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2.
PLoS One ; 16(2): e0246515, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33544772

RESUMEN

BACKGROUND: During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014-2016 Ebola virus disease that plagued the West African sub-region. METHODS: We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. RESULTS: After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05-0.30), depression (15%; 99% CI: 0.11-0.21), and insomnia (22%; 99% CI: 0.13-0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05-0.22), (0.15; 99% CI: 0.09-0.25) through to (0.13; 99% CI: 0.08-0.21) and (0.23; 99% CI: 0.11-0.41) to (0.23; 99% CI: 0.11-0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. CONCLUSION: Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.


Asunto(s)
Ansiedad/complicaciones , Depresión/complicaciones , Fiebre Hemorrágica Ebola/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , África Occidental/epidemiología , Ansiedad/epidemiología , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/epidemiología , Depresión/epidemiología , Trastorno Depresivo/complicaciones , Trastorno Depresivo/epidemiología , Ebolavirus/aislamiento & purificación , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Prevalencia , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Sobrevivientes
3.
PLoS One ; 16(2): e0246320, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33529237

RESUMEN

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013-2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013-2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers' access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants' insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.


Asunto(s)
Enfermedades Transmisibles Emergentes/terapia , Brotes de Enfermedades/ética , Asignación de Recursos para la Atención de Salud/ética , Fiebre Hemorrágica Ebola/terapia , Ensayos Clínicos Adaptativos como Asunto/ética , Adulto , África Occidental/epidemiología , Femenino , Personal de Salud/ética , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Terapias en Investigación/ética
4.
Nat Commun ; 12(1): 1153, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33608536

RESUMEN

Zaire ebolavirus (EBOV) is a highly pathogenic filovirus which can result in Ebola virus disease (EVD); a serious medical condition that presents as flu like symptoms but then often leads to more serious or fatal outcomes. The 2013-16 West Africa epidemic saw an unparalleled number of cases. Here we show characterisation and identification of T cell epitopes in surviving patients from Guinea to the EBOV glycoprotein. We perform interferon gamma (IFNγ) ELISpot using a glycoprotein peptide library to identify T cell epitopes and determine the CD4+ or CD8+ T cell component response. Additionally, we generate data on the T cell phenotype and measure polyfunctional cytokine secretion by these antigen specific cells. We show candidate peptides able to elicit a T cell response in EBOV survivors and provide inferred human leukocyte antigen (HLA) allele restriction. This data informs on the long-term T cell response to Ebola virus disease and highlights potentially important immunodominant peptides.


Asunto(s)
Ebolavirus/inmunología , Epítopos de Linfocito T/inmunología , Glicoproteínas/inmunología , Fiebre Hemorrágica Ebola/inmunología , Linfocitos T/inmunología , África Occidental/epidemiología , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , Ebolavirus/genética , Ensayo de Immunospot Ligado a Enzimas , Epidemias , Glicoproteínas/genética , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Inmunidad Celular , Interferón gamma , Sobrevivientes
5.
Nature ; 590(7846): 468-472, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33505020

RESUMEN

Neutralizing antibody function provides a foundation for the efficacy of vaccines and therapies1-3. Here, using a robust in vitro Ebola virus (EBOV) pseudo-particle infection assay and a well-defined set of solid-phase assays, we describe a wide spectrum of antibody responses in a cohort of healthy survivors of the Sierra Leone EBOV outbreak of 2013-2016. Pseudo-particle virus-neutralizing antibodies correlated with total anti-EBOV reactivity and neutralizing antibodies against live EBOV. Variant EBOV glycoproteins (1995 and 2014 strains) were similarly neutralized. During longitudinal follow-up, antibody responses fluctuated in a 'decay-stimulation-decay' pattern that suggests de novo restimulation by EBOV antigens after recovery. A pharmacodynamic model of antibody reactivity identified a decay half-life of 77-100 days and a doubling time of 46-86 days in a high proportion of survivors. The highest antibody reactivity was observed around 200 days after an individual had recovered. The model suggests that EBOV antibody reactivity declines over 0.5-2 years after recovery. In a high proportion of healthy survivors, antibody responses undergo rapid restimulation. Vigilant follow-up of survivors and possible elective de novo antigenic stimulation by vaccine immunization should be considered in order to prevent EBOV viral recrudescence in recovering individuals and thereby to mitigate the potential risk of reseeding an outbreak.


Asunto(s)
Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Convalecencia , Ebolavirus/inmunología , Fiebre Hemorrágica Ebola/inmunología , Sobrevivientes , Adolescente , Adulto , África Occidental/epidemiología , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Estudios de Cohortes , Femenino , Semivida , Fiebre Hemorrágica Ebola/sangre , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Neutralización , Factores de Tiempo , Viremia/sangre , Viremia/inmunología , Adulto Joven
7.
Epidemiol Infect ; 149: e6, 2020 12 28.
Artículo en Inglés | MEDLINE | ID: mdl-33357248

RESUMEN

Using monthly data from the Ebola-outbreak 2013-2016 in West Africa, we compared two calibrations for data fitting, least-squares (SSE) and weighted least-squares (SWSE) with weights reciprocal to the number of new infections. To compare (in hindsight) forecasts for the final disease size (the actual value was observed at month 28 of the outbreak) we fitted Bertalanffy-Pütter growth models to truncated initial data (first 11, 12, …, 28 months). The growth curves identified the epidemic peak at month 10 and the relative errors of the forecasts (asymptotic limits) were below 10%, if 16 or more month were used; for SWSE the relative errors were smaller than for SSE. However, the calibrations differed insofar as for SWSE there were good fitting models that forecasted reasonable upper and lower bounds, while SSE was biased, as the forecasts of good fitting models systematically underestimated the final disease size. Furthermore, for SSE the normal distribution hypothesis of the fit residuals was refuted, while the similar hypothesis for SWSE was not refuted. We therefore recommend considering SWSE for epidemic forecasts.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Modelos Biológicos , Modelos Estadísticos , África Occidental/epidemiología , Predicción , Humanos
9.
Epidemiol Infect ; 148: e213, 2020 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-32921332

RESUMEN

Although the African continent is, for the moment, less impacted than the rest of the world, it still faces the risk of a spread of COVID-19. In this study, we have conducted a systematic review of the information available in the literature in order to provide an overview of the epidemiological and clinical features of COVID-19 pandemic in West Africa and of the impact of risk factors such as comorbidities, climatic conditions and demography on the pandemic. Burkina Faso is used as a case study to better describe the situation in West Africa. The epidemiological situation of COVID-19 in West Africa is marked by a continuous increase in the numbers of confirmed cases. This geographic area had on 29 July 2020, 131 049 confirmed cases by polymerase chain reaction, 88 305 recoveries and 2102 deaths. Several factors may influence the SARS-CoV-2 circulation in Africa: (i) comorbidities: diabetes mellitus and high blood pressure could lead to an increase in the number of severe cases of SARS-CoV-2; (ii) climatic factors: the high temperatures could be a factor contributing to slow the spread of the virus and (iii) demography: the West Africa population is very young and this could be a factor limiting the occurrence of severe forms of SARS-CoV-2 infection. Although the spread of the SARS-CoV-2 epidemic in West Africa is relatively slow compared to European countries, vigilance must remain. Difficulties in access to diagnostic tests, lack of hospital equipment, but also the large number of people working in the informal sector (such as trading, businesses, transport and restoration) makes it difficult to apply preventive measures, namely physical distancing and containment.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , Adolescente , Adulto , África Occidental/epidemiología , Anciano , Anciano de 80 o más Años , Manejo de Caso , Niño , Preescolar , Clima , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Factores de Riesgo , Adulto Joven
10.
PLoS One ; 15(9): e0239300, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32956418

RESUMEN

BACKGROUND: Recent reports from small studies in West Africa suggest that Black children may have high rate of steroid sensitivity nephrotic syndrome (SSNS) contrary to long held knowledge. Herein, we determined the proportion of children with idiopathic nephrotic syndrome (INS) who achieved complete remission with steroid therapy and identified factors associated with complete remission. METHODS: We reviewed the medical records of 241 children with INS in two centres in Lagos from 2010 to 2019. We extracted demographic data, clinical features, laboratory values at the time of diagnosis, and receipt and response to steroids and other immunosuppressants. RESULTS: The median (interquartile range) age at diagnosis of INS was 5.1 (3.0-8.7) years and boys were 60.2% of the study population. Children with SSNS made up 85.9% (n = 207) of the study cohort. Among those aged 0-5 years, 92.6%were SSNS compared with 69.2% in those aged 11-17 years at the time of diagnosis. In addition, the proportion of children with SSNS increased from 73.8% between year 2010 and 2012 to 88.4% afterwards. Also, children with SSNS had lower serum creatinine (0.44 vs 0.70; p<0.001) and higher estimated glomerular filtration rate (101 vs 74.3 ml/min/1.73 m2; p = 0.008) at the time of diagnosis than those with steroid resistant nephrotic syndrome (SRNS). CONCLUSION: Among Black children in Lagos, the proportion with SSNS is comparable to proportions described in children of Asian and European descent. Furthermore, children with SSNS had lower serum creatinine and higher glomerular filtration rate than those with SRNS.


Asunto(s)
Síndrome Nefrótico/tratamiento farmacológico , Esteroides/efectos adversos , Adolescente , África Occidental/epidemiología , Grupo de Ascendencia Continental Africana/genética , Niño , Preescolar , Estudios Transversales , Femenino , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Masculino , Hombres , Síndrome Nefrótico/epidemiología , Síndrome Nefrótico/genética , Síndrome Nefrótico/patología , Nigeria/epidemiología , Esteroides/uso terapéutico
11.
Math Biosci ; 328: 108431, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32738248

RESUMEN

The novel coronavirus (COVID-19) pandemic is causing devastating demographic, social, and economic damage globally. Understanding current patterns of the pandemic spread and forecasting its long-term trajectory is essential in guiding policies aimed at curtailing the pandemic. This is particularly important in regions with weak economies and fragile health care systems such as West Africa. We formulate and use a deterministic compartmental model to (i) assess the current patterns of COVID-19 spread in West Africa, (ii) evaluate the impact of currently implemented control measures, and (iii) predict the future course of the pandemic with and without currently implemented and additional control measures in West Africa. An analytical expression for the threshold level of control measures (involving a reduction in the effective contact rate) required to curtail the pandemic is computed. Considering currently applied health control measures, numerical simulations of the model using baseline parameter values estimated from West African COVID-19 data project a 67% reduction in the daily number of cases when the epidemic attains its peak. More reduction in the number of cases will be achieved if additional public health control measures that result in a reduction in the effective contact rate are implemented. We found out that disease elimination is difficult when more asymptomatic individuals contribute in transmission or are not identified and isolated in a timely manner. However, maintaining a baseline level of asymptomatic isolation and a low transmission rate will lead to a significant reduction in the number of daily cases when the pandemic peaks. For example, at the baseline level of asymptomatic isolation, at least a 46% reduction in the transmission rate is required for disease elimination. Additionally, disease elimination is possible if asymptomatic individuals are identified and isolated within 5 days (after the incubation period). Combining two or more measures is better for disease control, e.g., if asymptomatic cases are contact traced or identified and isolated in less than 8 days, only about 29% reduction in the disease transmission rate is required for disease elimination. Furthermore, we showed that the currently implemented measures triggered a 33% reduction in the time-dependent effective reproduction number between February 28 and June 26, 2020. We conclude that curtailing the COVID-19 pandemic burden significantly in West Africa requires more control measures than those that have already been implemented, as well as more mass testing and contact tracing in order to identify and isolate asymptomatic individuals early.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , África Occidental/epidemiología , Número Básico de Reproducción , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Simulación por Computador , Trazado de Contacto , Infecciones por Coronavirus/epidemiología , Predicción/métodos , Humanos , Conceptos Matemáticos , Modelos Biológicos , Modelos Estadísticos , Neumonía Viral/epidemiología , Salud Pública
12.
PLoS One ; 15(8): e0238196, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32841291

RESUMEN

The need for an efficacious vaccine against highly pathogenic filoviruses was reinforced by the devastating 2014-2016 outbreak of Ebola virus (EBOV) disease (EVD) in Guinea, Sierra Leone, and Liberia that resulted in over 28,000 cases and over 11,300 deaths. In addition, the 2018-2020 outbreak in the Democratic Republic of the Congo currently has over 3,400 cases and over 2,200 deaths. A fully licensed vaccine and at least one other investigational vaccine are being deployed to combat this EVD outbreak. To support vaccine development and pre-clinical/clinical testing a Filovirus Animal Nonclinical Group (FANG) human anti-EBOV GP IgG ELISA was developed to measure anti-EBOV GP IgG antibodies. This ELISA is currently being used in multiple laboratories. Reported here is a characterization of an interlaboratory statistical analysis of the human anti-EBOV GP IgG ELISA as part of a collaborative study between five participating laboratories. Each laboratory used similar method protocols and reagents to measure anti-EBOV GP IgG levels in human serum samples from a proficiency panel consisting of ten serum samples created by the differential dilution of a serum sample positive for anti-GP IgG antibodies (BMIZAIRE105) with negative serum (BMI529). The total assay variability (inter- and intra-assay variability) %CVs observed at each laboratory ranged from 12.2 to 30.6. Intermediate precision (inter-assay variability) for the laboratory runs ranged from 8.9 to 21.7%CV and repeatability (intra-assay variability) %CVs ranged from 7.2 to 23.7. The estimated slope for the relationship between log10(Target Concentration) and the log10(Observed Concentration) across all five laboratories was 0.95 with a 90% confidence interval of (0.93, 0.97). Equivalence test results showed that the 90% confidence interval for the ratios for the sample-specific mean concentrations at the five individual labs to the overall laboratory consensus value were within the equivalence bounds of 0.80 to 1.25 for each laboratory and test sample, except for six test samples from Lab D, two samples from Lab B1, and one sample from Lab B2. The mean laboratory concentrations for Lab D were less than those from the other laboratories by 20% on average across the serum samples. The evaluation of the proficiency panel at these laboratories provides a limited assessment of assay precision (intermediate precision, repeatability, and total assay variability), dilutional linearity, and accuracy. This evaluation suggests that the within-laboratory performance of the anti-EBOV GP IgG ELISA as implemented at the five laboratories is consistent with the intended use of the assay based on the acceptance criteria used by laboratories that have validated the assay. However, the assessment of between-laboratory performance revealed lower observed concentrations at Lab D and greater variability in assay results at Lab B1 relative to other laboratories.


Asunto(s)
Anticuerpos Antivirales/sangre , Ebolavirus/inmunología , Ensayo de Inmunoadsorción Enzimática/normas , Fiebre Hemorrágica Ebola/inmunología , Proteínas Virales/inmunología , África Occidental/epidemiología , Animales , República Democrática del Congo/epidemiología , Brotes de Enfermedades , Vacunas contra el Virus del Ébola/inmunología , Vacunas contra el Virus del Ébola/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática/estadística & datos numéricos , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Inmunoglobulina G/sangre , Laboratorios , Variaciones Dependientes del Observador
13.
Int J Equity Health ; 19(1): 78, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32487158

RESUMEN

BACKGROUND: Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries. METHODS: The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d' Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization's Health Equity Assessment Toolkit (HEAT Plus) software was used to evaluate current levels of intra-country equity in access to SAB and DTP3 coverage across four equity dimensions (maternal education, location of residence, region within a country and family wealth status). RESULTS: There was a general trend of higher levels of coverage for DTP3 compared to access to SAB in the subregion. Across the various dimensions of equity, more gaps appear to have been closed in the subregion for DTP3 compared to SAB. The analysis revealed that countries such as Sierra Leone, Liberia and Ghana have made substantial progress towards equitable access for the two outcomes compared to others such as Nigeria, Niger and Guinea. CONCLUSION: In the race towards UHC, equity should remain a priority and comparative progress should be consistently tracked to enable the sharing of lessons. The West African subregion requires adequate government financing and continued commitment to move toward UHC and close health equity gaps.


Asunto(s)
Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Equidad en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Partería , Cobertura de Vacunación/estadística & datos numéricos , África Occidental/epidemiología , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Programas Informáticos , Cobertura Universal del Seguro de Salud , Organización Mundial de la Salud
14.
World Neurosurg ; 139: 512-518, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32380336

RESUMEN

BACKGROUND: Six decades after birth, the path to sustainable neurosurgical education and care in West Africa remains slow paced. We highlight plain sailing local attributes and global interventions for accelerated progress. METHODS: This was a 20-year study of neurosurgical practice and training status from 1999 to 2018. We prospectively evaluated development of neurosurgical units between 2009 and 2018 and compared with retrospective data both from 1999 to 2018 and from the origin of West African neurosurgery in 1962. RESULTS: The number of neurosurgeons rose from 1 in 1962 to 221 in 2018 with a mean of 3.95 neurosurgeons per year. Between 1998 and 2018, the subregional annual neurosurgeon birthrate varied significantly between 0.72 and 3.95. In 1998, 7 countries contributed to a neurosurgeon population of 26. In 2018, 13 countries contributed to a total of 221 neurosurgeons. The period 2009-2018 recorded the highest growth of neurosurgeons with a neurosurgeon birthrate of 7.5. Nigeria accounts for 51.6% (200.9 million) of the West African population and has 57% (11) of the 19 fully accredited training centers, while Ghana and Senegal account for 7.7% and 4.3% of the West African population, respectively, and each has 11% of the training centers. The 10-year unit procreativity index for the period 2009-2018 was 1.3, with Nigeria accounting for 0.7 (53.8%). CONCLUSIONS: The low unit procreativity index across West Africa, a major cause of the low neurosurgeon birthrate, can be resolved using tailored kindling and procreative strategies.


Asunto(s)
Salud Global/tendencias , Colaboración Intersectorial , Neurocirujanos/educación , Neurocirujanos/tendencias , Procedimientos Neuroquirúrgicos/educación , Procedimientos Neuroquirúrgicos/tendencias , África Occidental/epidemiología , Humanos , Procedimientos Neuroquirúrgicos/métodos , Estudios Prospectivos , Estudios Retrospectivos
15.
Acta Trop ; 209: 105468, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32416077

RESUMEN

Arboviruses transmitted by Aedes mosquitoes are a growing global concern; however, there remain large gaps in surveillance of both arboviruses and their vectors in West Africa. We reviewed over 50 years of data including outbreak reports, peer-reviewed literature, and prior data compilations describing Zika, dengue, and chikungunya, and their vectors in West Africa. Large outbreaks of dengue, Zika, and chikungunya have recently occurred in the region with over 27,000 cases of Aedes-borne disease documented since 2007. Recent arboviral outbreaks have become more concentrated in urban areas, and Aedes albopictus, recently documented in the region, has emerged as an important vector in several areas. Seroprevalence surveys suggest reported cases are a gross underestimate of the underlying arboviral disease burden. These findings indicate a shifting epidemiology of arboviral disease in West Africa and highlight a need for increased research and implementation of vector and disease control. Rapid urbanization and climate change may further alter disease patterns, underscoring the need for improved diagnostic capacity, and vector and disease surveillance to address this evolving health challenge.


Asunto(s)
Aedes/virología , Infecciones por Arbovirus/epidemiología , Mosquitos Vectores/virología , África Occidental/epidemiología , Animales , Infecciones por Arbovirus/transmisión , Brotes de Enfermedades , Humanos , Estudios Seroepidemiológicos
16.
Am J Trop Med Hyg ; 103(2): 696-703, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32458777

RESUMEN

Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pathogens in central nervous system infections is poorly characterized. Cerebrospinal fluid (CSF) specimens were collected from children younger than 5 years with suspected meningitis, presenting at pediatric teaching hospitals across West Africa in five countries including Senegal, Ghana, Togo, Nigeria, and Niger. Cerebrospinal fluid specimens were initially tested using bacteriologic culture and a triplex real-time polymerase chain reaction (PCR) assay for N. meningitidis, S. pneumoniae, and H. influenzae used in routine meningitis surveillance. A custom TaqMan Array Card (TAC) assay was later used to detect 35 pathogens including 15 bacteria, 17 viruses, one fungus, and two protozoans. Among 711 CSF specimens tested, the pathogen positivity rates were 2% and 20% by the triplex real-time PCR (three pathogens) and TAC (35 pathogens), respectively. TAC detected 10 bacterial pathogens, eight viral pathogens, and Plasmodium. Overall, Escherichia coli was the most prevalent (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%). Multiple pathogens were detected in 4.4% of the specimens. Children with human immunodeficiency virus (HIV) and Plasmodium detected in CSF had high mortality. Among 220 neonates, 17% had at least one pathogen detected, dominated by gram-negative bacteria. The meningitis TAC enhanced the detection of pathogens in children with meningitis and may be useful for case-based meningitis surveillance.


Asunto(s)
Infecciones por Escherichia coli/epidemiología , Malaria Cerebral/epidemiología , Meningitis Neumocócica/epidemiología , Meningitis/epidemiología , Meningitis/microbiología , África Occidental/epidemiología , Preescolar , Técnicas de Cultivo , Infecciones por Citomegalovirus/líquido cefalorraquídeo , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Infecciones por Escherichia coli/líquido cefalorraquídeo , Infecciones por Escherichia coli/diagnóstico , Femenino , Ghana/epidemiología , Infecciones por VIH/líquido cefalorraquídeo , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Vacunas contra Haemophilus/uso terapéutico , Humanos , Lactante , Recién Nacido , Infecciones por Klebsiella/líquido cefalorraquídeo , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/epidemiología , Malaria Cerebral/líquido cefalorraquídeo , Malaria Cerebral/diagnóstico , Masculino , Meningitis/líquido cefalorraquídeo , Meningitis/diagnóstico , Meningitis por Haemophilus/líquido cefalorraquídeo , Meningitis por Haemophilus/epidemiología , Meningitis por Haemophilus/prevención & control , Meningitis Meningocócica/líquido cefalorraquídeo , Meningitis Meningocócica/epidemiología , Meningitis Meningocócica/prevención & control , Meningitis Neumocócica/líquido cefalorraquídeo , Meningitis Neumocócica/prevención & control , Vacunas Meningococicas/uso terapéutico , Técnicas de Diagnóstico Molecular , Mortalidad , Reacción en Cadena de la Polimerasa Multiplex , Niger/epidemiología , Nigeria/epidemiología , Vacunas Neumococicas/uso terapéutico , Reacción en Cadena en Tiempo Real de la Polimerasa , Infecciones por Roseolovirus/líquido cefalorraquídeo , Infecciones por Roseolovirus/diagnóstico , Infecciones por Roseolovirus/epidemiología , Senegal/epidemiología , Infecciones Estafilocócicas/líquido cefalorraquídeo , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Togo/epidemiología
17.
Rev Med Suisse ; 16(690): 739-743, 2020 Apr 15.
Artículo en Francés | MEDLINE | ID: mdl-32301308

RESUMEN

The Ebola virus disease outbreak raging in the North-Kivu and Ituri provinces of Democratic Republic of the Congo already accounts for more than 3400 cases, from which 2200 died. Major progress have been achieved since the 2014-2016 West Africa outbreak. A vaccine is now approved by the European Medicine Agency and has been administered to more than 250 000 volunteers in the field. New specific antiviral treatments are now available. Ebola virus disease shifted from a deadly disease to a preventable, curable one. However, the long-lasting conflict and repeated attacks of civilians and health workers hampers the control of the outbreak.


Asunto(s)
Antivirales/provisión & distribución , Brotes de Enfermedades/estadística & datos numéricos , Vacunas contra el Virus del Ébola/provisión & distribución , Fiebre Hemorrágica Ebola/tratamiento farmacológico , Fiebre Hemorrágica Ebola/epidemiología , África Occidental/epidemiología , Antivirales/uso terapéutico , República Democrática del Congo/epidemiología , Vacunas contra el Virus del Ébola/administración & dosificación , Ebolavirus/efectos de los fármacos , Ebolavirus/inmunología , Fiebre Hemorrágica Ebola/prevención & control , Humanos
19.
Int Health ; 12(3): 192-202, 2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32141502

RESUMEN

BACKGROUND: A high prevalence and incidence of epilepsy has been reported in onchocerciasis-endemic regions in Central and East Africa. There is compelling epidemiological evidence suggesting that this high burden is caused by onchocerciasis-associated epilepsy (OAE). We hypothesized that OAE had also occured in West African onchocerciasis foci. METHODS: We searched PubMed, the African Journals Online platform and grey literature for population-based epilepsy studies in West African countries. Epilepsy and onchocerciasis prevalence data were extracted. The pre-control onchocerciasis endemicity in the study sites was estimated from historical data of onchocerciasis control programmes. The prevalence of epilepsy in different sites was analysed, taking into account onchocerciasis endemicity and the duration of control. RESULTS: The pooled prevalence of epilepsy in the West African study sites was 13.14 per 1000 (95% confidence interval 11.28-15.00). Higher pre-control endemicity and a shorter duration of onchocerciasis control were both associated with increased epilepsy prevalence (p<0.001). Two studies in Ivory Coast that provided detailed descriptions of persons with epilepsy in onchocerciasis-endemic settings revealed that most of them had features of OAE (73.7% and 83.3%, respectively). CONCLUSIONS: Our findings suggest that before and during the early years of implementing onchocerciasis control in West Africa, high onchocerciasis endemicity resulted in a high prevalence of OAE and that subsequent control efforts significantly reduced the prevalence of OAE.


Asunto(s)
Epilepsia/epidemiología , Epilepsia/etiología , Oncocercosis/complicaciones , África Oriental/epidemiología , África Occidental/epidemiología , Costa de Marfil/epidemiología , Humanos , Ivermectina/uso terapéutico , Oncocercosis/tratamiento farmacológico , Prevalencia
20.
Am J Trop Med Hyg ; 102(5): 924-925, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32162604

RESUMEN

This article describes similarities and differences in the response of governments and the international community to the current 2019 coronavirus disease (COVID-19) and the 2014 West African Ebola epidemic. It expresses the opinion that the speed and scale of the response to COVID-19 are affected by the important role that China plays in the global economy. By contrast, insufficient and less timely action was initially undertaken in West African countries during the 2014 Ebola epidemic. It concludes by stating why preparedness for and response to all disease outbreaks, also in countries of lower economic importance, should become a priority in the global health agenda.


Asunto(s)
Infecciones por Coronavirus , Planificación en Desastres , Ebolavirus , Carga Global de Enfermedades/economía , Salud Global , Fiebre Hemorrágica Ebola , Neumonía Viral , África Occidental/epidemiología , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades , Salud Global/economía , Fiebre Hemorrágica Ebola/economía , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Humanos , Cooperación Internacional , Pandemias , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/transmisión
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