Another dengue fever outbreak in Eastern Ethiopia-An emerging public health threat.

BackgroundDengue Fever (DF) is a viral disease primarily transmitted by Aedes (Ae.) aegypti mosquitoes. Outbreaks in Eastern Ethiopia were reported during 2014-2016. In May 2017, we investigated the first suspected DF outbreak from Kabridahar Town, Somali region (Eastern Ethiopia) to describe its magnitude, assess risk factors, and implement control measures.MethodsSuspected DF cases were defined as acute febrile illness plus ≥2 symptoms (headache, fever, retro-orbital pain, myalgia, arthralgia, rash, or hemorrhage) in Kabridahar District residents. All reported cases were identified through medical record review and active searches. Severe dengue was defined as DF with severe organ impairment, severe hemorrhage, or severe plasma leakage. We conducted a neighborhood-matched case-control study using a subset of suspected cases and conveniently-selected asymptomatic community controls and interviewed participants to collect demographic and risk factor data. We tested sera by RT-PCR to detect dengue virus (DENV) and identify serotypes. Entomologists conducted mosquito surveys at community households to identify species and estimate larval density using the house index (HI), container index (CI) and Breteau index (BI), with BI≥20 indicating high density.ResultsWe identified 101 total cases from May 12-31, 2017, including five with severe dengue (one death). The attack rate (AR) was 17/10,000. Of 21 tested samples, 15 (72%) were DENV serotype 2 (DENV 2). In the case-control study with 50 cases and 100 controls, a lack of formal education (AOR [Adjusted Odds Ratio] = 4.2, 95% CI [Confidence Interval] 1.6-11.2) and open water containers near the home (AOR = 3.0, 95% CI 1.2-7.5) were risk factors, while long-lasting insecticide treated-net (LLITN) usage (AOR = 0.21, 95% CI 0.05-0.79) was protective. HI and BI were 66/136 (49%) and 147 per 100 homes (147%) respectively, with 151/167 (90%) adult mosquitoes identified as Ae. aegypti.ConclusionThe epidemiologic, entomologic, and laboratory investigation confirmed a DF outbreak. Mosquito indices were far above safe thresholds, indicating inadequate vector control. We recommended improved vector surveillance and control programs, including best practices in preserving water and disposal of open containers to reduce Aedes mosquito density

Multivariable analysis of factors associated with SARS-CoV-2 co-infection with other respiratory viruses among ILI/SARI cases visited sentinel sites from January 2021 to June 2022, Ethiopia.

Multivariable analysis of factors associated with SARS-CoV-2 co-infection with other respiratory viruses among ILI/SARI cases visited sentinel sites from January 2021 to June 2022, Ethiopia.</p

Data set of the study.

SARS-CoV-2 co-infection with the influenza virus or human respiratory syncytial virus (RSV) may complicate its progress and clinical outcomes. However, data on the co-detection of SARS-CoV-2 with other respiratory viruses are limited in Ethiopia and other parts of Africa to inform evidence-based response and decision-making. We analyzed 4,989 patients’ data captured from the national severe acute respiratory illness (SARI) and influenza-like illness (ILI) sentinel surveillance sites over 18 months period from January 01, 2021, to June 30, 2022. Laboratory specimens were collected from the patients and tested for viral respiratory pathogens by real-time, reverse transcription polymerase chain reaction (RT-PCR) at the national influenza center. The median age of the patients was 14 years (IQR: 1–35 years), with a slight preponderance of them being at the age of 15 to less than 50 years. SARS-CoV-2 was detected among 459 (9.2%, 95% CI: 8.4–10.0) patients, and 64 (1.3%, 95% CI: 1.0–1.6) of SARS-CoV-2 were co-detected either with Influenza virus (54.7%) or RSV (32.8%) and 12.5% were detected with both of the viruses. A substantial proportion (54.7%) of SARS-CoV-2 co-detection with other respiratory viruses was identified among patients in the age group from 15 to less than 50 years. The multivariable analysis found that the odds of SARS-CoV-2 co-detection was higher among individuals with the age category of 20 to 39 years as compared to those less than 20 years old (AOR: 1.98, 95%CI:1.15–3.42) while the odds of SARS-CoV-2 co-detection was lower among cases from other regions of the country as compared to those from Addis Ababa (AOR:0.16 95%CI:0.07–0.34). Although the SARS-CoV-2 co-detection with other respiratory viral pathogens was minimal, the findings of this study underscore that it is critical to continuously monitor the co-infections to reduce transmission and improve patient outcomes, particularly among the youth and patients with ILI.</div

Demographic characteristics of ILI/SARI cases visited sentinel sites from January 2021 to June 2022, Ethiopia.

Demographic characteristics of ILI/SARI cases visited sentinel sites from January 2021 to June 2022, Ethiopia.</p

Characteristics of patients with SARS-CoV-2 and other respiratory viruses’ co-detection.

Characteristics of patients with SARS-CoV-2 and other respiratory viruses’ co-detection.</p

Distribution of SARS-CoV-2 co-detection and mono-infections across SARI/ILI sentinel sites from January 01, 2021, to June 30, 2022, Ethiopia.

Distribution of SARS-CoV-2 co-detection and mono-infections across SARI/ILI sentinel sites from January 01, 2021, to June 30, 2022, Ethiopia.</p

Monthly trends of proportions of co-detection among SARS-CoV-2 positive cases from January 01, 2021, to June 30, 2022, Ethiopia.

Monthly trends of proportions of co-detection among SARS-CoV-2 positive cases from January 01, 2021, to June 30, 2022, Ethiopia.</p

Regional and temporal variations in COVID-19 cases and deaths in Ethiopia: Lessons learned from the COVID-19 enhanced surveillance and response.

BackgroundThe COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia.MethodsCOVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data were captured by standardized tools and formats. Analysis of COVID-19 testing performed, cases detected, and deaths registered by region and time was carried out.ResultsWe analyzed 215,024 individuals' data that were captured through COVID-19 surveillance in Ethiopia. Of the 215,024 total tests, 18,964 COVID-19 cases (8.8%, 95% CI: 8.7%- 9.0%) were identified and 534 (2.8%, 95% CI: 2.6%- 3.1%) were deceased. The positivity rate ranged from 1% in the Afar region to 15% in the Sidama region. Eight (1.2%, 95% CI: 0.4%- 2.0%) HCWs died out of 664 infected HCWs, of which 81.5% were from Addis Ababa. Three waves of outbreaks were detected during the analysis period, with the highest positivity rate of 35% during the Omicron period and the highest rate of ICU beds and mechanical ventilators (38%) occupied by COVID-19 patients during the Delta period.ConclusionsThe temporal and regional variations in COVID-19 cases and deaths in Ethiopia underscore the need for concerted efforts to address the disparities in the COVID-19 surveillance and response system. These lessons should be critically considered during the integration of the COVID-19 surveillance system into the routine surveillance system