Resurgence of Ebola virus in 2021 in Guinea suggests a new paradigm for outbreaks.

Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization.

Épidémies et Covid-19 dans les prisons africaines : l'occasion d'une approche de la santé vraiment globale.

The Covid-19 epidemic is an opportunity to underline how prison health on the African continent remains a weak link of the prison system. Beyond the difficulties in caring for Covid-19 in detention, prison infirmaries, where they exist, are rarely integrated into the health system in practice. Administrations provide little for the vital needs of prisoners. Dietary deficiencies are frequent, skin diseases recurrent and prisoners are most often dependent on the financial means of their families or NGOs when it comes to access to health care. The social illegitimacy of the prison population and the reluctance of States to offer convicted prisoners what they do not guarantee to the general population are two arguments put forward to justify what amounts to necropolitics. At the same time, international actors working in prisons essentially target pathologies with epidemic potential, constrained by funding sources (UNAIDS, Global Fund) supporting population-wide health strategies. Here we would like to return to these two logics and develop an argument for a decompartmentalized approach to prison health. Beyond the recognition of individual health experience and epidemiological concerns, addressing prison health globally contributes to the restoration of prisoners' dignity and rights by the State, a necessary condition for the maintenance of citizenship beyond confinement.

[Epidemics and Covid-19 in African prisons: Towards an inclusive approach of health]. / Épidémies et Covid-19 dans les prisons africaines : l'occasion d'une approche de la santé vraiment globale.

The Covid-19 epidemic is an opportunity to underline how prison health on the African continent remains a weak link of the prison system. Beyond the difficulties in caring for Covid-19 in detention, prison infirmaries, where they exist, are rarely integrated into the health system in practice. Administrations provide little for the vital needs of prisoners. Dietary deficiencies are frequent, skin diseases recurrent and prisoners are most often dependent on the financial means of their families or NGOs when it comes to access to health care. The social illegitimacy of the prison population and the reluctance of States to offer convicted prisoners what they do not guarantee to the general population are two arguments put forward to justify what amounts to necropolitics. At the same time, international actors working in prisons essentially target pathologies with epidemic potential, constrained by funding sources (UNAIDS, Global Fund) supporting population-wide health strategies. Here we would like to return to these two logics and develop an argument for a decompartmentalized approach to prison health. Beyond the recognition of individual health experience and epidemiological concerns, addressing prison health globally contributes to the restoration of prisoners' dignity and rights by the State, a necessary condition for the maintenance of citizenship beyond confinement.

Correction: Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

[This corrects the article DOI: 10.1371/journal.pmed.1001967.].

Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea.

BACKGROUND: Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies. METHODS AND FINDINGS: Inclusion criteria were positive Ebola virus reverse transcription PCR (RT-PCR) test, age ≥ 1 y, weight ≥ 10 kg, ability to take oral drugs, and informed consent. All participants received oral favipiravir (day 0: 6,000 mg; day 1 to day 9: 2,400 mg/d). Semi-quantitative Ebola virus RT-PCR (results expressed in "cycle threshold" [Ct]) and biochemistry tests were performed at day 0, day 2, day 4, end of symptoms, day 14, and day 30. Frozen samples were shipped to a reference biosafety level 4 laboratory for RNA viral load measurement using a quantitative reference technique (genome copies/milliliter). Outcomes were mortality, viral load evolution, and adverse events. The analysis was stratified by age and Ct value. A "target value" of mortality was defined a priori for each stratum, to guide the interpretation of interim and final analysis. Between 17 December 2014 and 8 April 2015, 126 patients were included, of whom 111 were analyzed (adults and adolescents, ≥13 y, n = 99; young children, ≤6 y, n = 12). Here we present the results obtained in the 99 adults and adolescents. Of these, 55 had a baseline Ct value ≥ 20 (Group A Ct ≥ 20), and 44 had a baseline Ct value < 20 (Group A Ct < 20). Ct values and RNA viral loads were well correlated, with Ct = 20 corresponding to RNA viral load = 7.7 log10 genome copies/ml. Mortality was 20% (95% CI 11.6%-32.4%) in Group A Ct ≥ 20 and 91% (95% CI 78.8%-91.1%) in Group A Ct < 20. Both mortality 95% CIs included the predefined target value (30% and 85%, respectively). Baseline serum creatinine was ≥110 µmol/l in 48% of patients in Group A Ct ≥ 20 (≥300 µmol/l in 14%) and in 90% of patients in Group A Ct < 20 (≥300 µmol/l in 44%). In Group A Ct ≥ 20, 17% of patients with baseline creatinine ≥110 µmol/l died, versus 97% in Group A Ct < 20. In patients who survived, the mean decrease in viral load was 0.33 log10 copies/ml per day of follow-up. RNA viral load values and mortality were not significantly different between adults starting favipiravir within <72 h of symptoms compared to others. Favipiravir was well tolerated. CONCLUSIONS: In the context of an outbreak at its peak, with crowded care centers, randomizing patients to receive either standard care or standard care plus an experimental drug was not felt to be appropriate. We did a non-randomized trial. This trial reaches nuanced conclusions. On the one hand, we do not conclude on the efficacy of the drug, and our conclusions on tolerance, although encouraging, are not as firm as they could have been if we had used randomization. On the other hand, we learned about how to quickly set up and run an Ebola trial, in close relationship with the community and non-governmental organizations; we integrated research into care so that it improved care; and we generated knowledge on EVD that is useful to further research. Our data illustrate the frequency of renal dysfunction and the powerful prognostic value of low Ct values. They suggest that drug trials in EVD should systematically stratify analyses by baseline Ct value, as a surrogate of viral load. They also suggest that favipiravir monotherapy merits further study in patients with medium to high viremia, but not in those with very high viremia. TRIAL REGISTRATION: ClinicalTrials.gov NCT02329054.

Struggling with AIDS in South Africa: the space of the everyday as a field of recognition.

The space of volunteering is often seen as a place for rebuilding a world for individuals for whom life has been destroyed by the discovery of AIDS infection. People living with AIDS get involved in HIV support groups, become volunteers, and take care for each other. Without denying the reality of these processes leading to a "positive life" this article questions narratives of the transformation of the self-implied in the "caring for other" logic and argues that other spheres of life, less discernable because inscribed in the ordinary and in the intimacy of domestic life are at least as important as the involvement in biomedical care. The limits of voluntary work is highlighted and contrasted with a presentation of how life, love and affection is reconfigured within everyday life, leading to a consideration of people's struggles to build spaces of recognition. The argument of this article is built on a three year ethnography (2001-04) carried out in Soweto and Alexandra townships (South Africa).

A rapid assessment of health system preparedness and response to the COVID-19 pandemic in Guinea.

Epidemic-prone diseases have high adverse impacts and pose important threats to global health security. This study aimed to assess levels of health facility preparedness and response to the COVID-19 pandemic in Guinea. This was a cross-sectional study in public and private health facilities/services across 13 Guinean health districts. Managers and healthcare workers (HCWs) from departments in each facility/service were interviewed. Descriptive statistics and comparisons were presented using Pearson's Chi-Squared Test or Fischer exact test. Totally, 197 managers and 1020 HCWs participated in the study. Guidance documents and dedicated spaces for management/isolation of suspected COVID-19 cases were available only in 29% and 26% of facilities, respectively. Capacities to collect (9%) and safely transport (14%) samples were low. Intensive care units (5%), dedicated patient beds (3%), oxygenators (2%), and respirators (0.6%) were almost lacking. While 36% of facilities/services had received infection prevention and control supplies, only 20% had supplies sufficient for 30 days. Moreover, only 9% of HCWs had received formal training on COVID-19. The main sources of information for HCWs were the media (90%) and the internet (58%). Only 30% of HCWs had received personal protective equipment, more in the public sector (p<0.001) and in Conakry (p=0.022). This study showed low levels of preparedness of health facilities/services in Guinea and highlighted a lack of confidence among HCWs who felt unsafe at their workplace. Better governance to improve and maintain the capacity of the Guinean health system to respond to current and future epidemics is needed.

Postface: Meaning of the Experiment and Implications of the Experience.

Discussing specifically on the involvement of social sciences in and on the issue of recruitment in HIV vaccine trials, the postface of this special issue reasserts the importance of social science engagement in clinical research. Three entry themes are underlying the discussion: the relationship between the individual and society in consent, the analysis of consent as a transaction, the examination of the basis, and the context of trust within trials.

Vaccination and blood sampling acceptability during Ramadan fasting month: A cross-sectional study in Conakry, Guinea.

INTRODUCTION: There are few data on the acceptability of vaccination or blood sampling during Ramadan fasting month in Muslim countries. This could impact vaccination campaigns, clinical trials or healthcare during Ramadan. METHODS: Using a semi-structured questionnaire, we conducted a cross-sectional study on 201 practising Muslims and 10 religious leaders in Conakry, Guinea in the wake of the recent epidemic Ebola epidemic. Acceptability of vaccination and blood sampling during Ramadan were investigated as well as reasons for refusal. RESULTS: Vaccination was judged acceptable during Ramadan by 46% (93/201, 95% CI 0.40-0.53) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.11). Blood sampling was judged acceptable during Ramadan by 54% (108/201, 95% CI 0.47-0.60) of practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) of religious leaders (p=0.19). The percentage of participants that judged both blood sampling and vaccination acceptable during Ramadan was 40% (81/201, 95% CI 0.34-0.47) for practising Muslims versus 80% (8/10, 95% CI 0.49-0.94) for religious leaders (p=0.048). The most common reasons for refusal of vaccination or blood sampling were that nothing should enter or leave the body during Ramadan (43%), that adverse events could lead to breaking the fast (32%), that blood should not be seen during Ramadan (9%) and that the Quran explicitly forbids it (9%). DISCUSSION: Although most Muslims leaders and scientists consider that injections including immunization and blood sampling should be authorized during Ramadan, many Muslims in our study judged vaccination or blood sampling unacceptable when fasting. Widely available recommendations on healthcare during Ramadan would be useful to inform Muslims.

Negotiating care: patient tactics at an urban South African hospital.

OBJECTIVES: To examine the various ways in which patients sought to influence the care they received in the admission and adult medical services of a large urban, academic hospital in South Africa. These included the steps taken by patients to increase their access to services and improve their experience of care. METHODS: Part of a qualitative study of rationing behaviour, the methods combined, observations, interviews and a survey. RESULTS: Patient's actions were oriented to two main goals: obtaining care and preserving their sense of self and dignity. These actions shaped patients' pathways in five key ways: meeting the entry criteria for admission; presenting as a cooperative, expert patient; mobilizing social networks among health care staff; making use of complaints mechanisms; and deploying narratives of resistance. CONCLUSION: Patients made tactical use of small spaces at the margins of the health care system. Although, with some exceptions, they had limited impact on the care received in the hospital, they highlight patients as active players and point to the ways in which patient agency can be strengthened in the light of the shift towards chronic disease care and greater patient involvement in care.

People living with HIV and AIDS in everyday conditions of township life in South Africa: between structural constraint and individual tactics.

The HIV/AIDS pandemic in South Africa has negatively transformed the lives of many in townships and rural areas. People living with AIDS (PWAs) are the socially weakened, whose means of survival include migrating, enduring gender violence, and they are thus confined to living in the margins of society. Using the concept of tactic as defined by de Certeau, this paper shows how anthropology can use the narratives of everyday life to make sense of the different ways the socially weakened create networks of support, find a cure, and generate forms of income or use running away as a means to avoid gender violence. This paper argues that if the State hopes to successfully introduce antiretroviral therapy and so turn everyday logics of survival into long-term strategies, it needs to commit itself firmly to reducing inherited forms of inequalities. Similarly, the State's commitment to eradicate poverty also requires it to take cognisance of the different borderline activities the socially weakened regard as avenues of survival. Rather than morally condemn such activity as a wrongdoing, the State should enhance its knowledge of the socio-economic conditions that almost coerce the socially weakened to 'do wrong'. The data were collected during intensive fieldwork carried out in Alexandra township and Diepkloof (Gauteng) in 2001 - 2002, using participant observation and repeated in-depth interviews.