Disease Outbreaks Research Articles

Diarrheagenic Escherichia coli Outbreak Reporting to Foodborne Disease Outbreaks Surveillance System - China, 2011-2022.

Foodborne diarrheagenic Escherichia coli (DEC) outbreaks constitute a significant global public health concern, yet comprehensive data on outbreak incidence and epidemiological characteristics in China remain limited. Between 2011 and 2022, there were 413 foodborne DEC outbreaks reported to foodborne disease outbreak surveillance system, resulting in 8,127 illnesses, 2,565 hospitalizations, and one fatality. Enteroaggregative Escherichia coli (EAEC) emerged as the predominant causative pathogen (48.82% of outbreaks), with school canteens being the most frequent outbreak setting (21.79%). This systematic analysis of foodborne DEC outbreak trends and epidemiological characteristics in China over the past decade provides crucial insights for enhancing outbreak investigation capabilities and identifying specific etiologies, food vehicles, and high-risk settings associated with these outbreaks.

Fear in Media Headlines Increases Public Risk Perceptions but Decreases Preventive Behaviors: A Multi-Country Study During the COVID-19 Pandemic

The perception of reality could matter more than reality itself when it comes to disease outbreaks. News media are important sources of information during global disease outbreaks, such as the COVID-19 pandemic. Drawing on theories of fear appeals and the social ecological model, we conducted multilevel modeling analyses to examine how media-level and community-level factors influenced the public’s risk perceptions of COVID-19 and frequencies of preventive behaviors in the United States, United Kingdom, Canada, Australia, and India. We combined a large-scale multi-wave cross-country survey (N = 161,374) with a COVID-19 media coverage archive (N = 10,015,187) to test these relationships. We found that fear in media headlines was positively correlated with people’s perceptions of risk but negatively correlated with frequencies of preventive behaviors, controlling for individual-, community-, and cultural-level factors. Similar patterns were consistently identified within each individual country. We also show that community factors interacted with the media environment to influence public risk perceptions and behaviors. Our findings highlight a strong mass media influence during the pandemic, and we discuss the implications of our findings for health communication during crisis times.

Ebola Outbreak Response in the DRC with rVSV-ZEBOV-GP Ring Vaccination

BackgroundAt the beginning of the 2018–2020 outbreak of Ebola virus disease (EVD) in eastern Democratic Republic of Congo (DRC), no vaccine had been licensed. However, cluster-randomized evidence from Guinea in 2015 had indicated that ring vaccination around new cases (targeting contacts and contacts-of-contacts) with the use of single-dose live-replicating rVSV-ZEBOV-GP vaccine reduced EVD rates starting 10 days after vaccination. Thus, ring vaccination was added to the standard control measures for that outbreak.MethodsIn this study, we evaluated the incidence of EVD within the first 9 days after vaccination (when little protection was expected from case isolation or ring vaccination), during days 10 to 29, and at later time periods. We established 1853 rings around new cases or clusters within 21 days after symptom onset in the index case and offered vaccination to the ring members. Vaccinees were monitored for EVD onset until the end of the outbreak in mid-2020.ResultsFrom August 8, 2018, to January 14, 2020, we vaccinated 265,183 participants. Of these vaccinees, 102,515 were monitored on days 0, 3, and 21 for safety. Among the contacts and contacts-of-contacts, 434 cases of EVD (0.2 per ring) were diagnosed, almost all within 0 to 9 days (380 cases) or 10 to 29 days (32 cases) after vaccination. An additional 22 cases were diagnosed after day 29 during an average of 170 more days of follow-up. The sooner that control measures (including ring vaccination) began after EVD onset in the index case, the sooner EVD rates fell among contacts. In each subgroup, EVD rates fell suddenly around day 10. Among the contacts and contacts-of-contacts who were still disease-free at day 10, the EVD onset rate during days 10 to 29 was 0.16 per 1000 (in 32 of 194,019 participants). This rate was much lower than the rate of 4.64 per 1000 (in 21 of 4528 participants) that had been seen among similarly defined ring members in Guinea, in whom standard control measures had been promptly initiated but vaccination was delayed until 21 days after ring formation (rate ratio, 0.04; 95% confidence interval, 0.02 to 0.06). No safety concerns with the vaccine were identified.ConclusionsNonrandomized evidence regarding standard EVD control measures plus ring vaccination in eastern DRC reinforces the earlier randomized evidence from Guinea of vaccine efficacy against EVD onset 10 or more days after vaccination.

Beyond predation: Fish-coral interactions can tip the scales of coral disease.

Coral reefs are critical ecosystems, fostering biodiversity and sustaining the livelihoods of millions globally. Nonetheless, they confront escalating threats, with infectious diseases emerging as primary catalysts for extensive damage, surpassing the impacts of other human-induced stressors. Disease transmission via biotic factors, particularly during fish predation, is a crucial yet often overlooked pathway. While their feeding can spread infectious diseases through spores, it also controls the growth of macroalgae, a major competitor for space on the reef. Given this dual effect, the precise impact of fish on coral disease remains ambiguous and requires additional investigation. In this study, we addressed this gap for the first time by employing a mathematical model. Our analyses unveil intricate interactions between fish predation and coral health, revealing potential benefits and drawbacks for coral reef ecosystems. Coral survival hinges on a delicate balance of fish predation, with extremes (both low and high) offering some protection against disease outbreaks compared to moderate predation, which can cause sudden die-offs. More specifically, as fish predation intensifies, the ecosystem undergoes a tipping point, transitioning from a disease-dominated state to a healthier one. Moreover, the interplay between transmission rate and virulence in coral populations is significantly shaped by fish predation rates. Specifically, the threshold ratio of transmission to virulence, signalling a regime shift from a healthy to a disease-dominated state, exhibits a linear increase with fish predation rate. Overall, our findings emphasize the importance of considering biotic interactions in coral disease ecology and offer insights essential for effective reef conservation strategies.

Establishment of embryogenic Pinus thunbergii Parl. suspension cultures: growth parameters, dynamic analysis, and plant regenerative capacities

BackgroundPinus thunbergii is an economically important conifer species that plays a fundamental role in forest ecosystems. However, the population has declined dramatically in recent years as a result of the pine wilt disease outbreak. Thus, developing pine wilt-resistant P. thunbergii is an effective strategy for combating this epidemic.ResultsThe somatic embryogenesis of nematode-resistant P. thunbergii was previously reported by our group. The current study looked into the potential commercialization of suspension cultures as a means of large-scale production of nematode-resistant P. thunbergii seedlings. According to our findings, P. thunbergii suspension cultures were suitable for an initial inoculum of embryogenic tissue (2 g) and a subculture inoculum (6.7% (v/v)). Suspension cultures were cultivated for 8–10 days in a 30 mL liquid medium (Gupta and Durzan medium, DCR medium) to facilitate their maturation. The suspension cultures produced a large number of high-quality somatic embryos, which were then used to regenerate the plants and move them into the field. A more accurate assessment of the quality of suspension cultures for somatic embryogenesis could come from the suspension’s dynamics. The results showed that the medium’s phosphate, ammonium, nitrate, and carbohydrates were quickly eaten from day 0 to day 10. In terms of the absorption of nitrogen sources, the ammonium (NH4+) was absorbed prior to nitrate (NO3−). Additionally, the activity of mitochondrial succinate dehydrogenase and superoxide dismutase was directly related to cell growth.ConclusionsThis study presents an approach for selecting appropriate suspension cultures for efficient somatic maturation of P. thunbergii that can also be applied to other conifers. Furthermore, it is possible to commercialize nematode-resistant P. thunbergii seedlings using bioreactors, according to the suspension culture system we describe. To the best of our knowledge, this is the first work to describe a P. thunbergii suspension culture.

Beyond early warning: towards greater granularity in the use of event-based surveillance for public health emergencies

BackgroundThe international health emergency caused by the emergence of the SARS-CoV-2 virus demonstrated the expanding usefulness of multi-country disease outbreak information gathered through event-based surveillance (EBS) as an extension beyond the main purposes of early warning, alert, and response (EWAR). In this article, previous events of multi-country outbreaks from 2010–2019 were reviewed for how EBS, within an expanded sphere of Epidemic Intelligence (EI), may help to enhance the understanding of outbreaks for a more timely and nuanced, multiple-point trigger approach to health emergencies.MethodsThe public, open-source database of ProMed reports were reviewed for the date of first notification on major outbreaks of infectious diseases and then compared for subsequent dates of any new, exceptional epidemiological findings (novel host, settings, transmission characteristics) as a determining factor for prolonged, multi-country events later acknowledged on the WHO disease outbreak news (DON) website, or by peer-reviewed journal publication if no related DON information became available.ResultsDuring the preceding decade, there was an ongoing occurrence of unexpected outbreaks requiring new information about previously unknown pathogens, such as MERS-CoV, and longstanding threats from multiple neglected tropical diseases. During these international outbreaks, key scientific insights about new host species, viral persistence, occurrence of human-to-human spread, and transmission setting, became known over the course of the response.ConclusionThe timeliness between initial alerts of early outbreak detection and key epidemiological evidence about the emerging threat reached far beyond the first warning for the global community. To improve on the best knowledge available for an immediate response, it is recommended that further gathering and documentation from event-based surveillance is engaged to create a more complete assessment for uncontrollable infectious disease outbreaks and epidemics. Enhanced EBS (through modern tools, e.g., Epidemic Intelligence from Open Sources (EIOS) are critical for timely detection and response to such events.

Nigeria’s public health response to disease outbreaks: A review of strengths and weaknesses

Nigeria’s public health response to disease outbreaks: A review of strengths and weaknesses

Validation of a Nepali version of the questionnaire to assess preventive practices against the COVID-19 pandemic in the general population

BackgroundThe new coronavirus disease 2019 (COVID-19), caused by a virus in the coronavirus family called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to lack of effective treatment, the major way to breakdown the disease transmission is by application of preventive measures. For this, a preventive practice questionnaire was used to assess the preventive practice during COVID-19. A definite advantage of this questionnaire is its ability to identify individual level preventive practices. The objective of the study was to validate the Nepali version of Questionnaire to assess preventive practices against the COVID-19 pandemic in the General population.MethodsA web-based descriptive cross-sectional study was conducted from November 2022 to April 2023 using preventive practices against the COVID-19 pandemic questionnaire and was conducted among 351 respondents. The sensitivity and specificity of the questionnaire were calculated for validation. The best cutoff point for the Nepalese version of the questionnaire was identified and the area under the receiver operating characteristic curve (AUC) was calculated.ResultsThe overall prevalence of good preventive practices was 90.6%. The best cutoff points for the Nepali version of the questionnaire were 93% sensitivity and 67% specificity, respectively at a cutoff level of 47/48. The area under the curve was 0.859. Thus, the Nepalese version of the questionnaire concerning preventive practices during the COVID-19 pandemic in the general population had an accuracy of 85.9% (95% CI 0.757–0.961, p = 0.001).ConclusionThe Nepalese version of the questionnaire on preventive practices during the COVID-19 pandemic in the general population can be successfully used as a survey tool. These findings might help to detect appropriate adherence to preventive practices can be achieved in busy outpatient departments. Detecting adherence to preventive practices may help local health authorities and policymakers in identifying specific populations for future awareness campaigns during infectious disease outbreaks.

Pathology and VP2-Based Characterization of Infectious Bursal Disease Virus Associated with an Outbreak in Layer Chickens in Ghana.

Infectious bursal disease (IBD) continues to threaten poultry production globally, with highly virulent strains circulating in many parts of Africa. In this study, molecular characterization was performed on a circulating infectious bursal disease virus (IBDV) strain from an outbreak in a layer flock in Ghana. Layer chicks presented for necropsy had markedly enlarged and hemorrhagic bursae of Fabricius, with necrotic foci and catarrhal exudate on the serosal surface. Histopathology of the bursa of Fabricius revealed scattered to effacing hemorrhages on the plicae, extensive necrosis with expansion of the stroma between the follicles, and depletion of lymphocytes within the interfollicular epithelium. Reverse transcription polymerase chain reaction (RT-PCR) and subsequent sequencing of the VP2 gene showed the presence of IBDV in formalin-fixed paraffin-embedded tissues. A phylogenetic analysis compared 62 other IBDV sequences from different parts of the world and placed the Ghanaian IBDV in genogroup 3 (vvIBDV), closely related to IBDV from Nigeria. In comparison to reference vvIBDV, there were amino acid substitutions at positions 252, 254, and 300. To the best of our knowledge, this is the first report in which an IBDV from a disease outbreak in Ghana has been sequenced and compared with other IBDVs in a phylogenetic analysis.

Promising Probiotic Candidates for Sustainable Aquaculture: An Updated Review.

With the intensification of aquaculture to meet the rising demands of fish and shellfish, disease outbreaks during the larval and adult stages are a major challenge faced by aqua culturists. As the prophylactic use of vaccines and antibiotics has several limitations, research is now focused on sustainable alternatives to vaccines and antibiotics, e.g., medicinal plants, probiotics, postbiotics, prebiotics, and synbiotics, as promising candidates to strengthen the immune response of fish and shellfish and to control disease outbreaks. With respect to probiotics, numerous studies are available revealing their health-promoting and beneficial impacts in aquaculture. However, most studies focus on Bacillus and Lactobacillus species. Keeping in view the positive effects of probiotic lactic acid bacteria in aquaculture, researchers are now looking for other probiotic bacteria that can be used in aquaculture. Recently, many non-lactic acid bacteria (non-LAB), which are mainly host-associated, have been reported to reveal beneficial effects in fish and shellfish aquaculture. The main non-LAB probiotic genera are Bifidobacterium, Clostridium, Microbacterium, Micrococcus, Paenibacillus, Acinetobacter, Alcaligenes, Enterobacter, Phaeobacter Pseudoalteromonas, Pseudomonas, Pseudomonas, and Vibrio. Despite the promising effects of non-LAB probiotics, comparably, there is limited available information in this context. This review focuses only on probiotic strains that are non-LAB, mostly isolated from the host digestive tract or rearing water, and discusses their beneficial effects in fish and shellfish aquaculture. This review will provide detailed information on the use of various non-LAB bacteria and provide a roadmap to future studies on new probiotics for sustainable aquaculture.

Integrating dynamical modeling and phylogeographic inference to characterize global influenza circulation.

Global seasonal influenza circulation involves a complex interplay between local (seasonality, demography, host immunity) and global factors (international mobility) shaping recurrent epidemic patterns. No studies so far have reconciled the two spatial levels, evaluating the coupling between national epidemics, considering heterogeneous coverage of epidemiological, and virological data, integrating different data sources. We propose a novel-combined approach based on a dynamical model of global influenza spread (GLEAM), integrating high-resolution demographic, and mobility data, and a generalized linear model of phylogeographic diffusion that accounts for time-varying migration rates. Seasonal migration fluxes across countries simulated with GLEAM are tested as phylogeographic predictors to provide model validation and calibration based on genetic data. Seasonal fluxes obtained with a specific transmissibility peak time and recurrent travel outperformed the raw air-transportation predictor, previously considered as optimal indicator of global influenza migration. Influenza A subtypes supported autumn-winter reproductive number as high as 2.25 and an average immunity duration of 2 years. Similar dynamics were preferred by influenza B lineages, with a lower autumn-winter reproductive number. Comparing simulated epidemic profiles against FluNet data offered comparatively limited resolution power. The multiscale approach enables model selection yielding a novel computational framework for describing global influenza dynamics at different scales-local transmission and national epidemics vs. international coupling through mobility and imported cases. Our findings have important implications to improve preparedness against seasonal influenza epidemics. The approach can be generalized to other epidemic contexts, such as emerging disease outbreaks to improve the flexibility and predictive power of modeling.

Farmers’ Perception and Adaptation Strategies on Climate Change and Variability in Rice Production in Sarlahi, Nepal

A study conducted in Sarlahi, Nepal, from February to July 2024 examined farmers' perceptions of climate change and their adaptive strategies to sustain rice yields. Among the 94 surveyed households, 96.8% reported rising temperatures, while 90.4% noted reduced rainfall frequency and intensity. Additionally, most respondents (70.2%) observed decreased flooding intensity, and 90.4% reported lower water availability in tube wells, ponds, and rivers. The study revealed limited climate knowledge among farmers, with only 2.1% being well-informed; personal experience was the primary source of information for 75.5% of respondents. Farmers employed various adaptation techniques, including improved rice varieties (66%), green manuring (34%), and alternate wetting and drying (24.5%), although only a small percentage (8.5%) utilized crop insurance. Key challenges included climate-induced disease outbreaks like blast and bacterial blight, along with pests such as the rice stem borer and leaf roller. The findings indicated that gender and landholding size significantly influenced the adoption of adaptation practices, with larger landholders more likely to adapt than smaller ones. This research contributes valuable insights into the adaptive capacities of farmers facing climate change, underscoring the need for targeted policy interventions to enhance resilience in rice cultivation through comprehensive education and resource support.

Vaccine Hesitancy Toward COVID-19 Vaccines Among Humanitarian Healthcare Workers in Lebanon, 2021

Refusals and delay in receiving COVID-19 vaccines due to vaccine hesitancy present major barriers to optimal vaccine uptake and thus epidemic control, with crisis-affected populations facing additional challenges. International Medical Corps conducted a cross-sectional survey to evaluate knowledge, attitudes, and perceptions regarding COVID-19 and identify determinants of COVID-19 vaccine hesitancy among 413 healthcare workers (HCW) working at 90 national primary healthcare centers in Lebanon, just prior to widespread vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health belief Model. More than half (56.9%) of HCWs were categorized as being vaccine-hesitant, while 43.1% reported they would receive a vaccine when available. Perceived benefits, cues to action, and social norms were positively associated with vaccine acceptance. More than half (56.4%) believed the national health system was not capable of ensuring safe administration of the COVID-19 vaccine. Targeted interventions that emphasize the benefits of COVID-19 vaccination, highlight cues to vaccinate, and promote vaccination as a social norm are critical in motivating HCWs to get vaccinated. Increasing HCW trust in Lebanon’s national health system is critical to building confidence toward COVID-19 vaccines and has implications for the success of future responses to infectious disease outbreaks.

A content analysis of government-issued social media posts during multi-jurisdictional enteric illness outbreaks in Canada

IntroductionMost Canadians use at least one social media platform regularly, making social media a potentially effective tool for reaching broad audiences. The Public Health Agency of Canada (PHAC) uses social media as one tool for rapidly communicating with the public during multi-jurisdictional enteric illness outbreaks. However, the effectiveness of social media in enhancing public risk communication during these outbreaks remains unexplored. Addressing this gap may help optimise social media use for risk communication to inform the public and prevent additional illness. This study aims to analyse the engagement with and quality of PHAC’s social media content regarding multi-jurisdictional enteric illness outbreaks.MethodsUsing a search of PHAC’s social media platforms, 482 posts during enteric illness outbreaks (2014–2022) were identified, including 198 posts from Facebook and 284 posts from X (formerly Twitter) in English and French. A codebook was developed using engagement metrics for gauging public interest, the Centers for Disease Control and Prevention’s (CDC) Modified Clear Communication Index (CCI) to assess clarity as a proxy for comprehension, the Health Belief Model (HBM) to evaluate the potential to motivate behaviour change, and measures of consistency. Descriptive statistics were used to analyse post content.ResultsThe average engagement rates for PHAC social media accounts were < 1%, below standard average engagement rates (1–5%). While posts generally adhered to the CDC’s CCI criteria, clear language (45.7% on Facebook, 26.5% on X) and clear communication of risk (7.6% on Facebook, 0.0% on X) were scarce. HBM constructs were present in all posts, but certain constructs, such as barriers were used sparingly (1% on Facebook, 0% on X). Despite this, posts consistently communicated outbreak investigation details and prevention information.DiscussionThe low average engagement rates suggest a lack of public awareness or interest in the posts. The partial adherence to the CCI indicates room for improvement in clarity, a key component for supporting public understanding. Although some HBM constructs were utilised, no posts incorporated all HBM constructs, which may hinder efforts to promote behaviour change. To enhance effective risk communication using social media during multi-jurisdictional enteric illness outbreaks in Canada, tools like the CDC’s CCI should be used to improve message clarity, use of all HBM constructs as applicable, and message consistency across products and channels are recommended to improve overall message quality and content.

Prevalence and Risk Factors of Worsened Seizure Control in Pediatric Patients with Epilepsy during COVID-19 Pandemic in Tertiary Care Hospital

Background: Epilepsy can achieve remission through accessible medications and regular follow-up. However, maintaining remission became challenging due to the barriers to care that emerged during the COVID-19 pandemic. Objective: To assess the prevalence of worsened seizure control in pediatric patients with epilepsy during the COVID-19 pandemic. Associated factors would be defined and investigated. Materials and Methods: A cross-sectional study was conducted on patients with epilepsy at the Pediatric Outpatient Unit of Bhumibol Adulyadej Hospital in Bangkok, Thailand, between January and February 2022. The present study included patients aged 1 month to 18 years at the time of diagnosis, with epilepsy diagnosed at least six months before the COVID-19 pandemic, making the diagnosis between January 2012 and October 2019, and treated with at least one antiseizure medication. Guardians were interviewed via telephone to assess demographic data, epilepsy characteristics, and their views on changes in care. Results: Among the 509 patients, 128 were included. Forty percent of guardians reported facing challenges in scheduling follow-up doctor’s appointments, primarily due to the fear of COVID-19 infection for 61.9%. The prevalence of worsened seizure control during the COVID-19 pandemic was 4.7%. Uncontrolled seizures at baseline were identified as a significant factor influencing worsened seizure control (p=0.001). Conclusion: Approximately five percent of pediatric patients with epilepsy experienced worsened seizure control during the COVID-19 pandemic. This highlights the importance of continuous care for this vulnerable group, even between limitations in travel and access to medical services. Forty percent of guardians reported difficulty in scheduling follow-up physician appointments. These findings suggest the importance of establishing efficient medication delivery and that telemedicine services for epilepsy care be considered in future planning, especially in anticipation of potential future waves of COVID-19 or other disease outbreaks. Keywords: COVID-19; Epilepsy; Seizure control; Pediatric patients

Climate change and Vibrio vulnificus dynamics: A blueprint for infectious diseases.

Climate change is having increasingly profound effects on human health, notably those associated with the occurrence, distribution, and transmission of infectious diseases. The number of disparate ecological parameters and pathogens affected by climate change are vast and expansive. Disentangling the complex relationship between these variables is critical for the development of effective countermeasures against its effects. The pathogen Vibrio vulnificus, a naturally occurring aquatic bacterium that causes fulminant septicemia, represents a quintessential climate-sensitive organism. In this review, we use V. vulnificus as a model organism to elucidate the intricate network of interactions between climatic factors and pathogens, with the objective of identifying common patterns by which climate change is affecting their disease burden. Recent findings indicate that in regions native to V. vulnificus or related pathogens, climate-driven natural disasters are the chief contributors to their disease outbreaks. Concurrently, climate change is increasing the environmental suitability of areas non-endemic to their diseases, promoting a surge in their natural populations and transmission dynamics, thus elevating the risk of new outbreaks. We highlight potential risk factors and climatic drivers aggravating the threat of V. vulnificus transmission under both scenarios and propose potential measures for mitigating its impact. By defining the mechanisms by which climate change influences V. vulnificus disease burden, we aim to shed light on the transmission dynamics of related disease-causing agents, thereby laying the groundwork for early warning systems and broadly applicable control measures.

Genomic and transmission dynamics of the 2024 Marburg Virus Outbreak in Rwanda.

The ongoing outbreak of Marburg virus disease (MVD) in Rwanda marks the third largest historically, though it has exhibited the lowest fatality rate. Genomic analysis of samples from 18 cases identified a lineage with limited internal diversity, closely related to a 2014 Ugandan case. Our findings suggest that the Rwandan lineage diverged decades ago from a common ancestor shared with diversity sampled from bats in Uganda. Our genomic data reveals limited genetic variation, consistent with single zoonotic transmission event and limited human-to-human transmission. Investigations including contact tracing, clinical assessments, sequencing and serology, linked the index case to a mining cave inhabited by Rousettus aegyptiacus. Serology tests identified three individuals seropositive for IgG and IgM, further supporting the zoonotic origin of the outbreak through human-animal interactions.

Stigma among ebola disease survivors in Mubende and Kassanda districts, Central Uganda, 2022.

Ebola disease survivors often experience stigma in multiple forms, including felt (perceived) stigma, enacted (action-based) stigma, and institutional stigma. On September 20, 2022, Uganda declared a Sudan Virus Disease (species orthoebolavirus sudanense) outbreak after a patient with confirmed Sudan virus (SUDV) infection was identified in Mubende District. The outbreak led to 142 confirmed and 22 probable cases over the next two months. We examined the types of stigma experienced by survivors and their household members and its effect on their well-being. We conducted a qualitative study during January 2023 in Mubende and Kassanda Districts. We conducted in-depth and key informant interviews with ten SUDV disease survivors, ten household members of SUDV disease survivors, and ten key informants (district officials and health workers in the affected communities). Interviews were recorded, translated, transcribed, and analyzed thematically. Survivors reported experiencing isolation and rejection by community members and loss of work. They reported being denied purchases at shops or having their money collected in a basket and disinfected (enacted stigma), which led to self-isolation (felt stigma). Educational institutions denied admission to some students from affected homes, while parents of children in some affected families stopped sending children to school due to verbal abuse from students and teachers (structural stigma). Prolonged SUDV disease symptoms and additional attention to survivors from responders (including home visits by health workers, public distribution of support items, and conspicuous transport from home to the survivor's clinic) were perceived as aggravating both felt and enacted stigma. Even after the outbreak had been declared over, survivors felt that they were still considered a threat to the community. Survivors experienced mainly enacted stigma which was aggravated by the outbreak response and control activities such as additional attention to survivors from responders. Strengthening community engagement to counteract stigma, rethinking response activities that aggravate stigma, integrated response interventions by partners, private distribution of support items, and increasing awareness and sensitization could reduce stigma among the Ebola disease survivors in future responses.

Livestock abortion surveillance in Tanzania reveals disease priorities and importance of timely collection of vaginal swab samples for attribution

Lack of data on the aetiology of livestock diseases constrains effective interventions to improve livelihoods, food security and public health. Livestock abortion is an important disease syndrome affecting productivity and public health. Several pathogens are associated with livestock abortions but across Africa surveillance data rarely include information from abortions, little is known about aetiology and impacts, and data are not available to inform interventions. This paper describes outcomes from a surveillance platform established in Tanzania spanning pastoral, agropastoral and smallholder systems to investigate causes and impacts of livestock abortion. Abortion events were reported by farmers to livestock field officers (LFO) and on to investigation teams. Events were included if the research team or LFO could attend within 72 hr. If so, samples and questionnaire data were collected to investigate (a) determinants of attribution; (b) patterns of events, including species and breed, previous abortion history, and seasonality; (c) determinants of reporting, investigation and attribution; (d) cases involving zoonotic pathogens. Between 2017–2019, 215 events in cattle (n=71), sheep (n=44), and goats (n=100) were investigated. Attribution, achieved for 19.5% of cases, was significantly affected by delays in obtaining samples. Histopathology proved less useful than PCR due to rapid deterioration of samples. Vaginal swabs provided practical and sensitive material for pathogen detection. Livestock abortion surveillance, even at a small scale, can generate valuable information on causes of disease outbreaks, reproductive losses and can identify pathogens not easily captured through other forms of livestock disease surveillance. This study demonstrated the feasibility of establishing a surveillance system, achieved through engagement of community-based field officers, establishment of practical sample collection and application of molecular diagnostic platforms.

Livestock abortion surveillance in Tanzania reveals disease priorities and importance of timely collection of vaginal swab samples for attribution.

Lack of data on the aetiology of livestock diseases constrains effective interventions to improve livelihoods, food security and public health. Livestock abortion is an important disease syndrome affecting productivity and public health. Several pathogens are associated with livestock abortions but across Africa surveillance data rarely include information from abortions, little is known about aetiology and impacts, and data are not available to inform interventions. This paper describes outcomes from a surveillance platform established in Tanzania spanning pastoral, agropastoral and smallholder systems to investigate causes and impacts of livestock abortion. Abortion events were reported by farmers to livestock field officers (LFO) and on to investigation teams. Events were included if the research team or LFO could attend within 72 hr. If so, samples and questionnaire data were collected to investigate (a) determinants of attribution; (b) patterns of events, including species and breed, previous abortion history, and seasonality; (c) determinants of reporting, investigation and attribution; (d) cases involving zoonotic pathogens. Between 2017-2019, 215 events in cattle (n=71), sheep (n=44), and goats (n=100) were investigated. Attribution, achieved for 19.5% of cases, was significantly affected by delays in obtaining samples. Histopathology proved less useful than PCR due to rapid deterioration of samples. Vaginal swabs provided practical and sensitive material for pathogen detection. Livestock abortion surveillance, even at a small scale, can generate valuable information on causes of disease outbreaks, reproductive losses and can identify pathogens not easily captured through other forms of livestock disease surveillance. This study demonstrated the feasibility of establishing a surveillance system, achieved through engagement of community-based field officers, establishment of practical sample collection and application of molecular diagnostic platforms.