Sentinel Sites Research Articles

Geospatial Artificial Intelligence Infused into a Smartphone Drone Application for Implementing 'Seek and Destroy' in Uganda

This study provided important insights into new, real time, control measures at reducing larval, vector density [Macro Seek and Destroy (S&D) and blood parasite level [Micro S&D] in a malaria treated and suspected intervened population. Initially, this study employed a low-cost (< $1000) drone (DJI Phantom) for eco-geographically locating, water bodies including natural water bodies, irrigated rice paddies, cultivated swamps, ditches, ponds, and other geolocations, which are among the common breeding sites for <i>Anopheles</i> mosquitoes in Gulu district of Northern Uganda. Our hypothesis was that by integrating real time, scaled up, sentinel site, spectral signature, unmanned aerial vehicle (UAV) or drone imagery with satellite data using geospatial artificial intelligence [geo-AI] infused into an iOS application (app), a local, vector control officer could retrieve a ranked list of visually similar, breeding site, aquatic foci of <i>An.gambiae s.l. arabiensis s.s. fuentsus s.s.</i> mosquitoes, and their respective district-level, capture point, GPS indexed, centroid coordinates. We real time retrieved (hence, no lag time between seasonal, aquatic, <i>Anopheles</i>, larval habitat, mapping and treatment of foci) each georeferenced sentinel site signature which was subsequently archived in the drone dashboard spectral library using the smartphone app. Each georeferenced, UAV sensed, capture point was inspected using a mobile field team (i.e., trained local village residents led by a vector control officer) on the same day the habitats were geo-AI signature mapped, spatially forecasted and treated. A second hypothesis was that a real time, environmentally friendly, habitat alteration [i.e., Macro S&D] could reduce vector larval habitat density and blood parasite levels in treated and not suspected malaria patients at an entomological intervention site. A third hypothesis was: timely malaria diagnosis and treatment [Micro S&D] is associated with low population parasitemia and lower malaria incidences. In 31 days post-Macro S&D intervention, there was zero vector density, indoor, adult, female, <i>Anopheles</i> count as ascertained by pyrethrum spray catch at the intervention site. After a mean average of 62 days, blood parasite levels revealed a mean 0 count in timely diagnosed suspected and treated malaria patients. Implementing a real time Macro and Micro S&D intervention tool along with other existing tools [insecticide-treated mosquito nets (ITNs) and indoor residual spraying of insecticides (IRS)] in an entomological district-level intervention site can lower seasonal malaria prevalence either through timely modification of aquatic, <i>Anopheles</i>, larval habitats or through precisely targeted larvicide interventions.

Heterogeneity and Confinement of HIV Prevalence among Pregnant Women Calls for Decentralized HIV Interventions: Analysis of Data from Three Rounds of HIV Sentinel Surveillance in Karnataka: 2013-2017.

Background:The HIV sentinel surveillance (HSS) serves to estimate the levels and trend of HIV prevalence among high-risk, bridge, and general population and monitors HIV management at national, state, and district levels. Data from HSS are valuable in understanding the risk factors associated with HIV transmission with particular demographic characteristics.Objectives:The objective was to analyze the sociodemographic profile of the pregnant mothers attending the antenatal care (ANC) clinics in Karnataka, in order to understand the dynamics of HIV within the general population in Karnataka.Materials and Methods:Study design: this was a cross-sectional study conducted using consecutive sampling method. Study setting: the surveillance was conducted at select antenatal clinics, in Karnataka, India, between January and March, in the years 2013, 2015, and 2017. Methodology: in total, 74,278 eligible pregnant women aged between 15 and 49 years, attending the sentinel sites for the first time during the surveillance period, were included in the study. Information on their sociodemographic characteristics and blood samples was collected.Results:HIV prevalence among the ANC clinic attendees has significantly declined, reaching a recent stabilization. The risk factors significantly associated with HIV among pregnant women were age, education, occupation, and marital status. HIV is highly concentrated in the northern and southern districts of Karnataka.Conclusion:Despite the declining trends of HIV prevalence in Karnataka, the epidemic is heterogeneous and concentrated within the state, calling for decentralized region-specific interventions.

The first epidemiological and virological influenza surveillance in the Republic of Guinea revealed the predominance of influenza A/H3N2 and B Victoria viruses.

Little is known about respiratory viruses infection in Guinea. Influenza surveillance has not been implemented in Guinea mainly because of the paucity of laboratory infrastructure and capacity. This paper presents the first influenza surveillance data in Guinea.Swabs were obtained from August 2018 through December 2019 at influenza sentinel sites and transported to the Institut National de Santé Publique for testing. Ribonucleic acid was extracted and tested for the presence of influenza A and B by real-time reverse transcription-polymerase chain reaction (RT-PCR). Positive samples were further characterised to determine the subtypes and lineages of influenza viruses.A total of 862 swabs were collected and tested. Twenty-three per cent of samples tested positive for influenza A and B viruses. Characterisation of positive specimens identified influenza A/H1N1pmd09 (2.5%), influenza A/H3N2 (57.3%), influenza B/Victoria lineage (36.7%) and 7 (3.5%) influenza B with undetermined lineage. Influenza B virus activity clustered in August through November while influenza A/H3N2 displayed two clusters of activities that appeared in May through August and November through December.For the first time in Guinea, the epidemiology, diversity and period of circulation of influenza viruses were studied. The results indicate the predominance and the periods of activities of influenza B Victoria lineage and influenza A/H3N2 which are important information for preventive strategies. It is warranted to extend the influenza surveillance to other parts of Guinea to better understand the epidemiology of the viruses and monitor the emergence of influenza strains with pandemic potential.

Plasmodium falciparum Allelic Diversity: A Comparison of DNA Extraction from Isolates Collected on Rapid Diagnostic Tests (Rdts) and Filter Paper

Background:To perform molecular epidemiologic studies based on large cohorts, material such as RDTs or filter papers are useful for biological sample collection and extraction of RNA or DNA of good quality. Thus, we aimed to assess the quality of DNA extracted from malaria rapid diagnostic tests (RDTs) stored at various temperatures for the analysis of Plasmodium falciparum genetic diversity.Methods:Febrile patients benefitted from free malaria diagnosis using microscopy in a malaria sentinel site, at the Regional Hospital Estuaire-Melen, in Gabon, in 2015. P. falciparum isolates were collected onto one filter paper and 2 similar RDTs devices (Acon®) per patient. Nucleic acids were extracted with QiAmp Qiagen kit from paper and RDTs and the quality of the DNA was analyzed by msp1 gene amplification.Results:Msp1gene amplification was achieved in nucleic acids extracted from all filter papers and RDTs devices (n = 45, 100%). K1 alleles were detected in 93.3% (n = 42/45) of the samples and Mad20 alleles in 73.3% (n = 33/45). The number and the intensity of K1 and/or Mad20 fragments were comparable according to the sample collection material and the storage conditions (room temperature vs −20°C) of the samples. The size of the fragments indicating allelic diversity was comparable in 80% (n=36) of the samples.Conclusion:These data show that RDTs are a valuable source of DNA for malaria parasite genetic polymorphism analysis. Storage conditions of the devices did not influence the quality of DNA extracted from RDTs device, although some alleles may be missed.

HIV Sentinel Surveillance Survey 2019/ Prevalence and Characteristics of HIV Cases in Sri Lanka; Experience from Sentinel site Surveillance 2019

<strong>Introduction: </strong>Sri Lanka remains a low-prevalent country for HIV/ AIDS over last few decades, according to the reported cases to the National STD and AIDS Control Programme. Even among high risk population groups, the HIV prevalence remains low. It is very important to monitor HIV prevalence trends among these population groups as risk behaviours are changing and HIV prevalence might rise in escalating levels needing urgent action. <strong> </strong> <strong>Objective: </strong>The objective of the survey is to assess the prevalence of HIV infection among the subpopulation groups at risk for HIV infection and to monitor the trends of the HIV epidemic. <strong> </strong> <strong>Method: </strong>As a regular process, 14th round of HIV sentinel surveillance survey was conducted during the period of 3 months starting from 01st October to 31st December 2019. A survey protocol was developed in 2019 including same sentinel sites, modified sentinel groups and testing algorithms. The nine provinces of the country were identified as 9 sentinel sites and sentinel groups include Men who have sex with men (MSM), female sex workers (FSW), Clients of sex workers, Transgender women and people who inject drugs (PWID). <strong> </strong> <strong>Results: </strong>Prevalence of HIV was highest among MSM (1.46%) followed by transgender women (1.35%) and clients of sex workers (0.09%). The prevalence among FSW was 0.07%, and there were no HIV positives among the 70 PWID enrolled in the study. <strong> </strong> <strong>Conclusions: </strong>MSMs appears to be the highest risk group for contracting HIV and active syphilis in Sri Lanka. This trend should be taken into account when planning interventions to achieve programme objectives.

1439. High Rates of Drug Resistance in Escherichia coli from a Pilot Antimicrobial Resistance Surveillance System in Cambodia

BackgroundAntimicrobial resistance (AMR) is a major and growing global public health problem. The Cambodia Ministry of Health established a pilot laboratory-based AMR surveillance system for blood specimens in 2017. The objective of this study is to characterize AMR among pathogenic isolates from blood samples.MethodsA retrospective analysis was performed using one year of data from a pilot AMR Surveillance system in Cambodia. Four blood culture isolate pathogens were included: Escherichia coli, Klebsiella pneumoniae, Salmonella Typhi /Salmonella Paratyphi A and Staphylococcus aureus. Blood culture isolates that were referred from eleven sentinel sites were analyzed at the National Public Health Laboratory for identification. Antibiotic susceptibility testing (AST) was done using disk diffusion, minimum inhibitory concentration method following Clinical Laboratory Standard Institute (CLSI) guidelines.ResultsAmong 214 pathogenic isolates from blood samples, E.coli was the most common (56.1%), followed by Salmonella Typhi/Salmonella Paratyphi A (18.7%), Staphylococcus aureus (13.5%), and Klebsiella pneumoniae (11.7%). Methicillin Resistance Staphylococcus aureus (MRSA) was detected in half of the isolates. E.coli was resistant to ampicillin (94.4%), trimethoprim-sulfamethoxazole (84.5%), and ceftriaxone (79.2%). Salmonella Typhi was resistant to ampicillin (73.3%) and trimethoprim-sulfamethoxazole (60.0%) and Salmonella Paratyphi A were resistant to fluoroquinolones (91.7%). For last resort antibiotics, E.coli was resistant to carbapenem groups (3.2% for imipenem, 4.9% for meropenem, and 5.0% for ertapenem). Klebsiella pneumoniae was not resistant to any groups.Conclusion E.coli was found at high rates in blood samples and was resistant to common antibiotics used in Cambodia. These pilot data show the importance of establishing a national AMR surveillance system in Cambodia to monitor AMR trends following GLASS guidelines.Disclosures All Authors: No reported disclosures

Use of Filaria Test Strips (FTS) in Identification of Filaria Endemicity in Non Filaria Endemic Districts of Uttar Pradesh, India

Uttar Pradesh is the largest state of India and is comprised of 75 revenue districts. 51 districts of eastern Uttar Pradesh are endemic for LF and are under Elimination of Lymphatic Filariasis (ELF). In order to ensure elimination of the disease from the people, the Mass Drug Administration (MDA) was observed in these 51 districts since 2004 by ensuring administration of drug DEC alone once in a year according to the age excluding children &gt;2years, pregnant women &amp; seriously ill persons. Thereafter, 400 mg albendazole to &gt;2 years age group was added with DEC since 2008. 24 districts of Western Uttar Pradesh are non endemic for filariasis. The state in coordination with WHO has conducted filaria antigenemia tests in these 24 non filaria endemic districts with the help of Filaria Test Strips (FTS) and the drive is termed as Mini-transmission assessment survey (Mini-TAS). 300 persons were examined with Filaria Test Strip (FTS) from each of the 04 sentinel sites of each district. On the basis of test reports, all 24 non endemic districts reported &gt;2 % filaria antigenemia and the state claimed to declare the districts as filaria endemic districts/ areas. The possibilities of the claim to establish non filaria endemic districts to filaria endemic districts have been explored &amp; discussed in detail in this paper. The critical examination of the data does not support to assign any non endemic area to endemic area. On the basis of conducting direct filaria antigenemia tests alone and the term used as mini-transmission assessment survey (‘Mini-TAS’) will be a misnomer, consequently misleading to the ELF programme in the country.

The Evolutionary Dynamics of Influenza A Viruses Circulating in Mallards in Duck Hunting Preserves in Maryland, USA.

Duck hunting preserves (DHP) have resident populations of farm-raised mallard ducks, which create potential foci for the evolution of novel influenza A viruses (IAVs). Through an eleven-year (2003–2013) IAV surveillance project in seven DHPs in Maryland, USA, we frequently identified IAVs in the resident, free-flying mallard ducks (5.8% of cloacal samples were IAV-positive). The IAV population had high genetic diversity, including 12 HA subtypes and 9 NA subtypes. By sequencing the complete genomes of 290 viruses, we determined that genetically diverse IAVs were introduced annually into DHP ducks, predominantly from wild birds in the Anatidae family that inhabit the Atlantic and Mississippi flyways. The relatively low viral gene flow observed out of DHPs suggests that raised mallards do not sustain long-term viral persistence nor do they serve as important sources of new viruses in wild birds. Overall, our findings indicate that DHPs offer reliable samples of the diversity of IAV subtypes, and could serve as regional sentinel sites that mimic the viral diversity found in local wild duck populations, which would provide a cost-efficient strategy for long-term IAV monitoring. Such monitoring could allow for early identification and characterization of viruses that threaten bird species of high economic and environmental interest.

India Hypertension Control Initiative-Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics.

The India Hypertension Control Initiative (IHCI) is a multi‐partner initiative, implementing and scaling up a public health hypertension control program across India. A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use. Among all registrations, 11 274 (51%) of the patients returned for a follow‐up visit between July 2019 and September 2019. Among patients returning for follow‐up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow‐up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state‐specific treatment protocols. This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow‐up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care.

Laboratory confirmed circulating Influenza virus: Analysis of trend and seasonality in Nigeria from 2008–May 2019

Background: National Reference Laboratory detected different subtypes of influenza virus circulating among human population through national influenza sentinel surveillance for Ifluenza Like Ilnesses (ILI) and Severe Acute Respiratory Infection (SARI) across four geopolitical zones of Nigeria to help explain the epidemiology of influenza in Nigeria. Methods and materials: Nasopharyngeal/Oropharyngeal samples were collected from patients who met the criteria for ILI/ SARI in four sentinel sites, were tested by Real Time rtPCR technique. Data generated from April 2008 to May 2019 were analyzed by Epi info data analysis software and Microsoft Excel. Results: A total of 13792 samples were documented from April 2008–May 2019 with a total of 1351 positive and 12441 negative. Of which 869 (6.3%) tested positive to Flu A, 480 (3.5%) to Flu B, 2 (0.01%) to Flu A/B co-infection. The circulating influenza subtypes were H1N1pdm09 404 (3.2%), AH1N1 15 (0.1%), AH3N1 345 (2.8%), Flu B-Victoria 24 (0.2%), Flu B-Yamagata 3 (0.02%), Flu not subtype 107 (0.9%), Flu A un-subtype 453 (3.6%). Influenza positivity in females was 625 (46%) and 711 (53%) in males, missing variables for gender was 15 (1.%). Patient with Influenza Like Illnesses (ILI) with highest proportion of Flu A was among age-group 5-9 and 55–59 with 8%. Cases with Severe Acute Respiratory Infection (SARI) having highest proportion of FluA were age-group 50–54 and 55–59. Influenza B virus among ILI cases are higher among age-group 5–9 with 15%. There was no observed commonality in seasonal peaks across the years. Subtype A/H1N1pdm09 circulate the most after the pandemic of 2009 alongside A/HI & A/H3. While recently A/H3 and influenza B-Victoria are commonly isolated. The least influenza subtype circulating is influenza B-Yamagata. Seasonal trend of all the circulating subtypes was around September each year. Conclusion: Laboratory data showed year round influenza virus circulation with the younger and older age-groups affected the most in both ILI and SARI cases. Influenza AH1N1pdm(09) and Influenza A/H3 are the most isolated influenza virus strains in Nigeria with a recent increase in the incidence of FluA and FluB coinfection.

Prevalence of drink-driving in Thimphu, Bhutan: Targeted surveillance at sentinel sites.

Bhutan has a high incidence of alcohol-related disease. With economic development, motorised transport is proliferating, increasing the potential for traffic injury. We investigated drink-driving in the country's largest urban environment. Working with police, we set up checkpoints at major thoroughfares in Thimphu, on Tuesday, Friday and Saturday nights, from May to July 2017. Police directed cars to testing bays where drivers were breathalysed and interviewed. All 1596 drivers stopped by police were breathalysed, and 212 (13%) tested positive. Blood alcohol of >0.02 g/dL (which we defined as 'probable impairment') was detected in 178 drivers (11%), while 67 (4.2%) exceeded the legal limit of 0.08 g/dL. Probable impairment was more common in men, older drivers, on Tuesdays (versus Fridays or Saturdays) and later at night. Drink-driving is very common at night-time in Bhutan. Routine roadside random breath-testing, and media campaigns emphasising the risk of apprehension and consequent serious financial and social penalties, should be considered to deter drink-driving.

Decreased influenza activity during the COVID-19 pandemic-United States, Australia, Chile, and South Africa, 2020.

Transplant recipients are among the groups for whom the updated recommendations for 2020–2021 influenza vaccination should generally be considered essential, notably in the face of the COVID‐19 pandemic.

Five year burden of Streptococcus pneumoniae infection in under-five children: Observations from Meningitis Surveillance Network, India

Background: Streptococcus pneumoniae is an important cause for pneumonia, meningitis, bacteremia and sepsis among under-five children. Hospital Based Sentinel Surveillance for Bacterial Meningitis Network was established in India to generate baseline data on epidemiology of S. pneumoniae before introduction of Pneumococcal Conjugate Vaccine (PCV). The prevalence of S. pneumoniae, its serotype distribution and antimicrobial susceptibility profile are presented. Methods & Materials: Children aged between one and 59 months meeting the standard definition of meningitis from 11 sentinel hospital sites across India were included. CSF and other specimens were collected for biochemistry, culture and latex agglutination tests at sentinel site laboratories. Confirmation of S. pneumoniae in CSF by PCR, and serotyping by Quellung method and antimicrobial susceptibility tests were done in reference laboratory. Results: Totally 12,941 children with suspected meningitis between March 2012 and September 2016 were recruited. Of these, 438 cases were confirmed to be S. pneumoniae by one or more methods. Among them, S. pneumoniae was isolated by culture from blood, CSF and/or other sterile body fluids in 141 samples; 148 and 265 samples were positive by LAT and PCR respectively. Highest prevalence was observed among children aged between 1 and <2 years (82.7%). Serotyping was done in 110/141 isolates. The commonest circulating serotypes were 14 (16.4%), 19F (12.7%), 6B (11.8%), 6A (6.4%), 4 (5.5%) and 23F (5.5%). Antimicrobial resistance to cotrimoxazole and erythromycin was 100% and 47% respectively. Non- susceptible to penicillin and cefotaxime was 28% and 9% respectively. Conclusion: S. pneumoniae continues to be an important cause of bacterial meningitis among under-five children. In 2017, Government of India introduced PCV 13 vaccine in universal immunization program in high-burden districts and is expected to offer 73% protection against currently circulating serotypes of S. pneumoniae. In view of documented high prevalence of S. pneumoniae in bacterial meningitis in children, we recommend expansion of PCV 13 coverage for possible dual benefit against childhood pneumonias and bacterial meningitis. It is critical to continue surveillance to generate documented evidence of patterns of serotype distribution and pneumococcal prevalence following the introduction of PCV. This will help to inform policy on altering serotype composition of PCV for immunization in the programme.

Rotavirus cases among Rotarix vaccinated children below five years during the 2018 outbreak in the Kingdom of Eswatini

Background: A large outbreak of diarrhoeal disease in children under 5 years was reported in four surveillance sentinel sites Mbabane Government Hospital, Raleigh Fitkin Memorial Hospital, Hlathikhulu Government Hospital and Good Shepherd Hospital. Rapid increase of number diarrhoeal cases, were reported from week 34 to 41 (August to October 2018). Approximately 1,535 children presented with acute diarrhea, vomiting and dehydration. Methods and materials: Diarrhoeal stool samples were routinely collected for surveillance from children less than 5 years of age to determine the etiology of the diarrhoea. A total of 139 stool samples were tested for rotavirus using enzyme immunoassay kit, Molecular characterization using polyacrylamide gel electrophoresis, semi nested reverse-transcription polymerase chain reaction, sequencing and phylogenetic analysis. Rotavirus negative stool samples were further tested for bacteria and parasites using molecular diagnostic assays. Results: The rotavirus positive samples were positive for group A rotavirus with a prevalence of (117/211) 53% with the age groups mostly affected being;<12 months = (68/117)58.1%, 3-24 months = 23.9% (28/117) and >24 months = 16.2%(19/117). The PAGE patterns observed were long RNA migration pattern. The G3P[8] 59/75(78.6%) rotavirus strain were mainly associated with the outbreak. Phylogenetic analysis of the partial length VP4 P[8] associated G3 clustered together with other P[8] strains detected in Africa and distantly related to vaccine strains (Rotarix™ and RotaTeq™). Pathogens that were observed in Eswatini were Shigella/Enteroinvasive E. coli 18% (11/61) was frequently detected followed by Campylobacter jejuni/coli 13% (8/61) and Giardia lamblia 13% (8/61). Conclusion: Majority of the children affected by the rotavirus received vaccination and the rotavirus genotype G3P[8] was the major cause of these outbreak. It also important to note that the G3P[8] that was circulating was the wild type stains not related to the vaccine strains. As evident from the Maximum likelihood phylogenetic tree generated, G3P[8] study strains clustered in different lineages as compared to the vaccine strains (Rotarix™ and RotaTeq™). Further studies on whole genome sequence analysis are required to determine the evolutionary relationship among the strains and surveillance of rotavirus among the infants should be continued while increasing the rotavirus vaccine coverange and add a booster dose to increase protection.

Efficacy of extended release formulations of Natular\u2122 (spinosad) against larvae and adults of Anopheles mosquitoes in western Kenya

BackgroundLarval source management is recommended as a supplementary vector control measure for the prevention of malaria. Among the concerns related to larviciding is the feasibility of implementation in tropical areas with large numbers of habitats and the need for frequent application. Formulated products of spinosad that are designed to be effective for several weeks may mitigate some of these concerns.MethodsIn a semi-field study, three formulations of spinosad (emulsifiable concentrate, extended release granules and tablet formulations) were tested in naturalistic habitats in comparison to an untreated control. Cohorts of third instar Anopheles gambiae (Diptera: Culicidae) were introduced into the habitats in screened cages every week up to four weeks after application and monitored for survivorship over three days. A small-scale field trial was then conducted in two villages. Two of the spinosad formulations were applied in one village over the course of 18 months. Immature mosquito populations were monitored with standard dippers in sentinel sites and adult populations were monitored by pyrethrum spray catches.ResultsIn the semi-field study, the efficacy of the emulsifiable concentrate of spinosad waned 1 week after treatment. Mortality in habitats treated with the extended release granular formulation of spinosad was initially high but declined gradually over 4 weeks while mortality in habitats treated with the dispersable tablet formulation was low immediately after treatment but rose to 100% through four weeks. In the field study, immature and adult Anopheles mosquito populations were significantly lower in the intervention village compared to the control village during the larviciding period. Numbers of collected mosquitoes were lower in the intervention village compared to the control village during the post-intervention period but the difference was not statistically significant.ConclusionsThe extended release granular formulation and the dispersible tablet formulations of spinosad are effective against larval Anopheles mosquitoes for up to four weeks and may be an effective tool as part of larval source management programmes for reducing adult mosquito density and malaria transmission.

Understanding Pediatric Norovirus Epidemiology: A Decade of Study among Ghanaian Children.

Understanding the epidemiology of human norovirus infection in children within Ghana and the entire sub-Saharan African region, where future norovirus vaccines would have the greatest impact, is essential. We analyzed 1337 diarrheic stool samples collected from children <5 years from January 2008 to December 2017 and found 485 (36.2%) shedding the virus. GII.4 (54.1%), GII.3 (7.7%), GII.6 (5.3%), GII.17 (4.7%), and GII.5 (4.7%) were the most common norovirus genotypes. Although norovirus GII.4 remained the predominant capsid genotype throughout the study period, an increase in GII.6 and GII.3 capsid genotypes was observed in 2013 and 2014, respectively. The severity of clinical illness in children infected with GII.4 norovirus strains was similar to illness caused by non-GII.4 strains. Since the epidemiology of norovirus changes rapidly, establishment of systematic surveillance within sentinel sites across the country would enhance the monitoring of circulating norovirus strains and allow continuous understanding of norovirus infection in Ghana.

Relationship between new-type drug use and high risk sex behavior in men who have sex with men

Objective: To understand the relationship between new-type drug use and high risk behavior in men who have sex with men (MSM) in Shandong province. Methods: Cross-sectional surveys was conducted to collect the information about demographics, sexual and drug use behaviors of MSM and HIV-related services in MSM in three sentinel surveillance sites in Shandong from April to July in 2019. Blood samples were taken from the MSM for serological tests of HIV antibody and syphilis antibody. Results: A total of 1 203 MSM were included in this study. The average age of the MSM was 30.2±8.9 years. Among these MSM, 67.7% (815) were unmarried; 66.9% (805) had education level of college or above; 62.2% (721/1 160) had unprotected sex behaviors and 16.3% (189/1 160) had group sex behavior in the past six months and 54.2% (652/1 203) ever used new-type drugs. HIV infection and syphilis prevalence rates were 3.1% (37/1 203) and 4.7% (56/1 203), respectively. Multivariable logistic analysis indicated that MSM who had unprotected anal sex in the past six months were more likely to be from Qingdao (aOR=1.59, 95%CI:1.13-2.23), with education level of high school or below (aOR=1.61, 95%CI: 1.20-2.16), with male sex partners from bars/dance halls or other venues (aOR=1.69, 95%CI: 1.06-2.69), with HIV knowledge awareness score <6 (aOR=1.55, 95%CI: 1.01-2.37), with ≥2 sex partner in the past week (aOR=1.48, 95%CI: 1.12-1.95), to have group sex behaviors in the past six months (aOR=2.43, 95%CI:1.61-3.67) and to use new-type drugs (aOR=1.46, 95%CI: 1.11-1.91). MSM who had group sex were more likely to have following features: being from Qingdao (aOR=2.21, 95%CI: 1.45-3.38), non-Shandong residents (aOR=2.13, 95%CI: 1.28-3.55), HIV knowledge awareness score ≥6 (aOR=3.11, 95%CI: 1.55-6.25), ever having unprotected anal sex behaviors (aOR=2.60, 95%CI: 1.71-3.96) and ever having male commercial sex (aOR=3.38, 95%CI: 1.92-5.95) in the past six months, ever using new-type drugs (aOR=2.71, 95%CI: 1.82-4.04), and never having HIV testing in the past year (aOR=2.66, 95%CI: 1.59-4.43). Conclusion: New-type drug use is common in MSM in Shandong. The use of new-type drugs promotes unprotected sex and group sex in MSM. Surveillance and intervention measures targeting this population should be strengthened.

Detection and genetic characterization of community-based SARS-CoV-2 infections – New York City, March 2020

To limit SARS-CoV-2 introduction, the United States restricted travel from China on February 2 and from Europe on March 13, 2020 By March 15, community transmission was widespread in New York City (NYC) The NYC Department of Health and Mental Hygiene conducted sentinel surveillance of influenza-like symptoms (ILS) and genetic sequencing to characterize community transmission and determine the geographic origin of SARS-CoV-2 infections Among 544 specimens tested from persons with ILS and negative influenza test results, 36 (6 6%) were positive Genetically sequenced positive specimens most closely resembled sequences circulating in Europe Partnering with health care facilities and establishing systems for sentinel surveillance with capacity for genetic sequencing before an outbreak can inform timely public health response strategies

Point prevalence mapping reveals hotspot for onchocerciasis transmission in the Ndikinimeki Health District, Centre Region, Cameroon

BackgroundIvermectin-based preventive chemotherapy (PC) is distributed annually to all at-risk populations eligible for ivermectin treatment to control and/or eliminate onchocerciasis. Information on the impact of mass ivermectin administration on onchocerciasis transmission is scanty, and it is tricky to appreciate the progress towards elimination and engage corrective measures. To fill that gap in the Centre Region in Cameroon, the current onchocerciasis endemicity level in the Ndikinimeki Health District after about two decades of mass treatments was assessed.MethodsA cluster-based cross-sectional survey was carried out in the Ndikinimeki Health District and all volunteers aged ≥ 5 years were (i) interviewed on their compliance to ivermectin over the past five years and (ii) underwent clinical (nodule palpation and visual search for onchocercal lesions) and parasitological examinations (skin snip) for onchocerciasis.ResultsThe overall Onchocerca volvulus prevalence was 7.0% (95% CI: 5.2–9.3%). The prevalence of the disease was significantly higher in the communities Kiboum 1 and Kiboum 2 compared to the other communities (highest prevalence in Makénéné Town Water: 8.5%; 95% CI: 2.3–20.4%) (χ2 = 51.314, df = 11, P = 0.0001). The proportion of systematic non-compliers to ivermectin was 23.3% (95% CI: 19.9–27.1%) among individuals interviewed. In the sentinel sites (Kiboum communities), onchocerciasis prevalence decreased from 95.2% (95% CI: 88.3–98.1%) to 23.7% (95% CI: 14.7–36.0%).ConclusionsThis study has revealed that the Ndikinimeki Health District is hypo-endemic for onchocerciasis after about two decades of preventive chemotherapy. However, transmission is ongoing, with potential hotspots in the Kiboum 1 and Kiboum 2 communities, which are known as first-line communities (closest to the breeding sites of the vector). Alternative or complementary strategies to annual ivermectin appear compulsory to accelerate the momentum towards onchocerciasis elimination.

Incorporating Telementorship Into Laboratory Capacity Building Initiatives for Improved AMR Surveillance in Ethiopia

Background: In July 2017, recognizing the threat that antimicrobial resistance poses to the population, the Ethiopian Public Health Institute (EPHI) launched the Ethiopia AMR Surveillance Network at 4 sentinel laboratories. Simultaneously, laboratory capacity building was initiated to ensure the reporting of quality laboratory data to the surveillance system. One initiative, Project ECHO (Extension for Community Healthcare Outcomes) was used to virtually connect subject matter experts with participating laboratories in remote settings to provide ongoing education and telementoring and to foster peer-to-peer learning and problem solving in microbiology. The 10-month project was supported by the Centers for Disease Control and Prevention (CDC) and the American Society for Microbiology (ASM).Methods: Biweekly 1-hour sessions were held by ASM for 2 sentinel sites, Tikur Anbessa Specialized Hospital and the EPHI Clinical Microbiology and Mycology Laboratory, using a videoconferencing platform. Each virtual session consisted of a didactic session, a case presentation by a participating laboratory, open discussion and feedback. Case presentations focused on technical challenges and problems encountered in the preanalytical, analytical, and postanalytical phases of microbiology testing. Experts from CDC and ASM provided feedback along with a summation of key learning objectives. Sessions were recorded and post session reports were shared with participants. To assess participants’ baseline knowledge, a comprehensive pretest was administered prior to the first session. The same instrument was administered as a posttest 2 weeks after the final session. Unstructured interviews were also conducted to assess participants’ perceptions of the value of ECHO to their work. Results: Mean pretest scores were 69.25% and the posttest scores were 71.04%, a difference of 1.79% (P = NS). Participant interviews revealed perceived benefits of ECHO participation to include enhanced critical thinking and problem resolution in microbiology, increased communication and improved working relationships between participating sites, and improved understanding and application of CLSI standards. As a result of Ethiopia’s participation in Project ECHO, 23 case presentations have been added to ECHO Box, a resource bank and web portal, which allows members of the ECHO community to share and access didactics, documents, and learning materials. Conclusions: Despite minimal difference between pretest and posttest scores, the Project ECHO experience of virtual case-based learning and collaborative problem solving has encouraged critical thinking, peer-to-peer learning, networking among participants, and has provided microbiologists with the resources for improved bacterial isolation, identification, and antibiotic susceptibility testing. The lessons learned could be applied as this project is expanded to additional laboratories in the AMR Surveillance Network.Funding: NoneDisclosures: None