Cholera outbreak in Andoni Local Government Area, Rivers State, Nigeria; January 2015: the role of hand washing with soap

Background: In January 2015, an outbreak of cholera occurred in Andoni, Rivers State. We investigated to identify risk factors for infection and institute control measures.Methods: An un-matched case-control study with 62 cases and 62 neighborhood controls was conducted. A case was defined as an individual aged 5 years or more with three or more episodes of loose watery stool with or without vomiting residing in Andoni from 11th-18th January 2015. A control was a person without history of loose watery stool and vomiting, but residing in Andoni. A Semi-structured questionnaire was used to collect data on demographic characteristics, clinical information and risk factors. Univariate, bivariate and multivariate analysis was performed using Epi-info version 7. Twenty-one stool samples and 6 water samples from open wells and ponds were analyzed.Result: Median ages for cases and controls were 8.5 (range; 2– 65) and 18 (2–70) years respectively. Females were 32(51.6%) of cases and 36 (56.5%) of controls. The cases and controls did not differ in age and sex. Cases were less likely than controls to wash hands with soap after using the toilet (OR:0.4, Cl:0.17–0.96) and to drink from tap water (OR:0.09, 95% CI:0.01–0.69). Hand washing with soap and water remained protective of the disease after controlling for potential confounders. Eleven (52.4%) of the clinical samples and 6 (100%) of the water samples yielded vibrio cholera non O1/O139.Conclusion: Unhygienic hand washing practices was identified as a risk factor for cholera infection. The source of the outbreak possibly resulted from contaminated wells and ponds. We provided community health education on personal hygiene, with emphasis on hand washing with soap, and recommended super chlorination of wells

Methanol poisoning in South- South Nigeria: Reflections on the outbreak response

The methanol poisoning outbreak in Rivers State in May 2015, involved 84 persons in five local government areas. An incident management system comprised of an Emergency Preparedness and Response (EPR) committee and the Local Government Area Rapid Response Teams in an Emergency Operations Centre (EOC). The EOC teams conducted case finding activities, line listing, and descriptive analysis, a retrospective cohort study and collection of local gin samples for laboratory investigation. They also coordinated community mobilization and sensitization activities, intervention meetings with local gin sellers, trace back activities and case management. Those affected were male (72; 85.7%) aged between 20 and 79 years. Of the 55 persons whose socio-demographics were obtained, forty-one persons (74.6%) were married, and 23 (41.8%) had primary education. Case fatality rate was 83.3% with an attack rate of 16 per 100,000 persons. Those exposed to ingestion of adulterated gin were six times more likely to develop methanol poisoning than those not exposed RR=6 (1.0-38.5); P=0.0078. It is hoped that this experience has positioned the state for better preparedness towards future outbreaks

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Improvement in the Surveillance System for Livestock Diseases and Antimicrobial Use Following Operational Research Studies in Sierra Leone January–March 2023

In Sierra Leone, two operational research (OR) studies in 2019 and 2021 showed deficiencies in the data being captured by the Integrated Animal Disease Surveillance and Reporting (IADSR) system. This third OR study was conducted in 2023 to assess whether the second OR study’s results and recommendations were disseminated with the key stakeholders, the uptake of the recommendations, improvements in data capture in the IADSR system, and to describe the data on livestock disease and antimicrobial use. In 2022, on seven occasions, the authors of the second OR study disseminated the study’s findings. Of the four recommendations, the one on improving laboratory infrastructure for confirmation of animal disease was not implemented. The district animal health weekly surveillance reports received through the IADSR system were sustained at 88% between the second (2021) and third (2023) studies. In both studies, the proportion of sick animals receiving antibiotics (25%) remained the same, but the use of “critically important antimicrobials for veterinary use” declined from 77% (in 2021) to 69% (in 2023). The IADSR system has improved considerably in providing information on animal health and antibiotic use, and sequential OR studies have played a key role in its improvement