2009 Pandemic Influenza A (H1N1) Virus Outbreak and Response – Rwanda, October, 2009–May, 2010

BACKGROUND: In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic. METHODS: From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC's real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases. RESULTS: From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2-15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532). CONCLUSIONS: Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system

A National Electronic System for Disease Surveillance in Rwanda (eIDSR): Lessons Learned from a Successful Implementation

The lessons learned from the nationwide implementation of an electronic disease surveillance system highlighted in this abstract can help to guide the successful implementation of an electronic disease surveillance system in developing countries

Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew - Haiti, 2016.

BackgroundOn October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti.MethodsWe developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success.ResultsOf the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for ConclusionsDespite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster

TRACnet: A National Phone-based and Web-based Tool for the Timely Integrated Disease Surveillance and Response in Rwanda

OBJECTIVE: (1) To describe the implementation of the electronic system for integrated disease surveillance in Rwanda. (2) To present the sensitivity and specificity of the electronic reporting system to detect potential outbreaks INTRODUCTION: In Rwanda, communicable diseases are the mostly predominant representing 90% of all reported medical consultations in health centers. The country has often faced epidemics including emerging and re-emerging infectious diseases. To enhance its preparedness to identify and respond to outbreaks and prevent epidemics, the Government of Rwanda has developed and deployed an electronic Integrated Disease Surveillance and Response (eIDSR) working with Voxiva with funding from the U.S. Centers for Disease Control and Prevention(CDC). METHODS: The eIDSR is built on Rwanda’s existing national phone and web-based HIV-reporting system, “TRACnet” that has been operating nationwide since 2004. Data is collected for 23 communicable diseases under surveillance in Rwanda categorized into immediately and weekly reportable. If a lab test is required, the sample is taken and sent to laboratory for testing. Immediate, Weekly, Lab request and lab results forms are completed before submitting data in the system. Data is entered using phone or web based application and is stored in the central database. RESULTS: The design of eIDSR module was completed in November 2011. As of September 2012, 252 out of 457 health facilities in Rwanda have been trained and are using the electronic system (over 50% of coverage); the national roll out is still going on with complete coverage planned for December 2012. The system sends SMS reminders for due and overdue reports. The timeliness and completeness of reporting are 98% and 100% respectively. Notifications are sent to the concerned personnel when the threshold for outbreak detection is reached. When lab results are available and entered in the system, the results are automatically communicated to the health centers originating samples. Data is automatically summarized in predefined tables, graphs, dashboards and maps. As of September 3rd, 2012, a total of 5813 reports including 1325 immediate reports and 4488 weekly reports were submitted electronically. Out of 1325 immediate reports submitted, 406 potential outbreaks were detected and immediately notified and 7 of them were confirmed for cholera, rubella, Influenza-like illness (H1N1), measles and food poisoning. From these data, the eIDSR system shows a sensitivity of 100% and a specificity of 70% for outbreak detection. The early notification of probable outbreaks stimulated the early investigations and the quick response to outbreaks within the country and across the borders. CONCLUSIONS: The electronic disease surveillance system has improved timeliness and completeness of reporting and extremely supports early detection and notification of outbreaks for timely response. This system should be a model for the East African region as it has demonstrated advantages in the cross-border disease surveillance

A National Electronic System for Disease Surveillance in Rwanda (eIDSR): Lessons Learned from a Successful Implementation

The lessons learned from the nationwide implementation of an electronic disease surveillance system highlighted in this abstract can help to guide the successful implementation of an electronic disease surveillance system in developing countries

TRACnet: A National Phone-based and Web-based Tool for the Timely Integrated Disease Surveillance and Response in Rwanda

Based on 8 years of continuous performance (2004-present), the TRACnet platform provides eIDSR national coverage, security and reliability. Based on six month usage in 252 health facilities in all regions of Rwanda, eIDSR is: increasing timeliness and completeness of disease reporting in Rwanda; facilitating feedback of lab results to districts and health facilities; and identifying potential outbreaks early and facilitating rapid investigation and response

Fertility and HIV following universal access to ART in Rwanda: a cross-sectional analysis of Demographic and Health Survey data

Background: HIV infection is linked to decreased fertility and fertility desires in sub-Saharan Africa due to biological and social factors. We investigate the relationship between HIV infection and fertility or fertility desires in the context of universal access to antiretroviral therapy introduced in 2004 in Rwanda. Methods: We used data from 3532 and 4527 women aged 20–49 from the 2005 and 2010 Rwandan Demographic and Health Surveys (RDHS), respectively. The RDHSs included blood-tests for HIV, as well as detailed interviews about fertility, demographic and behavioral outcomes. In both years, multiple logistic regression was used to assess the association between HIV and fertility outcomes within three age categories (20–29, 30–39 and 40–49 years), controlling for confounders and compensating for the complex survey design. Results: In 2010, we did not find a difference in the odds of pregnancy in the last 5 years between HIV-seropositive and HIV-seronegative women after controlling for potential biological and social confounders. Controlling for the same confounders, we found that HIV-seropositive women under age 40 were less likely to desire more children compared to HIV-seronegative women (20–29 years adjusted odds ratio (AOR) = 0.31, 95% CI: 0.17, 0.58; 30–39 years AOR = 0.24, 95% CI: 0.14, 0.43), but no difference was found among women aged 40 or older. No associations between HIV and fertility or fertility desire were found in 2005. Conclusions: These findings suggest no difference in births or current pregnancy among HIV-seropositive and HIV-seronegative women. That in 2010 HIV-seropositive women in their earlier childbearing years desired fewer children than HIV-seronegative women could suggest more women with HIV survived; and stigma, fear of transmitting HIV, or realism about living with HIV and prematurely dying from HIV may affect their desire to have children. These findings emphasize the importance of delivering appropriate information about pregnancy and childbearing to HIV-infected women, enabling women living with HIV to make informed decisions about their reproductive life

Prevention of mother-to-child HIV-1 transmission in Burkina Faso: evaluation of vertical transmission by PCR, molecular characterization of subtypes and determination of antiretroviral drugs resistance

Background: Vertical human immunodeficiency virus (HIV) transmission is a public health problem in Burkina Faso. The main objective of this study on the prevention of mother-to-child HIV-1 transmission was to determine the residual risk of HIV transmission in infants born to mothers receiving highly active antiretroviral therapy (HAART). Moreover, we detect HIV antiretroviral (ARV) drug resistance among mother–infant pairs and identify subtypes and circulating recombinant forms (CRF) in Burkina Faso. Design: In this study, 3,215 samples of pregnant women were analyzed for HIV using rapid tests. Vertical transmission was estimated by polymerase chain reaction in 6-month-old infants born to women who tested HIV positive. HIV-1 resistance to ARV, subtypes, and CRFs was determined through ViroSeq kit using the ABI PRISM 3,130 sequencer. Results: In this study, 12.26% (394/3,215) of the pregnant women were diagnosed HIV positive. There was 0.52% (2/388) overall vertical transmission of HIV, with rates of 1.75% (2/114) among mothers under prophylaxis and 0.00% (0/274) for those under HAART. Genetic mutations were also isolated that induce resistance to ARV such as M184V, Y115F, K103N, Y181C, V179E, and G190A. There were subtypes and CRF of HIV-1 present, the most common being: CRF06_CPX (58.8%), CRF02_AG (35.3%), and subtype G (5.9%). Conclusions: ARV drugs reduce the residual rate of HIV vertical transmission. However, the virus has developed resistance to ARV, which could limit future therapeutic options when treatment is needed. Resistance to ARV therefore requires a permanent interaction between researchers, physicians, and pharmacists, to strengthen the network of monitoring and surveillance of drug resistance in Burkina Faso

Laboratory-confirmed A (H1N1) pdm09 by response phase and collection site in Rwanda from October 2009– May 2010.

*<p>n = 6; Districts with an ISS site;</p>±<p>n = 24; Districts without an ISS site.</p