Assessment of the yellow fever outbreak in Angola from December 2015 through December 2016: A retrospective study.

Background and Aims: The acute tropical infectious disease known as yellow fever (YF) is caused by an arbovirus and is characterized by fever, jaundice, hemorrhage, headache, muscle pain, nausea, vomiting, and fatigue. Angola experienced a yellow fever virus (YFV) outbreak that was documented in December 2015. However, little is known about the outcome of this outbreak. We aimed to demonstrate epidemic features and lessons learned during the YF epidemic in Angola. Methods: A total of 4618 blood samples from suspected YF cases were sent to the Instituto Nacional de Investigação em Saúde (INIS), a national referral and public health laboratory, between December 5, 2015, and December 23, 2016. Sample analyses were conducted using enzyme-linked immunosorbent assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR) assays. Blood samples were sent from 16 out of the 18 provinces of Angola. Results: We detected 884 (19.1%) cases that were positive for ELISA, which were confirmed by RT-PCR assay. Considering the positive cases, the incidence among male patients was around three times higher (n = 223; 10.9%) than in female patients (n = 59; 2.6%) in the 20-29 age group, followed by the age group 10-19 with n = 211 (6.8%) in males versus n = 108 (3.3%) in females; and the age group 30-39 had n = 68 (4.8%) in males versus n = 28 (1.8%) in females. The other groups had an incidence below 3.0%. The case fatality ratio for YF was in young adults in the age group 20-29 with n = 39 cases, followed by the age group 10-19 with n = 16 cases, and finally the age group 0-9 with n = 13 cases. The other age groups had several deaths by YF below 10 cases. Conclusions: This study demonstrates features of the YF epidemic that occurred in Angola. Also, it demonstrates that YF causes deaths in young people but is preventable by high vaccine coverage. Thus, public health laboratory surveillance must be strengthened to reduce the possibility of emerging and re-emerging human infections.

Characteristics of patients with influenza-like illness, severe acture respiratory illness, and laboratory-confirmed influenza at a major children's hospital in Angola, 2009-2011.

There are no published data on influenza trends in Angola, where pneumonia is a leading cause of death among young children. This study aims to describe the seasonal trends, types, and subtypes of influenza virus recovered from patients with respiratory illness who were admitted to the major children's hospital in Angola from May 2009 through April 2011. Nasal and oral swabs were collected from patients seen in the outpatient clinic with influenza-like illness (ILI) or hospitalized with severe acute respiratory illness (SARI) and tested for influenza virus by polymerase chain reaction assays. Of 691 samples collected, 334 (48%) were from case patients with ILI, and 357 (52%) were from case patients with SARI. Most (86%) of these children were <5 years of age. Thirty-nine samples (47% SARI, 53% outpatient) tested positive for influenza virus, including 2009 pandemic influenza A virus subtype H1N1 (A[H1N1]pdm09; n = 9), influenza A virus subtype H3, likely H3N2 (n = 12), and influenza B virus (n = 18). The proportion of specimens positive for influenza virus was 5% for ILI cases and 6% for SARI cases. After the peak of A(H1N1)pdm09 infection from May through September of 2009, additional peaks of ILI and SARI were seen, especially during February-April 2010. Influenza virus causes a small but preventable number of pneumonia cases among children in Angola.

Influenza surveillance in 15 countries in Africa, 2006-2010.

BACKGROUND: In response to the potential threat of an influenza pandemic, several international institutions and governments, in partnership with African countries, invested in the development of epidemiologic and laboratory influenza surveillance capacity in Africa and the African Network of Influenza Surveillance and Epidemiology (ANISE) was formed. METHODS: We used a standardized form to collect information on influenza surveillance system characteristics, the number and percent of influenza-positive patients with influenza-like illness (ILI), or severe acute respiratory infection (SARI) and virologic data from countries participating in ANISE. RESULTS: Between 2006 and 2010, the number of ILI and SARI sites in 15 African countries increased from 21 to 127 and from 2 to 98, respectively. Children 0-4 years accounted for 48% of all ILI and SARI cases of which 22% and 10%, respectively, were positive for influenza. Influenza peaks were generally discernible in North and South Africa. Substantial cocirculation of influenza A and B occurred most years. CONCLUSIONS: Influenza is a major cause of respiratory illness in Africa, especially in children. Further strengthening influenza surveillance, along with conducting special studies on influenza burden, cost of illness, and role of other respiratory pathogens will help detect novel influenza viruses and inform and develop targeted influenza prevention policy decisions in the region.

Early Evidence of Circulating SARS-CoV-2 in Unvaccinated and Vaccinated Measles Patients, September 2019-February 2020.

BACKGROUND: The global emergence of coronavirus disease 2019 (COVID-19) has challenged healthcare and rapidly spread over the globe. Early detection of new infections is crucial in the control of emerging diseases. Evidence of early recorded COVID-19 cases outside China has been documented in various countries. In this study, we aimed to identify the time of SARS-CoV-2 infection circulation by retrospectively analyzing sera of measles patients, weeks before the reported first COVID-19 cases in Angola. MATERIALS AND METHODS: We examined the humoral response against SARS-CoV-2 by using an enzyme-linked immunosorbent assay (ELISA)-based assay on a combined two-step sandwich enzyme immunoassay method. In total, we received 568 study patients with blood specimens collected from 23 September 2019 to 28 February 2020, 442 sera samples that met the criteria of the study were withdrawn and selected from the overall 568 received samples. In this study, we considered seropositives, patients who tested positive for SARS-CoV-2 immunoglobulin G (IgG) and M (IgM) antibodies with the index value >1. RESULTS: Of the 442 sera samples that met the criteria of the study, 204 were measles seropositive. Forty out of 204 were confirmed reactive to SARS-CoV-2 viral proteins using IgG and IgM more than 2 weeks before the first reported case in Angola. The humoral response analysis showed significant differences (p = 0.01) between the IgG and IgM indexes in the unvaccinated measles patients. Similarly, a significant difference (p = 0.001) was seen between the IgG and IgM indexes in the vaccinated measles patients. CONCLUSION: Here, using the humoral response analysis, we report the identification of early circulation SARS-CoV-2 infection weeks before the first recognized cases in the Republic of Angola.

Close phylogenetic relationship between Angolan and Romanian HIV-1 subtype F1 isolates.

BACKGROUND: Here, we investigated the phylogenetic relationships of the HIV-1 subtype F1 circulating in Angola with subtype F1 strains sampled worldwide and reconstructed the evolutionary history of this subtype in Central Africa. METHODS: Forty-six HIV-1-positive samples were collected in Angola in 2006 and subtyped at the env-gp41 region. Partial env-gp120 and pol-RT sequences and near full-length genomes from those env-gp41 subtype F1 samples were further generated. Phylogenetic analyses of partial and full-length subtype F1 strains isolated worldwide were carried out. The onset date of the subtype F1 epidemic in Central Africa was estimated using a Bayesian Markov chain Monte Carlo approach. RESULTS: Nine Angolan samples were classified as subtype F1 based on the analysis of the env-gp41 region. All nine Angolan sequences were also classified as subtype F1 in both env-gp120 and pol-RT genomic regions, and near full-length genome analysis of four of these samples confirmed their classification as "pure" subtype F1. Phylogenetic analyses of subtype F1 strains isolated worldwide revealed that isolates from the Democratic Republic of Congo (DRC) were the earliest branching lineages within the subtype F1 phylogeny. Most strains from Angola segregated in a monophyletic group together with Romanian sequences; whereas South American F1 sequences emerged as an independent cluster. The origin of the subtype F1 epidemic in Central African was estimated at 1958 (1934-1971). CONCLUSION: "Pure" subtype F1 strains are common in Angola and seem to be the result of a single founder event. Subtype F1 sequences from Angola are closely related to those described in Romania, and only distantly related to the subtype F1 lineage circulating in South America. Original diversification of subtype F1 probably occurred within the DRC around the late 1950s.

Transcranial direct current stimulation for the treatment of generalized anxiety disorder: A randomized clinical trial.

BACKGROUND: Generalized anxiety disorder (GAD) is a common condition with current treatments being only moderately effective. Non-invasive brain stimulation techniques might provide a novel approach for treating GAD. Transcranial direct current stimulation (tDCS) has shown promising efficacy and tolerability for major depression but has not been investigated for GAD yet. Thus, we investigated the effects of tDCS on patients with GAD. METHODS: We conducted a pilot, double-blind, randomized, sham-controlled trial on 30 GAD patients. Five sessions of tDCS (2 mA, 20 min, anode over the left dorsolateral prefrontal cortex and cathode over the right supraorbital cortex) were performed. Anxiety was the primary outcome and it was measured by the Hamilton Anxiety Rating Scale and the Beck Anxiety Inventory. Secondary outcomes were accessed by the Lipp Inventory of Stress Symptoms for Adults, Positive and Negative Affect Schedule, and the Beck Depression Inventory (BDI). Data were examined at baseline, after the 5th day of intervention, and at 1-week follow-up. RESULTS: Thirty patients finished the study. There were no significant improvements in anxiety, mood symptoms of stress, affectivity or depression. Anodal stimulation of the left DLPFC showed significant improvements in physical symptoms of stress in GAD patients. LIMITATIONS: Additional tDCS sessions could have resulted in larger tDCS effects. CONCLUSION: Five sessions of anodal tDCS over the DLPFC did not improve the main outcomes for GAD patients, although physical symptoms of stress were improved. The role of tDCS in GAD should be explored in larger patient samples using different parameters.

First report on antimicrobial resistance and molecular characterisation of Salmonella enterica serotype Typhi isolated from human specimens in Luanda, Angola.

OBJECTIVES: Typhoid fever is a common infection in Africa and, despite scarce surveillance reports, its incidence is commonly considered high by the Angolan health system. Drug-resistant Salmonella enterica serotype Typhi has emerged, making antimicrobial susceptibility testing essential to provide clinical guidance. This is the first report analysing the antimicrobial resistance patterns and population structure of the few S. enterica ser. Typhi isolated from patients with typhoid fever in Luanda, Angola. METHODS: Isolates were collected by the Angolan National Institute of Public Health between September 2013 and May 2014. Ten isolates were identified by the API 20E system and serotyping, and the genus was confirmed by PCR. All isolates were tested for antibiotic susceptibility, and the presence of resistance genes [blaCTX-M, blaSHV, blaTEM, blaOXA-1, several plasmid-borne genes encoding AmpC ß-lactamases, sul and qnr genes, dfrIa, dfrA12, aac(6')-Ib, cmlA and floR] were screened by PCR. Isolates were typed by PFGE and MLST. RESULTS: Several isolates were identified with resistance to trimethoprim/sulfamethoxazole (n=6), ß-lactams (n=5) and chloramphenicol (n=1) and reduced susceptibility to ciprofloxacin (n=2). PFGE revealed eight closely related restriction patterns, and MLST grouped these into three sequence types (ST1, ST2 and ST8), with ST2 being predominant. CONCLUSION: This first epidemiological report provides a preliminary description of S. enterica ser. Typhi strains circulating in Luanda and emphasises the need for continuous monitoring of this pathogen to provide information in order to implement better epidemiological strategies for the control of typhoid fever in Angola.

Nivel de conocimiento de antioxidantes y su relación con el estilo de vida

El presente estudio tiene por objetivo determinar el nivel de conocimiento respecto a los antioxidantes y su relación con el estilo de vida. Estudio descriptivo, de corte transversal con la participación de 392 pobladores de la ciudad de Trujillo, que dieron respuesta a dos cuestionarios: uno para determinar el nivel de conocimiento respecto a los antioxidantes elaborado por la Dra. Carolina González, nutrióloga de la Clínica Alemana, que consta de cinco preguntas relacionadas a los antioxidantes y el cuestionario de estilo de vida promueve la salud elaborado por Walker, Sechrist y Pender, y modificado por Delgado, R; Reyna E y Diaz, R constituido por 25 preguntas, obteniendo información sobre conocimiento de antioxidantes y alimentación, ejercicio y actividad, estrés. Con los datos obtenidos se obtuvo la calificación respectiva y la escala de puntuación saludable y no saludable y si tiene conocimiento o no. De las encuestas procesadas, se evidenció mayor porcentaje de pobladores que no tenían conocimiento de antioxidantes 222 (56.64%) con predominio de los jóvenes 141 (35.97%), así como de un estilo de vida no saludable 285 (72.71%). Se presentó una relación entre nivel de conocimiento de antioxidantes y sexo, con la edad no hubo relación. Además, no hubo relación entre las variables sexo y edad con estilo de vida, teniendo en cuenta que si P > 0.05 no hay relación o diferencia significativa. Finalmente podemos concluir que la población en estudio no tenía conocimiento sobre antioxidantes y estilo de vida no adecuado.

The objective of this study was to determine the level of knowledge about antioxidants and their relationship with lifestyle. A descriptive, cross-sectional study with the participation of 392 inhabitants of the city of Trujillo, who responded to two questionnaires: one to determine the level of knowledge about antioxidants prepared by Dr. Carolina Gonzalez, a nutritionist from Clínica Alemana, consisting of five questions related to antioxidants, and the other questionnaire of lifestyle promotes health elaborated by Walker, Sechrist and Pender, and modified by Delgado, R; Reyna E and Diaz, R constituted by 25 questions, obtaining information on knowledge of antioxidants and nutrition, exercise and activity, stress. With the obtained data the respective qualification and the healthy and unhealthy score scale and has knowledge or not was obtained. From the processed surveys, there was evidence of a higher percentage of people who had no knowledge of antioxidants 222 (56.64%) with a predominance of young people 141 (35.97%), as well as an unhealthy lifestyle 285 (72.71%). There was a relationship between the level of antioxidant knowledge and sex but there was no relationship with respect to age. In addition, there was no relationship between the variables sex and age with lifestyle, taking into account that if P > 0.05 there is no relationship or significant difference. Finally, we can conclude that the study population had no knowledge of antioxidants and inadequate lifestyle.

Antimicrobial storage and antibiotic knowledge in the community: a cross-sectional pilot study in north-western Angola.

BACKGROUND: Antimicrobials are drugs that were once lifesavers and mainly curative. Nowadays their value is increasingly under pressure because of the rapid and worldwide emergence of antimicrobial resistance, which, in low-resource settings, frequently occurs in microorganisms that are likely to be transmitted in the community. METHODS: This was a cross-sectional pilot study including 102 households within the 10th Health and Demographic Surveillance System round in Dande, Bengo Province, Angola. RESULTS: Of the total 102 households piloted, 79 (77.45%) were urban. Fifty-seven respondents were female (56.44%), and the mean age of the respondents was 39.70±15.35years. Overall, storage of antimicrobials was found in 55/102 households (53.92%). More than 66% of the antimicrobials stored were prescribed by a health professional and the majority of antimicrobials were bought at pharmacies or at a street market. Penicillin and its derivatives, antimalarial drugs, and metronidazole were the antimicrobials most frequently stored. Households with female respondents reported storing any drugs at home more frequently (82.50%; p=0.002) and also storing antimicrobials more frequently (64.91%; p=0.016) as compared to households with male respondents. Reported use of antimicrobials was significantly higher in urban households (60.76%, 48/79) as compared to rural households (30.43%, 7/23) (p=0.010). Overall, 74 of 101 respondents (73.26%) reported having already heard about antibiotics. The common reasons given for their use were cough and other respiratory symptoms, wounds, flu and body muscle pain, fever, bladder complaints, and diarrhoea and/or presumed typhoid fever. Nearly 40% (28/74) of the respondents thought that antibiotics should be stopped as soon as the person does not feel sick anymore. CONCLUSIONS: Community interventions for appropriate use of antibiotics should be designed with a special focus on women. This should be done through public awareness campaigns and improving access to reliable medical services. Drug prescribers are key not only to appropriate antimicrobial prescription, but also to adequate dispensing, and are strong advocates for the possible misconceptions on antimicrobial usage by lay people.

Genotypic and phenotypic features of enteropathogenic Escherichia coli isolated in industrialized and developing countries.

INTRODUCTION: Typical EPEC are considered a leading cause of diarrhoea in developing countries, while atypical EPEC have been isolated more frequently in developed areas. The actual geographic distribution of the two EPEC subgroups is controversial, since data can be highly influenced by laboratory resources. This study aimed to compare the distribution of typical and atypical EPEC among children in developed and developing countries, and to characterize the bacterial isolates, using a unique methodological approach. METHODOLOGY: A total of 1,049 E. coli were isolated from faeces of children with acute diarrhoea in Mozambique, Angola and Italy, and processed by PCR to assess the presence of a large panel of virulence genes. All isolates classified as EPEC were further characterized by evaluating adherence and capability to induce actin rearrangement on Hep-2 cells. RESULTS: Overall we isolated 59 EPEC, likewise distributed in the three countries, representing the 5.04%, 4.44% and 6.97% of all Mozambican, Angolan and Italian isolates, respectively. Nevertheless, the geographic distribution of the two EPEC subgroups was not homogeneous: in Italy we isolated 28 aEPEC but no tEPEC, while in Angola and Mozambique the percentage of the two subgroups was comparable. Twelve atypical EPEC were FAS positive and able to induce localized-like adherence on Hep-2 cells, but no correlation with the geographic origin of isolates was observed. CONCLUSION: Atypical EPEC are present in sub-Saharan areas in a percentage similar to that of typical strains, and are not mainly restricted to industrialized countries, as it was previously supposed.

Aplicación de la actividad pirazinamidasa para la identificación en especies de Aeromonas / Application of the pyrazinamidase activity for the identification of Aeromonas species

Se ubicaron en especies 70 cepas de Aeromonas aisladas de pacientes con enfermedad diarreica aguda, utilizando las pruebas del factor CAMP y la actividad pirazinamidasa. Se destaca el alto tanto por ciento de coincidencia entre ambas pruebas de fácil realización en los laboratorios de microbiología clínica