Cholera outbreak at a city hotel in Kenya, 2017: a retrospective cohort study

Introduction: The Ministry of Health, Kenya (MOH) investigated a report on acute watery diarrhea (AWD) cases at a city hotel to confirm the cause, characterize, and identify associated factors. Methods: A suspected case of cholera was defined as AWD in any person aged >2 years at the hotel from August 31, 2017, to September 6, 2017. We took rectal swabs for laboratory confirmation and summarized the AWD data by person, place, and time. We defined a cohort of hotel staff with those who ate dinner on August 31, 2017, considered exposed and conducted a retrospective cohort study. We calculated attack rates (AR) and risk ratios (RR) with 95% confidence interval. Variables with p<0.1 at bivariate analysis were entered into a multivariate model and those with p<0.05 in the final model considered independently associated with the AWD. Results: Vibrio cholera was isolated from seven (10.1%) out of 69 samples. Line listed 139 cases with a median age of 32 years (Range: 20–58 years) included 127 (91.4%) male and 127 (91.4%) guests. Index case was reported on August 31, 2017, cases peaked at 95 cases on September 3, 2017, and declined to three on September 6, 2017. A total of 30 (81.1%) of 37 hotel staff were exposed with 17 (56.7%) cases. Food specific ARs were: steamed spinach 78.6% and pineapples 26.3%. Spinach (RR: 3.0 (95%CI: 1.76-72.97)) was a risk factor while pineapples (RR: 0.4 (95%CI: 0.01-0.58)) was protective. Conclusion: This was a point source cholera outbreak likely due to eating contaminated spinach

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Séroprévalence du paludisme chez les patients ayant séjourné en zone d’endémie palustre : étude réalisée à l’HMIMV de Rabat.

Introduction : Le paludisme post – transfusionnel est un risque bien décrit mais malheureusement peu documenté, privant ainsi les centres de transfusion d’un bon nombre de candidats potentiels au don. La réglementation marocaine en vigueur n’accepte pas les donneurs de sang ayant visité les zones d’endémie palustre quel que soit l’ancienneté et la durée du séjour. Notre étude a pour but d’établir une prévalence des anticorps anti plasmodium chez la population étudiée et faire une approche sur les modalités de refus ou d’accepter un donneur de sang ayant séjourné en zone endémique au paludisme Matériel et Méthodes : Sur une durée de 12 mois, les donneurs potentiels ayant séjournés en zone d’endémie et des donneurs n’ayant jamais séjourné en zone d’endémie ont été testé, pour le dépistage des anticorps antipalustres, par un essai immunoenzymatique à l’aide du kit Malaria EIA. Les échantillons étaient aussi testés par un test immunochromatographique et par des examens microscopiques des étalements de sang (goutte épaisse rapide et frottis sanguin). Résultats : Durant toute la période de l’étude, 158 donneurs de sang ont été testé dont 78 donneurs ayant séjourné en zone impaludée et 80 donneurs témoins n’ayant jamais voyagé hors du Maroc. Seuls 2.56% (2/78) des donneurs à risque de transmettre le paludisme ont été positifs pour les anticorps totaux. Aucun patient n’a été positif au test de diagnostique rapide. Un seul a été positif à l’examen microscopique. Conclusion : En se basant sur nos résultats, l’exclusion des donneurs de sang ayant séjourné en zone d’endémie de paludisme, semblerait exagérée. Ainsi, pour augmenter la disponibilité des produits sanguins dans les centres de transfusion sanguine, nous proposons d’établir un test de dépistage du paludisme pour évaluer le risque de paludisme chez le donneur. Ceci permettra de rejeter les donneurs de moins de 3 mois après leur visite en zone endémique et de faire systématiquement un test sérologique chez les donneurs qui ont fait plus de 3 mois avant d’accepter ou rejeter leur don