• Feasibility of Xpert Ebola Assay in Médecins Sans Frontières Ebola Program, Guinea

      Van den Bergh, R; Chaillet, P; Sow, MS; Amand, M; van Vyve, C; Jonckheere, S; Crestani, R; Sprecher, A; Van Herp, M; Chua, A; et al. (Center for Disease Control and Prevention, 2016-02-01)
      Rapid diagnostic methods are essential in control of Ebola outbreaks and lead to timely isolation of cases and improved epidemiologic surveillance. Diagnosis during Ebola outbreaks in West Africa has relied on PCR performed in laboratories outside this region. Because time between sampling and PCR results can be considerable, we assessed the feasibility and added value of using the Xpert Ebola Assay in an Ebola control program in Guinea. A total of 218 samples were collected during diagnosis, treatment, and convalescence of patients. Median time for obtaining results was reduced from 334 min to 165 min. Twenty-six samples were positive for Ebola virus. Xpert cycle thresholds were consistently lower, and 8 (31%) samples were negative by routine PCR. Several logistic and safety issues were identified. We suggest that implementation of the Xpert Ebola Assay under programmatic conditions is feasible and represents a major advance in diagnosis of Ebola virus disease without apparent loss of assay sensitivity.
    • Lessons and challenges for measles control from unexpected large outbreak, Malawi

      Minetti, Andrea; Kagoli, Matthew; Katsulukuta, Agnes; Huerga, Helena; Featherstone, Amber; Chiotcha, Hazel; Noel, Delphine; Bopp, Cameron; Sury, Laurent; Fricke, Renzo; et al. (Center for Disease Control and Prevention, 2013-02-01)
      Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6-8, and 9-11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15-19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12-23 months; 57.9% for children 9-11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.
    • Mortality Rates During Cholera Epidemic, Haiti, 2010-2011

      Luquero, FJ; Rondy, M; Boncy, J; Munger, A; Mekaoui, H; Rymshaw, E; Page, AL; Toure, B; Degail, MA; Nicolas, S; et al. (Center for Disease Control and Prevention, 2016-03-01)
      The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1-35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported.
    • Outbreak of Pneumococcal Meningitis, Paoua Subprefecture, Central African Republic, 2016-2017

      Coldiron, Me; Touré, O; Frank, T; Bouygues, N; Grais, RFF (Center for Disease Control and Prevention, 2018-09)
      We report a pneumococcal meningitis outbreak in the Central African Republic (251 suspected cases; 60 confirmed by latex agglutination test) in 2016-2017. Case-fatality rates (10% for confirmed case-patients) were low. In areas where a recent pneumococcal conjugate vaccine campaign was conducted, a smaller proportion of cases was seen in youngest children.