• The 2014–2015 Ebola Outbreak in West Africa: Hands On

      Vetter, P; Dayer, JA; Schibler, M; Allegranzi, B; Brown, D; Calmy, A; Christie, D; Eremin, S; Hagon, O; Henderson, D; et al. (BioMed Central, 2016-05-05)
      The International Consortium for Prevention and Infection Control (ICPIC) organises a biannual conference (ICPIC) on various subjects related to infection prevention, treatment and control. During ICPIC 2015, held in Geneva in June 2015, a full one-day session focused on the 2014–2015 Ebola virus disease (EVD) outbreak in West Africa. This article is a non-exhaustive compilation of these discussions. It concentrates on lessons learned and imagining a way forward for the communities most affected by the epidemic. The reader can access video recordings of all lectures delivered during this one-day session, as referenced. Topics include the timeline of the international response, linkages between the dynamics of the epidemic and infection prevention and control, the importance of community engagement, and updates on virology, diagnosis, treatment and vaccination issues. The paper also includes discussions from public health, infectious diseases, critical care and infection control experts who cared for patients with EVD in Africa, in Europe, and in the United Sates and were involved in Ebola preparedness in both high- and low-resource settings and countries. This review concludes that too little is known about the pathogenesis and treatment of EVD, therefore basic and applied research in this area are urgently required. Furthermore, it is clear that epidemic preparedness needs to improve globally, in particular through the strengthening of health systems at local and national levels. There is a strong need for culturally sensitive approaches to public health which could be designed and delivered by social scientists and medical professionals working together. As of December 2015, this epidemic killed more than 11,000 people and infected more than 28,000; it has also generated more than 17,000 survivors and orphans, many of whom face somatic and psychological complications. The continued treatment and rehabilitation of these people is a public health priority, which also requires an integration of specific medical and social science approaches, not always available in West Africa.
    • Characteristics of human encounters and social mixing patterns relevant to infectious diseases spread by close contact: a survey in Southwest Uganda

      le Polain de Waroux, O; Cohuet, S; Ndazima, D; Kucharski, AJ; Juan-Giner, A; Flasche, S; Tumwesigye, E; Arinaitwe, R; Mwanga-Amumpaire, J; Boum, Y; et al. (BioMed Central, 2018-04-11)
      Quantification of human interactions relevant to infectious disease transmission through social contact is central to predict disease dynamics, yet data from low-resource settings remain scarce.
    • Ciprofloxacin for Contacts of Cases of Meningococcal Meningitis as an Epidemic Response: Study Protocol for a Cluster-Randomized Trial

      Coldiron, M; Alcoba, G; Ciglenecki, I; Hitchings, M; Djibo, A; Page, A; Langendorf, C; Grais, RF (BioMed Central, 2017-06-24)
      Epidemics of meningococcal meningitis are common in the "African meningitis belt." Current response strategies include reactive vaccination campaigns, which are often organized too late to have maximal impact. A novel strain of Neisseria meningitidis serogroup C has been circulating in recent years, and vaccine supplies are limited. An evaluation of chemoprophylaxis with single-dose ciprofloxacin for household contacts of meningitis cases has therefore been recommended.
    • CMV retinitis in China and SE Asia: the way forward

      Heiden, David; Saranchuk, Peter; Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Berkeley, CA, USA; South African Medical Unit, Operational Centre Brussels, Medicines Sans Frontieres, Cape Town, South Africa (BioMed Central, 2011-11-24)
      AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extraocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.
    • CMV retinitis screening and treatment in a resource-poor setting: three-year experience from a primary care HIV/AIDS programme in Myanmar

      Tun, Nini; London, Nikolas; Kyaw, Moe Kyaw; Smithuis, Frank; Ford, Nathan; Margolis, Todd; Drew, W Lawrence; Lewallen, Susan; Heiden, David; Medical Action Myanmar, Yangon, Myanmar; Wills Eye Institute, Retina Service, Philadelphia, PA, USA; Médecins Sans Frontières OCA, Yangon, Myanmar; Médecins Sans Frontières, London, UK; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa; University of California San Francisco, San Francisco, CA, USA; Kilimanjaro Centre for Community Ophthalmology, Moishe, Tanzania; California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Berkeley, CA, USA. (BioMed Central, 2011-08-15)
      Cytomegalovirus retinitis is a neglected disease in resource-poor settings, in part because of the perceived complexity of care and because ophthalmologists are rarely accessible. In this paper, we describe a pilot programme of CMV retinitis management by non-ophthalmologists. The programme consists of systematic screening of all high-risk patients (CD4 <100 cells/mm3) by AIDS clinicians using indirect ophthalmoscopy, and treatment of all patients with active retinitis by intravitreal injection of ganciclovir. Prior to this programme, CMV retinitis was not routinely examined for, or treated, in Myanmar.
    • Community-based measles mortality surveillance in two districts of Katanga Province, Democratic Republic of Congo

      N Goran, Alexandra A; Ilunga, Ngoie; Coldiron, Matthew E; Grais, RFebecca F; Porten, Klaudia (BioMed Central, 2013-12-17)
      Mortality due to measles is often under-reported. Traditional methods of measuring mortality can be time and resource-intensive. We describe the implementation of a community-based method to monitor measles mortality.
    • Description of a large measles epidemic in Democratic Republic of Congo, 2010-2013

      Mancini, Silvia; Coldiron, Matthew E; Ronsse, Axelle; Ilunga, Benoît Kebela; Porten, Klaudia; Grais, RFebecca F (BioMed Central, 2014-07-03)
      Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC.
    • Diagnostic accuracy of VIKIA® Rota-Adeno and Premier™ Rotaclone® tests for the detection of Rotavirus in Niger

      Lagare, A; Moumouni, A; Kaplon, J; Langendorf, C; Pothier, P; Grais, RF; Issaka, B; Page, A (BioMed Central, 2017-10-23)
      We conducted a parallel evaluation of the diagnostic accuracy of VIKIA® Rota-Adeno, a rapid diagnostic test (RDT) and Premier™ Rotaclone® an enzyme immunoassay (EIA) using reverse transcription polymerase chain reaction (RT-PCR) as the reference standard. The study was part of a rotavirus surveillance project in Niger.
    • Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned

      Borchert, Matthias; Mutyaba, Imaam; Van Kerkhove, Maria D; Lutwama, Julius; Luwaga, Henry; Bisoborwa, Geoffrey; Turyagaruka, John; Pirard, Patricia; Ndayimirije, Nestor; Roddy, Paul; et al. (BioMed Central, 2011-12-28)
    • The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone

      Caleo, G; Duncombe, J; Jephcott, F; Lokuge, K; Mills, C; Looijen, E; Theoharaki, F; Kremer, R; Kleijer, K; Squire, J; et al. (BioMed Central, 2018-02-13)
      Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone.
    • Global epidemiology of invasive meningococcal disease

      Jafri, Rabab Z; Ali, Asad; Messonnier, Nancy E; Tevi-Benissan, Carol; Durrheim, David; Eskola, Juhani; Fermon, Florence; Klugman, Keith P; Ramsay, Mary; Sow, Samba; et al. (BioMed Central, 2013-09-10)
      Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20 years in World Health Organization and European Centre for Disease Prevention and Control collections and published articles are included in this review, as well as direct communications with leading experts in the field. Countries were grouped into high-, moderate-, and low-incidence countries. The majority of countries in the high-incidence group are found in the African meningitis belt; many moderate-incidence countries are found in the European and African regions, and Australia, while low-incidence countries include many from Europe and the Americas. Priority countries for vaccine intervention are high- and moderate-incidence countries where vaccine-preventable serogroups predominate. Epidemiological data on burden of IMD are needed in countries where this is not known, particularly in South- East Asia and Eastern Mediterranean regions, so evidence-based decisions about the use of meningococcal vaccines can be made.
    • Increased Hepatitis C Virus Co-infection and Injection Drug Use in HIV-infected Fishermen in Myanmar

      Ousley, J; Nesbitt, R; Kyaw, NTT; Bermudez, E; Soe, KP; Anicete, R; Mon, PE; Le Shwe Sin Ei, W; Christofani, S; Fernandez, M; et al. (BioMed Central, 2018-12-14)
      In Southeast Asia, though fishermen are known to be a key population at high risk of HIV, little is known about their co-infection rates with Hepatitis C virus (HCV), or how illness and risk behaviors vary by occupation or type of fishermen. In Myanmar, this lack of knowledge is particularly acute, despite the fact that much of the country's border is coastline.
    • Offering General Pediatric Care During the Hard Times of the 2014 Ebola Outbreak: Looking Back at How Many Came and How Well They Fared at a Médecins Sans Frontières Referral Hospital in Rural Sierra Leone

      Hermans, V; Zachariah, R; Woldeyohannes, D; Saffa, G; Kamara, D; Ortuno-Gutierrez, N; Kizito, W; Manzi, M; Alders, P; Maikere, J (BioMed Central, 2017-01-25)
      In Bo district, rural Sierra Leone, we assessed the burden of the 2014 Ebola outbreak on under-five consultations at a primary health center and the quality of care for under-15 children at a Médecins Sans Frontières (MSF) referral hospital.
    • Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo

      Mancini, Silvia; Coldiron, Matthew E; Nicholas, Sarala; Llosa, Augusto E; Mouniaman-Nara, Isabelle; Ngala, Joseph; Grais, RFebecca F; Porten, Klaudia (BioMed Central, 2014-10-23)
      A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.
    • Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016.

      Fily, F; Ronat, JB; Malou, N; Kanapathipillai, R; Seguin, C; Hussein, N; Fakhri, RM; Langendorf, C (BioMed Central, 2019-01-31)
      War-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria.
    • Pre-emptive steroids for a severe oedematous Buruli ulcer lesion: a case report

      O'Brien, Daniel P; Huffam, Sarah (BioMed Central, 2015-05-01)
      Severe oedematous forms of Buruli ulcer (BU) often result in extensive tissue destruction, even with the institution of appropriate antibiotic treatment, leading to reconstructive surgery and long-term disability. We report a case of a patient with severe oedematous BU, which describes for the first time the pre-emptive use of prednisolone therapy commenced at the time of antibiotic initiation aimed at limiting the ongoing tissue destruction and its secondary sequelae.
    • Prevalence of Antibodies to Brucella Species in Commercial Raw Bovine Milk in Southwestern Uganda

      Kamwine, M; Orikiriza, P; Taseera, K; Iramiot, J; Ojuka, P; Ikiriza, S; Atwebembeire, J; Otieno, D; Tweshengyereze, S; Mwanga-Amumpaire, J; et al. (BioMed Central, 2017-09-08)
      The purpose and objective of this research was to explore the prevalence of antibodies against Brucella species in raw milk samples collected in Southwestern Uganda, one of the biggest milk producing regions in the Country. We hypothesized that there is a high level of antibodies in milk samples from this region. This builds more evidence to other studies in the region on the level contamination of raw milk.
    • Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries

      Osborn, J; Roberts, T; Guillen, E; Bernal, O; Roddy, P; Ongarello, S; Sprecher, A; Page, AL; Ribeiro, I; Piriou, E; et al. (BioMed Central, 2020-02-10)
      BACKGROUND: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. METHOD: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. RESULTS: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. CONCLUSION: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.
    • Serological evaluation for Chagas disease in migrants from Latin American countries resident in Rome, Italy

      Pane, S; Giancola, ML; Piselli, P; Corpolongo, A; Repetto, E; Bellagamba, R; Cimaglia, C; Carrara, S; Ghirga, P; Oliva, A; et al. (BioMed Central, 2018-05-08)
      Chagas disease (CD) is a systemic parasitic infection caused by the protozoan Trypanosoma cruzi, whose chronic phase may lead to cardiac and intestinal disorders. Endemic in Latin America where it is transmitted mainly by vectors, large-scale migrations to other countries have turned CD into a global health problem because of its alternative transmission routes through blood transfusion, tissue transplantation, or congenital. Aim of this study was to compare the performance of two commercially available tests for serological diagnosis of CD in a group of Latin American migrants living in a non-endemic setting (Rome, Italy). The study was based on a cross-sectional analysis of seroprevalence in this group. Epidemiological risk factors associated to CD were also evaluated in this study population.
    • Seroprevalence and risk factors of recent infection with hepatitis E virus during an acute outbreak in an urban setting in Chad, 2017

      Vernier, L; Lenglet, A; Hogema, BM; Moussa, AM; Ariti, C; Vollmer, S; Irwin, A; Alfani, P; Sang, S; Kamau, C (BioMed Central, 2018-06-26)
      From September 2016-April 2017, Am Timan, Chad, experienced a large HEV outbreak in an urban setting with a limited impact in terms of morbidity and mortality. To better understand HEV epidemiology in this context, we estimated the seroprevalence of anti-HEV antibodies (IgM and IgG) and assessed the risk factors for recent HEV infections (positive anti-HEV IgM) during this outbreak.