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

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

The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review

Background: Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers. Methods and Findings: We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low. Conclusions: Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes

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

Environmental impact on the bacteriological quality of domestic water supplies in Lagos, Nigeria Impacto ambiental sobre a qualidade bacteriológica do abastecimento domiciliar de água em Lagos, Nigéria

OBJECTIVE: To assess the impact of town planning, infrastructure, sanitation and rainfall on the bacteriological quality of domestic water supplies. METHODS: Water samples obtained from deep and shallow wells, boreholes and public taps were cultured to determine the most probable number of Escherichia coli and total coliform using the multiple tube technique. Presence of enteric pathogens was detected using selective and differential media. Samples were collected during both periods of heavy and low rainfall and from municipalities that are unique with respect to infrastructure planning, town planning and sanitation. RESULTS: Contamination of treated and pipe distributed water was related with distance of the collection point from a utility station. Faults in pipelines increased the rate of contamination (p<0.5) and this occurred mostly in densely populated areas with dilapidated infrastructure. Wastewater from drains was the main source of contamination of pipe-borne water. Shallow wells were more contaminated than deep wells and boreholes and contamination was higher during period of heavy rainfall (p<0.05). E. coli and enteric pathogens were isolated from contaminated supplies. CONCLUSIONS: Poor town planning, dilapidated infrastructure and indiscriminate siting of wells and boreholes contributed to the low bacteriological quality of domestic water supplies. Rainfall accentuated the impact.<br>OBJETIVO: Avaliar o impacto do planejamento urbano, da infra-estrutura, do saneamento e dos índices pluviométricos sobre a qualidade bacteriológica do abastecimento domiciliar de água. MÉTODOS: Foi realizada cultura de amostras de água obtida de poços superficiais e profundos, fossos e água corrente de bicas públicas para determinar o número mais provável de Escherichia coli e coliformes totais por meio da técnica de múltiplos tubos. Patógenos entéricos foram detectados pelo uso de meios diferenciais e seletivos. Amostras foram coletadas durante os períodos de seca e de chuvas intensas em municípios com características singulares de infra-estrutura, planejamento urbano e saneamento. RESULTADOS: A contaminação de água tratada ou encanada esteve relacionada à distância do ponto de coleta com relação à estação de tratamento. Defeitos na canalização aumentaram o índice de contaminação (p<0,5), principalmente em áreas densamente povoadas com infra-estrutura arruinada. Os despejos de bueiros representaram a principal fonte de contaminação da água encanada. Houve maior contaminação em poços superficiais do que em fossos e durante os períodos de chuvas intensas (p<0,05). E. coli e outros patógenos entéricos foram isolados de fontes de abastecimento contaminadas. CONCLUSÕES: A falta de planejamento urbano, as más condições de infra-estrutura e a localização indiscriminada de poços e fossos contribuíram para a baixa qualidade bacteriológica do abastecimento domiciliar de água. As águas das chuvas agravaram o impacto

Current challenges and implications for dengue, chikungunya and Zika seroprevalence studies worldwide: A scoping review.

BACKGROUND:Arboviral infections are a public health concern and an escalating problem worldwide. Estimating the burden of these diseases represents a major challenge that is complicated by the large number of unapparent infections, especially those of dengue fever. Serological surveys are thus required to identify the distribution of these diseases and measure their impact. Therefore, we undertook a scoping review of the literature to describe and summarize epidemiological practices, findings and insights related to seroprevalence studies of dengue, chikungunya and Zika virus, which have rapidly expanded across the globe in recent years. METHODOLOGY/PRINCIPAL FINDINGS:Relevant studies were retrieved through a literature search of MEDLINE, WHOLIS, Lilacs, SciELO and Scopus (2000 to 2018). In total, 1389 publications were identified. Studies addressing the seroprevalence of dengue, chikungunya and/or Zika written in English or French and meeting the inclusion and exclusion criteria were included. In total, 147 studies were included, from which 185 data points were retrieved, as some studies used several different samples. Most of the studies were exclusively conducted on dengue (66.5%), but 16% were exclusively conducted on chikungunya, and 7 were exclusively conducted on Zika; the remainder were conducted on multiple arboviruses. A wide range of designs were applied, but most studies were conducted in the general population (39%) and in households (41%). Although several assays were used, enzyme-linked immunosorbent assays (ELISAs) were the predominant test used (77%). The temporal distribution of chikungunya studies followed the virus during its rapid expansion since 2004. The results revealed heterogeneity of arboviruses seroprevalence between continents and within a given country for dengue, chikungunya and Zika viruses, ranging from 0 to 100%, 76% and 73% respectively. CONCLUSIONS/SIGNIFICANCE:Serological surveys provide the most direct measurement for defining the immunity landscape for infectious diseases, but the methodology remains difficult to implement. Overall, dengue, chikungunya and Zika serosurveys followed the expansion of these arboviruses, but there remain gaps in their geographic distribution. This review addresses the challenges for researchers regarding study design biases. Moreover, the development of reliable, rapid and affordable diagnosis tools represents a significant issue concerning the ability of seroprevalence surveys to differentiate infections when multiple viruses co-circulate