Case Investigation Form Research Articles

Gaps in the prevention of mother-to-child transmission of syphilis: a review of reported cases, South Africa, January 2020-June 2022.

Congenital syphilis (CS) is preventable through timely antenatal care (ANC), syphilis screening and treatment among pregnant women. Robust CS surveillance can identify gaps in this prevention cascade. We reviewed CS cases reported to the South African notifiable medical conditions surveillance system (NMCSS) from January 2020 to June 2022. CS cases are reported using a case notification form (CNF) containing limited infant demographic and clinical characteristics. During January 2020-June 2022, healthcare workers supplemented CNFs with a case investigation form (CIF) containing maternal and infant testing and treatment information. We describe CS cases with/without a matching CIF and gaps in the CS prevention cascade among those with clinical information. During January 2020-June 2022, 938 CS cases were reported to the NMCSS with a median age of 1 day (interquartile range: 0-5). Nine percent were diagnosed based on clinical signs and symptoms only. During January 2020-June 2022, 667 CIFs were reported with 51% (343) successfully matched to a CNF. Only 57% of mothers of infants with a matching CIF had an ANC booking visit (entry into ANC). Overall, 87% of mothers were tested for syphilis increasing to 98% among mothers with an ANC booking visit. Median time between first syphilis test and delivery was 16 days overall increasing to 82 days among mothers with an ANC booking visit. Only 37% of CS cases had accompanying clinical information to support evaluation of the prevention cascade. Mothers with an ANC booking visit had increased syphilis screening and time before delivery to allow for adequate treatment.

A Prolonged Outbreak of Enteric Fever Associated With Illegal Miners in the City of Matlosana, South Africa, November 2020-September 2022.

In South Africa, the annual incidence of enteric fever averaged 0.1 per 100 000 persons between 2003 and 2018. During 2021 an increase in the number of enteric fever cases was observed. An outbreak investigation was conducted to determine the magnitude and source of the outbreak. We performed a cross-sectional descriptive study. Data were collected through telephonic or face-to-face interviews with cases or proxies via a standardized case investigation form. Whole genome sequencing was performed on all Salmonella Typhi isolates. Drinking water samples were collected, tested, and analyzed. Descriptive analysis was performed with Microsoft Excel. Between January 2020 and September 2022, a cluster of 53 genetically highly related Salmonella Typhi isolates was identified from 5 provinces in South Africa. Isolates associated with the cluster showed ≤5 allelic differences, as determined following core genome multilocus sequence typing analysis. Most cases (60%, 32/53) were in the North West province. Males represented 68% (36/53). Of these, 72% (26/36) were aged 15 to 49 years, with a median age of 31 years. Where occupation was known within this age group, 78% (14/18) were illegal gold miners. Illegal miners reported illness onset while working underground. Five municipal tap water samples were tested and showed no evidence of fecal contamination. This outbreak predominantly affected illegal gold miners, likely due to the consumption of contaminated groundwater while working in a gold mine shaft. In addition, this investigation highlights the value of whole genome sequencing to detect clusters and support epidemiologic investigation of enteric fever outbreaks.

Epidemiological and clinical characteristics of Mpox Cases in Serbia in 2022

Abstract Introduction Mpox viral infection, previously known as an endemic zoonosis typical for West and South Africa, appeared in the Republic of Serbia in early summer among young and middle-aged men, particularly Belgrade's citizens. The aim of this study is to evaluate the epidemiological and clinical characteristics of Mpox cases registered in Serbia in 2022. Methods We conducted a national observational study using the national surveillance anonymized data of people who met case definition criteria on Mpox infection and confirmation by the polymerase chain reaction method. Clinical data were collected by standardized case investigation form used for epidemiological and clinical evaluation of cases. Results A total of 43 cases reported from the 17th of June to the 5th of October 2022 were men, aged between 20 and 54 (median age, 35 years), 74,4% living in Belgrade. Three-quarters of cases reported sex with other men as a potential disease transmission route. Out of the total, 15 (34,9%) Mpox cases had HIV co-infection. HIV-positive patients were older than negative cases (p = 0,023). The mean incubation period among patients who reported exposition to a probable or confirmed case was 9,3 (2-22) days. The most common systemic symptoms were fever (86%) and lymphadenopathy (44,2%). Three patients with common symptoms of fever were hospitalized. All cases presented a rash, mostly in pustule form (90,7%). The dominant localization of the skin lesions was the anogenital region (62,5%), whereas 9,3% of the patient's lower extremities were affected. Conclusions In Serbia, the outbreak of Mpox infection affected young and middle-aged men, mainly situated in the capital of Serbia. The disease had a polymorphic presentation, including a characteristical rash of the anogenital region implying the main transmission route. Key messages • Health promotion and community engagement regarding Mpox are very important in large urban settings. • Risk communication should be prioritized to promote safe sexual practices in vulnerable populations.

Marburg virus disease: lesson learned from the first outbreak encounter in Tanzania

Marburg virus disease: lesson learned from the first outbreak encounter in Tanzania

Epidemiological and clinical characteristics of children with confirmed COVID-19 infection in a tertiary referral hospital in Manila, Philippines

BackgroundCOVID-19 has challenged the under-resourced health systems of low- and middle-income countries, significantly affecting child health. Available published data on Filipino children with COVID-19 infection are limited. This study aims to describe the epidemiological and clinical characteristics of pediatric patients with confirmed COVID-19 in an infectious disease hospital in Manila, Philippines.Main textThis cross-sectional study reviewed data on patients ages 0 to 18 years with confirmed COVID-19 infection, admitted to San Lazaro Hospital from January 25, 2020 to January 25, 2022. Demographic data and clinical characteristics obtained from COVID-19 case investigation forms were summarized and compared between severe and non-severe cases. Risk factors for disease severity and mortality were analyzed. Of 115 patients, 64% were males. There were 87 patients (75.7%) with asymptomatic, mild, or moderate disease, and 28 cases (24.3%) with severe or critical illness. The median age of all patients was 10 years (interquartile range: 4–15 years). The majority of patients (40.9%) were adolescents ages 13 to 18 years. Predominant symptoms were fever (73.9%) and cough (55.7%). Patients with severe or critical illness were more likely to experience difficulty of breathing (55.2% vs 44.8%, p < 0.001), and have a longer hospital stay (11 days vs 8 days, p = 0.043). Among all patients, 48.7% had at least one underlying disease; and common infectious co-morbidities were tuberculosis (17.4%), dengue (12.2%), and HIV (4.3%). Having tuberculosis (p = 0.008) or at least one co-morbidity (p < 0.001) was associated with disease severity. Ten patients (8.7%) died; and mortality was higher among those with severe or critical illness (80% vs 20%, p < 0.001). Sepsis (p = 0.020) or having at least one co-morbidity (p = 0.007) was associated with death.ConclusionChildren of all ages remain susceptible to COVID-19 infection, and usually present with mild or moderate symptoms. In this study, many adolescents are affected, highlighting the value of COVID-19 vaccination in this age group. Understanding the clinical features of COVID-19 in Filipino children is essential to identifying and optimally managing those at highest risk of severe disease.

Factors contributing to a measles outbreak in a hard-to-reach rural village in Xaisomboun Province, Lao People’s Democratic Republic

ObjectiveAn increase in measles cases was reported in the north-western of the Lao People's Democratic Republic beginning in January 2019, with outbreaks quickly spreading throughout the country. Following identification of two laboratory-confirmed cases in Xaisomboun Province, we conducted an outbreak investigation to identify factors contributing to the measles outbreak in hard-to-reach Village X.MethodsActive case-finding was undertaken at the provincial hospital and primary health care centre via a retrospective search through admission logbooks and house-to-house surveys in Village X and surrounding villages. Clinical samples were collected from suspected cases, and data were collected using a standard case investigation form. Vaccine coverage data were reviewed.ResultsOf the 40 suspected measles cases with rash onset during 12 February–27 April 2019, 83% (33/40) resided in Village X and 98% (39/40) were of Hmong–Lu Mien ethnicity. Ages ranged from 22 days to 5 years, with 70% (28) aged < 24 months. Almost half of cases aged 9 to < 18 months (5/11) and 67% (8/12) of cases aged 324 months had received a measles-containing vaccine (MCV). Reported MCV coverage in Xaisomboun for children aged < 1 year in 2017–2018 was < 50%. In 55% (22/40) of cases, case notification was delayed by 36 days. The final case classification comprised 10% laboratory-confirmed, 20% clinically compatible, 60% epidemiologically linked and 10% non-cases.DiscussionThis measles outbreak was likely associated with low immunization coverage, compounded by delays in reporting. Effective strategies are needed to address beliefs about and health literacy barriers to immunization and measles awareness. Such strategies may improve MCV coverage and early diagnosis, enabling timely public health interventions and reducing mortality and morbidity.

Evaluation of the measles case-based surveillance system in Kwekwe city, 2017-2020: a descriptive cross-sectional study.

Introductionin 2011, WHO African region set a target for elimination of measles by 2020. During period 2017-2020, Kwekwe city, with an estimated population of 117,116, detected one case of suspected measles. This was against a target of 2 cases per year. We evaluated the system to establish why it was failing to detect at least 2 cases per year.Methodswe conducted a descriptive cross-sectional study using the Centre for Disease Control (CDC) Updated Guidelines. Nineteen health facilities were selected and fifty-seven health workers were randomly recruited. An interviewer-administered questionnaire and checklists were used to collect data. We generated frequencies, proportions, and means.Resultsthe mean years in service was 22.8 years (SD=12.6). Thirty (52.6%) respondents had fair knowledge. Fourteen (73.7%) of the nineteen respondents who had ever completed case investigation forms took between 10-20 minutes to complete. Only two (10.5%) of the nineteen facilities had case investigation forms. The majority of the respondents 54 (93%) were willing to continue participating in the measles Community Base Surveillance System (CBSS). None of the health facilities had used the system to inform decision-making. Reasons highlighted for poor suspected measles case detection included lack of health worker training 28/57 (49.1%).Conclusiondespite the high age in service, knowledge of the surveillance system was mostly fair. The system was found to be simple, not stable and not useful. The main reason for the system failure was lack of health worker training. We recommend retraining on Integrated Disease Surveillance and Response (IDSR) and case investigation forms distribution.

Epidemiological analysis of rubella-confirmed cases from measles suspected cases in Ethiopia: Threat for Congenital Rubella Syndrome.

Abstract Rubella is a highly contagious mild viral illness. It is a leading cause of congenital rubella syndrome (CRS). Routine data of rubella do not exist in Ethiopia. However, laboratory-based conformation of rubella cases from measles negative samples were collected from a measles surveillance system. The current study was to analyse the epidemiological distribution of rubella cases from measles-suspected cases in Ethiopia from 2011 to 2015. National-based secondary data analysis of rubella through measles-based surveillances was carried out. Measles-suspected cases were investigated using the case investigation form, and a serum sample collected and sent to the Ethiopian laboratory for conformation. Samples tested for measles immunoglobulin M (IgM) were tested for rubella. The investigation results were entered into an electronic database using SPSS version 25 for analysis. Out of 11749 samples tested for rubella IgM from 2011 to 2015, 2295 (19.5%) were positive for rubella IgM and 51% of rubella-positive cases were female. Five per cent of all cases were female aged between 15 and 49. Cases were confirmed from all regions, two administrative towns and seasonal variations were observed with peaks in the first and fourth seasonal periods of the years. As fear of congenital abnormality (CRS), the Ethiopian government should focus on rubella syndrome surveillance with the aim of starting a rubella vaccine.

Factors influencing the acquisition of COVID infection among high-risk contacts of COVID-19 patients in Madurai district-A case control study.

Introduction:COVID is a new disease; understanding the transmission dynamics and epidemiological characteristics may help in developing the effective control measures. The study is done 1. To determine the various factors influencing the acquisition of COVID-19 infection among high-risk contacts 2. To estimate the secondary attack rate among high-risk contacts 3. To determine the factors in COVID index cases influencing their secondary attack rate.Methodology:Unmatched case control study was conducted from March to August 2020 among 139 COVID index cases in Madurai district from March–May (Reference period) and their 50 COVID positive (cases), 551 COVID negative (controls) high-risk contacts. Case investigation form* and contact tracing Proforma*were used to collect data. Chi-square test and independent sample t test were used to find out the association. Univariate* and Multivariate logistic regression* were used to predict the risk of various factors in acquisition of COVID infection with the help of adjusted and unadjusted odds ratio. P value < 0.05 was considered statistically significant.Results:Male contacts (P = 0.005, OR = 2.520), overcrowding (P = 0.007, OR = 3.810), and duration of exposure to index case (for 4-7 days P = 0.014, OR = 2.902, for >7 days P = 0.001, OR = 6.748 and for > 12 hours/day P = 0.000, OR = 5.543) were significant factors predicted to be associated with acquisition of COVID infection among high-risk contacts. Reproductive number (R0)* estimated was 1.3. Secondary attack rate (SAR)* estimated among high-risk contacts was 8.32%. Index cases whose outcome was death (P = 0.026); symptomatic index cases (P = 0.000), cases with fever (P = 0.001); sorethroat (P = 0.019); breathlessness (P = 0.010); cough (P = 0.006) and running nose (P = 0.002) had significantly higher mean SAR than their counterparts.Conclusion:Contacts with above said risk factors who were found to be more prone to infection could be given special focus to prevent the transmission in them.

Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria.

Rotavirus infection is a significant cause of gastroenteritis in developing countries and, in severe cases even leads to death. The impact of rotavirus vaccine introduction in reducing the rotavirus disease burden in children was well known. The study was aimed to determine the prevalence and clinical characteristics of rotavirus gastroenteritis before the introduction of rotavirus vaccine into Nigeria's routine immunization program. We conducted a cross-sectional hospital-based study involving 735 children aged 0-59 months with acute gastroenteritis hospitalized at the Ahmadu Bello University Teaching Hospital Zaria from September 2017 to August 2020. Relevant sociodemographic and clinical data were obtained and entered into the World Health Organization standardized case investigation forms. Stool specimens were tested for rotavirus Group A antigen using the ProSpecT™ Rotavirus Microplate Assay by Thermoscientific Oxoid Microbiology UK. One hundred and fifty-three stool samples tested positive for rotavirus giving a prevalence of 20.8%. One hundred and two (66.7%) children with rotavirus gastroenteritis were infants. There were 87 males and 66 females with M: F ratio of 1.3:1. Only 30 (19.6%) children with rotavirus-associated diarrhea presented with severe dehydration. The presence of vomiting was significantly associated with rotavirus diarrhea (P = 0.001). More cases of rotavirus diarrhea occurred in September through February. None of the studied children were vaccinated against rotavirus. The prevalence of rotavirus diarrhea remains high in this study. Infants were recognized as a high-risk group, and none of them were vaccinated against rotavirus and this underscores the urgent need for implementing the rotavirus vaccine in the national vaccination program to reduce the disease burden in the country.

Contribution of the Advanced Research Laboratories at the Noguchi Memorial Institute for Medical Research (NMIMR) to SARS-CoV-2 Testing in Ghana

In March 2020, the first cases of SARS-CoV-2 were reported in Accra, Ghana. These initial cases were diagnosed at the Advanced Research Laboratories (ARL) of the Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana. The ARL which hitherto was used for routine clinical research in viral, bacteria and immunological studies has since been the facility of choice for testing for all suspected cases of COVID-19 submitted from across Ghana and beyond. The success of testing at the ARL hinged on the availability of several laboratory spaces furnished with state-of-the-art diagnostic equipment and working aids. During the “peak season” where overwhelming numbers of clinical specimens were received, the ARL processed and got results for close to four thousand samples daily. After general disinfection and re-bagging into smaller numbers, at the entrance of the ARL, the samples are taken to a central receiving laboratory, where they are received and entered in a database with accompanying case investigation forms. All samples that are successfully sorted and matched are sent to general laboratories for nucleic acid extraction and then referred to the Instrumentation laboratory for real time reverse-transcription polymerase chain reaction (RT-PCR). When the RT-PCRs were completed, results were analysed and transmitted via email and/or local network to the data reporting office. The data managers then reported results to the investigators and the Ghana Health Service (GHS). Additionally, the ARL provided a next-generation Genome Sequencing platform in partnership with the West African Centre for Cell Biology of Infectious Pathogens at the University of Ghana, which was essential in reporting the genome data of the circulating variants of SARS-CoV-2 in Ghana. Conclusively, it is worth noting, that the NMIMR fulfilled its mandate of supporting the country with specialized diagnostics through the judicious use of the ARL for SARS-CoV-2 testing, from sample receipt to data reporting. The ARL facility and the research faculty have trained and continue to train budding laboratories on biosafety, biosecurity, best practices and testing protocols. It is obvious that the success story of SARS-CoV-2 testing in Ghana, cannot be complete without the mention of the ARL at NMIMR.

Outbreak Investigation and Enhanced Contact Tracing of Novel Coronavirus Disease 2019 (COVID-19), Ablekuma North Municipality, Greater Accra, Ghana

Background: After Ghana recorded its first two cases of COVID-19, other cases were subsequently identified in other parts of the country. The Ablekuma North Municipal Health Directorate was notified of a resident who reported to Korle-Bu Teaching Hospital on March 29, 2020 with fever, shortness of breath, general weakness, cough, chest pain. We investigated the report to estimate the magnitude of cases, to determine the secondary infection rate and to institute control and preventive measures. Methods: We conducted active case search using Ghana Health Service interim guideline for COVID-19 case investigation and management in Ablekuma North Municipality from April-July 31, 2020. We interviewed and collected samples of contacts and at-risk groups in affected households using collector for ArcGis and case investigation form. We summarized information of COVID-19 cases on our line list after samples have been confirmed. We analyzed data using Microsoft Excel 2016 and Stata 15, and presented as frequency and proportions. Results: The municipality recorded 213 cases with four deaths (Case fatality Rate=1.88%). The attack rate was 111.47 per 100,000 (213/ 191,075). Males were 135 (63.38%). The median age of case-patients was 27 years (interquartile range: 19 - 36years). Majority were students; 64 (30.05%). Most of the cases 89.20% (190/213) were asymptomatic. The median time between sample collection and release of laboratory results was 15 days (range: 4 - 22days). This response was a multi-sectorial approach, involving the Ministry of Health and the Ghana Health Service, Municipal Assembly, National Security Ministry, Ministry of Communication, Ministry of Information, and other government agencies. Conclusion: All confirmed cases were investigated. The attack rate was relatively high but low case fatality rate in the municipality. Strengthening laboratory capacity to test, to early report results is recommended. Lessons in handling cases indicate the need to sustain multi-sectorial collaboration to fight the outbreak.

Demographic profile of COVID-19 positive mothers & their outcome in government Rajaji hospital, Madurai, Tamilnadu – A cross sectional Study

BackgroundCOVID-19 is a new pandemic disease. This disease course and its effect on pregnancy is little known due to limited available data. The objective of this study was to describe the demographic profile of COVID-19 positive mothers admitted in Government Rajaji hospital, Madurai in terms of time, place and person and to assess the general and pregnancy outcome of study population. MethodsThis cross-sectional study was done among 381 COVID-19 positive mothers* admitted during March 22 – August 31, 2020 in dedicated COVID-19 hospital, Madurai. Data was collected using Case Investigation Form (CIF) as a part of Rapid Response Team*(RRT) by Community Medicine* Department and analysed using SPSS version 21. Descriptive statistics done; Chi-square test & Fischer exact test was done to find out association between patient profile and outcomes. ResultsOut of 381, 154 (40.4%) belonged to 21–25 years, 192 (50.4%) to rural area, 318 (83.5%) to 3rd trimester,189 (49.6%) Primi gravida. 125 (32.8%) were symptomatic and 153 (80.8%) had at least one comorbidity. Death as general outcome was 3 (0.8%), all of them were referred cases and had comorbidity like GDM/PIH. 10 (2.62%) had abortion or perinatal death, 14 (3.77%) had preterm delivery, 99 (25.98%) babies were born small for gestational age. Increased maternal age had more death but was not statistically significant; All symptomatic mothers (p = 0.000),1st & 2nd trimester (p = 0.000) mothers had statistically significant poor pregnancy outcome*. ConclusionCOVID positive mothers with increased age, symptomatic, 1st & 2nd trimester were significantly associated with poor outcome, requires special attention. Early referral must be emphasized to mitigate maternal death.

1170Investigation of COVID-19 outbreak in a South West State of Nigeria: Preliminary findings

1170Investigation of COVID-19 outbreak in a South West State of Nigeria: Preliminary findings

Congenital Syphilis Case Surveillance in South Africa 2017-19: Experience, Challenges and Opportunities.

Untreated or inadequately treated maternal syphilis infection may be transmitted from mother to child resulting in congenital syphilis (CS) infection. In South Africa (SA), CS is a notifiable medical condition (NMC). The NMC surveillance system (NMCSS) was improved by introducing an electronic notification application, a new case notification form and training resources in July 2017. We describe CS surveillance in SA and report on experiences from implementing an improved NMCSS from August 2017 to December 2019. We present the CS case definition, data collected by the CS case investigation and notification forms and data flow through the NMCSS. Descriptive statistics were used to analyse CS notifications received from August 2017 to December 2019. Qualitative inductive analysis of the stakeholder communications diary was conducted to identify CS surveillance challenges. There were 418 CS notifications submitted from 80 facilities in 35 out of 52 districts. Of the notified cases, 194 (46.8%) were male and the median age at notification was 7 days (interquartile range: 3-16 days). The majority were diagnosed in hospital (98.6%). KwaZulu-Natal Province notified the most cases (52.9%) followed by Gauteng (28.0%). Challenges in CS surveillance included the lack of awareness of the CS case definition, completed paper-based notifications not reaching the NMCSS and the limited ability of the system to distinguish improved notifications from increase in disease burden. Improved CS surveillance through NMCSS was implemented in SA. Training, support and mentoring on CS and the notification system will be needed to inform elimination efforts.

Characteristics of Lassa Fever Outbreak in Ondo State, Nigeria, Year 2019

Background: Lassa fever (LF) is an acute viral haemorrhagic illness of a 2–21-day incubation period that occurs in West Africa. It is endemic in Nigeria and peaks during the first 12 weeks of the year. On January 22, 2019, the Nigeria Centre for Disease Control (NCDC) declared an outbreak of LF following an upsurge of LF cases in the country. A total of 213 confirmed cases including 41 deaths were reported from sixteen states including Ondo State. A multi-sectoral national rapid-response-team (RRT) was deployed to Ondo State to characterise the outbreak, assess its determinants, and institute control measures. Methods: An Emergency Operations Center (EOC) was activated to coordinate activities. We defined a suspected case as anyone with one or more of the following symptoms: malaise, fever, headache, sore throat, cough, vomiting and either history of contact with rodents, or a probable or confirmed LF case in the past 21 days, or any person with inexplicable bleeding between January 1, 2019, to February 26, 2019, in Ondo State. A confirmed case was any suspected case with laboratory confirmation. We conducted active case search, collected data using the LF case investigation form and reviewed the existing line list. We conducted contact tracing in hospitals and affected Local Government Areas (LGA). Data was analysed using and Epi info 7.0. Results: We identified 287 LF suspected cases in 6 LGAs; 118 were confirmed with 21 deaths (case fatality rate: 17.8%). The mean age was 39.2 ±20 years with a male-to-female ratio of 1.3:1. Of the 1,269 contacts line-listed, 20 became symptomatic, while 14 (70.0%) were confirmed positive. The secondary attack rate was 1.1%. Conclusion: The confirmed cases were more of primary cases, hence the need to focus more on reducing rodent-to-human transmission of LF. We recommend continuous education on community and health facility infection prevention control, contact tracing and enforcement of environmental sanitation measures across the state to mitigate future outbreaks

Analysis of SARS-CoV-2 RT-PCR Testing and Pooling Strategies for Screening of Asymptomatic Individuals - The Philippine Children's Medical Center Experience

Background. The availability of reverse transcription-polymerase chain reaction (RT-PCR) in detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited by the scarcity of resources prompting the use of pooling strategies. Evaluated in this study is the Philippine Children’s Medical Center’s (PCMC) experience in pooled testing done in asymptomatic population. Objectives. Review the pooled SARS-CoV-2 RT-PCR results and case investigation forms (CIF) in asymptomatic population. Determine the incidence of SARS-CoV-2 in asymptomatic population and compare all the individual and pooled tests results. Determine the number of saved test kits and identify clustering in the community. Methodology. This is a retrospective study that reviewed the pooled and individual SARS-CoV-2 RT-PCR results using Allsheng Auto-Pure 32a extraction kit, Sansure Biotech PCR machine and Maccura Sars-CoV-2 test kits. The pooling protocol used by the institution followed the recommendation by Lo et al in the study entitled “An Evaluation of Pooling Strategies for RT-qPCR testing for SARS-CoV-2 infection.” &nbsp;Results. There are 1828 samples which resulted to 165 negative, 68 indeterminate, and 137 positive pools. There are 157, 135, and 68 pools containing 5 individual samples that were classified as negative, positive and indeterminate pools, respectively. Additionally, the negative pools contained 8 pools with 3 individual samples and the positive pools contained 2 pools with 2 individual samples. Deconvolution of the positive and indeterminate pools resulted to 227 and 74 positive individuals, respectively. In this review, the laboratory saved 24% of the test kits and shorten the overall turnaround time by 23 hours. Conclusions and Recommendations. The incidence of SARS-CoV-2 in the population is higher compared to the prevalence of infection in the country. Pooled testing conserved test kits and congruence of pooled and individual ORF Ct-values was observed. An in-depth study including other genes is recommended and assessment of pooling in other population may be pursued.

Measles outbreak in Western Uganda: a case-control study

BackgroundMeasles outbreaks are prevalent throughout sub-Saharan Africa despite the preventive measures like vaccination that target under five-year-old children and health systems strengthening efforts like prioritizing the supply chain for supplies. Measles immunization coverage for Kasese district and Bugoye HC III in 2018 was 72 and 69%, respectively. This coverage has been very low and always marked red in the Red categorization (below the national target/poor performing) on the national league table indicators. The aim of this study was to assess the scope of the 2018–2019 measles outbreak and the associated risk factors among children aged 0–60 months in Bugoye sub-county, Kasese district, western Uganda.MethodsWe conducted a retrospective unmatched case-control study among children aged 0–60 months with measles (cases) who had either a clinical presentation or a laboratory confirmation (IgM positivity) presenting at Bugoye Health Centre III (BHC) or in the surrounding communities between December 2018 and October 2019.. Caregivers of the controls (whose children did not have measles) were selected at the time of data collection in July 2020. A modified CDC case investigation form was used in data collection. Quantitative data was collected and analyzed using Microsoft excel and STATA version 13. The children’s immunization cards and health registers at BHC were reviewed to ascertain the immunization status of the children before the outbreak.ResultsAn extended measles outbreak occurred in Bugoye, Uganda occured between December 2018 and October 2019. All 34 facility-based measles cases were documented to have had maculopapular rash, conjunctivitis, and cough. Also, the majority had fever (97%), coryza (94.1%), lymphadenopathy (76.5%), arthralgias (73.5%) and Koplik Spots (91.2%) as documented in the clinical registers. Similar symptoms were reported among 36 community-based cases. Getting infected even after immunized, low measles vaccination coverage were identified as the principal risk factors for this outbreak.ConclusionMeasles is still a significant problem. This study showed that this outbreak was associated with under-vaccination. Implementing a second routine dose of measles-rubella vaccine would not only increase the number of children with at least one dose but also boost the immunity of those who had the first dose.

Outcome of Epidemiological Investigation of COVID-19 Outbreak in a South West State of Nigeria, March to August 2020

Background: On 3rd April 2020, an outbreak of Coronavirus disease-2019 (COVID-19) was confirmed in Ondo State, Southwest Nigeria. Field investigations were conducted by the State Ministry of Health (MoH) to identify and confirm additional cases. This paper provides the outcome of the epidemiological investigation of the outbreak to further guide outbreak response activities. Methods: Field epidemiology methods coordinated by the State Public Health Emergency Operations Center (PHEOC) were used in the outbreak investigation. Suspected cases were reported through the routine Integrated Disease Surveillance and Response (IDSR) network in the State. Also, active case search/finding to communities and health facilities using the operational case definitions was conducted. Furthermore, the state COVID-19 emergency call center was established with toll-free phone number provided to members of the public to call-in to report suspected persons with symptoms consistent with the COVID-19 operational case definition (signal). All cases reported were investigated with nasopharyngeal sample collected and confirmatory testing for COVID-19 done by real-time polymerase chain reaction (RT-PCR) in a national reference laboratory. Information of each case investigated was documented using the COVID-19 case investigation form and COVID-19 line-list which captured socio-demographic characteristics, history of exposure to COVID-19, presenting symptoms, travel history and sample collection details. Data were extracted from the case investigation form and line list and analyzed using SPSS version 20, with a p-value set at

Evaluation of acute flaccid paralysis surveillance system, 2013 to 2017 – Bayelsa State, Nigeria

Background: Nigeria is one of the three countries where transmission of Wild Polio Virus (WPV) still occurs. Documented transmission occurs mainly in the northern part of the country. Acute flaccid paralysis (AFP) surveillance is one of polio eradication and endgame strategic plan. On this basis, we evaluated the AFP surveillance system in Bayelsa state, Nigeria with the aim of assessing the attributes of the system. Methods & Materials: We interviewed Stakeholders and reviewed AFP surveillance data from 2013 to 2017 using the updated CDC guidelines for evaluating the public health surveillance systems and the WHO performance standards to assess the performance of the system. Relevant data were extracted and analyzed using Microsoft Excel spreadsheet. Results: All 27 respondents knew that poliomyelitis was caused by a virus and they all felt that AFP case definition was easy to understand. 73% percent of them reported that completion of the Case Investigation Form (CIF) was simple. All the respondents were willing to continue to participate in the AFP surveillance. The non-polio AFP rate (12.3–16.6%) and stool specimen adequacy rate (98–100%) indicate high sensitivity. Proportion of AFP cases investigated within 48 h of notification, timely transportation, specimen arriving laboratory in good condition were all above WHO minimum standard of 80%. The surveillance system has dedicated staff from state ministry of health and support from National Stop Transmission of Polio (NSTOP). Conclusion: The AFP surveillance system in Bayelsa State is performing well. The system is useful, simple, flexible, acceptable, sensitive, representative, timely and stable. We recommended that regular training of data collectors should be implemented.