We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, ...2020-September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.
is a rare, potentially serious pathogen. Most clinicians have no experience with its clinical appearance or treatment. We describe a case of a child presenting with necrotizing pneumonia caused by
. ...We describe case complexities, including the need for a multidisciplinary approach to diagnosis and treatment.
In August 2016, extensive flooding occurred in south-central Louisiana. Approximately 1 month after the flood, the Louisiana Office of Public Health received notification through electronic ...laboratory reporting of two patients with serologic evidence of leptospirosis (immunoglobulin M antibodies to Leptospira species). Both patients were hospitalized with severe illness at the time of laboratory testing and recovered after appropriate treatment. Hospital record review revealed that both patients were exposed to floodwater before illness onset. Suspected leptospirosis cases were defined as the occurrence of fever with at least two nonspecific symptoms, or at least one diagnosis indicating severe illness during August 13-September 21, 2016 in a patient exposed to floodwater. No additional confirmed cases of postflooding leptospirosis were identified. Nonetheless, cases might have been missed because of flood-related access to care difficulties and patients not seeking medical care for less than severe illness.
Objective: To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. ...Methods: We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. Results: Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. Conclusions: There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.
After six years without any detection of poliomyelitis cases, Angola reported a case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with paralysis onset date of 27 March 2019. Ultimately, ...141 cVDPV2 polio cases were reported in all 18 provinces in 2019–2020, with particularly large hotspots in the south-central provinces of Luanda, Cuanza Sul, and Huambo. Most cases were reported from August to December 2019, with a peak of 15 cases in October 2019. These cases were classified into five distinct genetic emergences (emergence groups) and have ties with cases identified in 2017–2018 in the Democratic Republic of Congo. From June 2019 to July 2020, the Angola Ministry of Health and partners conducted 30 supplementary immunization activity (SIA) rounds as part of 10 campaign groups, using monovalent OPV type 2 (mOPV2). There were Sabin 2 vaccine strain detections in the environmental (sewage) samples taken after mOPV2 SIAs in each province. Following the initial response, additional cVDPV2 polio cases occurred in other provinces. However, the national surveillance system did not detect any new cVDPV2 polio cases after 9 February 2020. While reporting subpar indicator performance in epidemiological surveillance, the laboratory and environmental data as of May 2021 strongly suggest that Angola successfully interrupted transmission of cVDPV2 early in 2020. Additionally, the COVID-19 pandemic did not allow a formal Outbreak Response Assessment (OBRA). Improving the sensitivity of the surveillance system and the completeness of AFP case investigations will be vital to promptly detect and interrupt viral transmission if a new case or sewage isolate are identified in Angola or central Africa.
An objective evaluation of implementation fidelity is integral to an accurate assessment of outcomes in a complex intervention. Process evaluation is one way to assess implementation fidelity. The ...LARK Hypertension study is a complex randomized trial aimed at determining whether community health workers (CHWs) equipped with a tailored behavioral communication strategy and decision-support tools, can increase linkage and retention of hypertensive individuals to a care program and thereby significantly reduce blood pressure. This thesis describes the findings of hypertension-related knowledge and skills retention evaluations in CHWs trained by the LARK study, two components of a larger process evaluation. LARK trained CHWs exhibited relatively low levels of study intervention fidelity but had good knowledge of certain aspects of hypertension management. As well as providing useful information to the LARK study, this thesis adds valuable research to the scarce body of literature about process evaluation of CHW driven interventions.
Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study ...used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs.
What is already known about this topic? Identifying and linking children living with HIV to treatment is essential to reduce morbidity and mortality. What is added by this report? During the first 3 ...months of the COVID-19 pandemic, HIV testing and case identification among children and adolescents aged 1–14 years in 22 PEPFAR-supported countries decreased by 40.1% and 29.4%, respectively. Although outpatient testing decreased (21%), testing increased for other strategies, including mobile (38%), facility-based index (8%), and malnutrition (7%), suggesting these strategies can mitigate the impact of COVID-19 on pediatric case identification. What are the implications for public health practice? HIV testing programs can use programmatic, surveillance, and financial data to determine the optimal mix of testing strategies during the COVID-19 pandemic.
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