Prevalence of human enteroviruses among apparently healthy nursery school children in Accra

Introduction: Human enteroviruses are common in children causing asymptomatic infections ranging  from mild to severe illnesses. In Ghana, information on the prevalence of non-polio enterovirus causing  acute flaccid paralysis is available but data on surveillance of these viruses in school children is scanty. Here, the prevalence of human enteroviruses among apparently healthy children in selected school in Accra was studied.Methods: Stool samples from 273 apparently healthy children less than eight years of age in 9 selected nursery schools were collected between December 2010 and March 2011and processed for human  enteroviruses on L20B, RD and Hep-2 cell lines. Positive Isolates were characterized by microneutralisation assay with antisera pools from RIVM, the Netherlands according to standard  methods recommended by WHO. Results: Of the 273 samples processed, 66 (24.2%) non-polio enteroviruses were isolated. More growth  was seen on Hep-2C (46%) only than RD (18%) only and on both cell lines (34%). No growth was seen on  L20B even after blind passage. Excretion of non-polio enteroviruses was found in all the schools with  majority in BD school. Serotyping of the isolates yielded predominantly Coxsackie B viruses followed by echoviruses 13 and 7. More than half of the isolates could not be typed by the antisera pools.Conclusion: The study detected 13 different serotypes of non-polio enteroviruses in circulation but no poliovirus was found. BD school was found to have the highest prevalence of NPEV. Complete  identification through molecular methods is essential to establish the full range of NPEVs in circulation in these schools.Key words: Non-polio enterovirus, apparently healthy, school children, Accra

Respiratory syncytial virus genotypes circulating in urban Ghana: february to november 2006

Introduction: Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract  infection (ALRI) in young children. RSV strains have been divided into 2 major antigenic groups (A and B), which are further divided into several genotypes, but very little is known about its circulating genotypes in Ghana. This study characterized RSV genotypes detected in children with ALRI in Accra between  February and November 2006. Methods: Nasopharyngeal aspirates (NPA) were obtained from children diagnosed with ALRI between  February and November 2006. The NPA were screened for RSV using a nested multiplex reverse  transcriptase polymerase chain reaction (RT-PCR) method for genotyping RSV. Viral RNA was extracted from the NPA using guanidinium isothiocyanate method and purified with an RNAID commercial kit.  Care-givers gave their consent prior to specimen collection. Administered questionnaires captured  information on patient demographic and clinical history. Results: A total of 53 children were enrolled in the study with a male to female ratio of 3:1. Of the 53 NPA  analyzed, 60.4% (32/53) were positive for RSV. Subsequent genotypic analysis showed that 72% (23/32) of the 60.4% RSV infections were RSV B only and 28% (9/32) were co-infections of both RSV A and B. Children between the ages of 2 - 12 months were the most affected age group per an RSV infection rate of 37.5% (12/32). No significant difference was detected in the recovery rate of ALRI (98.1%) and RSV (96.9%) positive patients from the infection. One patient died resulting in a mortality rate of 3.1%. Bronchopneumonia (20 out of 32 cases) was the major diagnosis on admission. RSV infection was  seasonal dependent, described by 2 peaks in October and April-May.Conclusion: Both RSV A and RSV B genotypes co-circulated during the study period with RSV B  predominating. RSV may possibly be the main pathogen of lower respiratory tract illness during  epidemics in the wet seasons. Genotyping by the multiplex RT-PCR is one of the first attempts at  molecular diagnosis of RSV infection in Ghana.Key words: Respiratory syncytial viruses, lower respiratory tract infections, multiplex RT-PC

Respiratory syncytial virus genotypes circulating in urban Ghana: february to

Abstract Introduction: Respiratory syncytial virus (RSV) is the major cause of acute lower respiratory tract infection (ALRI) in young children. RSV strain

SARS-CoV-2 detection among international air travellers to Ghana during mandatory quarantine

Objectives: To determine the prevalence of SARS-CoV-2 detection among international travellers to Ghana during mandatory quarantine.Design: A retrospective cross-sectional study.Setting: Air travellers to Ghana on 21st and 22nd March 2020.Participants: On 21st and 22nd March 2020, a total of 1,030 returning international travellers were mandatorily quarantined in 15 different hotels in Accra and tested for SARS-CoV-2. All of these persons were included in the study.Main outcome measure: Positivity for SARS-CoV-2 by polymerase chain reaction.Results: The initial testing at the beginning of quarantine found 79 (7.7%) individuals to be positive for SARS-CoV-2. In the exit screening after 12 to 13 days of quarantine, it was discovered that 26 of those who tested negative for SARS-CoV-2 in the initial screening subsequently tested positive.Conclusions: Ghana likely averted an early community spread of COVID-19 through the proactive approach to quarantine international travellers during the early phase of the pandemic

Data management during COVID-19 outbreak response in Ghana: a reference laboratory perspective on key issues and measures

The COVID-19 pandemic caused by SARS-CoV-2 is an important subject for global health. Ghana experienced lowmoderate transmission of the disease when the first case was detected in March 12, 2020 until the middle of July when the number of cases begun to drop. By August 24, 2020, the country's total number of confirmed cases stood at 43,622, with 263 deaths. By the same time, the Noguchi Memorial Institute for Medical Research (NMIMR) of the University of Ghana, the primary testing centre for COVID-19, had tested 285,501 with 28,878 confirmed cases. Due to database gaps, there were initial challenges with timely reporting and feedback to stakeholders during the peak surveillance period. The gaps resulted from mismatches between samples and their accompanying case investigation forms, samples without case investigation forms and vice versa, huge data entry requirements, and delayed test results. However, a revamp in data management procedures, and systems helped to improve the turnaround time for reporting results to all interested parties and partners. Additionally, inconsistencies such as multiple entries and discrepant patient-sample information were resolved by introducing a barcoding electronic capture system. Here, we describe the main challenges with COVID-19 data management and analysis in the laboratory and recommend measures for improvement

Molecular diagnosis for the novel coronavirus SARS-CoV-2: lessons learnt from the Ghana experience

Background: A novel coronavirus, SARS-CoV-2 is currently causing a worldwide pandemic. The first cases of SARS-CoV-2 infection were recorded in Ghana on March 12, 2020. Since then, the country has been combatting countrywide community spread. This report describes how the Virology Department, Noguchi Memorial Institute for Medical Research (NMIMR) is supporting the Ghana Health Service (GHS) to diagnose infections with this virus in Ghana.Methods: The National Influenza Centre (NIC) in the Virology Department of the NMIMR, adopted real-time Polymerase Chain Reaction (rRT-PCR) assays for the diagnosis of the SARS-CoV-2 in January 2020. Samples from suspected cases and contact tracing across Ghana were received and processed for SARS-CoV-2. Samples were ‘pooled’ to enable simultaneous batch testing of samples without reduced sensitivity.Outcomes: From February 3 to August 21, the NMIMR processed 283 946 (10%) samples. Highest number of cases were reported in June when the GHS embarked on targeted contact tracing which led to an increase in number of samples processed daily, peaking at over 7,000 samples daily. There were several issues to overcome including rapid consumption of reagents and consumables. Testing however continued successfully due to revised procedures, additional equipment and improved pipeline of laboratory supplies. Test results are now provided within 24 to 48 hours of sample submission enabling more effective response and containment.Conclusion: Following the identification of the first cases of SARS-CoV-2infection by the NMIMR, the Institute has trained other centres and supported the ramping up of molecular testing capacity in Ghana. This provides a blueprint to enable Ghana to mitigate further epidemics and pandemics

SARS-CoV-2 infections among asymptomatic individuals contributed to COVID-19 cases: A cross-sectional study among prospective air travelers from Ghana

BackgroundThe spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by asymptomatic individuals has been reported since the early stages of the coronavirus disease 2019 (COVID-19) outbreak in various parts of the world. However, there are limited data regarding SARS-CoV-2 among asymptomatic individuals in Ghana. The aim of the study was to use test data of prospective travelers from Ghana as a proxy to estimate the contribution of asymptomatic cases to the spread of COVID-19.MethodsThe study analyzed the SARS-CoV-2 PCR test data of clients whose purpose for testing was classified as “Travel” at the COVID-19 walk-in test center of the Noguchi Memorial Institute for Medical Research (NMIMR) from July 2020 to July 2021. These individuals requesting tests for travel generally had no clinical symptoms of COVID-19 at the time of testing. Data were processed and analyzed using Microsoft Excel office 16 and STATA version 16. Descriptive statistics were used to summarize data on test and demographic characteristics.ResultsOut of 42,997 samples tested at the center within that period, 28,384 (66.0%) were classified as “Travel” tests. Of these, 1,900 (6.7%) tested positive for SARS-CoV-2. The majority (64.8%) of the “Travel” tests were requested by men. The men recorded a SARS-CoV-2 positivity of 6.9% compared to the 6.4% observed among women. Test requests for SARS-CoV-2 were received from all regions of Ghana, with a majority (83.3%) received from the Greater Accra Region. Although the Eastern region recorded the highest SARS-CoV-2 positivity rate of 8.35%, the Greater Accra region contributed 81% to the total number of SARS-CoV-2 positive cases detected within the period of study.ConclusionOur study found substantial SARS-CoV-2 positivity among asymptomatic individuals who, without the requirement for a negative SARS-CoV-2 result for travel, would have no reason to test. These asymptomatic SARS-CoV-2-infected individuals could have traveled to other countries and unintentionally spread the virus. Our findings call for enhanced tracing and testing of asymptomatic contacts of individuals who tested positive for SARS-CoV-2

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines

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

Die molekulare Epidemiologie von Atmungsviren verbunden mit akuten Erkrankungen/Infektionen der unteren Atemwege (ALRI) vom Kindern in Ghana

Acute lower respiratory tract infections (ALRI) cause annually more than one million deaths in children under the age of five years worldwide. This accounts for 18% of all childhood mortality, of which 99% occurs in developing countries. In Ghana, ALRI, particularly pneumonia, accounted for an 11.3% increase in hospital admissions with a case fatality rate of 38% in 2011. However, collection and analysis of surveillance data is rarely performed and limited to a few pathogens. Therefore from February 2006 to November 2006, and January 2013 to December 2014, children with ALRI between 0 and 5 years of age were prospectively enrolled from two hospitals in Accra, Ghana. Children below the age of one year were mostly affected by ALRI. Nasopharyngeal aspirates or nasal swabs were collected from all patients and investigated for 16 common respiratory pathogens by specific real-time PCR assays. Seventy-three percent (404/552) of the specimens were positive for at least one respiratory virus. Beside RSV (23%), RV (19%), HBoV (14%), HPIV (12%), and HAdV (12%) were found to considerably contribute to ALRI. Respiratory viruses each circulated in the dry and/or the rainy season causing enhanced ALRI activity in February, July, and October of each year. Further, infants were mainly infected with RSV (33%), toddlers with HBoV (21%), and preschool children with influenza viruses (22%). The clinical diagnosis of ALRI patients included bronchopneumonia and bronchiolitis, each being highly associated with RSV. Pneumonia was significantly associated with RV, and respiratory tract infection with HAdV and influenza viruses. To investigate the circulating virus strains phylogenetic analyses were performed. Of RSV group A and B viruses mainly genotypes ON1 and BA9, respectively, caused ALRI. Further, of HMPV genetic lineages A2a, B1, and B2 as well as of influenza virus A(H3N2), A(H1N1), and B /Victoria-lineage clades 3C.3, 6C, and 1A viruses were identified. HAdV species B and C were most commonly detected among other species in these patients. As expected, a high number of RV types including four new provisionally assigned types were identified. RV mainly belonged to species A and C. This study investigated the role of 16 respiratory pathogens on the viral etiology of ALRI in Ghana. For the first time, comprehensive molecular and epidemiological data were provided including rarely investigated pathogens like HMPV, RV, HBoV, and HCoV. The detection of multiple viruses highlights the need for prospective surveillance and routine diagnostic in order to take protective measures or to improve patient care.Jährlich sterben weltweit mehr als eine Million Kinder bis zu einem Alter von fünf Jahren an akuten Erkrankungen der unteren Atemwege (ALRI). Dies entspricht einer Kindersterblichkeit von 18%; wobei 99% dieser Fälle in Entwicklungsländern auftreten. In Ghana führten 2011 ALRI, insbesondere Pneumonien, zu einem Anstieg der Krankenhauseinweisungen auf 11,3% und zu einer Letalität von 38%. Erregerspezifische Surveillance-Daten werden jedoch kaum erhoben und sind zudem auf wenige Pathogene begrenzt. Daher wurden von Februar 2006 bis November 2006 und Januar 2013 bis Dezember 2014 prospektiv Kinder mit ALRI im Alter von 0 und 5 Jahren aus zwei Krankenhäusern in Accra, Ghana in diese Studie aufgenommen. Der Großteil der an ALRI erkrankten Patienten waren Kleinkinder jünger als ein Jahr. Von allen Patienten wurden entweder Nasen-Rachen-Aspirate oder Nasenabstriche mit spezifischen real-time PCR-Assays auf 16 respiratorischer Erreger untersucht. Dreiundsiebzig Prozent (404/552) der Proben waren für mindestens ein Atemwegsvirus positiv. Neben RSV (23%) trugen RV (19%), HBoV (14%), HPIV (12%) und HAdV (12%) erheblich zu ALRI bei. Die respiratorischen Viren zirkulierten in der Trocken- und/oder Regenzeit und führten jedes Jahr im Februar, Juli und Oktober zu einer Verstärkung der ALRI Aktivität. Darüber hinaus wurden hauptsächlich Säuglinge mit RSV infiziert (33%), Kleinkinder mit HBoV (21%), und Vorschulkinder mit Influenzaviren (22%). Die klinische Diagnose von ALRI-Patienten beinhaltete unter anderem Bronchopneumonie und Bronchiolitis, welche jeweils signifikant mit RSV assoziiert waren. Pneumonie war signifikant mit RV und Erkrankungen der Atemwege mit HAdV und Influenza-Viren assoziiert. Um Informationen über die zirkulierenden Viren zu erhalten, wurden phylogenetische Analysen durchgeführt. ALRI wurde von RSV Gruppe A und B Viren hauptsächtlich durch die Genotypen ON1 und BA9 verursacht. Weiterhin wurden von HMPV die genetischen [237] Linien A2a, B1 und B2 sowie von Influenzavirus A(H3N2), A(H1N1) und B /Victoria-Linie die Clades 3C.3, 6C und 1A identifiziert. HAdV Spezies B und C wurden am häufigsten neben anderen HAdV Spezies in diesen Patienten nachgewiesen. Wie erwartet wurde eine hohe Anzahl von RV-Typen, darunter vier neue vorläufig bezeichnete RV-Typen, identifiziert. Diese RV-Typen gehörten vor allem zu den Spezies A und C. In dieser Studie wurde die Rolle von 16 Atemwegserregern auf die virale Ätiologie von ALRI in Ghana untersucht. Erstmalig wurden umfassende molekulare und epidemiologische Daten einschließlich selten untersuchter Erreger wie HMPV, RV, HBoV und HCoV erhoben. Die Vielzahl der nachgewiesenen respiratorischen Viren unterstreicht die Notwendigkeit für eine prospektive Surveillance und Routinediagnostik, um geeignete Präventionsmaßnahmen zu ergreifen oder die Patientenversorgung in Ghana zu verbessern