Implementation of a mass gathering surveillance system during a Mozambican cultural ceremony in 2020

Introduction: Cultural festivals are events that bring together a large number of people in close contact for extended periods of time, which can contribute to disease outbreaks and other public health threats. Every year in Maputo province, on February 2, the capital of Mozambique celebrates the traditional ceremony Gwaza-Muthini (GM), where nearly 5000 people participate. An enhanced real-time surveillance system was implemented to monitor the occurrence of health events during the GM event. Methods: A cross-sectional descriptive study was conducted between February 1-3, 2020. A direct observation of the event site, waste disposal, public toilets, hygiene, sanitation, and safety conditions of the food vendors was carried out prior to the event. To monitor health events, clinical patient data were collected from the event’s medical post and the local health facility’s registration logbooks, using a real-time electronic mobile system. For the diagnosis evaluation, they were divided into traumatic and non-traumatic origin. Results: Forty patients were seen at the two health facilities; of whom, 73% (29) were male, 58% (23) presented with traumatic injuries, 43% (17) with non-traumatic diagnosis. Of injuries, 48% (11/23) were victims of physical aggression, 35% (8/23) of traffic accidents. Of the 17 patients with non-traumatic diagnosis, 47% (8/17) were hypertensive. No foodborne disease was observed during the event. Conclusion: Although this study was focused on monitoring health events that could lead to outbreak diseases, such as foodborne diseases the 2020 annual GM traditional ceremony occurred without significant health risk, and patients had no condition needing hospitalization

Investigation and contact tracing of the first eight cases of COVID-19 in Mozambique, 2020

Introduction: contact tracing is an important strategy to interrupt the spread of infectious disease and prevent new cases. After the confirmation of the first positive case of COVID-19 in Mozambique on March 22, 2020, case investigation and contact tracing were immediately initiated, which included clinical and laboratory monitoring of cases and contacts throughout the quarantine period. We aim to describe the methodology and impact of early investigation and contact tracing. Methods: in the context of implementation of the national COVID�19 preparedness and response plan, guidelines and forms for contact tracing were adapted from the existing World Health Organization (WHO) and The Centers for Disease Control and Prevention (CDC) guidelines. The case definition used was “patient with travel or residency history in a country reporting local transmission of COVID-19 during the 14 days prior to the onset of symptoms”. The cases interviews were face to face and contacts were followed up daily by phone calls for 14 consecutive days: using a structured questionnaire. Data were entered in an electronic Excel database. We collected samples for diagnosis of those who developed symptoms and provided quarantine follow up. Results: a total of 8 cases were confirmed, of which 6 (75%) were male. The average age of the cases was 51, median 44 (range: 31 to 80) years old. The majority of cases presented common symptoms of COVID-19, including headaches (50%), cough (37.5%), and fever (25%). Our case series included the country´s index case, two close positive contacts, and 5 additional cases that were not epidemiologically linked to the others and identified by the COVID-19 national surveillance system. All of them were identified in Maputo City from March 22 to March 28. Cases had a total of 123 contacts and all of them were tracked; 79 were contacts of the first case. From all the contacts in follow up, two had laboratory confirmed COVID-19. All cases and contacts were quarantined and none of them developed severe symptoms or required hospitalization. Conclusion: timely case identification and systematic contact tracing can be effective in breaking the chain of COVID-19 transmission when there is strong collaboration between epidemiological, laboratory surveillance and case management

Access to and use of health and social services among people who inject drugs in two urban areas of Mozambique, 2014 : qualitative results from a formative assessment

BackgroundPrior to 2014, data about health seeking behaviors or service uptake for People who inject drugs (PWID) in Mozambique did not exist. We present the results from the formative assessment component of the Biological and Behavioral Survey (BBS).MethodsStandardized interview guides were used during key informant interviews (KII) and focus group discussions (FGD) in Maputo and Nampula/Nacala to discuss issues related to risk behaviors and access to and utilization of health and social services by PWID. The target sample size was not defined a priori, but instead KII and FGD were conducted until responses reached saturation. Data analysis was based on the principles of grounded theory related to qualitative research.ResultsEighty-eight respondents, ages 15 to 60, participated in KIIs and FGDs. Participants were majority male from diverse income and education levels and included current and former PWID, non-injection drug users, health and social service providers, peer educators, and community health workers. Respondents reported that PWID engage in high-risk behaviors such as needle and syringe sharing, exchange of sex for drugs or money, and low condom use. According to participants, PWID would rather rent, share or borrow injection equipment at shooting galleries than purchase them due to stigma, fear of criminalization, transportation and purchase costs, restricted pharmacy hours, personal preference for needle sharing, and immediacy of drug need. Barriers to access and utilization of health and social services include distance, the limited availability of programs for PWID, lack of knowledge of the few programs that exist, concerns about the quality of care provided by health providers, lack of readiness as a result of addiction and perceived stigma related to the use of mental health services offering treatment to PWID.ConclusionsMozambique urgently needs to establish specialized harm reduction programs for PWID and improve awareness of available resources. Services should be located in hot spot areas to address issues related to distance, transportation and the planning required for safe injection. Specific attention should go to the creation of PWID-focused health and social services outside of state-sponsored psychiatric treatment centers

Conditions to eliminate cholera in Mozambique - the pathway for the development of the national cholera plan

Cholera disproportionately affects the most vulnerable segments of the population, particularly those who have low or no access to basic water, sanitation, and hygiene (WASH). Despite some improvements in WASH conditions, cholera still represents a persistent challenge in Mozambique, where outbreaks occur almost every year, with high case fatality rates, posing a threat to the country's economic development. The Government of Mozambique has started developing a revised National Cholera Plan (NCP), which aligns with “ending cholera-a global roadmap to 2030” launched by the Global Task Force on Cholera Control (GTFCC) in 2017. Ending cholera represents a critical step towards achieving the sustainable development goals and requires effective prevention and control interventions, ensuring that no one is left behind. The NCP must use a multi-sector approach and broad stakeholder collaboration with well-coordinated roles and functions of different partners to address major areas for cholera elimination - water and sanitation, health care services and management, epidemiology and surveillance, and health and hygiene promotion. Every cholera death is preventable. In this review, we reiterate the need for effective coordinated actions to control and eliminate cholera in Mozambique and decrease the cholera burden, enabling a healthy population over the generations

High prevalence of HIV, HBsAg and anti-HCV positivity among people who injected drugs : results of the first bio-behavioral survey using respondent-driven sampling in two urban areas in Mozambique

Background Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. Methods We used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights. Results We enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV. Conclusion Unsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission

Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015.

Mozambique has recorded cyclically epidemic outbreaks of cholera. Antibiotic therapy is recommended in specific situations for management and control of cholera outbreaks. However, an increase in resistance rates to antibiotics by Vibrio cholerae has been reported in several epidemic outbreaks worldwide. On the other hand, there are few recent records of continuous surveillance of antibiotics susceptibility pattern of V. cholerae in Mozambique.The purpose of this study was to evaluate antibiotics resistance pattern of Vibrio cholerae O1 Ogawa isolated during Cholera outbreaks in Mozambique to commonly used antibiotics.We analyzed data from samples received in the context of surveillance and response to Cholera outbreaks in the National Reference Laboratory of Microbiology from the National Institute of Health of Mozambique, 159 samples suspected of cholera from cholera treatment centers of, Metangula (09), Memba (01), Tete City (08), Moatize (01), Morrumbala (01) districts, City of Quelimane (01), Lichinga (06) and Nampula (86) districts, from 2012 to 2015. Laboratory culture and standard biochemical tests were employed to isolate and identify Vibrio cholerae; serotypes were determined by antisera agglutination reaction in blade. Biotype and presence of important virulence factors analysis was done by PCR. Antibiotics susceptibility pattern was detected by disk diffusion method Kirby Bauer. Antibiotic susceptibility and results were interpreted by following as per recommendations of CLSI (Clinical and Laboratory Standards Institute) 2014. All samples were collected and tested in the context of Africhol Project, approved by the National Bioethics Committee for Health.Among isolates from of Vibrio cholerae O1 El Tor Ogawa resistance to Sulphamethoxazole-trimethropim was 100% (53/53) to Trimethoprim-, being 100% (54/54) for Ampicillin, 99% (72/74) for Nalidixic Acid, 97% (64/66) to Chloramphenicol, 95% (42/44) for Nitrofurantoin and (19/20) Cotrimoxazole, 83% (80/97) Tetracycline, 56% (5/13) Doxycycline, 56% (39/70) Azithromycin and 0% (0/101) for Ciprofloxacin. PCR analysis suggested strains of V. cholerae O1 being descendants of the current seventh pandemic V. cholerae O1 CIRS 101 hybrid variant. The V. cholerae O1 currently causing cholera epidemics in north and central Mozambique confirmed a CTXΦ genotype and a molecular arrangement similar to the V. cholerae O1 CIRS 101.Although V. cholerae infections in Mozambique are generally not treated with antibiotics circulating strains of the bacteria showed high frequency of in vitro resistance to available antibiotics. Continuous monitoring of antibiotic resistance pattern of epidemic strains is therefore crucial since the appearance of antibiotic resistance can influence cholera control strategies

CTX ϕ cluster analysis of <i>Vibrio cholerae</i> O1 El Tor Ogawa isolated during cholera outbreaks in Mozambique from 2012 to 2015.

<p>Showing a classic signature of <i>Vibrio cholerae</i> O1 El Tor variants B33 and CIRS 101. AMP- Ampicillin; TE-Tetracycline; NA- Nalidixic Acid; C-Chloramphenicol; CIP-Ciprofloxacin; SXT- Sulphamethoxazol-trimethropim; F- Nitrofurantoin; AZM- Azithromycin; rstR, ctxB and tcpA- <i>Vibrio cholerae</i> virulence genes; TLC-RS1, CORE-RTX and TCL-RS2—primers for the presence of CTX ϕ on chromosome 1; Chr II—Chromosome 2.</p

AST per district and per year, for <i>V</i>. <i>cholerae</i> O1 El Tor Ogawa isolated during cholera outbreaks in Mozambique from 2012 to 2015.

<p>In 2012 (Cuamba district in Niassa province and Montepuez <i>district</i> in Cabo Delgado province), 2013 (Cuamba district in Niassa province, Pemba city and Montepuez <i>districts</i> in Cabo Delgado province, Nampula city <i>district</i> in Nampula province and Alto-Molócue <i>district</i> in Zambezia province), 2014 (Nampula city <i>district</i> in Nampula province), 2015 (Lichinga city, Lago and Cuamba <i>districts</i> in Niassa province, Nampula city <i>district</i> in Nampula province and Morrumbala and Quelimane city <i>districts</i> in Zambézia province, Tete city and Moatize <i>districts</i> in Tete province, Beira city <i>district</i> in Sofala province and Matola city <i>district</i> in Maputo province). AMP- Ampicillin; TE-Tetracycline; NA- Nalidixic Acid; C-Chloramphenicol; CIP-Ciprofloxacin; SXT- Sulphamethoxazol-trimethropim; F- Nitrofurantoin; AZM- Azithromycin; rstR, ctxB and tcpA- <i>Vibrio cholerae</i> virulence genes; TLC-RS1, CORE-RTX and TCL-RS2—primers for the presence of CTX ϕ on chromosome 1; Chr II—Chromosome 2</p

Multi-site cholera surveillance within the African Cholera Surveillance Network shows endemicity in Mozambique, 2011–2015

<div><p>Background</p><p>Mozambique suffers recurrent annual cholera outbreaks especially during the rainy season between October to March. The African Cholera Surveillance Network (Africhol) was implemented in Mozambique in 2011 to generate accurate detailed surveillance data to support appropriate interventions for cholera control and prevention in the country.</p><p>Methodology/Principal findings</p><p>Africhol was implemented in enhanced surveillance zones located in the provinces of Sofala (Beira), Zambézia (District Mocuba), and Cabo Delgado (Pemba City). Data were also analyzed from the three outbreak areas that experienced the greatest number of cases during the time period under observation (in the districts of Cuamba, Montepuez, and Nampula). Rectal swabs were collected from suspected cases for identification of <i>Vibrio cholerae</i>, as well as clinical, behavioral, and socio-demographic variables. We analyzed factors associated with confirmed, hospitalized, and fatal cholera using multivariate logistic regression models.</p><p>A total of 1,863 suspected cases and 23 deaths (case fatality ratio (CFR), 1.2%) were reported from October 2011 to December 2015. Among these suspected cases, 52.2% were tested of which 23.5% were positive for <i>Vibrio cholerae</i> O1 Ogawa. Risk factors independently associated with the occurrence of confirmed cholera were living in Nampula city district, the year 2014, human immunodeficiency virus infection, and the primary water source for drinking.</p><p>Conclusions/Significance</p><p>Cholera was endemic in Mozambique during the study period with a high CFR and identifiable risk factors. The study reinforces the importance of continued cholera surveillance, including a strong laboratory component. The results enhanced our understanding of the need to target priority areas and at-risk populations for interventions including oral cholera vaccine (OCV) use, and assess the impact of prevention and control strategies. Our data were instrumental in informing integrated prevention and control efforts during major cholera outbreaks in recent years.</p></div

Tested and confirmed cases of cholera through Africhol, Mozambique, 2011–2015.

<p>Tested and confirmed cases of cholera through Africhol, Mozambique, 2011–2015.</p