South Sudan implemented Ebola virus disease preparedness interventions aiming at preventing and rapidly containing any importation of the virus from the Democratic Republic of Congo starting from ...August 2018. One of these interventions was a surveillance system which included an Ebola alert management system. This study analyzed the performance of this system. A descriptive cross-sectional study of the Ebola virus disease alerts which were reported in South Sudan from August 2018 to November 2019 was conducted using both quantitative and qualitative methods. As of 30 November 2019, a total of 107 alerts had been detected in the country out of which 51 (47.7%) met the case definition and were investigated with blood samples collected for laboratory confirmation. Most (81%) of the investigated alerts were South Sudanese nationals. The alerts were identified by health workers (53.1%) at health facilities, at the community (20.4%) and by screeners at the points of entry (12.2%). Most of the investigated alerts were detected from the high-risk states of Gbudwe (46.9%), Jubek (16.3%) and Torit (10.2%). The investigated alerts commonly presented with fever, bleeding, headache and vomiting. The median timeliness for deployment of Rapid Response Team was less than one day and significantly different between the 6-month time periods (K-W = 7.7567; df = 2; p = 0.0024) from 2018 to 2019. Strengths of the alert management system included existence of a dedicated national alert hotline, case definition for alerts and rapid response teams while the weaknesses were occasional inability to access the alert toll-free hotline and lack of transport for deployment of the rapid response teams which often constrain quick response. This study demonstrates that the Ebola virus disease alert management system in South Sudan was fully functional despite the associated challenges and provides evidence to further improve Ebola preparedness in the country.
ObjectivesWe conducted a review of intra-action review (IAR) reports of the national response to the COVID-19 pandemic in Africa. We highlight best practices and challenges and offer perspectives for ...the future.DesignA thematic analysis across 10 preparedness and response domains, namely, governance, leadership, and coordination; planning and monitoring; risk communication and community engagement; surveillance, rapid response, and case investigation; infection prevention and control; case management; screening and monitoring at points of entry; national laboratory system; logistics and supply chain management; and maintaining essential health services during the COVID-19 pandemic.SettingAll countries in the WHO African Region were eligible for inclusion in the study. National IAR reports submitted by March 2021 were analysed.ResultsWe retrieved IAR reports from 18 African countries. The COVID-19 pandemic response in African countries has relied on many existing response systems such as laboratory systems, surveillance systems for previous outbreaks of highly infectious diseases and a logistics management information system. These best practices were backed by strong political will. The key challenges included low public confidence in governments, inadequate adherence to infection prevention and control measures, shortages of personal protective equipment, inadequate laboratory capacity, inadequate contact tracing, poor supply chain and logistics management systems, and lack of training of key personnel at national and subnational levels.ConclusionThese findings suggest that African countries’ response to the COVID-19 pandemic was prompt and may have contributed to the lower cases and deaths in the region compared with countries in other regions. The IARs demonstrate that many technical areas still require immediate improvement to guide decisions in subsequent waves or future outbreaks.
•Pregnant women infected with Ebola virus may present atypically.•Current Ebola virus disease case definitions are inappropriate for pregnant women.•Infected newborns may appear asymptomatic despite ...being potentially infectious.•Obstetric care during an Ebola outbreak requires heightened precautions.•Pregnant contacts of Ebola-infected individuals require special considerations.
Between December 2013 and June 2016, West Africa experienced the largest Ebola virus disease (EVD) outbreak in history. Understanding EVD in pregnancy is important for EVD clinical screening and infection prevention and control.
We conducted a review of medical records and EVD investigation reports from three districts in Sierra Leone. We report the clinical presentations and maternal and fetal outcomes of six pregnant women with atypical EVD, and subsequent transmission events from perinatal care.
The six women (ages 18–38) were all in the third trimester. Each presented with signs and symptoms initially attributed to pregnancy. None met EVD case definition; only one was known at presentation to be a contact of an EVD case. Five women died, and all six fetuses/neonates died. These cases resulted in at least 35 additional EVD cases.
These cases add to the sparse literature focusing on pregnant women with EVD, highlighting challenges and implications for outbreak control. Infected newborns may also present atypically and may shed virus while apparently asymptomatic. Pregnant women identified a priori as contacts of EVD cases require special attention and planning for obstetrical care.
On 5 March 2020, South Africa recorded its first case of imported COVID-19. Since then, cases in South Africa have increased exponentially with significant community transmission. A multisectoral ...approach to containing and mitigating the spread of SARS-CoV-2 was instituted, led by the South African National Department of Health. A National COVID-19 Command Council was established to take government-wide decisions. An adapted World Health Organiszion (WHO) COVID-19 strategy for containing and mitigating the spread of the virus was implemented by the National Department of Health. The strategy included the creation of national and provincial incident management teams (IMTs), which comprised of a variety of work streams, namely, governance and leadership; medical supplies; port and environmental health; epidemiology and response; facility readiness and case management; emergency medical services; information systems; risk communication and community engagement; occupational health and safety and human resources. The following were the most salient lessons learnt between March and September 2020: strengthened command and control were achieved through both centralised and decentralised IMTs; swift evidenced-based decision-making from the highest political levels for instituting lockdowns to buy time to prepare the health system; the stringent lockdown enabled the health sector to increase its healthcare capacity. Despite these successes, the stringent lockdown measures resulted in economic hardship particularly for the most vulnerable sections of the population.
Following the West Africa Ebola virus disease (EVD) outbreak (2013-2016), WHO developed a preparedness checklist for its member states. This checklist is currently being applied for the first time on ...a large and systematic scale to prepare for the cross border importation of the ongoing EVD outbreak in the Democratic Republic of Congo hence the need to document the lessons learnt from this experience. This is more pertinent considering the complex humanitarian context and weak health system under which some of the countries such as the Republic of South Sudan are implementing their EVD preparedness interventions.
We identified four main lessons from the ongoing EVD preparedness efforts in the Republic South Sudan. First, EVD preparedness is possible in complex humanitarian settings such as the Republic of South Sudan by using a longer-term health system strengthening approach. Second, the Republic of South Sudan is at risk of both domestic and cross border transmission of EVD and several other infectious disease outbreaks hence the need for an integrated and sustainable approach to outbreak preparedness in the country. Third, a phased and well-prioritized approach is required for EVD preparedness in complex humanitarian settings given the costs associated with preparedness and the difficulties in the accurate prediction of outbreaks in such settings. Fourth, EVD preparedness in complex humanitarian settings is a massive undertaking that requires effective and decentralized coordination.
Despite a very challenging context, the Republic of South Sudan made significant progress in its EVD preparedness drive demonstrating that it is possible to rapidly scale up preparedness efforts in complex humanitarian contexts if appropriate and context-specific approaches are used. Further research, systematic reviews and evaluation of the ongoing preparedness efforts are required to ensure comprehensive documentation and application of the lessons learnt for future EVD outbreak preparedness and response efforts.
From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest ...experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events.
Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks.
Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.
To determine whether pre-emptive oral cholera vaccination reduces disease severity and mortality in people who develop cholera disease during an outbreak.
The study involved a retrospective analysis ...of demographic and clinical data from 41 cholera treatment facilities in South Sudan on patients who developed cholera disease between 23 April and 20 July 2014 during a large outbreak, a few months after a pre-emptive oral vaccination campaign. Patients who developed severe dehydration were regarded as having a severe cholera infection. Vaccinated and unvaccinated patients were compared and multivariate logistic regression analysis was used to identify factors associated with developing severe disease or death.
In total, 4115 cholera patients were treated at the 41 facilities: 1946 (47.3%) had severe disease and 62 (1.5%) deaths occurred. Multivariate analysis showed that patients who received two doses of oral cholera vaccine were 4.5-fold less likely to develop severe disease than unvaccinated patients (adjusted odds ratio, aOR: 0.22; 95% confidence interval, CI: 0.11-0.44). Moreover, those with severe cholera were significantly more likely to die than those without (aOR: 4.76; 95% CI: 2.33-9.77).
Pre-emptive vaccination with two doses of oral cholera vaccine was associated with a significant reduction in the likelihood of developing severe cholera disease during an outbreak in South Sudan. Moreover, severe disease was the strongest predictor of death. Two doses of oral cholera vaccine should be used in emergencies to reduce the disease burden.
Metodos El estudio involucro un analisis retrospectivo de datos demograficos y clinicos de 41 instalaciones de tratamiento del colera de Sudan del Sur en pacientes que desarrollaron la enfermedad ...entre el 23 de abril y el 20 de julio de 2014 durante un gran brote, pocos meses despues de una campana de vacunacion oral preventiva. Los pacientes que desarrollaron deshidratacion grave fueron diagnosticados con el colera. Se comparo a los pacientes vacunados con los no vacunados y se utilizo un analisis de regresion logistica multivariable para identificar los factores relacionados con el desarrollo de la enfermedad grave o la muerte.
To determine whether pre-emptive oral cholera vaccination reduces disease severity and mortality in people who develop cholera disease during an outbreak. The study involved a retrospective analysis ...of demographic and clinical data from 41 cholera treatment facilities in South Sudan on patients who developed cholera disease between 23 April and 20 July 2014 during a large outbreak, a few months after a pre-emptive oral vaccination campaign. Patients who developed severe dehydration were regarded as having a severe cholera infection. Vaccinated and unvaccinated patients were compared and multivariate logistic regression analysis was used to identify factors associated with developing severe disease or death. In total, 4115 cholera patients were treated at the 41 facilities: 1946 (47.3%) had severe disease and 62 (1.5%) deaths occurred. Multivariate analysis showed that patients who received two doses of oral cholera vaccine were 4.5-fold less likely to develop severe disease than unvaccinated patients (adjusted odds ratio, aOR: 0.22; 95% confidence interval, CI: 0.11-0.44). Moreover, those with severe cholera were significantly more likely to die than those without (aOR: 4.76; 95% CI: 2.33-9.77). Pre-emptive vaccination with two doses of oral cholera vaccine was associated with a significant reduction in the likelihood of developing severe cholera disease during an outbreak in South Sudan. Moreover, severe disease was the strongest predictor of death. Two doses of oral cholera vaccine should be used in emergencies to reduce the disease burden./Determiner si la vaccination orale preventive contre le cholera diminue la gravite de cette maladie et la mortalite qui lui est associee chez les individus qui attrapent le cholera lors d'une flambee. L'etude s'est basee sur une analyse retrospective de donnees demographiques et cliniques provenant de 41 centres de traitement du cholera au Soudan du Sud et relatives a des patients ayant contracte le cholera entre le 23 avril et le 20 juillet 2014 lors d'une epidemie de grande ampleur, quelques mois apres une campagne de vaccination orale preventive. Les patients qui ont souffert de deshydratation severe ont ete consideres comme atteints d'une infection cholerique grave. Une comparaison a ete etablie entre les patients vaccines et ceux qui ne l'ont pas ete et une analyse de regression logistique multivariee a ete utilisee pour identifier les facteurs associes au developpement d'une forme severe de la maladie ou au deces. Au total, 4115 patients atteints de cholera ont ete traites dans les 41 centres: 1946 (47,3%) ont developpe une forme severe de la maladie et 62 (1,5%) sont decedes. L'analyse multivariee a montre que le risque de developper une forme severe de la maladie etait 4,5 fois moindre pour les patients ayant recu deux doses de vaccins oraux contre le cholera que pour les patients non vaccines (rapport des cotes ajuste, RCa: 0,22; intervalle de confiance, IC, a 95%: 0,11-0,44). En outre, le risque de deces etait considerablement plus eleve chez les patients ayant developpe une forme severe de la maladie que chez les autres (RCa: 4,76; IC a 95%: 2,33-9,77). La vaccination preventive avec deux doses de vaccins oraux contre le cholera a ete associee a une reduction significative du risque de developper une forme severe du cholera lors d'une flambee au Soudan du Sud. Par ailleurs, le developpement d'une forme severe de la maladie est le plus important facteur predictif de deces. Deux doses de vaccins oraux contre le cholera doivent etre utilisees dans les situations d'urgence pour reduire la charge de morbidite./Determinar si la vacuna oral preventiva contra el colera reduce la gravedad de la enfermedad y la mortalidad en personas que desarrollan esta enfermedad durante un brote. El estudio involucro un analisis retrospectivo de datos demograficos y clinicos de 41 instalaciones de tratamiento del colera de Sudan del Sur en pacientes que desarrollaron la enfermedad entre el 23 de abril y el 20 de julio de 2014 durante un gran brote, pocos meses despues de una campana de vacunacion oral preventiva. Los pacientes que desarrollaron deshidratacion grave fueron diagnosticados con el colera. Se comparo a los pacientes vacunados con los no vacunados y se utilizo un analisis de regresion logistica multivariable para identificar los factores relacionados con el desarrollo de la enfermedad grave o la muerte. En total, se trato a 4 115 pacientes con colera en las 41 instalaciones: 1 946 (47,3%) sufrian de enfermedad grave y se produjeron 62 (1,5%) muertes. El analisis multivariable mostro que los pacientes que recibieron dos dosis de vacuna oral contra el colera eran 4,5 veces menos propensos a desarrollar la enfermedad grave en comparacion con los pacientes sin vacunar (coeficiente de posibilidades ajustado, CPa: 0,22; intervalo de confianza, IC, del 95%: 0,11-0,44). Asimismo, los pacientes con colera grave tenian muchas mas posibilidades de morir que los que no la padecian (CPa: 4,76; ...
Malawi—one of the low-income countries in Africa—has witnessed a series of flood-related disasters in many years. The recent tropical cyclone Freddy (TCF) has indispensable effects on the unequal ...distribution of the social determinants of health with tendencies for increased disease outbreaks across the districts of the country. This narrative study aimed at unravelling the consequences of the TCF and its possible relationship with the already existing cholera epidemic in the fourteen affected districts. Additionally, it aimed to document the immediate humanitarian responses in the acute phase of the disaster. We identified, used and extracted information and data from relevant documents available from the government records, WHO and other multiagency documents, which were summarised along with the humanitarian actions and the associated implications of the entire event. Areas of TCF’s main effects included health, shelter, education, nutrition, water sanitation and hygiene, agriculture and livelihood, transport and logistics including food security. The notable immediate humanitarian responses are donations, camp creation for accommodations, emergency life-saving response and essential healthcare services. Nsanje and Chikwawa districts experienced an increase in cholera cases and deaths post-TCF. The highest proportion of the disaster-impacted and intervention beneficiaries were women and children. The effects of the TCF on the social determinants of health in the affected districts and the associated negative impacts should be considered by the government and disaster management experts in evidence-based policy-making towards disaster risk reduction in the flood-prone districts using an all-hazard approach. This step might be useful in improving the vulnerable population’s standard of living and achievement of related Sustainable Development Goals in Malawi.
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