COVID-19 preparedness: capacity to manufacture vaccines, therapeutics and diagnostics in sub-Saharan Africa.

OBJECTIVE: The COVID-19 pandemic is a biosecurity threat, and many resource-rich countries are stockpiling and/or making plans to secure supplies of vaccine, therapeutics, and diagnostics for their citizens. We review the products that are being investigated for the prevention, diagnosis, and treatment of COVID-19; discuss the challenges that countries in sub-Saharan Africa may face with access to COVID-19 vaccine, therapeutics, and diagnostics due to the limited capacity to manufacture them in Africa; and make recommendations on actions to mitigate these challenges and ensure health security in sub-Saharan Africa during this unprecedented pandemic and future public-health crises. MAIN BODY: Sub-Saharan Africa will not be self-reliant for COVID-19 vaccines when they are developed. It can, however, take advantage of existing initiatives aimed at supporting COVID-19 vaccine access to resource-limited settings such as partnership with AstraZeneca, the Coalition for Epidemic Preparedness and Innovation, the Global Alliance for Vaccine and Immunisation, the Serum Institute of India, and the World Health Organization's COVID-19 Technology Access Pool. Accessing effective COVID-19 therapeutics will also be a major challenge for countries in sub-Saharan Africa, as production of therapeutics is frequently geared towards profitable Western markets and is ill-adapted to sub-Saharan Africa realities. The region can benefit from pooled procurement of COVID-19 therapy by the Africa Centres for Disease Control and Prevention in partnership with the African Union. If the use of convalescent plasma for the treatment of patients who are severely ill is found to be effective, access to the product will be minimally challenging since the region has a pool of recovered patients and human resources that can man supportive laboratories. The region also needs to drive the local development of rapid-test kits and other diagnostics for COVID-19. CONCLUSION: Access to vaccines, therapeutics, and diagnostics for COVID-19 will be a challenge for sub-Saharan Africans. This challenge should be confronted by collaborating with vaccine developers; pooled procurement of COVID-19 therapeutics; and local development of testing and diagnostic materials. The COVID-19 pandemic should be a wake-up call for sub-Saharan Africa to build vaccines, therapeutics, and diagnostics manufacturing capacity as one of the resources needed to address public-health crises.

Common childhood bacterial infections.

Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines.

Inhaled corticosteroids in asthma management.

Asthma is a disorder of the lower airways, characterized by bronchial hyperresponsiveness and airflow limitation, the pathogenesis of which is yet to be fully understood. Regardless of its triggers, asthma's hallmark is a state of inflammation that, when uncontrolled, results in persistence of symptoms. Inhaled corticosteroids are established as the mainstay of asthma therapy. This paper examines what is currently available among this class of drugs, features of the ideal inhaled corticosteroid, the delivery systems, dose-response relationships, adverse effects, combination with long-acting beta agonists, equipotent doses among the different types, and several special scenarios that involve the apparent incomplete or lack of response to treatment with inhaled corticosteroids among certain subgroups of patients, such as smokers and obese individuals, and we will discuss the scientific basis of such resistance and suggest alternative approaches to therapy.

Obliterative bronchiolitis in a 13-year-old pre-transplant cystic fibrosis patient.

Cystic fibrosis (CF)-related lung disease is characterized by a broad spectrum of pathologic changes. Most of these changes relate to progressive bronchiectasis and airway destruction due to recurrent infections. Other airway pathologies include but are not limited to nasal polyposis, bronchial hyperactivity, pneumothorax and allergic bronchopulmonary aspergillosis (ABPA). Constrictive obliterative bronchiolitis (COB) in CF is usually seen in post-transplant settings including lung and heart-lung transplants. We report a 13-year-old boy with CF and intractable deterioration in lung function that was ultimately diagnosed as COB.