A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

Lymphatic filariasis and onchocerciasis are neglected tropical diseases (NTDs) targeted for elimination by mass (antifilarial) drug administration. These drugs are predominantly active against the microfilarial progeny of adult worms. New drugs or combinations are needed to improve patient therapy and to enhance the effectiveness of interventions in persistent hotspots of transmission. Several therapies and regimens are currently in (pre-)clinical testing. Clinical trial simulators (CTSs) project patient outcomes to inform the design of clinical trials but have not been widely applied to NTDs, where their resource-saving payoffs could be highly beneficial. We demonstrate the utility of CTSs using our individual-based onchocerciasis transmission model (EPIONCHO-IBM) that projects trial outcomes of a hypothetical macrofilaricidal drug. We identify key design decisions that influence the power of clinical trials, including participant eligibility criteria and post-treatment follow-up times for measuring infection indicators. We discuss how CTSs help to inform target product profiles

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenge

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

Le cancer de l’estomac dans un pays d’Afrique sub-saharienne : aspects épidémiologiques, anatomocliniques et endoscopiques à Bobo-Dioulasso (Burkina Faso)

Le cancer de l’estomac constitue un problème de santé publique dans le monde. Le but de notre travail était d’évaluer la situation actuelle du cancer gastrique, à travers une description des aspects épidémiologiques, anatomo-cliniques et endoscopiques.Il s’est agi d’une étude transversale descriptive sur une période de 42 mois. Ont été inclus, tous cas de cancers gastriques confirmés histologiquement après biopsie per-endoscopique. Les variables étudiées étaient : l’âge, le sexe, la circonstance du diagnostic, l’aspect endoscopique, et le type histologique. Les données ont été saisies et analysées à l’aide du logiciel SPSS version 20. Au total 103 cas de cancers gastriques ont été diagnostiqués soit une moyenne annuelle de 29,4 cas. On dénombrait 68 (66 %) hommes soit un sex-ratio de 1,9. L’âge moyen était de 55,3 ± 13,4 ans (extrêmes de 20 et 90 ans). La tranche d’âges de 51 à 70 ans était la plus représentée avec 56 (54,4 %) cas. Les principaux symptômes au moment du diagnostic étaient les vomissements (n = 29 soit 28,2 %) et les épigastralgies (n = 23 soit 22,3 %). Plus de la moitié des cancers était de localisation antrale (57,2 %) ; et la forme ulcéro-bourgeonnante était dominante (62,5 % ; n = 64). A l’histologie, l’adénocarcinome était le type dominant (96,1%). L’adénocarcinome est le type de cancer gastrique fréquent dans notre contexte avec une prédominance masculine surtout à partir de 50 ans. Sa symptomatologie est dominée par les vomissements, preuve d’un diagnostic tardif.Mots-clés: cancer, estomac, épidémiologie, endoscopie, histologie, Bobo-DioulassoEnglish Title: Stomach cancer in a sub-Saharan African country: epidemiological, anatomical-clinical and endoscopic aspects in Bobo-Dioulasso (Burkina Faso)English AbstractStomach cancer is a public health problem worldwide. The aim of our work was to assess the current situation of gastric cancer, through a description of the epidemiological, anatomical-clinical and endoscopic aspects. This was a descriptive cross-sectional study over a 42-month period. Included were all histologically confirmed cases of gastric cancer after per-endoscopic biopsy. The variables studied were: age, sex, circumstance of diagnosis, endoscopic appearance, and histological type. The data were entered and analyzed by the SPSS. Results: 103 cases of gastric cancer were diagnosed, for an annual average of 29.4 cases. There were 68 (66%) men, or a sex ratio of 1.9. The average age was 55.3 ± 13.4 years (extremes of 20 and 90 years). The 51 to 70 age group was the most represented with 56 (54.4%) cases. The main symptoms at diagnosis were vomiting (n = 29 or 28.2%) and epigastralgia (n = 23 or 22.3%). More than half of the cancers were antral localized (57.2%); and the ulcer-budding form was dominant (62.5%; n = 64). At histology, adenocarcinoma was the dominant type (96.1%). Adenocarcinoma is the type of gastric cancer common in our context with a predominance of males, especially from the age of 50. His symptomatology is dominated by vomiting, evidence of a late diagnosis.Keywords: cancer, stomach, epidemiology, endoscopy, histology, Bobo-Dioulass

Occurrence of natural Anopheles arabiensis swarms in an urban area of Bobo-Dioulasso city, Burkina Faso, West Africa.

International audience: The swarming behaviour of natural populations of Anopheles arabiensis was investigated by conducting transect surveys on 10 consecutive days, around dusk, from March to April and from September to October 2012 in Dioulassoba, a district of Bobo-Dioulasso city in Burkina Faso (West Africa). Swarms were observed outside, around identified larval breeding sites on the banks of the Houet River, as well as in the open-air courtyards found at the centre of many homes in the region. Swarms were found to occur in open sunlit spaces, mostly located above physical or visual cues somehow visually distinct from the surrounding area. Overall 67 and 78 swarms were observed, respectively, during the dry season (March-April) and the rainy season (September-October) of 2012, between 1.5 and 4.5m above the ground at the centre. 964 mosquitoes were collected and analysed from dry season swarms, of which most were male, and all were An. arabiensis, as were the few resting mosquitoes collected indoors. Larvae collected from breeding sites found on the banks of the Houet River mostly consisted of An. arabiensis and only a minority of Anopheles coluzzii (formerly identified as An. gambiae M form). Of 1694 mosquitoes analysed from 78 swarms in the rainy season collections, a few An. gambiae (formerly known as An. gambiae S form) males were identified, and the remainders were An. arabiensis. The majority of larvae collected during the wet season from the same breeding sites were identified as An. arabiensis followed by An. coluzzii and An. gambiae. The same pattern of species composition was observed in resting mosquitoes, though the proportion of An. arabiensis was less overwhelming. These data support the conclusion that An. arabiensis is the most prevalent species in this area, though the difference in species composition when using different population sampling techniques is noteworthy. Further studies are required for more detailed investigations of male dispersal, feeding behaviour and mating patterns in this urban setting