Investigation of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infections among health care workers - Lusaka District, Zambia, April-June 2020

Introduction: Zambia is experiencing an epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19). Infections initially sporadic, but community transmission began to occur widely in late June 2020. Over 100 health care workers (HCWs) reported infected with SARS-CoV-2 in Lusaka District. We investigated factors associated with SARS-CoV-2 infections among HCWs in four hospitals in Lusaka District during April to June 2020. Methods: Case control study among HCWs with confirmed SARS-CoV-2 infections at Levy Mwanawasa Hospital, Cancer Disease Hospital, Chilenje First level Hospital, and Women and Newborn Hospital in April to June 2020. Controls drawn from HCWs working in a department within 14 days before a positive test of cases. Standardized questionnaire assessing demographics, medical history, exposures, and infection prevention practices administered. Logistic regression conducted to assess associations with SARS-CoV-2 infection, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results: Forty-three cases occurred in four facilities from April through June 2020. We interviewed 39 cases and 101 controls. Median age was 33 years (interquartile range: 28, 38). Twenty-nine (74%) cases self-reported being asymptomatic. Most (25(65.8%)) cases tested positive during HCW screening with no known HCW index case. Unknown exposure status in facilities had increased odds of acquiring SARS-CoV-2 compared to known exposure (OR = 4.5 (95% CI: 1.73, 11.9)). Low adherence to handwashing (OR=4.53 (95% CI: 1.74, 11.8)) and inadequate use of personal protective equipment (OR=2.87 (1.20, 6.87)) increased odds of having SARS-CoV-2. Conclusion: Low adherence to personal protective measures like hand washing, PPE use and absence of knowledge about potential SARS-CoV-2 exposures in health facilities suggest that transmission could have occurred in health facilities. Routine HCW screening for early identification and isolation of cases to minimise nosocomial transmission is recommended

Mumps outbreak in an unimmunized population – Luanshya District, Copperbelt Province, Zambia, 2015

Introduction: mumps is a vaccine-preventable viral disease that may cause deafness, orchitis, encephalitis or death. However, mumps vaccine is not included in Zambia’s Expanded Program for Immunization. In January 2015, Integrated Disease Surveillance and Response data revealed an increase in reported mumps cases in Luanshya District. We investigated to confirm the etiology and generate epidemiological data on mumps in Zambia. Methods: we conducted active case finding, examined possible case-patients, and administered a standard questionnaire. A suspected mumps case was defined as acute onset of salivary gland swelling in a Luanshya resident during January - June 2015. Eight case-patients provided serum samples to test for mumps-specific immunoglobulin IgM, and buccal swabs to test for mumps viral RNA by RT-PCR, and genotyping of mumps virus at the Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Results: from January – June 2015, a total of 283 mumps cases were reported in Luanshya, peaking in April (71 cases) and clustering (81%) in two townships. Of 72 suspected case-patients interviewed, 81% were aged < 15 years (29%, 1 - 4 years) and 61% were female. Common clinical characteristics were buccal tenderness (29%) and fever > 37.5ºC (29%). Mumps virus genotype D was confirmed in five case-patients who tested positive by RT-PCR; six case-patients were sero-positive for anti-mumps IgM antibodies (total seven lab-confirmed cases). Conclusion: our findings represent the first reported epidemiologic description of mumps in Zambia. While the epidemiology is consistent with prior descriptions of mumps in unimmunized populations and no serious complications arose, this report provides data to inform policy discussions regarding mumps vaccination in Zambia

Zambia field epidemiology training program: strengthening health security through workforce development

The Zambia Field Epidemiology Training Program (ZFETP) was established by the Ministry of Health (MoH) during 2014, in order to increase the number of trained field epidemiologists who can investigate outbreaks, strengthen disease surveillance, and support data-driven decision making. We describe the ZFETP´s approach to public health workforce development and health security strengthening, key milestones five years after program launch, and recommendations to ensure program sustainability. Program description: ZFETP was established as a tripartite arrangement between the Zambia MoH, the University of Zambia School of Public Health, and the U.S. Centers for Disease Control and Prevention. The program runs two tiers: Advanced and Frontline. To date, ZFETP has enrolled three FETP-Advanced cohorts (training 24 residents) and four Frontline cohorts (training 71 trainees). In 2016, ZFETP moved organizationally to the newly established Zambia National Public Health Institute (ZNPHI). This re-positioning raised the program´s profile by providing residents with increased opportunities to lead high-profile outbreak investigations and analyze national surveillance data-achievements that were recognized on a national stage. These successes attracted investment from the Government of Republic of Zambia (GRZ) and donors, thus accelerating field epidemiology workforce capacity development in Zambia. In its first five years, ZFETP achieved early success due in part to commitment from GRZ, and organizational positioning within the newly formed ZNPHI, which have catalyzed ZFETP´s institutionalization. During the next five years, ZFETP seeks to sustain this momentum by expanding training of both tiers, in order to accelerate the professional development of field epidemiologists at all levels of the public health system