Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Ocular manifestations in chronic inflammatory rheumatism

Objective: To contribute to the study of the characteristics of Chronic Inflammatory Rheumatism (RIC) in Guinea. Design: Cross-sectional study. Methods: The study was carried out over a period of nine months on patients with chronic inflammatory rheumatism and the ocular manifestations. Results: The study population consisted of 28 patients including 10 men and 18 women, the mean age was 39.07 ± 16.04 years. The different types of rheumatism encountered were: rheumatoid arthritis (n=18), ankylosing spondylitis (n=8) systemic lupus erythematosus (n=1), juvenile idiopathic arthritis (n=1). All patients presented with ocular manifestations (100%): sicca syndrome (n=24), allergic conjunctivitis (n=5), ametropia (n=5), cataract (n=3), anterior uveitis (n=3), episcleritis (n=1), keratitis (n=1) and glaucoma (n=1). Conclusion: Ocular manifestations during inflammatory rheumatism are frequent, the sicca syndrome was dominant

Prise en charge des rhumatismes inflammatoires chroniques en guinee

Objectif: Etudier la prise en charge des patients atteint de rhumatisme inflammatoire chronique en Guinée.Patients et méthodes: Etude transversale descriptive de 18 mois ( du 1er Octobre 2016 au 30 Avril 2018) au service de rhumatologie de l'hôpital national Ignace Deen. Tous les malades répondant aux critères diagnostiques des rhumatismes inflammatoires chroniques ont été inclus.Résultats: Nous avons colligé 339 cas de rhumatisme inflammatoire chronique sur 1502 patients (22,56 %) dont 56,63 % de femmes. L’âge moyen des patients était de 43,05 ±18,04 ans (extrêmes de 8 mois et 90 ans). L’âge moyen de début des symptômes était de 39,20± 18,04 ans. Le délai diagnostique moyen était de 3,88 ± 5,36 ans. La polyarthrite rhumatoïde était le rhumatisme inflammatoire chronique le plus fréquent (108 cas, soit 31,86%) et le méthotrexate était le traitement de fond le plus utilisé (36,09%). Aucun patient n’avait bénéficié de biothérapie. Le méthotrexate était le traitement qui avait le plus d’effets secondaires (12 ; 3,53%). L’évolution était favorable à 3 mois dans 57,52% des cas, marquée par une rémission. Le coût mensuel de la prise en charge était en moyenne équivalent à 1,5 fois le salaire minimum garanti en Guinée.Conclusion: Les rhumatismes inflammatoires chroniques sont fréquents en Guinée. La prise en charge est empreinte de difficultés liées à la faiblesse du plateau technique et au bas niveau socio-économique des patients. Mots clés : polyarthrite rhumatoïde, spondyloarthrites, méthotrexate, Guinée.   English title: Management of chronic inflammatory rhumatism in guinea Objective: To study the management of patients with chronic inflammatory rheumatism in Guinea. Patients and methods: descriptive cross-sectional study of 18 months (1st October 2016 to 30th April 2018) at the rheumatology department of Ignace Deen National Hospital. All patients meeting the diagnostic criteria were included. Results: We collected 339 cases (22.56%) of chronic inflammatory rheumatism in 1502 patients (22.56%), 56,63% of whom were women. The mean age of the patients was 43.05 ± 18.04 years (range: 8 months to 90 years). The mean age of onset of symptoms was 39.20 ± 18.04 years. The mean diagnostic delay was 3,88 ± 5.36 years. Rheumatoid arthritis was the most common condition (108 cases, or 31.86%), Methotrexate were the most commonly used DMARDs (36.09%). No patient had receive biotherapy. Methotrexate was the treatment with the most side effect (12 cases, 3.53%). The evolution was favourable at 3 months in 57.52% of the cases, marked by a remission. The monthly cost of care was on average equivalent to 1.5 times the guaranteed minimum wage in Guinea. Conclusion: Chronic inflammatory rheumatism is common in Guinea. The management is fraught with difficulties related to the weakness of the technical platform and the low socio-economic level of the patients. Keywords: Rheumatoid arthritis, spondyloarthritis, methotrexate, Guinea

Experimental treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial) : a historically controlled, single-arm proof-of-concept trial in Guinea

BACKGROUND:Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies.METHODS AND FINDINGS:Inclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 μmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 μmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 μmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 μmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within <72 h of symptoms compared to others. Favipiravir was well tolerated.CONCLUSIONS:In the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia.TRIAL REGISTRATION:ClinicalTrials.gov NCT02329054.Evaluation of the efficacy and of the antiviral activity of T-705 (favipiravir) duringEbola virus infection in non-human primates humansEbola Virus Disease - correlates of protection, determinants of outcome, and clinical managemen