Operational characteristic, indicators, and data sources for evaluation.

<p>Operational characteristic, indicators, and data sources for evaluation.</p

Major concerns and recommendations and/or actions taken to improve the Ebola Virus Disease Rapid Diagnostic Testing program.

<p>Major concerns and recommendations and/or actions taken to improve the Ebola Virus Disease Rapid Diagnostic Testing program.</p

Concordance between OraQuick^® Ebola Rapid Antigen Test and PCR testing for living patients and the deceased from October 2015 to April 2016 in Guinea.

<p>Concordance between OraQuick^® Ebola Rapid Antigen Test and PCR testing for living patients and the deceased from October 2015 to April 2016 in Guinea.</p

Cholera in Maritime Guinea between February and May 2012.

<p>The map illustrates the early propagation of the outbreak along the coast and the cumulated attack rate per sub-prefecture. Village positions are available on the Index Mundi website (<a href="http://www.indexmundi.com/zp/gv/" target="_blank">http://www.indexmundi.com/zp/gv/</a>).</p

Knowledge retention of Ebola Virus Disease Rapid Diagnostic Testing.

<p>Maximum score is 8. Respondent performance is shown overall, by region, by professional status, and by training type received.</p

Percentage of laboratories with equipment for the EVD RDT program by region.

<p>Percentage of laboratories with equipment for the EVD RDT program by region.</p

(A) Maximum likelihood phylogenetic tree of the seventh pandemic lineage of <i>V. cholerae</i> based on the SNP differences across the whole core genome and including a strain isolated during the onset of the Guinean 2012 outbreak.

<p>The pre-seventh pandemic isolate M66 was used as an outgroup to root the tree. Blue, green and red branches represent waves 1, 2 and 3, respectively. Purple and sky blue clade lineages represent the Kenyan clade and two South Asian clades within the third wave, respectively. Scale is provided as the number of substitutions per variable site. (B) Greater resolution of wave 3 of the seventh pandemic, in which the Guinean strain clustered distinctly from the two South Asian clades and the dominant Kenyan clade. Guinean isolate G298 is represented by the square while each colored circle indicates a spatially different isolate (as shown in the key). Scale is provided as the number of substitutions per variable site.</p

Cumulated cholera attack rates and deaths per prefecture during the 2012 Guinean epidemic.

<p>Cumulated cholera attack rates and deaths per prefecture during the 2012 Guinean epidemic.</p

MLVA-based genotypes and relatedness of 38 clinical <i>V. cholerae</i> strains isolated in Guinea in 2012.

<p>(A) Network of <i>V. cholerae</i> strain relatedness based on MLVA genotype. Following the genotype analysis of 38 <i>V. cholerae</i> strains using 6 different microsatellite loci, the strains were grouped according to the resulting MLVA genotype profiles. Each colored circle corresponds to a different genotype. The numbers indicate the sequential order when the first strain of the corresponding genotype was isolated. Circle diameter is relatively proportional to the number of isolates represented by each genotype (e.g., 14 strains displayed genotype #1, 7 isolates displayed genotype #8 and 1 strain displayed genotype #3). Each segment corresponds to a single mutation at 1 of the 6 assessed VNTRs. Bold segments represent primary and likely relatedness links between genotypes, while the dashed segments represent secondary and less likely genetic relationships. Genotype #1 was identified as the founder genotype using the eBURST algorithm. (B) Spatiotemporal repartition of genotyped <i>V. cholerae</i> strains. Prefecture-level maps of Guinea are displayed for each month from February to September 2012. The genotype color code described in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002898#pntd-0002898-g004" target="_blank">Figure 4A</a> was applied to spatially and temporarily localize the isolated strains. Therefore, the pie charts reflect the month and prefecture of strain isolation (represented by strain genotype) as well as the relative proportion of each genotype among them. Segments between different months spatially and temporarily illustrate the genetic relatedness displayed in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002898#pntd-0002898-g004" target="_blank">Figure 4A</a>. Only primary and sequentially earliest links between genotypes are represented.</p

Pregnancy Outcomes after a Mass Vaccination Campaign with an Oral Cholera Vaccine in Guinea: A Retrospective Cohort Study

<div><p>Introduction</p><p>Since 2010, WHO has recommended oral cholera vaccines as an additional strategy for cholera control. During a cholera episode, pregnant women are at high risk of complications, and the risk of fetal death has been reported to be 2–36%. Due to a lack of safety data, pregnant women have been excluded from most cholera vaccination campaigns. In 2012, reactive campaigns using the bivalent killed whole-cell oral cholera vaccine (BivWC), included all people living in the targeted areas aged ≥1 year regardless of pregnancy status, were implemented in Guinea. We aimed to determine whether there was a difference in pregnancy outcomes between vaccinated and non-vaccinated pregnant women.</p><p>Methods and Findings</p><p>From 11 November to 4 December 2013, we conducted a retrospective cohort study in Boffa prefecture among women who were pregnant in 2012 during or after the vaccination campaign. The primary outcome was pregnancy loss, as reported by the mother, and fetal malformations, after clinical examination. Primary exposure was the intake of the BivWC vaccine (Shanchol) during pregnancy, as determined by a vaccination card or oral history. We compared the risk of pregnancy loss between vaccinated and non-vaccinated women through binomial regression analysis. A total of 2,494 pregnancies were included in the analysis. The crude incidence of pregnancy loss was 3.7% (95%CI 2.7–4.8) for fetuses exposed to BivWC vaccine and 2.6% (0.7–4.5) for non-exposed fetuses. The incidence of malformation was 0.6% (0.1–1.0) and 1.2% (0.0–2.5) in BivWC-exposed and non-exposed fetuses, respectively. In both crude and adjusted analyses, fetal exposure to BivWC was not significantly associated with pregnancy loss (adjusted risk ratio (aRR = 1.09 [95%CI: 0.5–2.25], p = 0.818) or malformations (aRR = 0.50 [95%CI: 0.13–1.91], p = 0.314).</p><p>Conclusions</p><p>In this large retrospective cohort study, we found no association between fetal exposure to BivWC and risk of pregnancy loss or malformation. Despite the weaknesses of a retrospective design, we can conclude that if a risk exists, it is very low. Additional prospective studies are warranted to add to the evidence base on OCV use during pregnancy. Pregnant women are particularly vulnerable during cholera episodes and should be included in vaccination campaigns when the risk of cholera is high, such as during outbreaks.</p></div