Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre’s (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1–4). The average time between sample collection and molecular results’ availability was 3 days (IQR: 2–5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.Peer Reviewe

Exploring Educational Quality through Classroom Practices : A Study in Selected Primary School Classes in Burkina Faso

The paper reports on an exploratory study on the quality of education which attempts to identify and analyse classroom practices in a few Grade 5 (CM1) classes in Burkina Faso primary schools. The study is grounded on a model of the teaching-learning encounter and a framework for summarising the characteristics of a “good" teacher and an ideal classroom that underline the central place of classroom processes in a definition of quality education. The findings from the questionnaires and interviews summarize the views expressed by the various key actors of the educational system about the definition of quality education, some indicators that can be used to measure it, what one can expect to observe in an ideal classroom and the characteristics of a good teacher. The classroom observations revealed many of these “good" features of classroom practices. Some of the most important ones relate to a lively anxiety-free atmosphere and warm teacher-learner relations, and the special attention and initiative given to the pupils. These results as well as the feedback from the participants show that despite a certain number of methodological issues and practical diffi culties raised by this type of research, it can be further refi ned and used for monitoring quality and designing tools for school-based teacher development schemes

Approaches to increase HPV vaccination rate in Germany - challenges and opportunities. A qualitative study

Background: In Germany, the prevalence of infections with the human papilloma virus (HPV) among women and men is high. High-risk HPV types can lead to certain types of cancer (e. g., cervical cancer). Vaccination against HPV infections associated with cancer and genital warts was introduced in Germany in 2007. Currently, HPV vaccination is recommended for girls and boys by the German Standing Committee on Vaccination. The vaccination rate, however, remains rather low, with rates below 50% in 15-year-old girls and of about 5% in 15-year-old boys in 2019. This suggests that new approaches are urgently needed to increase HPV vaccination coverage in Germany in the coming years. Objectives: This qualitative study aimed at identifying opportunities and challenges related to the application and implementation of different approaches designed to increase HPV vaccination uptake among male and female adolescents in Germany according to expert views. Materials and methods: From April to July 2020, 43 experts from the field of HPV vaccination in Germany were interviewed using a semi-standardized interview guide. The audiotaped interviews were transcribed and analyzed using qualitative content analysis by Udo Kuckartz. Results and Conclusion: According to the experts interviewed the following would be the most promising approaches to increase HPV vaccination rates in Germany: educational measures, school vaccination programs, increasing participation in the adolescent health check-up 'J1', reminder and recall systems. The most reasonable solution would be to pursue several approaches simultaneously. According to the experts, more political support with implementing strategies and reducing bureaucratic obstacles as well as an increase in cooperation between relevant stakeholders is required to achieve the effective implementation of these strategies

EVALUATION DU RISQUE DE MAJORATION DES ANOMALIES ELECTROCARDIOGRAPHIQUES DE REPOS AU COURS D’UNE EPREUVE D’EFFORT CHEZ DES ARBITRES MASCULINS DE FOOTBALL DU BURKINA FASO / INCREASED RISK ASSESSMENT OF RESTING ELECTROCARDIOGRAPHIC ABNOMALIES DURING EXERCISE TEST AMONG MALE SOCCER REFEREES FRON BURKINA FASO

Introduction : L’activité physique régulière est bénéfique pour la santé cardiovasculaire mais chez les sujets présentant des anomalies à l’électrocardiogramme (ECG) standard, l’effort intense peut s’avérer délétère. Le but de cette étude était de déterminer au cours d’une épreuve d’effort, le risque de majoration des anomalies ECG de repos chez des arbitres de football d’élite et de sub-élite masculins du Burkina Faso. Méthodes : Il s’est agi une étude d’intervention, réalisée avec 18 arbitres, répartis en deux groupes : groupe cas (GCA : n = 7) et groupe contrôle (GCO : n = 11) à profil ECG de repos respectivement anomal et normal. GCA et GCO ont été soumis à une épreuve d’effort maximale suivant un protocole de Bruce avancé. Les profils chronotrope et tensionnel, l’accroissement tensionnel systolique, l’électrocardiogramme d’effort, puis l’échocardiogramme ont été étudiés. La pente d’accroissement tensionnel systolique à l’effort a été déterminée à l’aide de la régression Fc-PAS. Résultats : Les profils chronotrope et tensionnel étaient normaux dans les deux groupes mais la pression artérielle systolique était plus élevée (p = 0,01) dans GCA à la récupération. Dans GCA et dans GCO, la pression artérielle systolique s’est accrue de façon linéaire (p < 0,001) en fonction de la fréquence cardiaque, avec une équation de régression significative (p < 0,001). Deux extrasystoles ventriculaires isolées sont apparues chez un arbitre de GCA mais les résultats échocardiographiques n’étaient pas associés à une pathologie. Conclusion : Les résultats indiquent que les paramètres cardiovasculaires étudiés au cours de l’épreuve, chez les arbitres burkinabè à profil ECG de repos anormal, n’étaient pas associés à une maladie cardiaque. Ils devront être autorisés à participer aux compétitions sportives et suivre un contrôle périodique. Introduction: Regular physical activity is beneficial for cardiovascular health but in subjects with standard electrocardiogram (ECG) abnormalities, intense effort can be harmful. The aim of this study was to determine during a stress test, the risk of increased resting ECG abnormalities in male elite and sub-elite football referees from Burkina Faso. Methods: This was an intervention study, carried out with 18 referees, divided into two groups: case group (CAG: n = 7) and control group (COG: n = 11) with respectively abnormal and normal resting ECG profile. CAG and COG were subjected to a maximal exercise test following an advanced Bruce protocol. Results: The chronotropic and blood pressure profiles, the systolic blood pressure increase, the stress electrocardiogram, then the echocardiogram were studied. The systolic pressure increase slope during exercise was determined using Fc-PAS regression. Chronotropic and blood pressure profiles were normal in both groups but systolic blood pressure was higher (p = 0.01) in CAG at recovery. In both CAG and COG, systolic blood pressure increased linearly (p < 0.001) with heart rate, with a significant regression equation (p < 0.001). Two isolated ventricular extrasystoles appeared in one referee in CAG but the echocardiographic findings were not associated with pathology. Conclusion: The results indicate that the cardiovascular parameters studied during the stress test, in Burkinabè referees with an abnormal resting ECG profile, were not associated with heart disease. They must be authorized to participate in sports competitions and undergo periodic checks.  Article visualizations

Unique human immune signature of Ebola virus disease in Guinea.

Despite the magnitude of the Ebola virus disease (EVD) outbreak in West Africa, there is still a fundamental lack of knowledge about the pathophysiology of EVD. In particular, very little is known about human immune responses to Ebola virus. Here we evaluate the physiology of the human T cell immune response in EVD patients at the time of admission to the Ebola Treatment Center in Guinea, and longitudinally until discharge or death. Through the use of multiparametric flow cytometry established by the European Mobile Laboratory in the field, we identify an immune signature that is unique in EVD fatalities. Fatal EVD was characterized by a high percentage of CD4(+) and CD8(+) T cells expressing the inhibitory molecules CTLA-4 and PD-1, which correlated with elevated inflammatory markers and high virus load. Conversely, surviving individuals showed significantly lower expression of CTLA-4 and PD-1 as well as lower inflammation, despite comparable overall T cell activation. Concomitant with virus clearance, survivors mounted a robust Ebola-virus-specific T cell response. Our findings suggest that dysregulation of the T cell response is a key component of EVD pathophysiology