Low Endemicity Research Articles

1239. Hepatitis A Epidemiology in Europe: A Systematic Literature Review of the Last 20 Years

Abstract Background Hepatitis A (HepA) global burden is estimated to be > 100 million new cases/year. HepA is vaccine-preventable, but outbreaks still occur in regions with low endemicity such as Europe. Guidelines for HepA vaccination in adult risk groups are available in European countries, but adherence to vaccination recommendations is not systematically documented. Here we review European data on HepA infection outcomes, we discuss the HepA risk in the population in order to assess the adequacy of HepA vaccination strategies. Methods A systematic search in PubMed and Embase was performed from January 2001 to April 2021. Relevant data from ECDC, ProMED, ESCAIDE and national public health websites was also reviewed. We included articles in all languages, covering all ages and data published on 11 countries (Denmark, France, Germany, Greece, Hungary, Italy, the Netherlands, Spain, Sweden, Switzerland and the United Kingdom [UK]). Studies on seroprevalence and risk factors for HepA virus (HAV) were excluded. Results Overall, 134 articles and 85 grey literature reports were included in our review. In Europe, in the last 20 years, HepA infections were reported in all ages. Annual hospitalization rates exceeded 50% in 8 of the surveyed countries during 2016–2019. HAV complications were reported by 28 publications (ps): 8 liver transplantation cases in 6 ps ; liver failures in 0%–25% of HepA patients reported by 23 ps and hemorrhagic complications in 0%–51% of HepA patients reported by 8 ps. Fatality rates, reported by 12 ps for Italy, Hungary, Denmark, Germany and Spain were 0.05%–0.26%, mostly in adults/older adults. Conclusion In Europe, HepA infections are recorded in all ages despite not being consistently reported. Although the fatality rate is low, the hospitalization rates and the morbidity are high in adults/older adults. Considering the current epidemiological situation and HepA-related costs, authorities should raise awareness on HepA risk and adapt or improve compliance with the vaccination recommendations. Adherence to the existing recommendations should be monitored more closely. Universal HepA vaccination may be considered, similarly to the strategy adopted in the United States after widespread and ongoing HepA outbreaks. Funding GlaxoSmithKline Biologicals SA Disclosures Anar Andani, BSc, Medical director, GSK group of companies: Employee|GSK group of companies: Stocks/Bonds Eveline Bunge, PhD, GSK group of companies: My institution received grants and payment for developing studies Jennifer Eeuwijk, MSc, GSK group of companies: My institution received grants and payment for developing studies George Kassianos, MD (Hons), FRCGP, FESC, FBGTHA, FFTM RCPS(Glasg), FBHS, FHEA, FAcadMEd, DRCOG, LRCP (Edin.), LRCS (Edin.), LRCP&S (Glas.), DMedAcup., DMedHypn., DFP, AstraZeneca: Advisor/Consultant|British Global and Travel Health Association: President|European Scientific Working Group on Influenza (ESWI): Board Member|European Scientific Working Group on Influenza (ESWI): Lectures|MSD: Advisor/Consultant|Northern European Conference on Travel Medicine: Lectures|Novavax: Advisor/Consultant|Pfizer: Advisor/Consultant|RAISE Pan-European Committee on Influenza: Chair|Royal College of General Practitioners: National Immunisation Lead|Sanofi Vaccines: Advisor/Consultant|Seqirus: Advisor/Consultant|UK National Health Service: Lectures|Valneva: Advisor/Consultant Robert Steffen, MD, GSK group of companies: Advisor/Consultant|GSK group of companies: Honoraria.

Seroepidemiology of hepatitis A virus infection in Japan: An area of very low endemicity.

The incidence of hepatitis A virus (HAV) infection has declined significantly worldwide, including in Japan. A nationwide seroepidemiological study on hepatitis A in Japan has taken place almost every 10 years since 1973, and the last study was performed in 2003. In the present study, we describe the latest seroepidemiological pattern of hepatitis A in Japan using 7867 serum specimens obtained from healthy individuals collected between 2013 and 2017, approximately 10 years after the last study. Among them, 223 were anti-HAV positive. About 68% of individuals aged 60 years and older had anti-HAV antibodies, whereas only 1.1% of those aged below 60 years old had immunity; thus, almost all individuals younger than 60 years of age were HAV susceptible. In comparison with previous investigations, the susceptible population has increased and aged. According to data from the National Epidemiological Surveillance of Infectious Diseases (NESID) program, between 1989 and 2016, the proportion of patients with hepatitis A aged 60 years and older continuously increased with each year. The NESID data also suggested that recently, typical large foodborne outbreaks of hepatitis A have become rare, and cases tend to be reported among at-risk groups; overseas travelers contributed to 25% of hepatitis A cases, and in 2018, the first nationwide hepatitis A outbreak that affected mostly men who have sex with men was reported. The purpose of this study was to determine the current status of HAV infection in Japan, based on both seroepidemiology and the national surveillance data from the NESID.

Risk factors and housing effect on malaria infection: A case-control study

Background: This study aims to demonstrate the different risk factors between low and high endemicity area and housing effect on malaria infection. Methods: This study is a case-control study with a ratio of 1:2 comparing low (Jambi) and high (Sumba) endemicity areas. Initial screening of malaria was done to assign cases and controls following inclusion criteria. The selected cases and controls were then assessed with a structured questionnaire in relation to risk factors of malaria infection. Additionally, to discover the impact of house type on malaria infection, a total of 72 houses was observed in a series of six weeks (between 28 June and 12 August 2018) human landing catch (HLC) observations that includes three types of houses; malaria, non-malaria, and permanent dwellings. The HLC was done indoors and outdoors for each house type each night. A weekly screening was taken to monitor the malaria infection rate of each house type. Results: Jambi and Sumba shared several similar individual and environmental risk factors. However, agricultural activity or visiting forestry areas is a protective factor for malaria infection in Jambi but is a risk factor in Sumba. The general linear mixed univariate model result indicates the difference in risk factor variables between Jambi and Sumba. The entomological survey found that only malaria houses significantly differed in the number of means collected mosquitoes compared with the other type of houses. Weekly screening found that the incidence rate of malaria houses is highest among others. Conclusion: The risk factors are inevitably crucial for malaria prevention strategy. Risk factor management needs to consider the location where the endemicity level may differ for each risk factor, and housing improvement is not a proper strategy before controlling other environmental factors.

The aquatic Adephaga of the Makay, central-western Madagascar, with description of two new diving beetle species (Coleoptera, Gyrinidae, Haliplidae, Noteridae, Dytiscidae).

Water beetles of the families Gyrinidae, Haliplidae, Noteridae, and Dytiscidae (aquatic Adephaga) of the Makay in central-western Madagascar were surveyed in three campaigns during the years 2016-2018. A total of 74 species was collected from 62 sampling sites, all except one being newly recorded from the Makay. Copelatusmalavergnorum sp. nov. (irinus group) and C.zanabato sp. nov. (erichsonii group) (Dytiscidae, Copelatinae) are described and their habitus and male genitalia are illustrated. A systematic account is given, including description of habitat preferences for each species. Analyses of species composition and dominance, species diversity and endemism highlighted the strong singularity of the aquatic Adephaga fauna inhabiting the sandstone massif of inner Makay (notably with several local endemic dytiscids) with respect to its peripheral lowlands. These comparisons were also performed between groups of sites categorised according to vegetation context (forested, semi-forested, non-forested). Rather unexpectedly, inner Makay although well-preserved and little deforested has relatively low endemism level and low species diversity (H1 Hill number twice lower than in the geographically close and geologically similar massif of Isalo). Species diversity was higher in the deforested and man-impacted peripheral sites, which yielded a rich contingent of western Madagascar lowland species including a few undescribed or rarely observed dytiscids.

Urogenital schistosomiasis among pre-school and school aged children in four districts of north western Tanzania after 15 years of mass drug administration: Geographical prevalence, risk factors and performance of haematuria reagent strips.

Urogenital schistosomiasis remains as a public health problem in Tanzania and for the past 15 years, mass drug administration (MDA) targeting primary school children has remained as the mainstay for its control. However, after multiple rounds of MDA in highly risk groups, there are no data on the current status of Schistosoma haematobium in known endemic areas. Furthermore, the performance of commonly used diagnostic test, the urine reagent strips is not known after the decline in prevalence and intensities of infection following repeated rounds of treatment. Thus, after 15 of national MDA, there is a need to review the strategy and infection diagnostic tools available to inform the next stage of schistosomiasis control in the country. A analytical cross-sectional study was conducted between October and November, 2019 among pre-school (3-5years old) and school aged children (6-17 years old) living in four (4) districts with low (<10%) and moderate (10%-<50%) endemicity for schistosomiasis as per WHO classification at the start of the national control programme in 2005/06, with mean prevalence of 20.7%. A total of 20,389 children from 88 randomly selected primary schools participated in the study. A questionnaire was used to record demographic information. A single urine sample was obtained from each participant and visually examined for macrohaematuria, tested with a dipstick for micro-haematuria, to determine blood in urine; a marker of schistosome related morbidity and a proxy of infection. Infection intensity was determined by parasitological examination of the urine sample for S. haematobium eggs. Overall, mean infection prevalence was 7.4% (95%CI: 7.0-7.7, 1514/20,389) and geometric mean infection intensity was 15.8eggs/10mls. Both infection prevalence (5.9% versus 9%, P<0.001) and intensity (t = -6.9256, P<0.001) were significantly higher in males compared to females respectively. Light and heavy infections were detected in 82.3% and 17.7% of the positive children respectively. The prevalence of macrohaematuria was 0.3% and that of microhaematuria was 9.3% (95%CI:8.9-9.7). The sensitivity and specificity of the urine reagent strip were 78% (95%CI: 76.1-79.9) and 99.8% (95%CI: 99.7-99.9). Having light (P<0.001) and heavy infection intensities (P<0.001) and living in the study districts increased the odd of having microhaematuria. Predictors of S. haematobium infection were being male (P<0.003), microhaematuria (P<0.001), and living in the three study districts (P<0.001) compared to living at Nzega district. The findings provide an updated geographical prevalence which gives an insight on the planning and implementation of MDA. Comparing with the earlier mapping survey at the start of the national wide mass drug administration, the prevalence of S. haematobium infection have significantly declined. This partly could be attributed to repeated rounds of mass drug administration. The urine reagent strips remain as a useful adjunct diagnostic test for rapid monitoring of urogenital schistosomiasis in areas with low and high prevalence. Based on prevalence levels and with some schools having no detectable infections, review of the current blanket mass drug administration is recommended.

Communities' Perception, Knowledge, and Practices Related to Human African Trypanosomiasis in the Democratic Republic of Congo.

Background: The number of human African trypanosomiasis (HAT) cases in the Democratic Republic of Congo (DRC) has significantly reduced, thanks to more effective drugs and screening tools and regular mass screening. However, this potentially jeopardizes HAT control activities, especially community engagement. Methods: We used an ecological model framework to understand how various factors shape communities’ knowledge, perceptions, and behavior in this low endemicity context. Community members, frontline health providers, and policymakers were consulted using an ethnographic approach. Results: Communities in endemic areas are knowledgeable about causes, symptoms, and treatment of HAT, but this was more limited among young people. Few are aware of new HAT treatment or screening techniques. Participation in mass screening has declined due to many factors including fear and a lack of urgency, given the low numbers of cases. Delays in seeking medical care are due to confusion of HAT symptoms with those of other diseases and belief that HAT is caused by witchcraft. Conclusions: Community members see their role more in terms of vector control than participation in screening, referral, or accepting treatment. We propose recommendations for achieving sustainable community engagement, including development of an information and communication strategy and empowerment of communities to take greater ownership of HAT control activities.

Seroprevalence and genotype distribution of hepatitis A virus in the pre-vaccine era in South Transdanubia, Hungary (2010-2020).

In this study, the age-related seroprevalence of hepatitis A virus (HAV) infection was investigated in the population in South-Transdanubia, Southwest Hungary (Central Europe) between years 2010 and 2020. Up to the age of 40, the HAV seropositivity was less than 18% in all age groups indicating a low level of HAV endemicity in this part of the country in the covered study period. The HAV seropositivity started to increase at the age group 41-45 years, reaching the ∼50% at age group 56-60, and 75-80% at age group 66-70, respectively. A total of 43 (0.2%) of the 21,106 tested sera were HAV IgM-positive (the annual percentage range of HAV IgM-positivity was 0.046-0.6%). Total of 24 (55.8%) of the 43 HAV IgM-positive samples tested RT-PCR-positive confirmed as HAV sub-genotypes IA (N = 17; 70.8%) and IB (N = 7; 29.2%), respectively. Imported HAV infections (three cases from Romania, and one-one case from Austria and Italy), two small outbreaks and 11 cases of a genetically identical sub-genotype IA strain (GenBank number of the prototype strain: KM657825) from 2012 to 2014 were identified later connected directly to the enormous HAV outbreak initiated among men who have sex with men (MSM) at the end of 2011 in the capital Budapest.In summary, low endemicity but high and increased susceptibility for HAV infection was found in the population in Southwest Hungary, where repeated introduction of sub-genotypes IA and IB HAV strains were identified between 2010 and 2020.

Study of the prevention and control campaign for the hepatitis A outbreak in men who have sex with men in Seville (2016–2018)

IntroductionIn developed countries, several hepatitis A outbreaks have been documented in the last years in relation to sexual transmission, affecting mainly men who have sex with men. This work aims to describe the characteristics of the outbreak in the province of Seville from 2016 to 2018, as well as the vaccination campaign that took place to manage the outbreak. MethodsDescriptive study of the hepatitis A incidence from 2016 to 2018 in males between 18 and 64 years of age in the province of Seville, as well as the vaccination coverage in males of that age in that period. Data collected from RedAlerta and Diraya Vacunas. ResultsFrom 2016 to 2018 in the province of Seville, 499 hepatitis A cases were diagnosed in males between 18 and 65 years of age. During this time, 4676 males between 18 and 65 were vaccinated against hepatitis A, with a mean age of 35. There was a drop in the numbers of vaccinations in 2017 coinciding with a vaccine shortage after which the vaccination rate grew, accompanied by a decrease in cases (20%). ConclusionsHepatitis A is a public health problem that in countries with low endemicity, like Spain, is linked to high-risk groups, like HSH. The vaccine campaign is essential in the management of the outbreak, but so are the population's information and awareness.

Hepatitis B, C, and delta in the general population in Mayotte: hepatitis B as a major public health concern

BackgroundLocated in southwestern Indian Ocean, Mayotte is a French territory, with a very specific demographic, social and health context. To date, epidemiological data on infections by hepatitis B (HBV), C (HCV), and delta (HDV) viruses in Mayotte have been sparse. We aimed to estimate, in the 15–69-year-old general population living in Mayotte, the prevalence of infections by hepatitis B (HBV), C (HCV), and delta (HDV) viruses and the distribution of HBV status: current infection with positive HBs antigen (Ag); resolved infection with positive HBc antibodies and negative HBsAg; immunisation by vaccination with only positive HBs antibodies; and no infection/no immunisation with negative markers. We also described the characteristics of infected people and assessed the determinants of lifetime HBV infection.MethodsThe Unono Wa Maore survey, implemented in a random sample of the general population in 2018–2019, consisted of an at-home collection of epidemiological data and venous blood samples. Detection of hepatitis B, C, and delta serological and molecular markers was performed.ResultsAmong 5207 eligible people, 4643 responded to the questionnaire (89.2%), with 2917 being tested for HBV and HCV (62.8%). Estimated HBV status was as follows: current infection 3.0% (95% confidence interval [CI]: 2.3–3.9%) (n = 76); resolved infection 27.8% (95% CI: 25.8–29.9); immunisation by vaccination 27.7% (95% CI: 25.9–29.7); and no infection/no immunisation 41.5% (95% CI: 39.3–43.7). One participant was positive for HDV antibodies (Ab) (0.65%) with a negative HDV-RNA viral load. The risk of lifetime HBV infection was higher in men (adjusted prevalence ratio (aPR): 1.55, 95% CI: 1.29–1.89); in people aged 30–49 years (aPR: 3.83, 95% CI: 1.49–9.81) or 50–69 years (aPR: 4.52, 95% CI: 1.77–11.53) compared to those under 20; in individuals who reported no condom use during their first sexual intercourse (aPR: 1.46, 95% CI: 1.01–2.14); and in those living in Dembeni-Mamoudzou (aPR: 1.40, 95% CI: 1.09–1.80) compared to the West-Centre of Mayotte. Finally, six individuals were positive for HCV antibodies (0.21%), including three positive for HCV RNA.ConclusionsMayotte is an area of intermediate endemicity for HBV and low endemicity for HCV and HDV. With a prevalence of HBsAg 10 times higher than in mainland France, a high proportion of people susceptible to HBV infection, and a demographic, health, and social context that may favour its transmission, hepatitis B is a major public health concern in Mayotte.

Seroprevalence of Hepatitis B Virus Among Pregnant Women in India: A Systematic Review and Meta-Analysis

Hepatitis B virus (HBV) infection during pregnancy is associated with perinatal transmission contributing to the pool of HBV infection in the population. There is a wide variation in the reported data on the seroprevalence of HBV in pregnant patients from various parts of India. Hence, a systematic review and meta-analysis was conducted to determine the pooled seroprevalence of HBV and its associated demographic factors. A comprehensive literature search of Medline, Scopus, and Google Scholar was conducted from January 2000 to April 2022 for studies evaluating the prevalence of HBV in pregnant patients from India. A total of 44 studies with data on 272,595 patients were included in the meta-analysis. The pooled prevalence of hepatitis B surface antigen (HBsAg) in pregnant women was 1.6% [95% confidence interval (CI), 1.4-1.8]. Among patients with HBsAg positivity, the pooled prevalence of hepatitis B e antigen was 26.0% (95%CI 17.4-34.7). There was no significant difference in the odds of HBV seroprevalence based on the age (<25 years vs.>25 years) [odds ratio (OR) 1.07, 95%CI 0.74-1.55], parity (primipara vs. multipara) (OR 1.09, 95%CI 0.70-1.70) or area of residence (urban vs. rural) (OR 0.88, 95%CI 0.56-1.39). However, the odds of HBV seroprevalence in those with no or primary education was higher than in those with secondary level education or higher (OR 2.29, 95%CI 1.24-4.23). Prior history of risk factors was present in 13.5-22.7% of patients indicating a vertical mode of acquisition. There is a low endemicity of HBV among pregnant women in India. Risk factors are seen in less than 25% of the cases, indicating vertical transmission as the predominant mode of acquisition, which can be reduced by improving vaccination coverage.

Butterfly and food plant composition of a residential garden in Bago City, Negros Occidental, Philippines with four new butterfly locality records

Residential gardens are some of the most common human-managed habitats in highly urbanized areas but their roles on the ecology of various taxa such as butterflies are still understudied. A 7-year observation was conducted to determine the species composition of butterflies and food plants in an urban residential garden in Bago City, Negros Island. Using visual encounters and photo-documentation, the butterfly inventory was done from October 2013 to December 2020 while the food plant inventory covered only two years (2018–2020). The results revealed a total of 88 butterfly species belonging to five families and 60 genera, of which 20 species were classified as residents, 26 seasonal, and 42 vagrants. Despite the very low endemism (8%), it is noteworthy that four species are new island records: Parnara bada, Potanthus pava, Suastus gremius, and Tagiades trebellius martinus. For the food plants, 80 species from 33 families and 73 genera were identified, of which 37 species are recognized as larval host plants, 49 as nectar plants, and six as both larval host and nectar plant sources. Interestingly, a residential garden with such a small size could harbor 27% of Negros island’s and almost 10% of the country’s butterfly species. Species richness for both butterflies and food plants are high, which supports the idea that gardens could be an alternative habitat for wildlife in highly urbanized areas. Future studies should consider measuring the diversity for both taxa as well as environmental factors affecting butterfly and plant communities in a residential garden.

In Silico Screening of Schistosome Membrane Proteins as Candidate Diagnostic Antigens for Asian Schistosomiasis

Asian schistosomiasis is primarily caused by Schistosoma japonicum. Given the relatively low prevalence of the disease, efforts are now focused on its elimination. However, the low sensitivity of the current diagnostic techniques underestimates the actual prevalence of schistosomiasis in areas with low endemicity. Therefore, this study aims to identify candidate diagnostic antigens that are potentially useful for the development of a reliable serological diagnosis of Asian schistosomiasis using the genomic databases of S. haematobium and S. japonicum. On the SchistoDB database, this study first employed a preliminary genomic filtration on 12,021 S. haematobium genes – including the presence of transmembrane domain, signal peptides, isoelectric point, and molecular weight yielding 113 genes. Further gene ontology (GO) enrichment analysis resulted in 22 candidate S. haematobium genes. These S. haematobium genes were then compared with the S. japonicum genome in the WormBase ParaSite, identifying 36 S. japonicum homologous proteins. The amino acid sequences of the 36 proteins were aligned using ClustalW to identify identical proteins, resulting in 21 distinct S. japonicum proteins considered as the final set of candidate diagnostic antigens. Therefore, these 21 candidate diagnostic antigens can be useful in developing a reliable serological diagnosis of Asian schistosomiasis, which may be accomplished through in vitro validation, protein characterization, and serological evaluation.

Geospatial modeling of pre-intervention nodule prevalence of Onchocerca volvulus in Ethiopia as an aid to onchocerciasis elimination.

BackgroundOnchocerciasis is a neglected tropical filarial disease transmitted by the bites of blackflies, causing blindness and severe skin lesions. The change in focus for onchocerciasis management from control to elimination requires thorough mapping of pre-control endemicity to identify areas requiring interventions and to monitor progress. Onchocerca volvulus nodule prevalence in sub-Saharan Africa is spatially continuous and heterogeneous, and highly endemic areas may contribute to transmission in areas of low endemicity or vice-versa. Ethiopia is one such onchocerciasis-endemic country with heterogeneous O. volvulus nodule prevalence, and many districts are still unmapped despite their potential for onchocerciasis transmission.Methodology/Principle findingsA Bayesian geostatistical model was fitted for retrospective pre-intervention nodule prevalence data collected from 916 unique sites and 35,077 people across Ethiopia. We used multiple environmental, socio-demographic, and climate variables to estimate the pre-intervention prevalence of O. volvulus nodules across Ethiopia and to explore their relationship with prevalence. Prevalence was high in southern and northwestern Ethiopia and low in Ethiopia’s central and eastern parts. Distance to the nearest river (RR: 0.9850, 95% BCI: 0.9751–0.995), precipitation seasonality (RR: 0.9837, 95% BCI: 0.9681–0.9995), and flow accumulation (RR: 0.9586, 95% BCI: 0.9321–0.9816) were negatively associated with O. volvulus nodule prevalence, while soil moisture (RR: 1.0218, 95% BCI: 1.0135–1.0302) was positively associated. The model estimated the number of pre-intervention cases of O. volvulus nodules in Ethiopia to be around 6.48 million (95% BCI: 3.53–13.04 million).Conclusions/SignificanceNodule prevalence distribution was correlated with habitat suitability for vector breeding and associated biting behavior. The modeled pre-intervention prevalence can be used as a guide for determining priorities for elimination mapping in regions of Ethiopia that are currently unmapped, most of which have comparatively low infection prevalence.

Estudio de la campaña de prevención y control del brote de hepatitis A en hombres que tienen sexo con hombres en Sevilla (2016-2018)

IntroductionIn developed countries, several Hepatitis A outbreaks have been documented in the last years relating tosexual transmission, affecting mainly men who have sex with men. This work aims to describe the characteristics of the outbreak in the province of Seville from 2016 to 2018, as well as the vaccination campaign that took place to manage the outbreak. MethodsDescriptive study of the Hepatitis A incidence from 2016 to 2018 in males between 18 and 64 years of age in the province of Seville, as well as the vaccination coverage in males of that age in that period. Data collected from RedAlerta and Diraya Vacunas. ResultsFrom 2016 to 2018 in the province of Seville, 499 hepatitis A cases were diagnosed in males between 18 and 65 years of age. During this time, 4676 males between 18 and 65 were vaccinated against hepatitis A, with a mean age of 35. There was a drop in the numbers of vaccinations in 2017 coinciding with a vaccine shortage, after which the vaccination rate grew, accompanied by a decrease in cases (20%). ConclusionsHepatitis A is a public health problem that in countries with low endemicity, like Spain, is linked to high-risk groups, like HSH. The vaccine campaign is essential in the management of the outbreak, but so are the population's information and awareness.

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management.

As part of the 'Zero by 30' strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders' and practitioners' conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts' conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts' experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.

Diagnostic Performance of Parasitological, Immunological, Molecular, and Ultrasonographic Tests in Diagnosing Intestinal Schistosomiasis in Fieldworkers From Endemic Municipalities in the Philippines

Schistosomiasis remains to ha/ve a significant public health impact in the Philippines. The Kato-Katz (K-K) technique is the reference standard and most used technique for definitive diagnosis of intestinal schistosomiasis for control programs in endemic regions. However, this has a very low sensitivity when applied in areas of low endemicity and patients with light infection. Hence, this study determined the diagnostic performance of immunological, molecular, parasitological, and ultrasonographic tests in diagnosing intestinal schistosomiasis in endemic municipalities in the Philippines. We performed a community-based cross-sectional study to determine the positivity of schistosomiasis in Leyte, Philippines. The diagnostic performance of five different detection techniques: (1) three stool K-K with duplicate smears; (2) soluble egg antigen IgG ELISA; (3) urine point-of-care circulating cathodic antigen (POC-CCA) test; (4) detection of Schistosoma japonicum circulating DNA (SjcDNA) in serum and urine samples; (5) focused abdominal ultrasound (US), were also obtained in this study. Multiple stool examinations enhanced the sensitivity of K-K from 26.2% (95% CI [16.4, 38.8]) with single stool to 53.8% (95% CI [41.1, 66.1]) and 69.2% (95% CI [56.4, 80.0]) with two and three stools from consecutive days, respectively. Among the SjcDNA nucleic acid amplification test (NAAT)-based detection assays, loop-mediated isothermal amplification (LAMP) PCR using sera had the highest sensitivity at 92.3% (95% CI [82.2, 97.1]) with LAMP consistently identifying more positive cases in both serum and urine samples. This study showed that single stool K-K, which remains the only diagnostic test available in most endemic areas in the Philippines, had low sensitivity and failed to identify most patients with light infection. SjcDNA detection assay and POC-CCA urine test were more sensitive than stool microscopy in detecting schistosomiasis. On the other hand, US was less sensitive than the widely utilized K-K technique in diagnosing schistosomiasis. This study emphasizes the need to revisit the use of single stool K-K in the surveillance and case detection of schistosomiasis in endemic areas of the Philippines. The availability of advanced and more sensitive diagnostic tests will help better control, prevent, and eliminate schistosomiasis in the country.

Meningococcal Disease and Carriage in the Philippines: A Review of Recent Data

This article reviews recent data on meningococcal disease and carriage in the Philippines. It aims to provide information on the epidemiology of meningococcal disease, its carriage, data on prevention, and the impact of vaccination on disease and carriage. The World Health Organization considers the Philippines as having low endemicity for meningococcal disease. However, current data underestimates the true burden in the country due to many factors. In recent years, data from the Philippines show a high case-fatality rate since only the septicemic form is being reported. Studies on asymptomatic meningococcal carriage rates are sparse, with one study by Gonzales, et al. investigating the prevalence of meningococcal nasopharyngeal carriage in Filipinos aged 5-24 years old living in an urban setting. The study showed that the overall prevalence of carriage was 3.7% and was highest (9%) among the 10-14 age group. Serogroup B was the most common isolate. Effective meningococcal vaccines are available. Although not included in the National Immunization Program, medical societies recommend giving vaccines to individuals at high risk of infection. Data on local epidemiology accounting for the disease and asymptomatic carriage are important to strengthen future programs on immunization and prevention of meningococcal disease.

Hepatitis B and C: Neglected Infectious Diseases among Syrian Refugees in Lebanon

Hepatitis B and C are life-threatening infections that can result in liver-associated complications. Lebanon is a country experiencing its worst economic and political crises to date and is considered to be of low endemicity for hepatitis B virus (HBV) and hepatitis C virus (HCV).

A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda

BackgroundMalaria is a potentially fatal disease spread by the bites of Plasmodium-infected Anopheles mosquitoes. Despite long-term efforts to control malaria in Rwanda, malaria incidence increased from 48 to 403 cases/1000 individuals between 2012 and 2016. The diagnosis and treatment of malaria occurs at multiple levels, but the costs of these activities are not well understood. This research was conducted to estimate the direct medical costs incurred by the Ministry of Health in diagnosing and treating malaria in three districts of Rwanda in 2018.MethodsA cross-sectional and retrospective costing analysis was conducted in three districts that represented low (5–200 cases per 1000 individuals), moderate (> 200–400 cases per 1000 individuals), and high (> 400 cases per 1000 individuals) endemicity regions. Data on malaria cases managed at three healthcare levels (community, health centre, district hospital) was obtained from national databases. The direct medical costs of cases per malaria severity (‘simple malaria’, ‘simple malaria with minor digestive symptoms’, and ‘severe malaria’) were calculated based on the minimum package of health services provided. Total costs for each of the three districts were also calculated.ResultsA total of 298,381 malaria cases were recorded in Burera, Kirehe, and Southern Kayonza districts in 2018. The average unit cost per case ranged from USD 1.36 (for simple malaria at the community level) to USD 92.80 (for severe malaria with cerebral complications at district hospitals). Simple malaria cases managed at health centres and district hospitals were more than two-fold (USD 2.99–USD 3.00) and more than eight-fold (USD 12.10–USD 12.12) higher, respectively, than those managed in the community (USD 1.36). Overall, the Ministry of Health incurred USD 645,647.68 in direct medical costs related to malaria management across the three districts in 2018. Changes in disease rates from different endemicity regions and costs of anti-malarial oral medications significantly impacted the study results.ConclusionIn Rwanda, severe malaria results in much higher expenses compared to other malaria types. Prompt diagnosis and appropriate treatment are crucial to prevent the progression of simple malaria to severe malaria, to reduce Ministry of Health malaria expenditures, and to reduce community transmission.

Detection of specific antibodies against Leishmania infantum in canine serum and oral transudate using an in-house ELISA

BackgroundCanine leishmaniosis caused by the protozoan Leishmania infantum is a complex infection due to its variable clinical signs and laboratory findings. Therefore, a broad range of techniques is available for diagnosis. Testing for specific antibodies in serum is the most commonly used technique, although the testing of other body fluids, such as oral transudate (OT), can be an alternative as its collection is non-invasive and testing can be performed by untrained personnel. The aim of this study was to assess and compare the detection of L. infantum-specific antibodies in paired samples of serum and OT collected from apparently healthy dogs and dogs with clinical leishmaniosis using an in-house enyzme-linked immunosorbent assay (ELISA).MethodsSerum and OT were collected from 407 dogs, which varied in breed, sex, age, lifestyle and clinical status, by many practicing veterinarians in Spain. The main geographical areas of sampling included Barcelona (n = 110), Mallorca (n = 94), Cadiz (n = 54) and Asturias (n = 47). The majority of infected dogs were apparently healthy (89.9%) while 41 presented clinical signs and/or clinicopathological abnormalities compatible with L. infantum infection and subsequently diagnosed with leishmaniosis (10.1%). An in-house ELISA was performed to quantify the anti-Leishmania antibodies in serum and OT.ResultsThe L. infantum infection rate determined by the in-house ELISA was 37.1% in serum samples and 32.7% in OT samples. Serum and OT ELISA results showed a positive correlation (Spearman's correlation coefficient rs = 0.6687, P < 0.0001). The percent agreement between the serum and OT ELISA results was 84%, while agreement according to Cohen's kappa statistic (κ) was substantial (0.66) when all samples were analyzed. The highest percent agreement (92.1%) between both tests was found in dogs from low endemicity regions and from sick dogs, with both groups presenting almost perfect agreement according to Cohen’s κ agreement test (0.84). Few seronegative dogs (n = 23) tested positive by the OT ELISA. The agreement between serum and OT went from almost perfect to moderate when the geographical distribution and clinical status were analyzed.ConclusionsThe results of this study demonstrated an almost perfect to moderate agreement between OT and serum samples tested using the in-house ELISA. These results are particularly promising in sick dogs with high antibody levels while the results seem less optimal in apparently healthy dogs with low antibody levels.Graphical