, for contacts aged <5 years), and a minimum of 10% (in Guinea and Sierra Leone, for those aged ≥15 years). Assuming 85% compliance and taking into account the African population pyramid, the intervention is expected to be cost saving in contacts of all age groups in areas with malaria parasite prevalence in children aged 2–10 years as low as 10%. In Liberia during the wet season, malaria preventive treatment was cost saving even when average daily bed-stay costs were as low as US$5 for children younger than 5 years, $9 for those aged 5–14 years, and $22 for those aged 15 years or older.

Interpretation

Administration of preventive malaria treatment to contacts of patients with Ebola virus disease should be considered by public health officials when addressing Ebola virus disease outbreaks in countries and seasons where malaria reaches high levels of transmission.

Funding

Centers for Disease Control and Prevention.

Keywords: Research; Abstracts; Ebola; Malaria; African Region.

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#Africa- #Aflatoxins–#Poisoning #Health and #Trade (AllAfrica News, November 23 2015)

[Source: All Africa News, full page: (LINK).]

Africa- Aflatoxins – Poisoning Health and Trade [   !   ]

[IPS] Bulawayo -Aflatoxin contamination is a growing threat to trade, food and health security in sub-Saharan Africa, where smallholder farmers are challenged by food production and now climate change, researchers said.

(…)

Keywords: Africa; Food Safety; Aflatoxins.

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