Molecular detection of rabies virus strain with N-gene that clustered with China lineage 2 co-circulating with Africa lineages in Monrovia, Liberia: first reported case in Africa.

Despite a long history of dog-transmitted human rabies outbreaks in Liberia, West Africa, no reports exist of molecular characterisation of the causative lyssaviruses. This study investigated Rabies lyssavirus (RABV) strains isolated at the dog-human interface in Monrovia, Liberia 2016 and 2017, by reverse transcription polymerase chain reaction, using primers specific for the nucleoprotein (N) gene. Out of 20 specimens (19 dog brain samples and one human saliva) tested as suspected rabies cases, three (15%) were positive. Purified amplicons from all three positive specimens were sequenced in both forward and reverse directions. Phylogenetic analysis was conducted in MEGA7 and PhyML3 to determine their relationship with RABV sequences accessioned in NCBI GenBank. The first of three RABV strains detected clustered with China lineage 2 RABVs of dogs (99% homology to KU963489 and DQ666322). The second strain segregated with Africa lineage 2 RABVs also of dog origin, and the third strain segregated with Africa lineage 3 RABVs of Southern Africa viverrids. Our results show a transcontinental strain of rabies virus co-circulating with Africa lineages in post-conflict Liberia. This finding should stimulate more effective sub-regional planning and execution of one-health actions, towards stepwise surveillance and elimination of rabies in West Africa by 2030.

Enhancing tuberculosis case finding in Tanzania: implementation of a quality improvement initiative.

Tuberculosis (TB) is one of the major causes of morbidity and mortality in Tanzania. A quality improvement (QI) initiative was implemented by the National Tuberculosis Programme with support from The Global Fund to enhance TB case finding. The initiative involved identifying gaps in the quality of services, introducing tools, building capacity of health workers, and strengthening laboratory and referral services. The initiative was piloted at sub-national level and subsequently scaled-up nationally. Overall, 1280 health workers were trained, leading to an 81% cumulative increase in notified TB cases in the pilot region and 4000 additional TB cases notified nationally. The QI initiative could serve as a model for the improvement of TB case notification in other settings.

La tuberculose (TB) est une des causes majeures de morbidité et de mortalité en Tanzanie. Une initiative d'amélioration de la qualité (QI) en trois points a été mise en œuvre par le Programme National Tuberculose avec un soutien du Fonds Mondial pour améliorer la détection des cas de TB. L'initiative a impliqué l'identification des failles de qualité des services de TB, l'introduction d'outils, le renforcement des capacités du personnel de santé, le renforcement du laboratoire TB et des services de référence. L'initiative a été pilotée au niveau sous national et ensuite étendue au niveau national : 1280 personnels de santé ont été formés, la coordination de la QI a été renforcée et ceci a contribué à 81% de l'augmentation cumulée des cas de TB notifiés dans la région pilote et à la notification de 4000 cas de TB supplémentaires au niveau national. L'initiative QI pourrait servir de modèle pour améliorer la notification des cas de TB dans d'autres contextes.

La tuberculosis (TB) es una de las principales causas de morbilidad y mortalidad en Tanzanía. El Programa Nacional contra la Tuberculosis introdujo, con el apoyo del Fondo Mundial, una iniciativa triple de mejoramiento de la calidad (QI) encaminada a reforzar la búsqueda de casos de TB. La iniciativa comportaba el reconocimiento de las deficiencias en la calidad de los servicios de TB, la introducción de instrumentos, el fortalecimiento de la capacidad de los trabajadores de salud y el refuerzo de los laboratorios de TB y los servicios de remisiones. Después de un ensayo piloto a escala subnacional, se amplió la iniciativa a todo el país. Se capacitaron 1280 trabajadores de salud y se reforzó la coordinación de la QI, con lo cual se propició un aumento acumulado de 81% de los casos de TB notificados en la región piloto y la notificación de 4000 casos de TB adicionales a escala nacional. La iniciativa de QI podría servir como modelo para mejorar la notificación de casos de TB en otros entornos.

Population impact of factors associated with prevalent pulmonary tuberculosis in Tanzania.

SETTING: Tanzania has an estimated tuberculosis (TB) prevalence of 295 per 100 000 adult population. There is currently no nationally representative information on factors associated with TB in Tanzania. OBJECTIVE: To determine the demographic and clinical factors associated with bacteriologically confirmed TB in the adult general population of Tanzania. DESIGN: A case-control study nested in a nationally representative TB prevalence survey. All patients with bacteriologically confirmed pulmonary TB (PTB) constituted cases and a representative sample of people without bacteriologically confirmed PTB constituted controls. We calculated adjusted odds ratios (aORs) to identify factors associated with TB. RESULTS: Age groups 25-34 years (aOR 3.7, 95%CI 1.5-8.8) and 55-64 years (aOR 2.5, 95%CI 1.1-5.5), male sex (aOR 1.6, 95%CI 1.1-2.3) and low body mass index (BMI) (aOR 1.7, 95%CI 1.1-2.8) were significantly associated with TB. Association with human immunodeficiency virus (HIV) and diabetes mellitus (DM) was not statistically significant. The population attributable fraction (PAF) was 2% (95%CI -2 to 5) for DM and 3% (95%CI -2 to 8) for HIV. CONCLUSION: Being in an older age group, being male and having a low BMI were associated with bacteriologically confirmed PTB. On the population level, classic risk factors for TB have no major effect on prevalent TB from which future transmission may occur.