• Notes from the field: Hepatitis E Outbreak Among Refugees from South Sudan - Gambella, Ethiopia, April 2014- January 2015

      Browne, L B; Menkir, Z; Kahi, V; Maina, G; Asnakew, S; Tubman, M; Elyas, H Z; Nigatu, A; Dak, D; Maung, U A; et al. (Centers for Disease Control and Prevention, 2015-05-22)
      In early April 2014, two South Sudanese refugees in the Gambella region of western Ethiopia experienced acute onset of jaundice, accompanied by fever. One patient was a pregnant woman aged 24 years evaluated at a routine prenatal clinic visit in Leitchour refugee camp. The second patient was a malnourished boy aged 1 year who resided in Tierkidi refugee camp. The boy died despite hospitalization. During the last 2 weeks of May, four more cases of acute jaundice syndrome (AJS), defined as yellow discoloration of the eyes, were detected in Leitchuor. By mid-June, an additional 50 AJS cases were reported across three large camps in the region, Kule, Leitchuor, and Tierkidi, with 45 (90%) of these cases reported in Leitchuor. Sera collected from a convenience sample of 21 AJS cases were sent to Addis Ababa and Nairobi for real-time polymerase chain reaction testing; 12 (57%) were positive for hepatitis E virus (HEV) RNA. By January 2015, a total of 1,117 suspected cases of hepatitis E meeting the case definition of AJS were reported among refugees in camps across Gambella.
    • Notes from the Field: Outbreak of Vibrio cholerae Associated with Attending a Funeral - Chegutu District, Zimbabwe, 2018.

      McAteer, JB; Danda, S; Nhende, T; Manamike, P; Parayiwa, T; Tarupihwa, A; Tapfumanei, O; Manangazira, P; Mhlanga, G; Garone, DB; et al. (Centers for Disease Control and Prevention, 2018-05-18)
    • Off-Label Use of Bedaquiline in Children and Adolescents with Multidrug-Resistant Tuberculosis

      Achar, J; Hewison, C; Cavalheiro, AP; Skrahina, A; Cajazeiro, J; Nargiza, P; Herboczek, K; Rajabov, A; Hughes, J; Ferlazzo, G; et al. (Centers for Disease Control and Prevention, 2017-10)
      We describe 27 children and adolescents <18 years of age who received bedaquiline during treatment for multidrug-resistant tuberculosis. We report good treatment responses and no cessation attributable to adverse effects. Bedaquiline could be considered for use with this age group for multidrug-resistant tuberculosis when treatment options are limited.
    • Operational Research during the Ebola Emergency

      Fitzpatrick, G; Decroo, T; Draguez, B; Crestani, R; Ronsse, A; Van den Bergh, R; Van Herp, M (Centers for Disease Control and Prevention, 2017-07)
      Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.
    • Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis

      Mbuagbaw, L; Guglielmetti, L; Hewison, C; Bakare, N; Bastard, M; Caumes, E; Frechet-Jachym, M; Robert, J; Veziris, N; Khachatryan, N; et al. (Centers for Disease Control and Prevention, 2019-05-01)
      Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%-81.9%), and the treatment success rate was 65.8% (95% CI 59.9%-71.3%). Death rate was 11.7% (95% CI 7.0%-19.1%). Up to 91.1% (95% CI 82.2%-95.8%) of the patients experienced >1 adverse event, and 11.2% (95% CI 5.0%-23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.
    • Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012

      Page, Anne-Laure; Jusot, Viviane; Mamaty, Abdoul-Aziz; Adamou, Lagare; Kaplon, Jérôme; Pothier, Pierre; Djibo, Ali; Manzo, Mahamane L.; Toure, Brahima; Langendorf, Céline; et al. (Centers for Disease Control and Prevention, 2014-03)
      Knowledge of rotavirus epidemiology is necessary to make informed decisions about vaccine introduction and to evaluate vaccine impact. During April 2010–March 2012, rotavirus surveillance was conducted among 9,745 children <5 years of age in 14 hospitals/health centers in Niger, where rotavirus vaccine has not been introduced. Study participants had acute watery diarrhea and moderate to severe dehydration, and 20% of the children were enrolled in a nutrition program. Of the 9,745 children, 30.6% were rotavirus positive. Genotyping of a subset of positive samples showed a variety of genotypes during the first year, although G2P[4] predominated. G12 genotypes, including G12P[8], which has emerged as a predominant strain in western Africa, represented >80% of isolates during the second year. Hospitalization and death rates and severe dehydration among rotavirus case-patients did not differ during the 2 years. The emergence of G12P[8] warrants close attention to the characteristics of associated epidemics and possible prevention measures.
    • Symptom-Based Ebola Risk Score for Ebola Virus Disease, Conakry, Guinea

      Ingelbeen, B; De Weggheleire, A; Van Herp, M; van Griensven, J (Centers for Disease Control and Prevention, 2018-06)