The epidemiology of human brucellosis in the context of zoonotic diseases in Tanzania

The aims of the study were to determine the seroprevalence and incidence of human brucellosis in Arusha and Manyara regions, risk factors for human brucellosis, health-seeking behavior and clinical features of human brucellosis cases and to evaluate different diagnostic tests for brucellosis. Other objectives included determination of the knowledge of medical practitioners relevant for diagnosis of zoonoses and estimation of the burden of disease caused by human brucellosis in Tanzania.From cross-sectional studies, the Brucella seroprevalence in humans was 4.8% when determined by assays in the field and 6.4 % at the Sokoine University of Agriculture (SUA) based on the Rose Bengal Plate Test (RBPT). Based on the competitive ELISA (c-ELISA) test conducted at the Veterinary Laboratory Agencies (VLA) the seroprevalence of brucellosis was 7.7%. The majority of RBPT positive individuals were asymptomatic. Most of the c-ELISA positive individuals were above 15 years of age with the age group 16-30 years having the highest number of seropositive individuals. There was a significant association between the seroprevalence of brucellosis in humans and the seroprevalence of brucellosis in goats at the district level.Prospective hospital studies indicated that the incidence of brucellosis was 11.2 cases/100,000 people per annum. Joint pain, headache, backache, fever and fatigue were the main clinical features described by the confirmed (c-ELISA positive) patients, but these were also most commonly reported by the c-ELISA negative patients initially suspected as having brucellosis. Patients with brucellosis delayed going to hospital with a median delay time of 90 days. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. More cases of brucellosis were recorded in hospitals located in pastoral areas and brucellosis was more common among people engaging in business.Brucellosis was associated with assisting an aborting animal. It was shown that the closer the distance between households, the higher the risk of brucellosis. People who were of Christian religion were found to have a higher risk of disease compared to other religions.The sensitivity and specificity of the RBPT in the cross-sectional survey were 39.4% and 98.8% respectively, at the SUA laboratory 38.7% and 96.8% respectively and at the hospitals 44.3% and 89.5% respectively. The sensitivities and specificities of the diagnostic tests for brucellosis at the hospitals were also low. There was a poor agreement between the RBPT performed at SUA, the RBPT performed in crosssectional survey and the tests performed at the hospitals.Medical practitioners in rural hospitals had poorer knowledge of most zoonoses when compared to the practitioners in urban hospitals, including transmission of sleeping sickness, clinical presentations of anthrax and rabies in humans. In both areas practitioners had poor knowledge of echinococcosis transmission to humans, clinical features of echinococcosis in humans, and diagnosis of bovine tuberculosis in humans.Brucellosis contributed to an estimated 3,644 -3,708 Disability Adjusted Life Years (DALY) burden in Tanzania based on data collected from hospitals while data from the community resulted in an estimated 92,080 - 121,550 DALY burden in Tanzania. The majority of cases continued to have brucellosis clinical features for a period of over two years, and out of these, five days spent as inpatients. Households used a mean total of US $90.65 (92, 826 TShs.) to care for a single case of brucellosis per year and each health provider used a mean total of US$ 858 (878,592 TShs.) per year to care for cases of brucellosis.Brucellosis contributes to poverty and suffering particularly to the poor in the rural areas of Tanzania and yet it is neglected. There is a need for increased health education on risk factors for transmission of brucellosis to humans and the importance of going to hospital at an early stage of the disease. More efforts also need to be directed towards improving the diagnosis and treatment of brucellosis to reduce prolonged human suffering from brucellosis. This should include the adoption of standardized diagnostic and treatment protocols. Restructuring and updating of disease recording systems and diagnostic laboratories so that they diagnose and hence capture zoonoses such as brucellosis should be implemented. Efforts should be made to equip practitioners with adequate knowledge relevant for identification of zoonoses

After-action review of rabies and anthrax outbreaks multisectoral response in Tanzania, challenges and lessons

After-action review uses experiences gained from past events to adopt best practices, thereby improving future interventions. In December 2016 and late 2018, the government of Tanzania with support from partners responded to anthrax and rabies outbreaks in Arusha and Morogoro regions respectively. The One Health Coordination Desk (OHCD) of the Prime Minister’s Office (PMO) later coordinated after-action reviews to review the multi-sectoral preparedness and response to the outbreaks. To establish and describe actions undertaken by the multi-sectoral investigation and response teams during planning and deployment, execution of field activities, and outbreak investigation and response, system best practices and deficiencies. These were cross-sectional surveys. Semi-structured, open and closed-ended questionnaire and focus group discussions were administered to collect information from responders at the national and subnational levels. It was found that the surveillance and response systems were weak at community level, lack of enforcement of public health laws including vaccination of livestock and domestic animals and joint preparedness efforts were generally undermined by differential disease surveillance capacities among sectors. Lack of resources in particular funds for supplies, transport and deployment of response teams contributed to many shortfalls. The findings underpin the importance of after-action reviews in identifying critical areas for improvement in multi-sectoral prevention and control of disease outbreaks. Main sectors under the coordination of the OHCD should include after action reviews in their plans and budget it as a tool to continuously assess and improve multi-sectoral preparedness and response to public health emergencies

Social science in a water observing system

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95008/1/wrcr12336.pd

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

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

Prognostic implications of adaptive immune features in MMR-proficient colorectal liver metastases classified by histopathological growth patterns

BACKGROUND: After resection, colorectal cancer liver metastases (CRLM) surrounded by a desmoplastic rim carry a better prognosis than the metastases replacing the adjacent liver. However, these histopathological growth patterns (HGPs) are insufficient to guide clinical decision-making. We explored whether the adaptive immune features of HGPs could refine prognostication. METHODS: From 276 metastases resected in 176 patients classified by HGPs, tissue microarrays were used to assess intratumoral T cells (CD3), antigen presentation capacity (MHC class I) and CD73 expression producing immunosuppressive adenosine. We tested correlations between these variables and patient outcomes. RESULTS: The 101 (57.4%) patients with dominant desmoplastic HGP had a median recurrence-free survival (RFS) of 17.1 months compared to 13.3 months in the 75 patients (42.6%) with dominant replacement HGP (p = 0.037). In desmoplastic CRLM, high vs. low CD73 was the only prognostically informative immune parameter and was associated with a median RFS of 12.3 months compared to 26.3, respectively (p = 0.010). Only in dominant replacement CRLM, we found a subgroup (n = 23) with high intratumoral MHC-I expression but poor CD3(+) T cell infiltration, a phenotype associated with a short median RFS of 7.9 months. CONCLUSIONS: Combining the assessments of HGP and adaptive immune features in resected CRLM could help identify patients at risk of early recurrence

Organization in actual episodes of work : Harvey Sacks and organization studies

This paper explores the relevance of Harvey Sacks' work for contemporary organization studies. Sacks encourages analysts to tether their studies to real-time workplace activities; ordinary scenes of work are recorded, slowed down and made the central object of study. Something of Sacks' analytic mentality and style are illustrated through the analysis of two data extracts: an emergency 999 call and a face-to-face sales encounter. A distinctive way of doing organizational analysis is discussed that foregrounds knowledgeability and agency via the examination of sequence and method. Sacks raises the possibility that organization might be recoverable from the fine-grained detail of actual episodes. The idea that order, intelligibility and the constitution of social scenes might have a basis aside from the more general notion of discourse is discussed

Expressive Wähler bei der Bundestagswahl 2013

Die Theorie des expressiven Wählens hat sich in den vergangenen Jahren zwar als intellektuell anregend, empirisch aber wenig ertragreich erwiesen. Vor diesem Hintergrund stellt unser Beitrag ein Instrument direkter Messung expressiver Motivation vor, das bei der Bundestagswahl 2013 angewandt wurde. Das Hauptziel dieses Beitrags besteht in der Validierung dieses Instruments. Unsere Analysen zeigen, dass sich expressive Motivation sinnvoll von anderen Motivationen trennen lässt. Gleichzeitig finden wir systematische interindividuelle Unterschiede im Ausmaß expressiver Motivation. Schließlich zeigt sich auch eine Reihe von erwarteten Auswirkungen expressiver Motivation sowohl auf die persönliche Kommunikation der Bürger im Wahlkampf als auch auf die Art ihrer Entscheidungsfindung bei der Bundestagswahl 2013