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1.
PLoS One ; 17(1): e0262312, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34995319

RESUMO

Yellow fever is endemic in Ghana and outbreaks occur periodically. The prodromal signs due to Yellow Fever Virus (YFV) infection are non-specific, making clinical signs unreliable as the sole criteria for diagnosis. Accurate laboratory confirmation of suspected yellow fever cases is therefore vital in surveillance programs. Reporting of ELISA IgM testing results by laboratories can delay due to late arrival of samples from the collection sites as well as limited availability of ELISA kits. In this study, the diagnostic performance characteristics of a rapid immunochromatographic Standard Q Yellow Fever IgM test kit (SD Biosensor) was evaluated for the rapid diagnosis of Yellow Fever infection in Ghana. A panel of 275 sera, comprising 81 confirmed YFV positives and 194 negatives were re-tested in this study using the Standard Q Yellow Fever IgM test kit. Using the CDC/WHO Yellow Fever IgM capture ELISA as a benchmark, the sensitivity, specificity and accuracy of the Standard Q Yellow Fever test kit were 96.3%, 97.9% and 97.5%, respectively. The false positivity rate was 5.1% and there was no cross-reactivity when the Standard Q Yellow Fever test kit was tested against dengue, malaria and hepatitis B and C positive samples. In addition, inter-reader variability and invalid rate were both zero. The results indicate that the diagnostic performance of the Standard Q Yellow Fever IgM test kit on serum or plasma is comparable to the serum IgM detection by ELISA and can be used as a point of care rapid diagnostic test kit for YFV infection in endemic areas.

2.
medRxiv ; 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34751275

RESUMO

Governments around the world have implemented non-pharmaceutical interventions (NPIs), e.g. physical distancing and travel restrictions, to limit the transmission of COVID-19. While lockdowns and physical distancing have proven effective for reducing COVID-19 transmission, there is still limited understanding of the degree to which these interventions impact disease transmission, and how they are reflected in measures of human behaviour. Further, there is a lack of understanding about how new sources of data can be used to monitor NPIs, where these data have the potential to augment existing disease surveillance and modelling efforts. In this study, we assess the relationship between indicators of human mobility, NPIs, and estimates of R t , a real-time measure of the intensity of COVID-19 transmission in subnational districts of Ghana using a multilevel generalised linear mixed model. We demonstrate a relationship between reductions in human mobility and decreases in R t during the early stages of the COVID-19 epidemic in Ghana, and show how reductions in human mobility relate to increasing stringency of NPIs. We demonstrate the utility of combining local disease surveillance data with large scale human mobility data to augment existing surveillance capacity to estimate and monitor the effect of NPI policies. Summary Box: What is already known?: NPI measures including physical distancing, reduction of travel, and use of personal protective equipment have been demonstrated to reduce COVID-19 transmission. Much of the existing research focuses on comparisons of NPI stringency with COVID-19 transmission among different countries, or on high-income countries.What are the new findings?: We show how human mobility and NPI stringency were associated with changes in R t using detailed COVID-19 surveillance and human mobility data from districts in Ghana. We further demonstrate how this association was strongest in the early COVID-19 outbreak in Ghana, decreasing after the relaxation of national restrictions. What do the new findings imply?: The change in association between human mobility, NPI stringency, and R t may reflect a "decoupling" of NPI stringency and human mobility from disease transmission in Ghana as the COVID-19 epidemic progressed. This has implications for public responses to the early stages of epidemic outbreaks and our understanding of the utility of mobility data for predicting the spread of COVID-19.

3.
Pan Afr Med J ; 39: 132, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527148

RESUMO

Introduction: rubella is vaccine-preventable and vaccination is the most cost-effective approach to control the disease and avoid the management of congenital rubella syndrome cases. Ghana introduced the rubella vaccine into the routine immunization program in 2013. Since then there have not been any evaluation of the epidemiology of rubella. We determined the disease trends and the population demographics of rubella cases, in the Ghana national measles case-based surveillance system. Methods: we reviewed the measles case-based surveillance data from 2007 to 2017. Descriptive data statistics was done and expressed as frequencies and proportions. Chi-square test was used to establish associations. Results: a total of 11,483 suspected cases for measles received and tested for measles IgM antibodies and 1,137(12.98%) confirmed positive for the period. Of these 10,077 were negative and 250 indeterminate for measles and tested for rubella and 2,090 (20.23%) confirmed positive for rubella IgM antibodies. More females (21.45%) were affected than males (19.48%). Majority of the confirmed positives were recorded in the urban areas. Children aged 15 years or less were mostly affected. There was a statistical difference between incidence cases and sex (χ2=6.03, p-value = 0.014), or age (χ2=283.56, p-value < 0.001) or area (χ2= 6.17, p-value = 0.013). Most infections occurred during the dry season. Conclusion: children less than 15 years were mostly affected with majority being females. The highest incidence of cases was before the rains and occurred mostly in urban areas. The incidence of cases has declined significantly with the introduction of the rubella vaccine.


Assuntos
Sarampo/epidemiologia , Vacina contra Rubéola/administração & dosagem , Rubéola (Sarampo Alemão)/epidemiologia , Vacinação , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Gana/epidemiologia , Humanos , Programas de Imunização , Imunoglobulina M/imunologia , Incidência , Masculino , Vigilância da População , Rubéola (Sarampo Alemão)/prevenção & controle , Estações do Ano , Distribuição por Sexo , Adulto Jovem
4.
Sci Rep ; 11(1): 13945, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34230563

RESUMO

Acute gastroenteritis associated with diarrhea is considered a serious disease in Africa and South Asia. In this study, we examined the trends in the causative pathogens of diarrhea and the corresponding gut microbiota in Ghana using microbiome analysis performed on diarrheic stools via 16S rRNA sequencing. In total, 80 patients with diarrhea and 34 healthy adults as controls, from 2017 to 2018, were enrolled in the study. Among the patients with diarrhea, 39 were norovirus-positive and 18 were rotavirus-positive. The analysis of species richness (Chao1) was lower in patients with diarrhea than that in controls. Beta-diversity analysis revealed significant differences between the two groups. Several diarrhea-related pathogens (e.g., Escherichia-Shigella, Klebsiella and Campylobacter) were detected in patients with diarrhea. Furthermore, co-infection with these pathogens and enteroviruses (e.g., norovirus and rotavirus) was observed in several cases. Levels of both Erysipelotrichaceae and Staphylococcaceae family markedly differed between norovirus-positive and -negative diarrheic stools, and the 10 predicted metabolic pathways, including the carbohydrate metabolism pathway, showed significant differences between rotavirus-positive patients with diarrhea and controls. This comparative study of diarrheal pathogens in Ghana revealed specific trends in the gut microbiota signature associated with diarrhea and that pathogen-dependent dysbiosis occurred in viral gastroenteritis.


Assuntos
Disbiose/microbiologia , Disbiose/virologia , Gastroenterite/microbiologia , Gastroenterite/virologia , Microbioma Gastrointestinal , Adolescente , Adulto , Bactérias/classificação , Biodiversidade , Estudos de Casos e Controles , Criança , Pré-Escolar , Diarreia/microbiologia , Diarreia/virologia , Fezes/microbiologia , Feminino , Gana , Humanos , Masculino , Filogenia , Rotavirus/fisiologia
5.
Vaccine ; 39(33): 4685-4699, 2021 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-34218962

RESUMO

BACKGROUND: Ghana introduced 13-valent pneumococcal conjugate vaccine (PCV13) into the routine infant immunization program in 2012, using a three-dose primary series without a booster. Despite ≥ 88% reported three-dose vaccination coverage since 2013, PCV13-type pneumococcal meningitis outbreaks have occurred. We estimated the ongoing economic burden of PCV13-type pneumococcal meningitis and pneumonia in northern Ghana, an area within the African meningitis belt with seasonal increases of pneumococcal meningitis post-PCV13 introduction, to inform PCV13 vaccination policy. METHODS: We performed a cross-sectional survey among patients with pneumonia or meningitis at three hospitals in northern Ghana to determine patient-level costs (direct medical and nonmedical, indirect patient and caregiver costs) incurred in household, outpatient, and inpatient settings. Pneumonia burden was estimated using 2017-2018 administrative records. Pneumococcal meningitis burden was estimated using 2017-2018 case-based surveillance data. Economic burden was reported in 2019 U.S. dollars ($) from the societal perspective. RESULTS: For an area with a total population of 5,068,521, our model estimated 6,441 PCV13-type pneumonia cases and 286 PCV13-type meningitis cases occurred in a typical year post-PCV13. In the base case scenario, the total economic burden was $5,230,035 per year ($777 per case). By age group, cost per PCV13-type pneumonia case was $423 (<5 years), $911 (5-14 years), and $784 (≥15 years); cost per PCV13-type meningitis case was $2,128 (<5 years), $3,247 (5-14 years), and $2,883 (≥15 years). Most (78.0-93.4%) of the total societal cost was due to indirect costs related to deaths from PCV13-type diseases. CONCLUSIONS: The estimated economic burden of PCV13-type disease in northern Ghana remains substantial, especially in older children and adults who were expected to have benefited from indirect effects from infant immunization. Additional interventions such as changes in the infant immunization schedule, reactive vaccination, or catch-up PCV13 vaccination may be needed to control remaining vaccine-type disease.


Assuntos
Meningite Pneumocócica , Infecções Pneumocócicas , Pneumonia Pneumocócica , Pneumonia , Adulto , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Estudos Transversais , Gana/epidemiologia , Humanos , Lactente , Meningite Pneumocócica/epidemiologia , Meningite Pneumocócica/prevenção & controle , Vacinas Pneumocócicas , Vacinação , Vacinas Conjugadas
6.
Emerg Infect Dis ; 27(4): 1216-1219, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33754993

RESUMO

The human cutaneous anthrax case-fatality rate is ≈1% when treated, 5%-20% when untreated. We report high case-fatality rates (median 35.0%; 95% CI 21.1%-66.7%) during 2005-2016 linked to livestock handling in northern Ghana, where veterinary resources are limited. Livestock vaccination and access to human treatment should be evaluated.


Assuntos
Antraz , Bacillus anthracis , Antraz/epidemiologia , Surtos de Doenças , Gana , Humanos , Fatores de Risco
7.
BMC Public Health ; 20(1): 1423, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948154

RESUMO

BACKGROUND: Influenza is an acute viral respiratory tract infection caused by influenza virus and transmitted from person to person. Though usually seasonal in temperate climates, influenza occurs throughout the year in the tropics with outbreaks occurring at irregular intervals. On February 6, 2018, a number of students from a Senior High School (SHS) in Accra reported to a district hospital with cough, fever and other respiratory symptoms. An influenza-like illness (ILI) outbreak was suspected. We investigated to determine the magnitude and source of the outbreak and implement control and preventive measures. METHODS: We interviewed health workers, staff and students of the school as well as case-patients and reviewed health records to collect data on demographic characteristics, signs and symptoms, date of illness onset and outcome. We defined ILI case as "any person in the SHS with fever (measured axillary temperature of ≥ 37.5 °C or history of fever) and cough with or without sore throat or runny nose from January 21 to February 26, 2018". We conducted active case search to identify more cases and took oropharyngeal samples for laboratory testing. We performed descriptive and inferential analysis by calculating attack rate ratios (ARR) and their exact 95% confidence intervals (CI). RESULTS: Of the 3160 students, 104 case-patients were recorded from January 25, 2018 to February 13, 2018 (overall attack rate of 3.3%). Mean age of case-patients was 16.1 (±2.3) years with males constituting 71.2% (74/104). Sex specific attack rates were 5.6% (74/1331) and 1.6% (30/1829) for males and females respectively. Compared to females, males were 3.4 times as likely to be ill [ARR =3.4, 95%CI = (2.23-5.15)]. Nine oropharyngeal samples from 17 suspected case-patients tested positive for influenza A (H1N1)pdm09. CONCLUSION: Outbreak of influenza A (H1N1)pdm09 occurred in a SHS in Accra from January to February, 2018. Even though source of the outbreak could not be determined, prompt case management and health education on hand and personal hygiene as non-pharmacological factors probably contributed to the outbreak control. The outbreak ended with a scheduled mid-term break. This underscores the need for more evidence on the effect of school closure in influenza outbreak control.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Adolescente , Surtos de Doenças , Feminino , Gana/epidemiologia , Humanos , Influenza Humana/epidemiologia , Masculino , Instituições Acadêmicas
8.
PLoS One ; 15(8): e0237320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780775

RESUMO

Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Participação da Comunidade , Saúde Global , Implementação de Plano de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Conjuntivite Hemorrágica Aguda/epidemiologia , Conjuntivite Hemorrágica Aguda/prevenção & controle , Surtos de Doenças/prevenção & controle , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/prevenção & controle , Gana , Humanos , Governo Local , Medição de Risco/métodos
9.
Vaccine ; 38(14): 2937-2942, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32139314

RESUMO

BACKGROUND: Childhood vaccination in Ghana has historically been high, but the impact of recently introduced vaccines on coverage is unknown. We calculate vaccine coverage of Ghanaian children- contrasting newly introduced vaccines and those long available - and describe associations between sociodemographic indicators and full vaccination. METHODS: Data from the 2014 Ghana Demographic and Health Survey was used to calculate full vaccination, defined as receipt of one dose bacillus Calmette-Guérin (BCG); two doses of rotavirus vaccine; 3 doses of pentavalent vaccine, oral polio vaccine (OPV), and pneumococcal conjugate vaccine (PCV); and one dose of measles-rubella vaccine and yellow fever vaccine, among children age 12-24 months. Logistic regression with survey procedures was used to estimate odds ratios for socioeconomic factors' association with full vaccination. RESULTS: The sample comprised a total of 1107 children 12-24 months. Full vaccination coverage was 70.8%. Vaccination coverage was higher for vaccines administered at younger ages (e.g., birth dose of BCG was 97.0%) than at older ages (e.g., yellow fever at 9 months was 88.2%). Newly introduced vaccines had lower coverage: at 10 weeks, pentavalent 2 was 95.4%, versus 91.2% for PCV 2 and 88.8% for rotavirus 2. Living outside of Greater Accra, home delivery, younger maternal age, urban residence, and more than one child under five in the home were all associated with decreased odds of full vaccination in the adjusted analysis whereas sex of the child, wealth, religion, and maternal education were not associated with full vaccination status. CONCLUSION: Ghana has high overall vaccination rates although disparities in full vaccination by sociodemographic status exist. As vaccine recommendations are revised, it will be important to insure equitable access to vaccination for all children regardless of demographic and socioeconomic background.


Assuntos
Programas de Imunização , Fatores Socioeconômicos , Vacinação/estatística & dados numéricos , Gana/epidemiologia , Humanos , Lactente
10.
Ghana Med J ; 54(2 Suppl): 32-39, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33536666

RESUMO

Objective: We mapped and generated hot spots for potential meningitis outbreak from existing data in Upper East region, Ghana. Design: This was a cross-sectional study conducted in 2017. Data Source: Meningitis data in the Upper East Region from January 2007, to December 2016. Main outcome measure: We used spatial tools in Quantum Geographic Information System (QGIS) and Geoda to draw choropleth map of meningitis incidence, case fatality and hotspot for potential meningitis outbreak. Results: A total of 2312 meningitis cases (suspected and confirmed) were recorded from 2016-2017 with median incidence of 15.0cases/100,000 population (min 6.3, max 47.8). Median age of cases was 15 years (IQR: 6-31 years). Most (44.2%) of those affected were 10 years and below. Females (51.2%) constituted the highest proportion. Median incidence from 2007-2011 was 20cases/100,000 population (Min 11.3, Max 39.9) whilst from 2012-2016 was 11.1cases/100,000 populations (Min 6.3, Max 47.8). A total of 28 significant hotspot sub-districts clusters (p=0.024) were identified with 7 High-high risk areas as potential meningitis outbreak spots. Conclusion: The occurrence of meningitis is not random, spatial cluster with high -high-risk exist in some sub-districts. Overall meningitis incidence and fatality rate have declined in the region with district variations. Districts with high meningitis incidence and fatality rates should be targeted for intervention. Funding: Author EA was supported by the West Africa Health Organization (Ref.: Prog/A17IEpidemSurveillN°57212014/mcrt).


Assuntos
Hotspot de Doença , Surtos de Doenças , Meningite/epidemiologia , Adolescente , Adulto , Criança , Análise por Conglomerados , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Incidência , Análise Espacial , Adulto Jovem
11.
Ghana Med J ; 54(2 Suppl): 45-52, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33536668

RESUMO

Objective: On 24th October 2016, the Central Regional Health Directorate received report of a suspected cholera outbreak in the Cape Coast Metropolis (CCM). We investigated to confirm the diagnosis, identify risk factors and implement control measures. Design: We used a descriptive study followed by 1:2 unmatched case-control study. Data source: We reviewed medical records, conducted active case search and contact tracing, interviewed case-patients and their contacts and conducted environmental assessment. Case-patients' stool samples were tested with point of care test kits (SD Bioline Cholera Ag 01/0139) and sent to the Cape Coast Teaching Hospital Laboratory for confirmation. Main outcomes: Cause of outbreak, risk factors associated with spread of outbreak. Results: Vibrio cholerae serotype Ogawa caused the outbreak. There was no mortality. Of 704 case-patients, 371(52.7%) were males and 55(7.8%) were aged under-five years. The median age was 23 years (interquartile range: 16-32 years). About a third 248(35.2%) of the case patients were aged 15-24 years. The University of Cape Coast subdistrict was the epicenter with 341(48.44%) cases. Compared to controls, cholera case-patients were more likely to have visited Cholera Treatment Centers (CTC) (aOR=12.1, 95%CI: 1.5-101.3), drank pipe-borne water (aOR=11.7, 95%CI: 3.3-41.8), or drank street-vended sachet water (aOR=11.0, 95%CI: 3.7-32.9). Open defecation and broken sewage pipes were observed in the epicenter. Conclusion: Vibrio cholerae serotype Ogawa caused the CCM cholera outbreak mostly affecting the youth. Visiting CTC was a major risk factor. Prompt case-management, contact tracing, health education, restricting access to CTC and implementing water sanitation and hygiene activities helped in the control. Funding: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana.


Assuntos
Cólera/epidemiologia , Surtos de Doenças , Vibrio cholerae O1/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Gana/epidemiologia , Humanos , Higiene , Lactente , Masculino , Pessoa de Meia-Idade , Saneamento , Distribuição por Sexo , Vibrio cholerae O1/genética , Adulto Jovem
12.
Ghana Med J ; 54(4 Suppl): 5-15, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33976436

RESUMO

Objective: Describe the epidemiology of COVID-19 cases detected in the first four months of the pandemic in Ghana by person, place and time to provide an understanding of the local epidemiology of the disease. Methods: We conducted an exploratory descriptive study of all confirmed COVID-19 cases in Ghana from March 12 to June 30, 2020. Data was merged from the country's electronic databases, cleaned and summarized using medians, proportions and geospatial analysis. Design: A cross-sectional study design. Setting: Ghana. Participants: All confirmed COVID-19 cases in Ghana from March 12 to June 30, 2020. Interventions: None. Main Outcome measures: Epidemiological characterization of all confirmed COVID-19 cases recorded from March 12 - June 30, 2020 in Ghana by person, place and time. Results: A total of 17,763 cases were recorded with median age (IQR) of 33years (One month to 85 years). Among the confirmed cases, 10,272 (57.8%) were males and 3,521 (19.8%) were symptomatic with cough recorded in 1,420 (40.3%) cases. The remaining 14,242 (80.2%) were asymptomatic. Greater Accra region recorded the highest number of confirmed cases 11,348 (63.9%). All 16 administrative regions had recorded cases of COVID-19 by June 30, 2020 due to internal migration between the hotspots and other regions. The epidemiological curve showed a propagated outbreak with 117 deaths (CFR= 0.67%) recorded. Conclusion: A propagated outbreak of COVID - 19 was confirmed in Ghana on March 12, 2020. Internal migration from hotspots to other regions led to the spread of the virus across the nation. Majority of cases were asymptomatic. Funding: The COVID-19 pandemic response and writing workshop by the Ghana Field Epidemiology and Laboratory Training Programme (GFELTP) was supported with funding from President Malaria Initiative - CDC, and Korea International Cooperation Agency (on CDC CoAg 6NU2GGH001876) through AFENET.


Assuntos
COVID-19/epidemiologia , Surtos de Doenças , Transmissão de Doença Infecciosa/estatística & dados numéricos , SARS-CoV-2 , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Emigração e Imigração/estatística & dados numéricos , Feminino , Gana/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Vaccine ; 37(37): 5657-5663, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-29371015

RESUMO

Streptococcus pneumoniae is increasingly recognised as an important cause of bacterial meningitis in the African meningitis belt. The World Health Organization sets guidelines for response to outbreaks of meningococcal meningitis, but there are no current guidelines for outbreaks where S. pneumoniae is implicated. We aimed to evaluate the impact of using a similar response to target outbreaks of vaccine-preventable pneumococcal meningitis in the meningitis belt. Here, we adapt a previous model of reactive vaccination for meningococcal outbreaks to estimate the potential impact of reactive vaccination in a recent pneumococcal meningitis outbreak in the Brong-Ahafo region of central Ghana using weekly line list data on all suspected cases over a period of five months. We determine the sensitivity and specificity of various epidemic thresholds and model the cases and deaths averted by reactive vaccination. An epidemic threshold of 10 suspected cases per 100,000 population per week performed the best, predicting large outbreaks with 100% sensitivity and more than 85% specificity. In this outbreak, reactive vaccination would have prevented a lower number of cases per individual vaccinated (approximately 15,300 doses per case averted) than previously estimated for meningococcal outbreaks. Since the burden of death and disability from pneumococcal meningitis is higher than that from meningococcal meningitis, there may still be merit in considering reactive vaccination for outbreaks of pneumococcal meningitis. More outbreak data are needed to refine our model estimates. Whatever policy is followed, we emphasize the importance of timely laboratory confirmation of suspected cases to enable appropriate decisions about outbreak response.


Assuntos
Surtos de Doenças , Meningite Pneumocócica/epidemiologia , Meningite Pneumocócica/prevenção & controle , Vacinas Meningocócicas/imunologia , Vacinação , Gana/epidemiologia , Humanos , Incidência , Meningite Pneumocócica/mortalidade , Mortalidade , Vigilância em Saúde Pública , Streptococcus pneumoniae/imunologia
14.
PLoS One ; 13(12): e0208907, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30566466

RESUMO

Dengue fever is known to be one of the most common arthropod-borne viral infectious diseases of public health importance. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, Southeast Asia and the Western Pacific with an estimated two fifths of the world's population being at risk. The notable endemic viral hemorrhagic fevers (VHFs) found in West Africa, including yellow fever, Lassa fever, Rift Valley fever, dengue fever and until recently Ebola have been responsible for most outbreaks with fatal consequences. These VHFs usually produce unclear acute febrile illness, especially in the acute phase of infection. In this study we detected the presence of 2 different serotypes (DENV-2 and DENV-3) of Dengue virus in 4 sera of 150 patients clinically suspected of Ebola virus disease during the Ebola Virus Disease (EVD) outbreak in West Africa with the use of serological and molecular test assays. Sequence data was successfully generated for DENV-3 and phylogenetic analysis of the envelope gene showed that the DENV-3 sequences had close homology with DENV-3 sequences from Senegal and India. This study documents molecular evidence of an indigenous Dengue fever viral infection in Ghana and therefore necessitates the need to have an efficient surveillance system to rapidly detect and control the dissemination of the different serotypes in the population which has the potential to cause outbreaks of dengue hemorrhagic fevers.


Assuntos
Vírus da Dengue/genética , Dengue , Ebolavirus/genética , Doença pelo Vírus Ebola , Dengue/epidemiologia , Dengue/genética , Dengue/virologia , Surtos de Doenças , Feminino , Gana/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/genética , Doença pelo Vírus Ebola/virologia , Humanos , Masculino
15.
PLoS One ; 13(9): e0203205, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30192772

RESUMO

BACKGROUND: Increases in pneumococcal meningitis were reported from Ghanaian regions that lie in the meningitis belt in 2016-2017, despite introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in 2012 using a 3-dose schedule (6, 10, and 14 weeks). We describe pneumococcal meningitis epidemiology in the Ghanaian Northern and Upper West regions across two meningitis seasons. METHODS: Suspected meningitis cases were identified using World Health Organization standard definitions. Pneumococcal meningitis was confirmed if pneumococcus was the sole pathogen detected by polymerase chain reaction, culture, or latex agglutination in cerebrospinal fluid collected from a person with suspected meningitis during December 2015-March 2017. Pneumococcal serotyping was done using PCR. Annual age-specific pneumococcal meningitis incidence (cases per 100,000 population) was calculated, adjusting for suspected meningitis cases lacking confirmatory testing. FINDINGS: Among 153 pneumococcal meningitis cases, 137 (89.5%) were serotyped; 100 (73.0%) were PCV13-type, including 85 (62.0%) that were serotype 1, a PCV13-targeted serotype. Persons aged ≥5 years accounted for 96.7% (148/153) of cases. Comparing 2015-2016 and 2016-2017 seasons, the proportion of non-serotype 1 PCV13-type cases decreased from 20.0% (9/45) to 4.1% (3/74) (p = 0.008), whereas the proportion that was serotype 1 was stable (71.1% (32/45) vs. 58.1% (43/74); p = 0.16). Estimated adjusted pneumococcal meningitis incidence was 1.8 in children aged <5 years and ranged from 6.8-10.5 in older children and adults. CONCLUSIONS: High pneumococcal meningitis incidence with a large proportion of serotype 1 disease in older children and adults suggests infant PCV13 vaccination has not induced herd protection with this schedule in this high-transmission setting.


Assuntos
Meningite Pneumocócica/microbiologia , Meningite Pneumocócica/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/classificação , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Gana/epidemiologia , Humanos , Esquemas de Imunização , Lactente , Masculino , Meningite Pneumocócica/epidemiologia , Pessoa de Meia-Idade , Sorogrupo , Streptococcus pneumoniae/isolamento & purificação , Fatores de Tempo , Vacinas Conjugadas/administração & dosagem , Adulto Jovem
16.
MMWR Morb Mortal Wkly Rep ; 66(30): 806-810, 2017 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-28771457

RESUMO

Bacterial meningitis is a severe, acute infection of the fluid surrounding the brain and spinal cord that can rapidly lead to death. Even with recommended antibiotic treatment, up to 25% of infected persons in Africa might experience neurologic sequelae (1). Three regions in northern Ghana (Upper East, Northern, and Upper West), located in the sub-Saharan "meningitis belt" that extends from Senegal to Ethiopia, experienced periodic outbreaks of meningitis before introduction of serogroup A meningococcal conjugate vaccine (MenAfriVac) in 2012 (2,3). During December 9, 2015-February 16, 2016, a total of 432 suspected meningitis cases were reported to health authorities in these three regions. The Ghana Ministry of Health, with assistance from CDC and other partners, tested cerebrospinal fluid (CSF) specimens from 286 patients. In the first 4 weeks of the outbreak, a high percentage of cases were caused by Streptococcus pneumoniae; followed by an increase in cases caused by Neisseria meningitidis, predominantly serogroup W. These data facilitated Ghana's request to the International Coordinating Group* for meningococcal polysaccharide ACW vaccine, which was delivered to persons in the most affected districts. Rapid identification of the etiologic agent causing meningitis outbreaks is critical to inform targeted public health and clinical interventions, including vaccination, clinical management, and contact precautions.


Assuntos
Surtos de Doenças , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , Adolescente , Adulto , Líquido Cefalorraquidiano/microbiologia , Criança , Surtos de Doenças/prevenção & controle , Feminino , Gana/epidemiologia , Humanos , Masculino , Meningites Bacterianas/prevenção & controle , Vacinas Meningocócicas/administração & dosagem , Neisseria meningitidis/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Adulto Jovem
17.
BMC Infect Dis ; 16(1): 575, 2016 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-27756235

RESUMO

BACKGROUND: An outbreak of pneumococcal meningitis among non-infant children and adults occurred in the Brong-Ahafo region of Ghana between December 2015 and April 2016 despite the recent nationwide implementation of a vaccination programme for infants with the 13-valent pneumococcal conjugate vaccine (PCV13). METHODS: Cerebrospinal fluid (CSF) specimens were collected from patients with suspected meningitis in the Brong-Ahafo region. CSF specimens were subjected to Gram staining, culture and rapid antigen testing. Quantitative PCR was performed to identify pneumococcus, meningococcus and Haemophilus influenzae. Latex agglutination and molecular serotyping were performed on samples. Antibiogram and whole genome sequencing were performed on pneumococcal isolates. RESULTS: Eight hundred eighty six patients were reported with suspected meningitis in the Brong-Ahafo region during the period of the outbreak. In the epicenter district, the prevalence was as high as 363 suspected cases per 100,000 people. Over 95 % of suspected cases occurred in non-infant children and adults, with a median age of 20 years. Bacterial meningitis was confirmed in just under a quarter of CSF specimens tested. Pneumococcus, meningococcus and Group B Streptococcus accounted for 77 %, 22 % and 1 % of confirmed cases respectively. The vast majority of serotyped pneumococci (80 %) belonged to serotype 1. Most of the pneumococcal isolates tested were susceptible to a broad range of antibiotics, with the exception of two pneumococcal serotype 1 strains that were resistant to both penicillin and trimethoprim-sulfamethoxazole. All sequenced pneumococcal serotype 1 strains belong to Sequence Type (ST) 303 in the hypervirulent ST217 clonal complex. CONCLUSION: The occurrence of a pneumococcal serotype 1 meningitis outbreak three years after the introduction of PCV13 is alarming and calls for strengthening of meningitis surveillance and a re-evaluation of the current vaccination programme in high risk countries.


Assuntos
Meningite Pneumocócica/epidemiologia , Meningite Pneumocócica/microbiologia , Vacinas Pneumocócicas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Gana/epidemiologia , Haemophilus influenzae/isolamento & purificação , Haemophilus influenzae/patogenicidade , Humanos , Programas de Imunização , Lactente , Masculino , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Meningite Pneumocócica/tratamento farmacológico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/patogenicidade , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
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