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Bwire G.,Control of Diarrheal Diseases Unit | Malimbo M.,Ministry of Health Uganda | Makumbi I.,Ministry of Health Uganda | Kagirita A.,Central Public Health Laboratory | And 7 more authors.
Journal of Infectious Diseases

Introduction. Cholera outbreaks have occurred periodically in Uganda since 1971. The country has experienced intervals of sporadic cases and localized outbreaks, occasionally resulting in prolonged widespread epidemics.Methods. Cholera surveillance data reported to the Uganda Ministry of Health from 2007 through 2011 were reviewed to determine trends in annual incidence and case fatality rate. Demographic characteristics of cholera cases were analyzed from the national line list for 2011. Cases were analyzed by district and month of report to understand the geographic distribution and identify any seasonal patterns of disease occurrence.Results. From 2007 through 2011, Uganda registered a total of 7615 cholera cases with 181 deaths (case fatality rate = 2.4%). The absolute number of cases and incidence per 100 000 varied from year to year with the highest incidence occurring in 2008 following heavy rainfall and flooding in eastern Uganda. For 2011, cholera cases occurred in 1.6 times more males than females. The geographical areas affected by the outbreaks shifted each year, with the exception of a few endemic districts. No clear seasonal trends in cholera occurrence were identified for this time period.Conclusions. We observed an overall decline in cases reported during the 5 years under review. During this period, concerted efforts were made by the Ugandan government and development partners to educate communities on proper sanitation and hygiene and provide safe water and timely treatment. Mechanisms to ensure timely and complete cholera surveillance data are reported to the national level should continue to be strengthened. © 2013 The Author. Source

Gessner B.D.,Agence de Medecine Preventive AMP | Brooks W.A.,International Center for Diarrhoeal Disease Research | Brooks W.A.,Johns Hopkins University | Neuzil K.M.,PATH | And 6 more authors.

There is an increasing focus on influenza in low-resourced areas as a vaccine-preventable cause of severelower respiratory disease in young children, especially among those under two years of age. The extentof the disease burden is unclear: current etiologic studies may underestimate the impact of influenzaif recognized or unrecognized infection occurs some time before severe disease manifestations promptspecimen collection for diagnosis. Because of various methodological challenges, a vaccine probe approach was used to estimate vac-cine preventable disease incidence (VPDI) for Streptococcus pneumoniae and Haemophilus influenzae typeb, particularly for pneumonia outcomes among young children. A similar approach could be used todetermine VPDI for influenza. A highly effective vaccine would facilitate this approach; however, withappropriate design, a less than ideal vaccine also could be used to estimate VPDI. Because influenza vac-cine efficacy against severe disease may be greater than against all symptomatic influenza disease, avaccine probe approach could provide a better measure than etiologic studies of the public health utilityof influenza vaccine. The first 6 months of life is a time of particularly increased influenza risk among young children, andan age group for which current vaccines are not approved. Previous studies have found that maternalinfluenza immunization can reduce acute respiratory infection in the infant during this vulnerable period. Additional randomized, controlled trials are currently underway using a vaccine probe approach to esti-mate VPDI among mothers and their infants following maternal influenza immunization. The WorldHealth Organization now identifies pregnant women as the highest priority target group for influenzavaccination. Should countries implement this strategy, infants age 6-23 months likely would remain atincreased risk; vaccine probe approaches could quantify the public health benefit of immunizing thisgroup. © 2013. Source

Kebede S.,1163 Hidden Spirit Trail | Conteh I.N.,WHO Country Office | Steffen C.A.,Agence de Medecine Preventive AMP | Vandemaele K.,World Health Organization | And 7 more authors.
Health Research Policy and Systems

Background: Acute respiratory infections remain a leading cause of morbidity and mortality in Sierra Leone; however, similar to other African countries, little is known regarding the contribution of influenza. Routine influenza surveillance is thus a key element to improve understanding of the burden of acute respiratory infections in Africa. In 2011, the World Health Organization (WHO) funded the Strengthening Influenza Sentinel Surveillance in Africa (SISA) project with the goal of developing and strengthening influenza surveillance in eight countries in sub-Saharan Africa, including Sierra Leone. This paper describes the process of establishing a functional Influenza Sentinel Surveillance (ISS) system in Sierra Leone, a post-conflict resource-poor country previously lacking an influenza monitoring system.Methods: Sierra Leone utilized a systematic approach, including situational assessment, selection of sentinel sites, preparation of implementation plan, adaptation of the standard operating procedures, supervision and training of staff, and monitoring of influenza surveillance activities. The methods used in Sierra Leone were adapted to its specific context, using the Integrated Disease Surveillance and Response (IDSR) strategy as a platform for establishing ISS.Results: The ISS system started functioning in August 2011 with subsequent capacity to contribute surveillance activity data to global influenza databases, FluID and FluNet, demonstrating a functional influenza surveillance system in Sierra Leone within the period of the WHO SISA project support. Several factors were necessary for successful implementation, including a systematic approach, national ownership, appropriate timing and external support.Conclusions: The WHO SISA project demonstrated the feasibility of building a functional influenza surveillance system in Sierra Leone, integrated into existing national IDSR system. The ISS system, if sustained long-term, would provide valuable data to determine epidemiological and virological patterns and seasonal trends to assess the influenza disease burden that will ultimately guide national control strategies. © 2013 Kebede et al.; licensee BioMed Central Ltd. Source

Drach M.,University of Paris Dauphine | Le Gargasson J.-B.,Agence de Medecine Preventive AMP | Mathonnat J.,University dAuvergne | Da Silva A.,Agence de Medecine Preventive AMP | And 2 more authors.

The introduction of new vaccines with much higher prices than traditional vaccines results in increas-ing budgetary pressure on immunization programs in GAVI-eligible countries, increasing the need toensure their financial sustainability. In this context, the third EPIVAC (Epidemiology and Vaccinology)technical conference was held from February 16 to 18, 2012 at the Regional Institute of Public Healthin Ouidah, Benin. Managers of ministries of health and finance from 11 West African countries (GAVIeligible countries), as well as former EPIVAC students and European experts, shared their knowledge andbest practices on immunization financing at district and country level.The conference concluded by stressing five major priorities for the financial sustainability of nationalimmunization programs (NIPs) in GAVI-eligible countries.- Strengthen public financing by increasing resources and fiscal space, improving budget processes,increasing contribution of local governments and strengthen efficiency of budget spending.- Promote equitable community financing which was recognized as a significant and essential contri-bution to the continuity of EPI operations.- Widen private funding by exploring prospects offered by sponsorship through foundations dedicatedto immunization and by corporate social responsibility programs.- Contain the potential crowding-out effect of GAVI co-financing and ensure that decisions on newvaccine introductions are evidence-based.- Seek out innovative financing mechanisms such as taxes on food products or a national solidarityfund. © 2013. Source

Rebaudet S.,Aix - Marseille University | Mengel M.A.,Agence de Medecine Preventive AMP | Koivogui L.,Institute National Of Sante Publique Insp | Moore S.,Aix - Marseille University | And 9 more authors.
PLoS Neglected Tropical Diseases

Cholera is typically considered endemic in West Africa, especially in the Republic of Guinea. However, a three-year lull period was observed from 2009 to 2011, before a new epidemic struck the country in 2012, which was officially responsible for 7,350 suspected cases and 133 deaths. To determine whether cholera re-emerged from the aquatic environment or was rather imported due to human migration, a comprehensive epidemiological and molecular survey was conducted. A spatiotemporal analysis of the national case databases established Kaback Island, located off the southern coast of Guinea, as the initial focus of the epidemic in early February. According to the field investigations, the index case was found to be a fisherman who had recently arrived from a coastal district of neighboring Sierra Leone, where a cholera outbreak had recently occurred. MLVA-based genotype mapping of 38 clinical Vibrio cholerae O1 El Tor isolates sampled throughout the epidemic demonstrated a progressive genetic diversification of the strains from a single genotype isolated on Kaback Island in February, which correlated with spatial epidemic spread. Whole-genome sequencing characterized this strain as an "atypical" El Tor variant. Furthermore, genome-wide SNP-based phylogeny analysis grouped the Guinean strain into a new clade of the third wave of the seventh pandemic, distinct from previously analyzed African strains and directly related to a Bangladeshi isolate. Overall, these results highly suggest that the Guinean 2012 epidemic was caused by a V. cholerae clone that was likely imported from Sierra Leone by an infected individual. These results indicate the importance of promoting the cross-border identification and surveillance of mobile and vulnerable populations, including fishermen, to prevent, detect and control future epidemics in the region. Comprehensive epidemiological investigations should be expanded to better understand cholera dynamics and improve disease control strategies throughout the African continent. © 2014 Rebaudet et al. Source

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