The 2024 Public Health Emergency of International Concern: A Global Failure to Control Mpox.

On August 14, 2024, following a regional declaration by the Africa Centres for Disease Control and Prevention, the World Health Organization declared mpox a Public Health Emergency of International Concern, marking the second such declaration in two years. A series of outbreaks involving the more virulent clade I virus (compared to clade II, which caused a global outbreak in 2022), has now spread in 13 African countries, exposing the inadequacies of the public health infrastructure in these settings. There was significant investment during the 2022 global outbreak, but these efforts failed to address vaccine access and treatment in the Global South. Regulatory delays, unequal access to vaccines, and a lack of compassionate use treatments for severe cases have resulted in preventable cases and deaths, especially among vulnerable populations such as pregnant women, children, and the immunocompromised. The current outbreak also underscores critical knowledge gaps in our understanding of mpox, including its transmission, pathogenesis, and viral evolution. We join intensified calls for global solidarity and action to control mpox, emphasizing immediate containment measures and long-term local and international investment in African public health systems, to prevent future epidemics.

Hajj vaccination strategies: Preparedness for risk mitigation.

Millions of pilgrims travel annually to Makkah and Madinah, Saudi Arabia, for the Hajj, posing unique challenges for public health management and disease control. The large influx of pilgrims from diverse backgrounds traveling to a confined geographic area, coupled with the close proximity and interactions among them, create significant pressure on the healthcare system and heighten the potential for the spread of communicable diseases. This review examines current trends in communicable diseases and their impact, drawing insights from expert perspectives on the required (i.e., meningococcal meningitis, polio, and yellow fever) and recommended vaccinations (influenza, COVID-19) for Hajj participants. The updated COVID-19 vaccine is mandatory for local pilgrims and is strongly recommended for international visitors, with ongoing discussions on adapting protocols to address emerging variants. The timing and strain coverage of influenza vaccination, along with quadrivalent meningococcal vaccination, are also emphasized as critical preventive measures. Diseases such as cholera and yellow fever are addressed underscoring the need for rigorous surveillance and targeted vaccination strategies to mitigate the risk of transmission during the Hajj. By providing up-to-date information on mandated and recommended vaccinations, this review aims to empower pilgrims and healthcare professionals to make informed decisions regarding public health and disease prevention during this significant event.

IHR-PVS National Bridging Workshop for Somalia: An interactive and participatory approach for operationalizing the One Health roadmap.

Background: National Bridging Workshops (NBW) are a tool for reviewing collaboration gaps between line ministries relevant to the One Health framework. Methods: The NBW for Somalia was held on November 11-13, 2023 in Nairobi, Kenya with support from WHO and WOAH. Participants included representatives from the Somali government both national and sub-national (including Ministry of Health; Ministry of Livestock, Forestry and Range; Ministry of Agriculture and Irrigation; and Ministry of Environment and Climate Change). Other participants included representatives from non-governmental organizations, academia and the quadripartite. Structured sessions guided participants through a step-by-step process, starting from identifying gaps to collectively developing solutions. The design of these sessions aimed to foster active engagement and collaboration with the outcomes of each session contributing to the subsequent one. Results: A total of 60 participants partook in the exercise, representing human health (35%), animal health (27%), agriculture (13%), environmental health (7%) and other relevant sectors (18%). Eighty-three percent of participants represented the national level and 17% the sub-national level. The collaborative effort yielded a joint roadmap comprising 36 activities and 11 objectives. Priority objectives included: development of national joint surveillance systems for selected One Health threats (41/47 votes, or 87% of the total votes); establishment of a high-level ministerial system to govern and coordinate One Health activities (30/47; 64%); and establishment of emergency funding structures for priority zoonotic diseases along with development of a 5-year national investment plan for One Health (27/47; 57%). A total of 94% of activities required low or moderate cost to be implemented, and 90% of activities were identified to have a likely high impact on multisectoral collaboration. The timeline for implementing the activities is projected to span one to two years. Conclusion: The workshop promoted high-level engagement, national ownership, and leadership in addressing health threats at the human-animal-environment interface. The resulting co-created roadmap will be integrated into the National Action Plan for Health Security, supporting ongoing One Health efforts in Somalia.

Sacred journeys and pilgrimages: health risks associated with travels for religious purposes.

BACKGROUND: Pilgrimages and travel to religious Mass Gatherings (MGs) are part of all major religions. This narrative review aims to describe some characteristics, including health risks, of the more well known and frequently undertaken ones. METHODS: A literature search was conducted using keywords related to the characteristics (frequency of occurrence, duration, calendar period, reasons behind their undertaking and the common health risks) of Christian, Muslim, Hindu, Buddhist and Jewish religious MGs. RESULTS: About 600 million trips are undertaken to religious sites annually. The characteristics varies between religions and between pilgrimages. However, religious MGs share common health risks, but these are reported in a heterogenous manner. European Christian pilgrimages reported both communicable diseases, such as norovirus outbreaks linked to the Marian Shrine of Lourdes in France, and noncommunicable diseases (NCD). NCD predominated at the Catholic pilgrimage to the Basilica of Our Lady of Guadalupe in Mexico, which documented 11 million attendees in one week. The Zion Christian Church Easter gathering in South Africa, attended by about 10 million pilgrims, reported mostly motor vehicles accidents. Muslim pilgrimages, such as the Arbaeen (20 million pilgrims) and Hajj documented a high incidence of respiratory tract infections, up to 80% during Hajj. Heat injuries and stampedes have been associated with Hajj. The Hindu Kumbh Mela pilgrimage, which attracted 100 million pilgrims in 2013, documented respiratory conditions in 70% of consultations. A deadly stampede occurred at the 2021 Jewish Lag BaOmer MG. CONCLUSION: Communicable and NCD differ among the different religious MGs. Gaps exists in the surveillance, reporting, and data accessibility of health risks associated with religious MGs. A need exists for the uniform implementation of a system of real-time monitoring of diseases and morbidity patterns, utilising standardised modern information-sharing platforms. The health needs of pilgrims can then be prioritised by developing specific and appropriate guidelines.

Drug-induced hepatotoxicity and association with slow acetylation variants NAT2*5 and NAT2*6 in Cameroonian patients with tuberculosis and HIV co-infection.

BACKGROUND: Human immunodeficiency virus (HIV) and tuberculosis (TB) are major contributors to morbidity and mortality in sub-Saharan Africa including Cameroon. Pharmacogenetic variants could serve as predictors of drug-induced hepatotoxicity (DIH), in patients with TB co-infected with HIV. We evaluated the occurrence of DIH and pharmacogenetic variants in Cameroonian patients. METHODS: Treatment-naïve patients with HIV, TB or TB/HIV co-infection were recruited at three hospitals in Cameroon, between September 2018 and November 2019. Appropriate treatment was initiated, and patients followed up for 12 weeks to assess DIH. Pharmacogenetic variants were assessed by allele discrimination TaqMan SNP assays. RESULTS: Of the 141 treatment naïve patients, the overall incidence of DIH was 38% (53/141). The highest incidence of DIH, 52% (32/61), was observed among HIV patients. Of 32 pharmacogenetic variants, the slow acetylation variants NAT2*5 was associated with a decreased risk of DIH (OR: 0.4; 95%CI: 0.17-0.96; p = 0.038), while NAT2*6 was found to be associated with an increased risk of DIH (OR: 4.2; 95%CI: 1.1-15.2; p = 0.017) among patients treated for TB. Up to 15 SNPs differed in ≥ 5% of allele frequencies among African populations, while 25 SNPs differed in ≥ 5% of the allele frequencies among non-African populations, respectively. CONCLUSIONS: DIH is an important clinical problem in African patients with TB and HIV. The NAT2*5 and NAT2*6 variants were found to be associated with DIH in the Cameroonian population. Prior screening for the slow acetylation variants NAT2*5 and NAT2*6 may prevent DIH in TB and HIV-coinfected patients.