Towards a Sustainable Wild Poliovirus Containment Strategy in Zambia

Objective: The main objective of the survey and inventory of laboratories was to identify laboratories storing Wild Polio Virus (WPV) or potential infectious materials as a last step in contributing to sub-regional efforts in attaining a polio free status and the eradication of poliomyelitis in Zambia.Methods: An adapted WHO generic protocol was used by the National Task Force (NTF) on Poliovirus Containment in Zambia to identify all bio-medicallaboratories in Zambia. A questionnaire sent to all biomedical laboratories was used to identify laboratories storing WPV or potential infectious  materials. Further physical inspection was done on some laboratories.Results: Of the 170 biomedical laboratories in Zambia, 104 (61.1%) responded and 24 were identified as potentially storing infectious materials for WPV. Only one laboratory, the Virology Laboratory, University Teaching Hospital, Lusaka was noted to store both WPV and potential infectious  materials.Conclusion: The Ministry of Health through the NTF has set an impressive system in the laboratory containment of WPV and potential infectious  materials in Zambia. Appropriate bio-safety containment and restricted  access to stored materials containing WPV at the Virology Laboratory in Lusaka is a major step in the eradication of poliomyelitis in Zambia. Containment of these infectious materials will be particularly important in the post oral polio vaccination cessation era as there will be a large population of unimmunised children in the community who will be  susceptible to polio

Cholera Epidemiology in Zambia from 2000 to 2010: Implications for Improving Cholera Prevention and Control Strategies in the Country

Objective: To review the cholera epidemiology in Zambia from 2000 to 2010 in order to highlight the key lessons learned. Based on our findings, we make recommendations for improving cholera prevention and control in country.Design: Ten years descriptive cholera data was extracted from the national IDSR database and analysed.Setting: The study was conducted in Zambia using national epidemiology data which were disaggregated by Province.Subjects: NoneResults : Starting from 2003, there has been a progressive increase in yearly incidence of cholera in the country. In 2010, 6794 cases (500% increase compared to 2003) and 115 deaths (CFR 1.6%) of the disease were reported with Lusaka Province accounting for 85% of the total cases. Outbreaks start between epidemiological weeks 40 to 45 of the year and ends between weeks 20 to 25 of the following year (which correspondsto the Zambian rainy season). Outbreaks are largely confined to the peri-urban areas of Lusaka, Luapula, Southern and Copperbelt Provinces.Conclusion: In the last 10-20 years, the epidemiology of cholera in Zambia has changed; Laboratory confirmation of Vibrio cholerae in the country on a yearly basis in the last ten years suggests that the country is now endemic for cholera hence the need to review current cholera prevention and control strategies

The 2010 - 2011 measles outbreak in Zambia: Challenges and lessons learnt for future action

Objective: The key objective of the report was to document response and epidemiological factors surrounding the 2010 to 2011 Measles outbreak in Zambia and to share the challenges and lessons learnt for control and prevention of future outbreaks.Methods: Between January 2010 and September 2011, Measles line listed data, from 72 districts in Zambia was collected by the World Health Organisation /National Surveillance Officers (WHO/NSOs) through the Integrated Disease Surveillance Response (IDSR) system and aggregated at the Ministry of Health (MOH) headquarters. The response and epidemiological data was analysed and used for the report.Results: A total of 37,582 cases of measles were captured in the IDSR system and 30,397 (80.9%) had almost complete data for the period 2010-2011. Of the total cases of measles, 17.1% (5,195/30,397) were below the immunisation age of 9 months, and 12.9% were females in the reproductive age group. Supplemental Immunisation Activity (SIA) as a response to measles outbreak in 2010 implemented 6 months into the epidemic had no significant impact on the disease progression as the outbreak remained sustained into 2011.Conclusion: Resurgence outbreaks of measles following successful SIAs suggests that routine immunisation coverage has declined leading to the accumulation of a large pool of susceptible children in the communities. There is therefore an urgent need to strengthen and sustain high routine measles immunisation coverage which should include regular outreach services, supportive supervision and monitoring data for action. Measles SIAs should cover a wide age group, from 6 months to 15 years so that the adolescent females can enter the reproductive age group with high levels of measles antibodies to transfer to their newborns. As a matter of priority, immunisation outreach programmes should be reactivated by MOH and data collection in the IDSR system should be strengthened.Key words: Measles outbreak, low immunisation coverage rate, late SIA implentatio

Acute Flaccid Paralysis Surveillance in Zambia: Progress towards the Polio End Game

Background: In the global polio eradication initiative acute flaccid paralysis cases are followed up two to three months after onset of paralysis to assess recovery of the children. In Zambia AFP cases are followed up regularly but there is no documentation of the clinical and laboratory findings. The purpose of this paper is to document the support WHO country office offers to the follow up of the AFP cases in Zambia to identify gaps which the WHO Country office could address.Methods: This study used secondary data from a case control study design, conducted and supported by WHO country office, which was aimed at assessing the association of NPEVs with AFP. Particularly this study aims at assessing the presence or absence of residual paralysis and the laboratory findings of the affected children.Results: A total of 93 cases of, which over 55% were males were included in this study. Majority of the cases were aged between 24 and 35 months (28.4%). Regarding vaccination status, 77% of the cases had received 1 to 4 doses of the Oral Polio (OPV) vaccine. About 62% of the viruses isolated were identified as Cox B, and Echo 3, 6, 7, 11, 12, 14 and 29. Of all NPEVs 37.1% yielded no neutralization pattern. Only 9 (9.67%) cases were followed up; out of which 3 (33.3%) had residual paralysis with one of those with residual paralysis who later died.Conclusion: AFP surveillance and follow up of cases is carried out in Zambia. However, rehabilitation information of the affected children is not followed up, an issue which WHO country office with regards to the transformation agenda could pursue to ensure that the affected children are adequately supported as a contribution to the polio eradication end game

Successful multi-partner response to a cholera outbreak in Lusaka, Zambia 2016: a case control study

Background: A Cholera outbreak was reported in Lusaka District between February and May 2016, with 1,079 cases and 20 deaths recorded in the per-urban areas. Bauleni catchment area alone reported 441 (40.9%) case patients with case fatality rate of 4 (0.9%). Bauleni clinic was one of the three established cholera treatment centres (CTC) and other two being Kanyama and Matero Health Centres. Ministry of Health engaged partners that conducted a multi-intervention response to the outbreak. This study is aimed at identifying factors associated with the outbreak.Materials and methods: We conducted a case-control study, at the ratio 1:3, to identify risk factors associated with cholera outbreak. We identified cases of cholera through the cholera register at Bauleni health centre and randomly selected population based controls being residents of Bauleni Township without watery diarrhoea. The standard case definition for suspected cholera case was any person of any age with profuse, effortless watery diarrhoea (three or more stools in 24 hours), with or without vomiting. Aconfirmed cholera case was defined as any person suspected to have cholera with a positive  laboratory result. Univariate and multivariate analysis was performed using Epi-Info version 3.5.4 and Stata version 11.2.Results: On the Cholera Treatment Centre surveillance case-patients register, out of 441 cases, 241 (54.6%) cases were male while 200 (45.4 %%) cases were female, with an attack rate of 14.8/1,000 population and 4 (0.9%) fatalities. The study participants, who included 49 casepatients and 151 controls, had mean-age of 31 years [range, 29-34 years]. Positive Vibrio in stool cholera was associated with drinking inadequately treated borehole water [Adjusted OR=0.79; 95% CI (0.10-6.04), p>0.05]. This odds ratio was adjusted for level education and gender to control and account for any confounding. Though this finding was not statistically significant at p>0.05, the laboratory result was biologically significant as vibrio cholerae was isolated in the borehole water. Drinking treated water was protective [Adjusted OR 0.13; 95% CI (0.05-0.31, p<0.05].Conclusion: Improving methods that promote safe drinking water are likely to be effective measures in averting future cholera outbreaks in this setting.Keywords: Cholera, Lusaka, risk factors, case contro