Seroprevalence of West Nile Virus specific IgG and IgM antibodies in North-Western and Western provinces of Zambia

Background: West Nile Virus (WNV) infection has been reported worldwide, including in Africa but its existence in Zambia is unknown. Symptoms for the virus include headache, myalgia, arthralgia and rash.Objectives: This study aimed to determine the seroprevalence of WNV and its correlates.Methods: A cross sectional study was conducted in North-Western and Western provinces of Zambia. Samples were subjected to IgG and IgM antibodies testing against WNV. Logistic regression analyses were conducted to determine magnitudes of association.Results: A total of 3,625 of persons participated in the survey out of which 10.3% had WNV infection. Farmers were 20% (AOR=0.80; 95% CI [0.64, 0.99]) less likely to have infection compared to students. Meanwhile participants who lived in grass roofed houses were 2.97 (AOR=2.97; 95% CI [1.81, 4.88]) times more likely to be infected than those who lived in asbestos roofed houses. IRS was associated with reduced risk of infection (AOR=0.81; 95% CI [0.69, 0.94]). Travelling to Angola was associated with the infection [AOR=1.40; 95% CI [1.09, 1.81].Conclusion: Spraying houses with insecticide residual spray would minimize mosquito-man contact. Furthermore, surveillance at the border with Angola should be enhanced in order to reduce importation of the virus into the country.Keywords: Seroprevalence, West Wile Virus, Western province, North-Western province, Zambi

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

Increased Sensitization of Health Workers Leading to Detection of Unintended Cases of Acute Flaccid Paralysis: A Case of a “Konzo” Outbreak in Western Zambia

Background: The threat of high profile diseases causing outbreaks has drawn attention to public health surveillance systems, much needed for the timely detection of outbreaks. A disease characterized by weakness of the lower limbs in Luatembo rural health facility was reported to the province in 2013. Through the Acute Flaccid Paralysis surveillance (AFP) program the Western Province in Zambia recorded an increase in the numbers of people affected with spastic paraparesis. The disease affected clusters of families, especially women and children. The disease was found to be in specific geographic areas, with the initial cases being identified in Mongu district followed by Luampa and Senanga districts. Surveillance for a particular disease condition may sometimes lead to detection of a related or unrelated condition. This study aims to assess the sensitivity of the Acute Flaccid Paralysis surveillance program surveillance program to detect other diseases of public health importance using the suspected 'Konzo' outbreak in Western Province as a case study.Methods: Through the surveillance system and medical records review, patients with spastic paraparesis were identified and brought for clinical examination to selected health facilities. A team of specialists comprising of an infectious disease specialist and neurologist, supported by physiotherapists, epidemiologist, surveillance officers and laboratory scientists comprehensively investigated the cases. To improve the diagnosis a detailed case investigation form and checklist were used to capture clinical data and socio demographic information. Laboratory investigations included routine urine microscopy and full blood count. Further analysis inc luded viral analysis for enteroviruses , cytomegalovirus among others, copper levels and thiocyanate levels.Results: Preliminary laboratory results indicated no viral infections. Thiocyanate and copper levels are yet to be analysed.Discussion: As a result of the increased sensitization of health workers and communities, more cases were reported in other parts of Western Province, namely Luampa and Senanga districts. All the cases were detected through active surveillance for AFP. This study indicates a potential role for integrating AFP surveillance with other notifiable diseases within the integrated disease surveillance and response for early notification of unusual events in the community and community involvement to foster health seeking behaviors.Conclusion: This paper reflects on the role of AFP surveillance in integrated disease surveillance and response that resulted in the detection of an uncommon spastic paralysis 'Konzo' disease in Mongu, Western Province