Momentum of hope: The journey toward a universal TB vaccine.

In addressing the persistent threat of tuberculosis (TB) - a disease that claims millions of lives, especially in low-income countries - this correspondence underlines the critical role of advancing vaccine research. Historically, the BCG vaccine, developed over a century ago, has been the cornerstone of TB prevention. However, its efficacy is limited, particularly in adults and against pulmonary TB, the most common form of the disease. Recent developments, such as the M72/AS01E vaccine, demonstrate promising results in increasing protection against TB in adults with latent infections. These advancements represent a significant leap forward in the quest to control and eventually eradicate TB. This piece highlights the necessity of continued investment in vaccine research and development. The pursuit of more effective TB vaccines, capable of providing broader protection across all age groups, is paramount. This effort not only aligns with the WHO's End TB Strategy but also offers hope for a future where TB is no longer a global health crisis.

Vaccine hesitancy under the lens: Nigeria's struggle against the worst diphtheria outbreak in decades.

The resurgence of diphtheria in Nigeria, culminating in an outbreak surpassing previous records, has spotlighted the critical imperative for robust immunization policies amidst a milieu of vaccine hesitancy. This commentary delineates the multifaceted dimensions of the current diphtheria outbreak, which started in May 2022, juxtaposed against historical outbreaks, with a focal examination of the pervasive vaccine hesitancy and its underpinning sociocultural and systemic determinants. The discourse extends to a meticulous evaluation of Nigeria's public health response, underlined by the synergy with international organizations, reflecting a global collaborative ethos in combating the diphtheria menace. A critical appraisal of the prevailing immunization policies unveils a necessity for strategic amendments to invigorate vaccination uptake, essential for curbing the diphtheria outbreak and enhancing public health resilience. The reflections herein advocate for a comprehensive, culturally resonant, and sustainable public health paradigm, encompassing a synergistic approach of policy fortification, community engagement, and international collaboration to navigate the challenges posed by vaccine-preventable diseases epitomized by the ongoing diphtheria outbreak. Through a synthesis of historical lessons, contemporary challenges, and global solidarity, this piece contributes to the broader discourse on enhancing immunization coverage and infectious disease control in Nigeria.

Fighting diphtheria in Nigeria: the challenge of getting everyone vaccinated Recently, Nigeria has faced its worst diphtheria outbreak in years, showing how important it is to get people vaccinated. This article looks closely at the current outbreak, compares it to past ones, and explores why some people are hesitant to get vaccinated. We discuss the reasons behind this hesitation, including cultural and social factors. We also review how Nigeria is responding to the outbreak with help from international groups. We point out that Nigeria's vaccination policies need to be updated to encourage more people to get vaccinated, which is crucial to stop the outbreak and strengthen overall health defenses. The article calls for a well-rounded and lasting approach to public health that includes better policies, working closely with communities, and international cooperation.

Closing the antimicrobial stewardship gap - a call for LMICs to embrace the global antimicrobial stewardship accreditation scheme.

The escalating challenge of antimicrobial resistance (AMR) poses a considerable concern for global health, particularly impacting low- and middle-income countries (LMICs). This article highlights the critical importance of tackling AMR in LMICs by adopting the Global Antimicrobial Stewardship Accreditation Scheme (GAMSAS). GAMSAS is portrayed as a holistic and sustainable strategy for antimicrobial stewardship, extending beyond accreditation to include educational programs, capacity enhancement, improved surveillance, and support for AMS policy research. While acknowledging the global uptake of the scheme, the article highlights its preliminary phase of adoption in LMICs, particularly in high-AMR burden regions like Sub-Saharan Africa. The piece stresses the imperative for LMICs to integrate GAMSAS, underscoring its significance in optimizing antimicrobial usage and patient health outcomes. It advocates for an all-encompassing approach that leverages international cooperation and sustained financial backing, crucial for the effective deployment and enduring success of antimicrobial stewardship efforts in these key areas.

Pushing the frontiers in the fight against antimicrobial resistance: the potential of fecal and maggot therapies.

The escalating crisis of antimicrobial resistance (AMR) warrants innovative therapeutic strategies. Fecal microbiota transplantation (FMT) and maggot debridement therapy (MDT) represent paradigm-shifting approaches, leveraging biological systems to mitigate AMR. FMT restores a healthy gut microbiome, providing a biotherapeutic counter to pathogenic bacteria, thereby reducing reliance on traditional antibiotics. Conversely, MDT, a form of bio-debridement, utilizes the antimicrobial secretions of maggots to cleanse wounds and eliminate resistant bacteria. Despite the promise these therapies hold, their broader clinical adoption faces multifaceted challenges including the need for rigorous scientific substantiation, standardized protocols, deepened understanding of mechanisms of action, and surmounting regulatory and public acceptance barriers. However, their potential integration with precision medicine could revolutionize disease management, particularly with antibiotic-resistant infections.

The rising problem of drug-resistant infections calls for new treatment methods. Fecal microbiota transplantation (FMT) and maggot debridement therapy (MDT) offer innovative solutions. FMT uses healthy gut bacteria to fight harmful ones, while MDT employs maggots to clean wounds and kill resistant bacteria. Although promising, these methods face challenges like a lack of understanding, standardization and public acceptance. Their potential, however, could transform how we manage antibiotic-resistant diseases.

Antibiotic resistance and the COVID-19 pandemic: A dual crisis with complex challenges in LMICs.

Background and Aims: Antimicrobial resistance (AMR), a global health crisis of mounting urgency, has been further complicated by the ongoing COVID-19 pandemic. The intricate relationship between these two phenomena is especially pronounced in low- and middle-income countries (LMICs) due to the distinct obstacles encountered by their healthcare systems and policy structures. This study aims to explore the complex challenges arising from the coexistence of these two crises in LMICs and proffer specific recommendations for holistic management. Methods: An exhaustive bibliographic survey was executed, employing search queries in specialized databases such as PubMed, SCOPUS, and Web of Science's SCI-EXPANDED index. The timeframe for the literature search extended from January 2020 to January 2023. The search strategy employed key terms including antibiotic resistance, AMR, COVID-19 pandemic, low- and middle-income countries, SARS-CoV-2, and LMICs. Results: The pandemic has aggravated various drivers of AMR in LMICs, including limited capabilities, weak frameworks, and socioeconomic factors. New challenges have emerged, such as disruptions in the antibiotic supply chain and an increased risk of healthcare-associated infections. The interaction between these drivers presents a complex problem that demands a coordinated response. Specific recommendations include strengthening health systems, funding research and innovation, and enhancing infection prevention control measures. Conclusion: The coexistence of AMR and the COVID-19 pandemic in LMICs demands an integrated approach involving multiple stakeholders. Emphasis must be placed on constructing aligned regulatory frameworks, nurturing regional collaborations, and focusing on accessible therapeutic options. The study underscores the necessity for actionable strategies to achieve sustainable access to clean water and sanitation and also highlights the importance of long-term planning, funding, and specialized expertise in emerging modalities like phage therapy.

Harnessing artificial intelligence in the post-COVID-19 era: A global health imperative.

Despite the World Health Organization's declaration that the COVID-19 global emergency has ended, the threat of future pandemics remains a significant concern. This paper highlights the potential role of Artificial Intelligence (AI) in strengthening global health systems and mitigating future health crises. We discuss AI's proven utility throughout the COVID-19 pandemic, including disease surveillance, diagnostics, and drug discovery. AI's ability to rapidly analyze vast amounts of data to derive accurate trends and predictions underscores its superiority over traditional computer technology. However, the effective and ethical implementation of AI encounters significant challenges, including a pronounced digital divide, with applications mainly concentrated in high-income countries, thus exacerbating health inequities. We argue for international cooperation to enhance digital infrastructure in low- and middle-income countries, tailoring AI solutions to local needs, and addressing ethical and regulatory issues. The importance of maintaining evidence-based practice, rigorous evaluation of AI's impact, and investment in AI education and innovation are stressed. Ultimately, the potential of AI in global health systems is clear, and tackling these challenges will ensure its robust contribution to global health equity and resilience against future health crises.

Longitudinal Analysis of the Impacts of Urogenital Schistosomiasis on the Gut microbiota of Adolescents in Nigeria.

The gut microbiome is important for many host physiological processes and helminths and these interactions may lead to microbial changes. We carried out a longitudinal study of the impacts of S. haematobium infection on the gut microbiome of adolescents (11-15 years) in northern Nigeria pre and post praziquantel treatment. Using 16S sequencing a total of 267 DNA from faecal samples of infected versus uninfected adolescents were amplified and sequenced on an Illumina Miseq. We assessed the diversity of the taxa using alpha diversity metrices and observed that using Shannon index we obtained significant differences when we compared infected samples at 3, 9 and 12 months to baseline uninfected controls (P= <0.0001, P=0.0342 and P=0.0003 respectively). Microbial community composition analysis revealed that there were only significant differences at 3, 9 and 12 months (P=0.001, P=0.001, P=0.001 and P=0.001, respectively). We also demonstrated that the effects of the infection on the gut was more significant than praziquantel. Overall, our data suggests that S. haematobium, a non-gut resident parasite has indirect interactions with the gut. The bacterial taxa changes we have identified opens up the opportunity to investigate their role in human health, especially in urogenital schistosomiasis endemic communities.

Revisiting the blind spot of substandard and fake drugs as drivers of antimicrobial resistance in LMICs.

One of the most significant risks to public health is ongoing antimicrobial resistance (AMR). Substandard and fraudulent medications, particularly in low- and middle-income countries (LMICs), are thought to have a role in the genesis and spread of AMR. There are numerous reports concerning the availability of subpar pharmaceuticals in developing countries, with no scientific evidence as to what exactly is included in some of the prescriptions supplied there. These counterfeit and inferior pharmaceuticals are a financial burden of up to US$200 billion, causing thousands of patient deaths, endangering both individual and public health,and undermining patient trust in the healthcare system. Poor quality and counterfeit antibiotics are often disregarded as possible causes of AMR in AMR studies. Therefore, we examined the issue of fake drugs in LMICs and its possible links to the emergence and spread of AMR.

Tuberculosis treatment outcomes among pulmonary TB patients attending public hospitals in Kebbi State, Northern Nigeria: a four-year retrospective study.

Background: In Nigeria, effective case management and evaluation of pulmonary tuberculosis treatment outcomes are an integral part of controlling the spread of infectious diseases. The study reviewed the treatment outcomes of pulmonary tuberculosis and the factors associated with rates of successful and unsuccessful treatment outcomes in the 21 referral hospitals in Kebbi State, Nigeria. Methods: Documented records of pulmonary tuberculosis patients from January 2018 to December 2021 in 21 Local Area Councils in Kebbi State, Northern Nigeria were reviewed. A structured questionnaire collated the socio-demographic and clinical data from the documented records. Descriptive statistics were used to compute and analyse the outcomes of successful and unsuccessful treatment. Logistic regression models were used to determine the association of socio-demographic and clinical data with the unsuccessful treatment outcomes. Results: The study reviewed data from 6114 records of TB patients. 1161 (18.9%) started treatment, 963 (82.9%) were males and 198 (17.1%) were females. Of the 1161 patients, 985 (18.2%) had documented treatment outcomes. 932 of 985 (95.1%) had a pulmonary infection. 64 (5.8%) patients with documented treatment outcomes were HIV seropositive. 903 (91.7%) were successfully treated, and 82 (8.3%) failed. Of the patients with failed treatment outcomes, 15 (1.5%) were lost to follow-up, 43 (4.4%) defaulted and 24 (2.4%) died. In the logistic analysis, the odds of unsuccessful treatment outcomes were higher among elderly patients (AOR = 2.00, 95% CI 1.37-2.92), patients with extrapulmonary infections (AOR = 2.40, 95% CI 1.12-5.39), and with old cases of pulmonary TB (AOR = 3.03, 95% CI 1.47-7.19) when compared to their groups. Conclusions: The study reported a treatment success rate of 91.7% among TB patients attending public hospitals in Kebbi State. The outcome was higher than the projected success rate of 85% set by the WHO. However, one-fourth of the total patients reviewed were not documented for treatment. Therefore, the need to design an appropriate recruitment strategy to identify and enrol those patients for an effective and successful TB control program in Nigeria.

Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies.

The emergence of antibiotic-resistant pathogens has threatened not only our ability to deal with common infectious diseases but also the management of life-threatening complications. Antimicrobial resistance (AMR) remains a significant threat in both industrialized and developing countries alike. In Africa, though, poor clinical care, indiscriminate antibiotic use, lack of robust AMR surveillance programs, lack of proper regulations and the burden of communicable diseases are factors aggravating the problem of AMR. In order to effectively address the challenge of AMR, antimicrobial stewardship programs, solid AMR surveillance systems to monitor the trend of resistance, as well as robust, affordable and rapid diagnostic tools which generate data that informs decision-making, have been demonstrated to be effective. However, we have identified a significant knowledge gap in the area of the application of fast and affordable diagnostic tools, surveillance, and stewardship programs in Africa. Therefore, we set out to provide up-to-date information in these areas. We discussed available hospital-based stewardship initiatives in addition to the role of governmental and non-governmental organizations. Finally, we have reviewed the application of various phenotypic and molecular AMR detection tools in both research and routine laboratory settings in Africa, deployment challenges and the efficiency of these methods.

Typhoid Fever Diagnosis in Endemic Countries: A Clog in the Wheel of Progress?

Typhoid fever causes significant morbidity and mortality in developing countries, with inaccurate estimates in some countries affected, especially those situated in Sub-Saharan Africa. Disease burden assessment is limited by lack of a high degree of sensitivity and specificity by many current rapid diagnostic tests. Some of the new technologies, such as PCR and proteomics, may also be useful but are difficult for low-resource settings to apply as point-of-care diagnostics. Weak laboratory surveillance systems may also contribute to the spread of multidrug resistant Salmonella serovar Typhi across endemic areas. In addition, most typhoid-endemic countries employ serological tests that have low sensitivity and specificity making diagnosis unreliable. Here we review currently available typhoid fever diagnostics, and advances in serodiagnosis of S. Typhi.

Tools for Detection of Schistosomiasis in Resource Limited Settings.

Schistosomiasis is a debilitating disease affecting over 200 million people, with the highest burden of morbidity and mortality in African countries. Despite its huge impact on the health and socio-economic burden of the society, it remains a neglected tropical disease, with limited attention from governments and stakeholders in healthcare. One of the critical areas that is hugely under-developed is the development of accurate diagnostics for both intestinal and urogenital schistosomiasis. Diagnosis of schistosomiasis is important for the detection and treatment of disease in endemic and non-endemic settings. A conclusive detection method is also an indispensable part of treatment, both in the clinic and during mass drug administration (MDA), for the monitoring efficacy of treatment. Here, we review the available diagnostic methods and discuss the challenges encountered in diagnosis in resource limited settings. We also present the available diagnostics and cost implications for deployment in resource limited settings. Lastly, we emphasize the need for more funding directed towards the development of affordable diagnostic tools that is affordable for endemic countries as we work towards the elimination of the disease.