56 results on '"Emile Okitolonda Wemakoy"'
Search Results
2. Seroreactivity against Marburg or related filoviruses in West and Central Africa
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Imke Steffen, Kai Lu, Nicole A. Hoff, Prime Mulembakani, Emile Okitolonda Wemakoy, Jean-Jacques Muyembe-Tamfum, Nicaise Ndembi, Catherine A. Brennan, John Hackett, William M. Switzer, Sentob Saragosti, Guy O. Mbensa, Syria Laperche, Anne W. Rimoin, and Graham Simmons
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Filoviruses ,Marburgvirus ,hemorrhagic fever virus ,serology ,prevalence ,Cameroon ,Infectious and parasitic diseases ,RC109-216 ,Microbiology ,QR1-502 - Abstract
ABSTRACTA serological survey of 2,430 archived serum samples collected between 1997 and 2012 was conducted to retrospectively determine the prevalence of Marburg virus in five African countries. Serum samples were screened for neutralizing antibodies in a pseudotype micro-neutralization assay and confirmed by enzyme-linked immunosorbent assay (ELISA). Surprisingly, a seroprevalence for Marburg virus of 7.5 and 6.3% was found in Cameroon and Ghana, respectively, suggesting the circulation of filoviruses or related viruses outside of known endemic areas that remain undetected by current surveillance efforts. However, due to the lack of validated assays and appropriate positive controls, these results must be considered preliminary.
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- 2020
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3. Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012–2015
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Pélagie Babakazo, Joelle Kabamba-Tshilobo, Emile Okitolonda Wemakoy, Léopold Lubula, Léonie Kitoko Manya, Benoit Kebela Ilunga, Wally Disasuani, Edith Nkwembe, Hugo Kavunga-Membo, Jean-Claude Changachanga, Saleh Muhemedi, Jean-Jacques Muyembe Tamfum, and Stefano Tempia
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Influenza ,Surveillance ,Evaluation ,Democratic Republic of Congo ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012–2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: 90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored > 70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. Conclusions The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.
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- 2019
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4. Human T-cell lymphotropic virus type 1 transmission dynamics in rural villages in the Democratic Republic of the Congo with high nonhuman primate exposure.
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Megan Halbrook, Adva Gadoth, Anupama Shankar, HaoQiang Zheng, Ellsworth M Campbell, Nicole A Hoff, Jean-Jacques Muyembe, Emile Okitolonda Wemakoy, Anne W Rimoin, and William M Switzer
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
The Democratic Republic of the Congo (DRC) has a history of nonhuman primate (NHP) consumption and exposure to simian retroviruses yet little is known about the extent of zoonotic simian retroviral infections in DRC. We examined the prevalence of human T-lymphotropic viruses (HTLV), a retrovirus group of simian origin, in a large population of persons with frequent NHP exposures and a history of simian foamy virus infection. We screened plasma from 3,051 persons living in rural villages in central DRC using HTLV EIA and western blot (WB). PCR amplification of HTLV tax and LTR sequences from buffy coat DNA was used to confirm infection and to measure proviral loads (pVLs). We used phylogenetic analyses of LTR sequences to infer evolutionary histories and potential transmission clusters. Questionnaire data was analyzed in conjunction with serological and molecular data. A relatively high proportion of the study population (5.4%, n = 165) were WB seropositive: 128 HTLV-1-like, 3 HTLV-2-like, and 34 HTLV-positive but untypeable profiles. 85 persons had HTLV indeterminate WB profiles. HTLV seroreactivity was higher in females, wives, heads of households, and increased with age. HTLV-1 LTR sequences from 109 persons clustered strongly with HTLV-1 and STLV-1 subtype B from humans and simians from DRC, with most sequences more closely related to STLV-1 from Allenopithecus nigroviridis (Allen's swamp monkey). While 18 potential transmission clusters were identified, most were in different households, villages, and health zones. Three HTLV-1-infected persons were co-infected with simian foamy virus. The mean and median percentage of HTLV-1 pVLs were 5.72% and 1.53%, respectively, but were not associated with age, NHP exposure, village, or gender. We document high HTLV prevalence in DRC likely originating from STLV-1. We demonstrate regional spread of HTLV-1 in DRC with pVLs reported to be associated with HTLV disease, supporting local and national public health measures to prevent spread and morbidity.
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- 2021
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5. Changes in childhood vaccination coverage over time in the Democratic Republic of the Congo.
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Vivian H Alfonso, Anna Bratcher, Hayley Ashbaugh, Reena Doshi, Adva Gadoth, Nicole Hoff, Patrick Mukadi, Angie Ghanem, Alvan Cheng, Sue Gerber, Guillaume Ngoie Mwamba, Jean Jacques Muyembe Tamfum, Emile Okitolonda Wemakoy, and Anne W Rimoin
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Medicine ,Science - Abstract
Despite increased vaccination rates, the burden, morbidity and mortality associated with vaccine preventable diseases remains high. In the Democratic Republic of the Congo (DRC), potentially unreliable data and geographically varied program provision call for a better understanding of vaccination coverage and its changes over time at the country and province level. To assess changes in the proportion of children who were fully vaccinated over time in the DRC, vaccination histories for children 12-59 months of age were obtained from both the 2007 and 2013-2014 Demographic and Health Surveys (DHS). Changes were assessed, both at the country- and province-levels, to identify potential geographic variations. Vaccination coverage improved 70% between the DHS waves: 26% compared to 44% of 12-59 month-old children met full vaccination criteria in 2007 and 2013-2014, respectively (n2007 = 3032 and n2013-14 = 6619). Similarly, there was an overall trend across both DHS waves where as year of birth increased, so did vaccination coverage. There was geographic variation in immunization changes with most central and eastern provinces increasing in coverage and most northern, western and southern provinces having decreased vaccination coverage at the second time point. Using nationally representative data, we identified significant changes over time in vaccination coverage which may help to inform future policy, interventions and research to improve vaccination rates among children in the DRC. This study is the first of its kind for the population of DRC and provides an important initial step towards better understanding trends in vaccination coverage over time.
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- 2019
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6. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo
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Leisha Diane Nolen, Lynda Osadebe, Jacques Katomba, Jacques Likofata, Daniel Mukadi, Benjamin Monroe, Jeffrey B. Doty, Christine Marie Hughes, Joelle Kabamba, Jean Malekani, Pierre Lokwa Bomponda, Jules Inonga Lokota, Marcel Pie Balilo, Toutou Likafi, Robert Shongo Lushima, Benoit Kebela Ilunga, Frida Nkawa, Elisabeth Pukuta, Stomy Karhemere, Jean-Jacques Muyembe Tamfum, Beatrice Nguete, Emile Okitolonda Wemakoy, Andrea M. McCollum, and Mary G. Reynolds
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monkeypox ,monkeypox virus ,viruses ,transmission ,incubation ,animal diseases ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
A >600% increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.
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- 2016
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7. Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases
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Miriam L. Shiferaw, Jeffrey B. Doty, Giorgi Maghlakelidze, Juliette Morgan, Ekaterine Khmaladze, Otar Parkadze, Marina Donduashvili, Emile Okitolonda Wemakoy, Jean-Jacques Muyembe, Leopold Mulumba, Jean Malekani, Joelle Kabamba, Theresa Kanter, Linda Lucy Boulanger, Abraham Haile, Abyot Bekele, Meseret Bekele, Kasahun Tafese, Andrea M. McCollum, and Mary G. Reynolds
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zoonoses ,public health program implementation ,prevention and control ,program design ,global health security ,Republic of Georgia ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.
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- 2017
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8. Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo
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Jeffrey R. Kugelman, Sara C. Johnston, Prime M. Mulembakani, Neville Kisalu, Michael S. Lee, Galina Koroleva, Sarah E. McCarthy, Marie C. Gestole, Nathan D. Wolfe, Joseph N. Fair, Bradley S. Schneider, Linda L. Wright, John Huggins, Chris A. Whitehouse, Emile Okitolonda Wemakoy, Jean Jacques Muyembe-Tamfum, Lisa E. Hensley, Gustavo F. Palacios, and Anne W. Rimoin
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Monkeypox virus ,genomic diversity ,emerging infectious disease ,genomic reduction ,gene loss ,Democratic Republic of the Congo ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Monkeypox virus is a zoonotic virus endemic to Central Africa. Although active disease surveillance has assessed monkeypox disease prevalence and geographic range, information about virus diversity is lacking. We therefore assessed genome diversity of viruses in 60 samples obtained from humans with primary and secondary cases of infection from 2005 through 2007. We detected 4 distinct lineages and a deletion that resulted in gene loss in 10 (16.7%) samples and that seemed to correlate with human-to-human transmission (p = 0.0544). The data suggest a high frequency of spillover events from the pool of viruses in nonhuman animals, active selection through genomic destabilization and gene loss, and increased disease transmissibility and severity. The potential for accelerated adaptation to humans should be monitored through improved surveillance. Download MP3 Length: 1:11
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- 2014
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9. Zoonotic risk factors associated with seroprevalence of Ebola virus GP antibodies in the absence of diagnosed Ebola virus disease in the Democratic Republic of Congo.
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Anna Bratcher, Nicole A Hoff, Reena H Doshi, Adva Gadoth, Megan Halbrook, Patrick Mukadi, Kamy Musene, Benoit Ilunga-Kebela, D'Andre Spencer, Matthew S Bramble, David McIlwan, J Daniel Kelly, Daniel Mukadi, Placide Mbala Kingebeni, Steve Ahuka, Emile Okitolonda-Wemakoy, Jean-Jacques Muyembe-Tamfum, and Anne W Rimoin
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundEbola virus (EBOV) is a zoonotic filovirus spread through exposure to infected bodily fluids of a human or animal. Though EBOV is capable of causing severe disease, referred to as Ebola Virus Disease (EVD), individuals who have never been diagnosed with confirmed, probable or suspected EVD can have detectable EBOV antigen-specific antibodies in their blood. This study aims to identify risk factors associated with detectable antibody levels in the absence of an EVD diagnosis.MethodologyData was collected from September 2015 to August 2017 from 1,366 consenting individuals across four study sites in the DRC (Boende, Kabondo-Dianda, Kikwit, and Yambuku). Seroreactivity was determined to EBOV GP IgG using Zaire Ebola Virus Glycoprotein (EBOV GP antigen) ELISA kits (Alpha Diagnostic International, Inc.) in Kinshasa, DRC; any result above 4.7 units/mL was considered seroreactive. Among the respondents, 113 (8.3%) were considered seroreactive. Several zoonotic exposures were associated with EBOV seroreactivity after controlling for age, sex, healthcare worker status, location, and history of contact with an EVD case, namely: ever having contact with bats, ever having contact with rodents, and ever eating non-human primate meat. Contact with monkeys or non-human primates was not associated with seroreactivity.ConclusionsThis analysis suggests that some zoonotic exposures that have been linked to EVD outbreaks can also be associated with EBOV GP seroreactivity in the absence of diagnosed EVD. Future investigations should seek to clarify the relationships between zoonotic exposures, seroreactivity, asymptomatic infection, and EVD.
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- 2021
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10. Risk Factors for Ebola Exposure in Health Care Workers in Boende, Tshuapa Province, Democratic Republic of the Congo
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Anna Bratcher, Benoit Ilunga-Kebela, Adva Gadoth, Matthew S. Bramble, Vivian H. Alfonso, Cyrus Sinai, Jean-Jacques Muyembe-Tamfum, Anne W. Rimoin, Alexis Mwanza, Bradly P. Nicholson, Nicole A. Hoff, Rupal Shah, Matthias Mossoko, Patrick Mukadi, Daniel Mukadi, Reena H. Doshi, Emile Okitolonda-Wemakoy, Joseph Wasiswa, and Russell A. Williams
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Health Personnel ,030231 tropical medicine ,Population ,Disease ,medicine.disease_cause ,Logistic regression ,Asymptomatic ,Medical and Health Sciences ,Microbiology ,health care workers ,Disease Outbreaks ,Vaccine Related ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Clinical Research ,Environmental health ,Biodefense ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,education ,Subclinical infection ,education.field_of_study ,Ebola virus ,business.industry ,Transmission (medicine) ,Prevention ,Outbreak ,Hemorrhagic Fever, Ebola ,Biological Sciences ,Ebolavirus ,Emerging Infectious Diseases ,Infectious Diseases ,Good Health and Well Being ,Immunoglobulin G ,Ebola ,Democratic Republic of the Congo ,Hemorrhagic Fever ,medicine.symptom ,business ,Infection - Abstract
Background Health care workers (HCW) are more likely to be exposed to Ebola virus (EBOV) during an outbreak compared to people in the general population due to close physical contact with patients and potential exposure to infectious fluids. However, not all will fall ill. Despite evidence of subclinical and paucisymptomatic Ebola virus disease (EVD), prevalence and associated risk factors remain unknown. Methods We conducted a serosurvey among HCW in Boende, Tshuapa Province, Democratic Republic of Congo. Human anti-EBOV glycoprotein IgG titers were measured using a commercially available ELISA kit. We assessed associations between anti-EBOV IgG seroreactivity, defined as ≥2.5 units/mL, and risk factors using univariable and multivariable logistic regression. Sensitivity analyses explored a more conservative cutoff, >5 units/mL. Results Overall, 22.5% of HCWs were seroreactive for EBOV. In multivariable analyses, using any form of personal protective equipment when interacting with a confirmed, probable, or suspect EVD case was negatively associated with seroreactivity (adjusted odds ratio, 0.23; 95% confidence interval, .07–.73). Discussion Our results suggest high exposure to EBOV among HCWs and provide additional evidence for asymptomatic or minimally symptomatic EVD. Further studies should be conducted to determine the probability of onward transmission and if seroreactivity is associated with immunity.
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- 2022
11. Poliovirus immunity among adults in the Democratic Republic of the Congo: a cross-sectional serosurvey
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Vivian H. Alfonso, Arie Voorman, Nicole A. Hoff, William C. Weldon, Sue Gerber, Adva Gadoth, Megan Halbrook, Amelia Goldsmith, Patrick Mukadi, Reena H. Doshi, Guillaume Ngoie-Mwamba, Trevon L. Fuller, Emile Okitolonda-Wemakoy, Jean-Jacques Muyembe-Tamfum, and Anne W. Rimoin
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Oral ,Adult ,Adult immunity ,viruses ,Clinical Sciences ,Infectious and parasitic diseases ,RC109-216 ,complex mixtures ,Microbiology ,Disease Outbreaks ,Vaccine Related ,Rare Diseases ,Seroepidemiologic Studies ,Clinical Research ,Biodefense ,Humans ,Child ,Preschool ,Aged ,Polio ,Prevention ,Research ,Infant ,Demographic and Health Survey ,Poliovirus Vaccine ,Poliovirus ,Cross-Sectional Studies ,Emerging Infectious Diseases ,Good Health and Well Being ,Infectious Diseases ,Medical Microbiology ,Child, Preschool ,Poliovirus Vaccine, Oral ,Vaccine-preventable diseases ,Democratic Republic of the Congo ,Female ,Immunization ,Infection ,Poliomyelitis - Abstract
Background Vaccination efforts to eradicate polio currently focus on children under 5 years of age, among whom most cases of poliomyelitis still occur. However, in the Democratic Republic of the Congo (DRC), an outbreak of wild poliovirus type 1 occurred in 2010–2011 in which 16% of cases occurred among adults; in a related outbreak in the neighboring Republic of Congo, 75% of cases occurred among the same adult age-group. Given that infected adults may transmit poliovirus, this study was designed to assess adult immunity against polioviruses. Methods We assessed poliovirus seroprevalence using dried blood spots from 5,526 adults aged 15–59 years from the 2013–2014 Demographic and Health Survey in the DRC. Results Among adults in the DRC, 74%, 72%, and 57% were seropositive for neutralizing antibodies for poliovirus types 1, 2, and 3, respectively. For all three serotypes, seroprevalence tended to be higher among older age groups, those living in households with more children, and among women. Conclusions Protection against poliovirus is generally low among adults in the DRC, particularly for type 3 poliovirus. The lack of acquired immunity in adults suggests a potentially limited poliovirus circulation over the lifetime of those surveyed (spanning 1954 through 2014) and transmission of vaccine-derived poliovirus in this age group while underscoring the risk of these outbreaks among adults in the DRC.
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- 2022
12. Prenatal chlamydial, gonococcal, and trichomonal screening in the Democratic Republic of Congo for case detection and management
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Jeffrey D. Klausner, Nicole A. Hoff, Risa M Hoffman, Emile Okitolonda-Wemakoy, Kamy Musene, Gisèle Mvumbi, Anne W. Rimoin, Chelsea Shannon, and Adva Gadoth
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Infectious Disease Transmission ,Chlamydia trachomatis ,Reproductive health and childbirth ,Azithromycin ,medicine.disease_cause ,Tinidazole ,Gonorrhea ,0302 clinical medicine ,Pregnancy ,Vertical ,Mass Screening ,Pharmacology (medical) ,030212 general & internal medicine ,Chlamydia ,Pregnancy Complications, Infectious ,Pediatric ,screening and diagnosis ,0303 health sciences ,Obstetrics ,Infectious ,Diagnostic test ,Prenatal Care ,Health Services ,Anti-Bacterial Agents ,Detection ,Treatment Outcome ,Infectious Diseases ,Medical Microbiology ,Public Health and Health Services ,Democratic Republic of the Congo ,Female ,Public Health ,Infection ,Trichomonas Vaginitis ,4.2 Evaluation of markers and technologies ,Urologic Diseases ,Adult ,medicine.medical_specialty ,Clinical Sciences ,Dermatology ,Article ,Vaccine Related ,03 medical and health sciences ,Clinical Research ,Biodefense ,Metronidazole ,Trichomonas vaginalis ,medicine ,Humans ,Conditions Affecting the Embryonic and Fetal Periods ,Case detection ,030306 microbiology ,business.industry ,screening ,Prevention ,Public Health, Environmental and Occupational Health ,Perinatal Period - Conditions Originating in Perinatal Period ,Chlamydia Infections ,Patient Acceptance of Health Care ,Infectious Disease Transmission, Vertical ,Neisseria gonorrhoeae ,Pregnancy Complications ,Good Health and Well Being ,Cross-Sectional Studies ,Africa ,Sexually Transmitted Infections ,Feasibility Studies ,trichomoniasis ,business - Abstract
Prenatal Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) infections are associated with adverse birth outcomes. As rapid diagnostic tests become available, it is important to evaluate prenatal sexually transmitted infection (STI) prevalence, as well as the acceptability and feasibility of prenatal screening programs. We recruited 371 pregnant women from four clinics in Kisantu Health Zone, Democratic Republic of Congo (DRC) from October 2016 to March 2017. Trained clinicians collected cervical swabs, and samples were tested by nucleic acid amplification for CT, NG, and TV using a GeneXpert® system. Those testing positive for an STI were treated and asked to return after 4–8 weeks for tests-of-cure. Screening for STIs was widely accepted (99%). STI prevalence at baseline was CT, 3.2%; NG, 1.5%; and TV, 14%; treatment completion was 97%. Symptoms were reported among 34% of STI-positive women at baseline, compared with 37% of STI-negative women. Upon first test-of-cure, 100% of returning women were cured of CT ( n = 10) and NG ( n = 5), but only 47% were cured of TV. This study demonstrates the feasibility of implementing diagnostic STI testing for case detection and treatment among expectant mothers in DRC, with implications for maternal and birth outcomes.
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- 2020
13. Seroreactivity against Marburg or related filoviruses in West and Central Africa
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Prime Mulembakani, Emile Okitolonda Wemakoy, Anne W. Rimoin, Jean-Jacques Muyembe-Tamfum, Sentob Saragosti, Nicole A. Hoff, Syria Laperche, Nicaise Ndembi, Kai Lu, John Hackett, Guy Olivier Mbensa, Graham Simmons, William M. Switzer, Catherine A. Brennan, and Imke Steffen
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0301 basic medicine ,Letter ,Epidemiology ,serology ,Antibodies, Viral ,Ghana ,Serology ,Seroepidemiologic Studies ,Drug Discovery ,Medicine ,Marburg Virus Disease ,Viral ,Cameroon ,biology ,hemorrhagic fever virus ,General Medicine ,Hemorrhagic fever virus ,3. Good health ,Infectious Diseases ,Filoviruses ,Antibody ,Infection ,Biotechnology ,prevalence ,030106 microbiology ,Immunology ,Enzyme-Linked Immunosorbent Assay ,Microbiology ,Antibodies ,Vaccine Related ,Marburg virus ,03 medical and health sciences ,Biodefense ,Virology ,Filoviridae Infections ,Animals ,Humans ,Seroprevalence ,Retrospective Studies ,business.industry ,Prevention ,Central africa ,Filoviridae ,Serum samples ,Marburgvirus ,biology.organism_classification ,Good Health and Well Being ,030104 developmental biology ,biology.protein ,Parasitology ,business - Abstract
A serological survey of 2,430 archived serum samples collected between 1997 and 2012 was conducted to retrospectively determine the prevalence of Marburg virus in five African countries. Serum samples were screened for neutralizing antibodies in a pseudotype micro-neutralization assay and confirmed by enzyme-linked immunosorbent assay (ELISA). Surprisingly, a seroprevalence for Marburg virus of 7.5 and 6.3% was found in Cameroon and Ghana, respectively, suggesting the circulation of filoviruses or related viruses outside of known endemic areas that remain undetected by current surveillance efforts. However, due to the lack of validated assays and appropriate positive controls, these results must be considered preliminary.
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- 2020
14. Measles antibody levels among vaccinated and unvaccinated children 6–59 months of age in the Democratic Republic of the Congo, 2013–2014
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Jean Jacques Muyembe-Tamfum, Adva Gadoth, Sue Gerber, Roger Budd, Hayley R. Ashbaugh, Guillaume Ngoie Mwamba, Vivian H. Alfonso, Emile Okitolonda-Wemakoy, Nicole A. Hoff, Reena H. Doshi, Patrick Mukadi, James D. Cherry, Christina Randall, Anne W. Rimoin, and Stephen G. Higgins
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Male ,Vaccination Coverage ,030231 tropical medicine ,Measles Vaccine ,Logistic regression ,Antibodies, Viral ,Measles ,Article ,Herd immunity ,03 medical and health sciences ,0302 clinical medicine ,Immunity ,Seroepidemiologic Studies ,Medicine ,Humans ,030212 general & internal medicine ,General Veterinary ,General Immunology and Microbiology ,Transmission (medicine) ,business.industry ,Immunization Programs ,Public Health, Environmental and Occupational Health ,Infant ,medicine.disease ,Vaccination ,Infectious Diseases ,Immunization ,Child, Preschool ,Immunoglobulin G ,Democratic Republic of the Congo ,Molecular Medicine ,Female ,Serostatus ,business ,Demography - Abstract
Background Measles is endemic in the Democratic Republic of the Congo (DRC), and 89–94% herd immunity is required to halt its transmission. Much of the World Health Organization African Region, including the DRC, has vaccination coverage below the 95% level required to eliminate measles, heightening concern of inadequate measles immunity. Methods We assessed 6706 children aged 6–59 months whose mothers were selected for interview in the 2013–2014 DRC Demographic and Health Survey. History of measles was obtained by maternal report, and classification of children who had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained from a multiplex chemiluminescent automated immunoassay dried blood spot analysis. A logistic regression model was used to identify associations of covariates with measles and seroprotection, and vaccine effectiveness (VE) was calculated. Results Out of our sample, 64% of children were seroprotected. Measles vaccination was associated with protection against measles (OR: 0.15, 95% CI: 0.03, 0.81) when administered to children 12 months of age or older. Vaccination was predictive of seroprotection at all ages. VE was highest (88%) among children 12–24 months of age. Conclusion Our results demonstrated lower than expected seroprotection against measles among vaccinated children. Understanding the factors that affect host immunity to measles will aid in developing more efficient and effective immunization programs in DRC.
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- 2020
15. Urogenital Schistosomiasis and Sexually Transmitted Coinfections among Pregnant Women in a Schistosome-Endemic Region of the Democratic Republic of Congo
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Pamina M. Gorbach, Patrick Mukadi, Marjan Javanbakht, Emile Okitolonda-Wemakoy, Anne W. Rimoin, Hayley R. Ashbaugh, Kamy Musene, Reena H. Doshi, Jeffrey D. Klausner, Adva Gadoth, Gisèle Mvumbi, and Nicole A. Hoff
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Endemic Diseases ,Cross-sectional study ,Reproductive health and childbirth ,medicine.disease_cause ,Medical and Health Sciences ,Schistosomiasis haematobia ,0302 clinical medicine ,Pregnancy ,2.2 Factors relating to the physical environment ,Pregnancy Complications, Infectious ,Aetiology ,Reproductive health ,Pediatric ,Schistosoma haematobium ,biology ,Coinfection ,Transmission (medicine) ,Obstetrics ,Infectious ,Articles ,Infectious Diseases ,Democratic Republic of the Congo ,Female ,Infection ,Adult ,Urologic Diseases ,medicine.medical_specialty ,030231 tropical medicine ,Sexually Transmitted Diseases ,Schistosomiasis ,Prenatal care ,Vaccine Related ,03 medical and health sciences ,Rare Diseases ,Clinical Research ,Tropical Medicine ,Virology ,medicine ,Humans ,Conditions Affecting the Embryonic and Fetal Periods ,business.industry ,Prevention ,Perinatal Period - Conditions Originating in Perinatal Period ,biology.organism_classification ,medicine.disease ,Female Urogenital Diseases ,Pregnancy Complications ,Vector-Borne Diseases ,Cross-Sectional Studies ,Good Health and Well Being ,Sexually Transmitted Infections ,Parasitology ,Trichomonas vaginalis ,Digestive Diseases ,business ,Chlamydia trachomatis - Abstract
Schistosomiasis afflicts an estimated 10 million pregnant women in Africa annually. With mounting evidence of adverse impacts to reproductive health resulting from urogenital schistosomiasis, including increased transmission of HIV, further research on prenatal disease epidemiology is warranted, with implications for maternal and fetal health. Between October 2016 and March 2017, we conducted a cross-sectional study examining the prevalence of urogenital schistosomiasis and its association with sexually transmitted infections (STIs) other than HIV among pregnant women visiting antenatal clinics in Kisantu health zone, Democratic Republic of Congo. An extensive sociodemographic and clinical survey was administered to consenting participants, with urine samples and vaginal swabs collected to deduce active schistosomiasis and STIs, respectively. In total, 17.4% of expectant mothers were infected with Schistosoma haematobium, 3.1% with Chlamydia trachomatis (CT), 1.4% with Neisseria gonorrhoeae (NG), and 14.6% with Trichomonas vaginalis (TV). Women infected with urogenital schistosomiasis were at significantly increased odds of harboring a CT, NG, or TV infection (adjusted odds ratio = 3.0, 95% CI: 1.5, 6.0), but reports of clinical symptoms were low, ranging from 17.2% of schistosomiasis to 30.8% of TV cases. Laboratory confirmation of schistosomiasis and STIs provided objective evidence of disease in a cohort with low symptomology where syndromic management may not suffice. Shedding light on local risk factors and associated coinfections of urogenital schistosomiasis can identify unique intervention opportunities for prenatal care in trematode-endemic regions and aid in reducing adverse pregnancy outcomes.
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- 2019
16. Tetanus seroprotection among children in the Democratic Republic of the Congo, 2013-2014
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Alvan Cheng, Angie Ghanem-Uzqueda, Nicole A. Hoff, Hayley Ashbaugh, Reena H. Doshi, Patrick Mukadi, Roger Budd, Stephen G. Higgins, Christina Randall, Sue Gerber, Michel Kabamba, Guilluame Ngoie Mwamba, Emile Okitolonda-Wemakoy, Jean Jacques Muyembe-Tanfum, Anne W. Rimoin, and Borrow, Ray
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Pediatric ,and promotion of well-being ,Multidisciplinary ,Tetanus ,General Science & Technology ,Prevention ,Vaccination ,Infant ,Prevention of disease and conditions ,Vaccine Related ,Emerging Infectious Diseases ,Infectious Diseases ,Good Health and Well Being ,3.4 Vaccines ,Seroepidemiologic Studies ,Democratic Republic of the Congo ,Tetanus Toxoid ,Humans ,Immunization ,Child ,Measles - Abstract
Background Tetanus is a potentially fatal disease that is preventable through vaccination. While the Democratic Republic of the Congo (DRC) has continued to improve implementing routine vaccination activities throughout the country, they have struggled to maintain high childhood vaccine coverage. This study aims to examine the seroprevalence of tetanus in children 6 to 59 months to identify areas for intervention and improvement of vaccination coverage. Methods In collaboration with the 2013–2014 Demographic and Health Survey, we assessed the seroprevalence of tetanus antibodies among children in the DRC. Dried blood spot samples collected from children 6–59 months of age were processed using a prototype DYNEX Multiplier® chemiluminescent automated immunoassay instrument with a multiplex measles, mumps, rubella, varicella and tetanus assay. Multivariable logistic regression was used to determine factors associated with tetanus vaccination and seroprotection. Results Overall, 36.1% of children 6–59 months of age reported receiving at least 1 dose of tetanus vaccine while 28.7% reported receiving 3 doses; tetanus seroprotection was 40%. Increasing age in children was associated with decreased tetanus seroprotection, but increased number tetanus vaccinations received. Factors related to increased tetanus seroprotection included number of children in the household, wealth index of the family, urban residence compared to rural, level of maternal education, and province and geography. Conclusions Our findings in this nationally representative sample indicate that serology biomarkers may help identify children who are not fully immunized to tetanus more accurately than reported vaccination. While children may be captured for routine immunization activities, as children age, decreasing seroprevalence may indicate additional need to bolster routine vaccination activities and documentation of vaccination in school aged children. Additionally, the study highlights gaps in rural residential areas and vaccination coverage based on maternal education, indicating that policies targeting maternal education and awareness could improve the coverage and seroprevalence of tetanus antibodies in the DRC.
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- 2021
17. Serologic Prevalence of Ebola Virus in Equatorial Africa
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Catherine A. Brennan, Susan L. Stramer, Lauren K. Yamamoto, Jean-Jacques Muyembe-Tamfum, Sentob Saragosti, Nicaise Ndembi, William M. Switzer, Nicole A. Hoff, Syria Laperche, Guy Olivier Mbensa, Imke Steffen, Prime Mulembakani, John Hackett, Graham Simmons, Kai Lu, Anne W. Rimoin, and Emile Okitolonda Wemakoy
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Blood transfusion ,Epidemiology ,medicine.medical_treatment ,lcsh:Medicine ,medicine.disease_cause ,Antibodies, Viral ,Ghana ,Serology ,Ebola virus ,0302 clinical medicine ,Viral Envelope Proteins ,Seroepidemiologic Studies ,neutralization assay ,Medicine ,Uganda ,Viral ,Cameroon ,030212 general & internal medicine ,Central ,biology ,Viral Core Proteins ,hemorrhagic fever virus ,Hemorrhagic fever virus ,Ebolavirus ,3. Good health ,pseudotypes ,Infectious Diseases ,Medical Microbiology ,Ebola ,Democratic Republic of the Congo ,Public Health and Health Services ,ELISA ,Antibody ,Infection ,filovirus ,Microbiology (medical) ,Republic of the Congo ,Clinical Sciences ,030231 tropical medicine ,Enzyme-Linked Immunosorbent Assay ,Microbiology ,serologic prevalence ,Antibodies ,lcsh:Infectious and parasitic diseases ,Vaccine Related ,03 medical and health sciences ,Biodefense ,folivirus ,Microneutralization Assay ,Seroprevalence ,Humans ,Immunoprecipitation ,Africa, Central ,viruses ,lcsh:RC109-216 ,business.industry ,Prevention ,Research ,lcsh:R ,Outbreak ,equatorial Africa ,Hemorrhagic Fever, Ebola ,Virology ,Emerging Infectious Diseases ,Good Health and Well Being ,HEK293 Cells ,Nucleoproteins ,Africa ,biology.protein ,Hemorrhagic Fever ,business ,luciferase immunoprecipitation system - Abstract
We conducted a serologic survey of 2,430 serum samples collected during 1997-2012 for various studies to determine the prevalence of the hemorrhagic fever virus Ebola virus (EBOV) in equatorial Africa. We screened serum samples for neutralizing antibodies by using a pseudotype microneutralization assay and a newly developed luciferase immunoprecipitation system assay. Specimens seroreactive for EBOV were confirmed by using an ELISA. Our results suggest a serologic prevalence of 2%-3.5% in the Republic of the Congo and the Democratic Republic of the Congo, which have reported outbreaks of infection with EBOV. In addition we detected a seroprevalence of 1.3% in southern Cameroon, which indicated a low risk for exposure in this region.
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- 2019
18. Spatial and molecular mapping of Pfkelch13 gene polymorphism in Africa in the era of emerging Plasmodium falciparum resistance to artemisinin : a systematic review
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Yoshio Yamaoka, Emile Okitolonda Wemakoy, Nadine Kalenda Kayiba, Angel Rosas-Aguirre, Marie-Pierre Hayette, Doudou Malekita Yobi, Patrick De Mol, Georges Lelo Mvumbi, Niko Speybroeck, Dieudonné Makaba Mvumbi, Evariste Tshibangu-Kabamba, Vo Phuoc Tuan, Brecht Devleesschauwer, and UCL - SSS/IRSS - Institut de recherche santé et société
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0301 basic medicine ,030231 tropical medicine ,030106 microbiology ,Genes, Protozoan ,Plasmodium falciparum ,Drug Resistance ,Protozoan Proteins ,Drug resistance ,Polymorphism, Single Nucleotide ,03 medical and health sciences ,Antimalarials ,0302 clinical medicine ,parasitic diseases ,medicine ,Medicine and Health Sciences ,Humans ,Allele ,Artemisinin ,Malaria, Falciparum ,Gene ,Genetics ,Resistance (ecology) ,biology ,Biology and Life Sciences ,DNA, Protozoan ,medicine.disease ,biology.organism_classification ,Artemisinins ,Infectious Diseases ,Africa ,Mutation ,Gene polymorphism ,Malaria ,medicine.drug - Abstract
The spread of Plasmodium falciparum isolates carrying mutations in the kelch13 (Pfkelch13) gene associated with artemisinin resistance (PfART-R) in southeast Asia threatens malaria control and elimination efforts. Emergence of PfART-R in Africa would result in a major public health problem. In this systematic review, we investigate the frequency and spatial distribution of Pfkelch13 mutants in Africa, including mutants linked to PfART-R in southeast Asia. Seven databases were searched (PubMed, Embase, Scopus, African Journal Online, African Index Medicus, Bioline, and Web of Science) for relevant articles about polymorphisms of the Pfkelch13 gene in Africa before January, 2019. Following PRISMA guidelines, 53 studies that sequenced the Pfkelch13 gene of 23 100 sample isolates in 41 sub-Saharan African countries were included. The Pfkelch13 sequence was highly polymorphic (292 alleles, including 255 in the Pfkelch13-propeller domain) but with mutations occurring at very low relative frequencies. Non-synonymous mutations were found in only 626 isolates (2·7%) from west, central, and east Africa. According to WHO, nine different mutations linked to PfART-R in southeast Asia (Phe446Ile, Cys469Tyr, Met476Ile, Arg515Lys, Ser522Cys, Pro553Leu, Val568Gly, Pro574Leu, and Ala675Val) were detected, mainly in east Africa. Several other Pfkelch13 mutations, such as those structurally similar to southeast Asia PfART-R mutations, were also identified, but their relevance for drug resistance is still unknown. This systematic review shows that Africa, thought to not have established PfART-R, reported resistance-related mutants in the past 5 years. Surveillance using PfART-R molecular markers can provide valuable decision-making information to sustain the effectiveness of artemisinin in Africa.
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- 2021
19. The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018-2020 Outbreak in the Democratic Republic of the Congo
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Seth Blumberg, Sarah Rae Wannier, Caitlin A. Moe, Gerardo Chowell-Puente, Travis C. Porco, Jean Jacques Muyembe-Tamfum, Eugene T Richardson, Anne W. Rimoin, John Daniel Kelly, Nicole A. Hoff, Bernice Selo, Thomas M. Lietman, Cyrus Sinai, George W. Rutherford, Emile Okitolonda-Wemakoy, James Holland Jones, and Mathais Mossoko
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History ,Injury control ,Accident prevention ,media_common.quotation_subject ,030231 tropical medicine ,Poison control ,Geographic Mapping ,Ebola virus disease ,Civil Disorders ,medicine.disease_cause ,Medical and Health Sciences ,Microbiology ,law.invention ,Disease Outbreaks ,Major Articles and Brief Reports ,03 medical and health sciences ,violence ,0302 clinical medicine ,law ,medicine ,Immunology and Allergy ,Humans ,AcademicSubjects/MED00860 ,030212 general & internal medicine ,media_common ,Violence Research ,Peace ,Ebola virus ,transmission ,Outbreak ,Hemorrhagic Fever, Ebola ,Armed Conflicts ,Biological Sciences ,Ebolavirus ,Confidence interval ,Democracy ,Justice and Strong Institutions ,AcademicSubjects/MED00290 ,Infectious Diseases ,Transmission (mechanics) ,Mental Health ,Good Health and Well Being ,Viruses ,Ebola ,Africa ,Democratic Republic of the Congo ,Hemorrhagic Fever ,Demography - Abstract
Background Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. Methods We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. Results Average Rt was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission. Conclusions Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission., A time-series study of the 2018–2020 Ebola virus disease outbreak in the Democratic Republic of the Congo found both Ebola-targeted and untargeted violence increased transmission, though targeted violence, primarily driven by civilian-involved events, had the largest impact.
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- 2020
20. Human T-cell lymphotropic virus type 1 transmission dynamics in rural villages in the Democratic Republic of the Congo with high nonhuman primate exposure
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Nicole A. Hoff, William M. Switzer, HaoQiang Zheng, Emile Okitolonda Wemakoy, Jean-Jacques Muyembe, Ellsworth M. Campbell, Megan Halbrook, Anupama Shankar, Anne W. Rimoin, Adva Gadoth, and Van Weyenbergh, Johan
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0301 basic medicine ,RNA viruses ,Epidemiology ,viruses ,RC955-962 ,Simian foamy virus ,Artificial Gene Amplification and Extension ,Simian ,Monkeys ,Pathology and Laboratory Medicine ,Polymerase Chain Reaction ,Medical and Health Sciences ,Serology ,Allenopithecus nigroviridis ,Geographical Locations ,Retrovirus ,Medical Conditions ,Proviruses ,Arctic medicine. Tropical medicine ,Surveys and Questionnaires ,Zoonoses ,Medicine and Health Sciences ,2.2 Factors relating to the physical environment ,Public and Occupational Health ,Human T cell lymphotropic virus type 1 ,Aetiology ,Child ,Phylogeny ,Data Management ,Mammals ,Family Characteristics ,Human T-lymphotropic virus 1 ,biology ,Transmission (medicine) ,Human T-lymphotropic virus 2 ,Monkey Diseases ,Eukaryota ,Phylogenetic Analysis ,Biological Sciences ,Viral Load ,Phylogenetics ,Infectious Diseases ,Medical Microbiology ,Viral Pathogens ,Viruses ,Vertebrates ,Democratic Republic of the Congo ,Population study ,Female ,Public Health ,Public aspects of medicine ,RA1-1270 ,Pathogens ,Infection ,Simian T-lymphotropic virus 1 ,Research Article ,Primates ,Computer and Information Sciences ,Adolescent ,030106 microbiology ,Wild ,Animals, Wild ,Research and Analysis Methods ,Microbiology ,03 medical and health sciences ,Tropical Medicine ,Retroviruses ,Genetics ,Animals ,Humans ,Evolutionary Systematics ,Molecular Biology Techniques ,Microbial Pathogens ,Molecular Biology ,Taxonomy ,Evolutionary Biology ,Biology and life sciences ,Public Health, Environmental and Occupational Health ,Organisms ,Htlv-1 ,biology.organism_classification ,Virology ,HTLV-I Infections ,030104 developmental biology ,Good Health and Well Being ,Medical Risk Factors ,Amniotes ,People and Places ,Africa ,Zoology ,Retroviridae Infections - Abstract
The Democratic Republic of the Congo (DRC) has a history of nonhuman primate (NHP) consumption and exposure to simian retroviruses yet little is known about the extent of zoonotic simian retroviral infections in DRC. We examined the prevalence of human T-lymphotropic viruses (HTLV), a retrovirus group of simian origin, in a large population of persons with frequent NHP exposures and a history of simian foamy virus infection. We screened plasma from 3,051 persons living in rural villages in central DRC using HTLV EIA and western blot (WB). PCR amplification of HTLV tax and LTR sequences from buffy coat DNA was used to confirm infection and to measure proviral loads (pVLs). We used phylogenetic analyses of LTR sequences to infer evolutionary histories and potential transmission clusters. Questionnaire data was analyzed in conjunction with serological and molecular data. A relatively high proportion of the study population (5.4%, n = 165) were WB seropositive: 128 HTLV-1-like, 3 HTLV-2-like, and 34 HTLV-positive but untypeable profiles. 85 persons had HTLV indeterminate WB profiles. HTLV seroreactivity was higher in females, wives, heads of households, and increased with age. HTLV-1 LTR sequences from 109 persons clustered strongly with HTLV-1 and STLV-1 subtype B from humans and simians from DRC, with most sequences more closely related to STLV-1 from Allenopithecus nigroviridis (Allen’s swamp monkey). While 18 potential transmission clusters were identified, most were in different households, villages, and health zones. Three HTLV-1-infected persons were co-infected with simian foamy virus. The mean and median percentage of HTLV-1 pVLs were 5.72% and 1.53%, respectively, but were not associated with age, NHP exposure, village, or gender. We document high HTLV prevalence in DRC likely originating from STLV-1. We demonstrate regional spread of HTLV-1 in DRC with pVLs reported to be associated with HTLV disease, supporting local and national public health measures to prevent spread and morbidity., Author summary HTLV-1 is a human retrovirus of zoonotic simian origin that has spread globally causing inflammatory and carcinogenic disease. We previously showed that persons with high nonhuman primate (NHP) exposure in the Democratic Republic of the Congo (DRC) can be infected with another simian retrovirus, simian foamy virus (SFV), suggesting they are also at risk for infection with STLV-1. We conducted follow-up analysis of the same persons from rural villages of central DRC to determine exposure and transmission risks for STLV-1 and HTLV-1 infection. Most persons, especially women, reported high levels of NHP exposure. We identified possible introduction and spread of STLV-1 from a local monkey species across households, villages, and health zones in DRC. Most persons had HTLV-1 levels above those reported in previous studies for persons with disease. Our findings reveal that coordinated public health strategies are needed at both local and national levels to prevent further spread and morbidity of HTLV-1.
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- 2020
21. A Tale of Two Viruses: Coinfections of Monkeypox and Varicella Zoster Virus in the Democratic Republic of Congo
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Whitni Davidson, Toutou Likafi, Benjamin Monroe, Mary G. Reynolds, Robert Shongo Lushima, Andrea M. McCollum, Kimberly Wilkins, Stomy Karhemere, Kay Radford, D. Scott Schmid, Jean Malekani, Jean-Jacques Muyembe Tamfum, Beatrice Nguete, Christine M. Hughes, Maureen G. Metcalfe, Lindy Liu, Elisabeth Pukuta, Emile Okitolonda Wemakoy, and Joelle Kabamba
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Adult ,Male ,medicine.medical_specialty ,Herpesvirus 3, Human ,Adolescent ,viruses ,030231 tropical medicine ,Disease ,medicine.disease_cause ,Herpes Zoster ,Lesion ,03 medical and health sciences ,Monkeypox ,Young Adult ,0302 clinical medicine ,Virology ,Epidemiology ,medicine ,Humans ,Orthopoxvirus ,Monkeypox virus ,Child ,Aged ,Aged, 80 and over ,biology ,business.industry ,Coinfection ,Varicella zoster virus ,virus diseases ,Infant ,Articles ,biochemical phenomena, metabolism, and nutrition ,Middle Aged ,medicine.disease ,biology.organism_classification ,Rash ,Infectious Diseases ,Child, Preschool ,Epidemiological Monitoring ,Democratic Republic of the Congo ,Parasitology ,Female ,medicine.symptom ,business - Abstract
Recent enhanced monkeypox (MPX) surveillance in the Democratic Republic of Congo, where MPX is endemic, has uncovered multiple cases of MPX and varicella zoster virus (VZV) coinfections. The purpose of this study was to verify if coinfections occur and to characterize the clinical nature of these cases. Clinical, epidemiological, and laboratory results were used to investigate MPX/VZV coinfections. A coinfection was defined as a patient with at least one Orthopoxvirus/MPX-positive sample and at least one VZV-positive sample within the same disease event. Between September 2009 and April 2014, 134 of the 1,107 (12.1%) suspected MPX cases were confirmed as MPX/VZV coinfections. Coinfections were more likely to report symptoms than VZV-alone cases and less likely than MPX-alone cases. Significantly higher lesion counts were observed for coinfection cases than for VZV-alone but less than MPX-alone cases. Discernible differences in symptom and rash severity were detected for coinfection cases compared with those with MPX or VZV alone. Findings indicate infection with both MPX and VZV could modulate infection severity. Collection of multiple lesion samples allows for the opportunity to detect coinfections. As this program continues, it will be important to continue these procedures to assess variations in the proportion of coinfected cases over time.
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- 2020
22. Varicella Coinfection in Patients with Active Monkeypox in the Democratic Republic of the Congo
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James O. Lloyd-Smith, Douglas S. Morier, Lisa E. Hensley, Nicole A. Hoff, Sara C. Johnston, Anne W. Rimoin, Reena H. Doshi, Jean Jacques Muyembe-Tamfum, Neville K. Kisalu, and Emile Okitolonda-Wemakoy
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Adult ,Male ,0301 basic medicine ,Herpesvirus 3, Human ,Adolescent ,viruses ,Health, Toxicology and Mutagenesis ,030106 microbiology ,030231 tropical medicine ,medicine.disease_cause ,Young Adult ,03 medical and health sciences ,Monkeypox ,Chickenpox ,0302 clinical medicine ,Prevalence ,Animals ,Humans ,Medicine ,Monkeypox virus ,Child ,Aged ,Aged, 80 and over ,Ecology ,biology ,Coinfection ,business.industry ,Incidence ,Incidence (epidemiology) ,Infant, Newborn ,Varicella zoster virus ,Infant ,Middle Aged ,medicine.disease ,biology.organism_classification ,Virology ,Animal ecology ,Child, Preschool ,Epidemiological Monitoring ,Democratic Republic of the Congo ,Emerging infectious disease ,Female ,business - Abstract
From 2006 to 2007, an active surveillance program for human monkeypox (MPX) in the Democratic Republic of the Congo identified 151 cases of coinfection with monkeypox virus and varicella zoster virus from 1158 suspected cases of human MPX (13%). Using clinical and socio-demographic data collected with standardized instruments by trained, local nurse supervisors, we examined a variety of hypotheses to explain the unexpectedly high proportion of coinfections among the sample, including the hypothesis that the two viruses occur independently. The probabilities of disease incidence and selection necessary to yield the observed sample proportion of coinfections under an assumption of independence are plausible given what is known and assumed about human MPX incidence. Cases of human MPX are expected to be underreported, and more coinfections are expected with improved surveillance.
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- 2017
23. Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013
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Jamie Lloyd-Smith, Jean-Jacque Muyembe-Tamfum, Patrick Mukadi, Mathias Mossoko, Nicole A. Hoff, Brian Colwell, D’Andre Spencer, Anne W. Rimoin, Reena H. Doshi, Emile Okitolonda-Wemakoy, and Benoit Kebela-Illunga
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Disease occurrence ,030231 tropical medicine ,Disease ,Article ,Vaccine Related ,passive surveillance ,03 medical and health sciences ,Monkeypox ,Rare Diseases ,0302 clinical medicine ,Environmental protection ,Biodefense ,Environmental health ,medicine ,030212 general & internal medicine ,Aetiology ,Disease surveillance ,Data collection ,business.industry ,Prevention ,Incidence (epidemiology) ,Human monkeypox ,General Medicine ,Democratic Republic of Congo ,medicine.disease ,disease trends ,Infectious Diseases ,Emerging Infectious Diseases ,Good Health and Well Being ,Epidemiological surveillance ,business ,2.4 Surveillance and distribution - Abstract
Objective Evaluating the effectiveness of a surveillance system, and how it improves over time has significant implications for disease control and prevention. In the Democratic Republic of Congo (DRC), the Integrated Disease Surveillance and Response (IDSR) was implemented to estimate the burden of disease, monitor changes in disease occurrence, and inform resource allocation. For this effort we utilized national passive surveillance data from DRC's IDSR to explore reporting trends of human monkeypox (MPX) from 2001 to 2013. Methods We obtained surveillance data on MPX cases occurring between January 2001 and December 2013 from the DRC Ministry of Health (MoH). Phases of the surveillance system, yearly trends in reporting and estimated incidence for MPX were analyzed using SAS v9.2 and Health Mapper. Results Between 2001 and 2013, three discrete surveillance phases were identified that described the evolution of the surveillance system. Overall, an increase in suspected MPX cases was reported, beyond what would be expected from simply an improved reporting system. When restricting the analysis to the "stable phase," national estimated incidence increased from 2.13 per 100,000 in 2008 to 2.84 per 100,000 in 2013. Conclusions The reported increase in MPX, based on an evolving surveillance system, is likely to be a true increase in disease occurrence rather than simply improvements to the surveillance system. Further analyses should provide critical information for improved prevention and control strategies and highlight areas of improvement for future data collection efforts.
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- 2017
24. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance
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Julian W Tang, Tommy T Lam, Hassan Zaraket, W Ian Lipkin, Steven J Drews, Todd F Hatchette, Jean-Michel Heraud, Marion P Koopmans, Ashta Mary Abraham, Amal Baraket, Seweryn Bialasiewicz, Miguela A Caniza, Paul KS Chan, Cheryl Cohen, André Corriveau, Benjamin J Cowling, Marcela Echavarria, Ron Fouchier, Pieter LA Fraaij, Todd F Hachette, Hamid Jalal, Lance Jennings, Alice Kabanda, Herve A Kadjo, Mohammed Rafiq Khanani, Evelyn SC Koay, Mel Krajden, Hong Kai Lee, W. Ian Lipkin, Julius Lutwama, David Marchant, Hidekazu Nishimura, Pagbajabyn Nymadawa, Benjamin A Pinsky, Sanjiv Rughooputh, Joseph Rukelibuga, Taslimarif Saiyed, Anita Shet, Theo Sloots, JJ Muyembe Tamfum, Stefano Tempia, Sarah Tozer, Florette Treurnicht, Matti Waris, Aripuana Watanabe, Emile Okitolonda Wemakoy, University Hospitals Leicester, The University of Hong Kong (HKU), American University of Beirut [Beyrouth] (AUB), Columbia University [New York], University of Alberta, International Network for the Sequencing of resPIRratory vIrusEs (INSPIRE), Dalhousie University [Halifax], Unité de Virologie [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Institut Pasteur de Côte d'Ivoire, Réseau International des Instituts Pasteur (RIIP), and Virology
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0301 basic medicine ,medicine.medical_specialty ,viruses ,MESH: Global Health ,Disease ,medicine.disease_cause ,Virus ,MESH: Population Surveillance ,03 medical and health sciences ,0302 clinical medicine ,Human metapneumovirus ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,Epidemiology ,medicine ,Global health ,030212 general & internal medicine ,Coronavirus ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,MESH: Humans ,biology ,virus diseases ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,biology.organism_classification ,Virology ,3. Good health ,030104 developmental biology ,Infectious Diseases ,Preparedness ,MESH: Respiratory Tract Infections ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Rhinovirus ,MESH: RNA Viruses - Abstract
International audience; Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, little is known about the contemporaneous global diversity of these viruses, and the relevance of such for development of pharmaceutical interventions. Although far less advanced than for influenza, antiviral drugs and vaccines are in different stages of development for several of these viruses, but no interventions have been licensed. This scarcity of global genetic data represents a substantial knowledge gap and impediment to the eventual licensing of new antiviral drugs and vaccines for NIRVs. Enhanced genetic surveillance will assist and boost research and development into new antiviral drugs and vaccines for these viruses. Additionally, understanding the global diversity of respiratory viruses is also part of emerging disease preparedness, because non-human coronaviruses and paramyxoviruses have been listed as priority concerns in a recent WHO research and development blueprint initiative for emerging infectious diseases. In this Personal View, we explain further the rationale for expanding the genetic database of NIRVs and emphasise the need for greater investment in this area of research.
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- 2017
25. Real-time predictions of the 2018-2019 Ebola virus disease outbreak in the Democratic Republic of the Congo using Hawkes point process models
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Emile Okitolonda-Wemakoy, Bathe Njoloko, J. Daniel Kelly, Placide Mbala-Kingebeni, Jean Jacques Muyembe-Tamfum, Steve Ahuka-Mundeke, Rae Wannier, Ryan J. Harrigan, Sarita D. Lee, Thomas B. Smith, Nicole A. Hoff, Frederic Paik Schoenberg, Junhyung Park, George W. Rutherford, Anne W. Rimoin, Mathias Mossoko, and Bernice Selo
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Epidemiology ,medicine.disease_cause ,Disease Outbreaks ,0302 clinical medicine ,Theoretical ,Models ,030212 general & internal medicine ,Prospective Studies ,media_common ,Mathematical modelling ,Hawkes point process ,Data Collection ,Statistical ,Ebolavirus ,Democracy ,Infectious Diseases ,Geography ,Ebola ,Democratic Republic of the Congo ,Public Health and Health Services ,Christian ministry ,Infection ,media_common.quotation_subject ,030231 tropical medicine ,Decision Making ,Clinical Sciences ,Armed conflict ,Ebola virus disease ,Bioengineering ,Microbiology ,Article ,World health ,lcsh:Infectious and parasitic diseases ,Civil strife ,Time ,Vaccine Related ,03 medical and health sciences ,Biodefense ,Virology ,medicine ,Humans ,lcsh:RC109-216 ,Models, Statistical ,Ebola virus ,Prevention ,Public Health, Environmental and Occupational Health ,Outbreak ,Hemorrhagic Fever, Ebola ,Models, Theoretical ,Democratic Republic of Congo ,Emerging Infectious Diseases ,Good Health and Well Being ,Hemorrhagic Fever ,Parasitology ,Mathematical modeling ,Point process models ,Compartmental models ,Demography - Abstract
As of June 16, 2019, an Ebola virus disease (EVD) outbreak has led to 2136 reported cases in the northeastern region of the Democratic Republic of the Congo (DRC). As this outbreak continues to threaten the lives and livelihoods of people already suffering from civil strife and armed conflict, relatively simple mathematical models and their short-term predictions have the potential to inform Ebola response efforts in real time. We applied recently developed non-parametrically estimated Hawkes point processes to model the expected cumulative case count using daily case counts from May 3, 2018, to June 16, 2019, initially reported by the Ministry of Health of DRC and later confirmed in World Health Organization situation reports. We generated probabilistic estimates of the ongoing EVD outbreak in DRC extending both before and after June 16, 2019, and evaluated their accuracy by comparing forecasted vs. actual outbreak sizes, out-of-sample log-likelihood scores and the error per day in the median forecast. The median estimated outbreak sizes for the prospective thee-, six-, and nine-week projections made using data up to June 16, 2019, were, respectively, 2317 (95% PI: 2222, 2464); 2440 (95% PI: 2250, 2790); and 2544 (95% PI: 2273, 3205). The nine-week projection experienced some degradation with a daily error in the median forecast of 6.73 cases, while the six- and three-week projections were more reliable, with corresponding errors of 4.96 and 4.85 cases per day, respectively. Our findings suggest the Hawkes point process may serve as an easily-applied statistical model to predict EVD outbreak trajectories in near real-time to better inform decision-making and resource allocation during Ebola response efforts. Keywords: Ebola virus disease, Hawkes point process, Mathematical modeling, Democratic Republic of Congo, Compartmental models
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- 2019
26. Projections of epidemic transmission and estimation of vaccination impact during an ongoing Ebola virus disease outbreak in Northeastern Democratic Republic of Congo, as of Feb. 25, 2019
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Emile Okitolonda-Wemakoy, Mathias Mossoko, Bernice Selo, Kamy Musene, Lee Worden, Travis C. Porco, Anne W. Rimoin, Rae Wannier, Nicole A. Hoff, Thomas M. Lietman, Jean Jacques Muyembe Tamfum, George W. Rutherford, J. Daniel Kelly, and Peterson, Townsend
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0301 basic medicine ,Viral Diseases ,Vaccination Coverage ,Epidemiology ,RC955-962 ,Binomials ,Prevalence ,Negative binomial distribution ,medicine.disease_cause ,Polynomials ,Medical and Health Sciences ,Disease Outbreaks ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Theoretical ,Models ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,Public and Occupational Health ,Prospective Studies ,Vaccines ,Simulation and Modeling ,Statistics ,Biological Sciences ,Ebolavirus ,Vaccination and Immunization ,Curve Fitting ,3. Good health ,Geography ,Infectious Diseases ,Physical Sciences ,Ebola ,Democratic Republic of the Congo ,Regression Analysis ,Public aspects of medicine ,RA1-1270 ,Infection ,Research Article ,Neglected Tropical Diseases ,medicine.medical_specialty ,Infectious Disease Control ,Health Personnel ,Immunology ,030231 tropical medicine ,Research and Analysis Methods ,Ebola Hemorrhagic Fever ,Vaccine Related ,03 medical and health sciences ,Biodefense ,Tropical Medicine ,medicine ,Humans ,Statistical Methods ,Viral Hemorrhagic Fevers ,Ebola virus ,Prevention ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,Prediction interval ,Outbreak ,Hemorrhagic Fever, Ebola ,Models, Theoretical ,Tropical Diseases ,Algebra ,030104 developmental biology ,Emerging Infectious Diseases ,Good Health and Well Being ,13. Climate action ,Hemorrhagic Fever ,Immunization ,Preventive Medicine ,Mathematical Functions ,Mathematics ,Contact tracing ,Forecasting ,Demography - Abstract
Background As of February 25, 2019, 875 cases of Ebola virus disease (EVD) were reported in North Kivu and Ituri Provinces, Democratic Republic of Congo. Since the beginning of October 2018, the outbreak has largely shifted into regions in which active armed conflict has occurred, and in which EVD cases and their contacts have been difficult for health workers to reach. We used available data on the current outbreak, with case-count time series from prior outbreaks, to project the short-term and long-term course of the outbreak. Methods For short- and long-term projections, we modeled Ebola virus transmission using a stochastic branching process that assumes gradually quenching transmission rates estimated from past EVD outbreaks, with outbreak trajectories conditioned on agreement with the course of the current outbreak, and with multiple levels of vaccination coverage. We used two regression models to estimate similar projection periods. Short- and long-term projections were estimated using negative binomial autoregression and Theil-Sen regression, respectively. We also used Gott’s rule to estimate a baseline minimum-information projection. We then constructed an ensemble of forecasts to be compared and recorded for future evaluation against final outcomes. From August 20, 2018 to February 25, 2019, short-term model projections were validated against known case counts. Results During validation of short-term projections, from one week to four weeks, we found models consistently scored higher on shorter-term forecasts. Based on case counts as of February 25, the stochastic model projected a median case count of 933 cases by February 18 (95% prediction interval: 872–1054) and 955 cases by March 4 (95% prediction interval: 874–1105), while the auto-regression model projects median case counts of 889 (95% prediction interval: 876–933) and 898 (95% prediction interval: 877–983) cases for those dates, respectively. Projected median final counts range from 953 to 1,749. Although the outbreak is already larger than all past Ebola outbreaks other than the 2013–2016 outbreak of over 26,000 cases, our models do not project that it is likely to grow to that scale. The stochastic model estimates that vaccination coverage in this outbreak is lower than reported in its trial setting in Sierra Leone. Conclusions Our projections are concentrated in a range up to about 300 cases beyond those already reported. While a catastrophic outbreak is not projected, it is not ruled out, and prevention and vigilance are warranted. Prospective validation of our models in real time allowed us to generate more accurate short-term forecasts, and this process may prove useful for future real-time short-term forecasting. We estimate that transmission rates are higher than would be seen under target levels of 62% coverage due to contact tracing and vaccination, and this model estimate may offer a surrogate indicator for the outbreak response challenges., Author summary As of February 25, 2019, 875 cases of Ebola virus disease (EVD) were reported in North Kivu and Ituri Provinces, Democratic Republic of Congo. Since the beginning of October 2018, the outbreak has largely shifted into regions in which active armed conflict has been reported, and in which EVD cases and their contacts have been difficult for health workers to reach. We used an ensemble of models to estimate EVD transmission rates and to forecast the short- and long-term course of the outbreak. Our models project that a final size of roughly up to 300 additional cases is most likely, and estimate that transmission rates are higher than would be seen under optimal levels of contact tracing and vaccination. While a catastrophic outbreak is not projected, is it not ruled out, and prevention and vigilance are warranted.
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- 2019
27. Field Test and Validation of the Multiplier Measles, Mumps, Rubella, and Varicella-Zoster Multiplexed Assay System in the Democratic Republic of the Congo by Using Dried Blood Spots
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Hayley R. Ashbaugh, Christina Randall, Melanie Poncheri, Russell A. Williams, Jean-Jacque Muyembe-Tamfum, Patrick Mukadi, Robert Wolfert, Reena H. Doshi, Adva Gadoth, Andrew Fusellier, Vivian H. Alfonso, Nicole A. Hoff, Anne W. Rimoin, Stephen G. Higgins, Emile Okitolonda-Wemakoy, Sue Gerber, Roger Budd, and Pasetti, Marcela F
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Antibodies, Viral ,Medical and Health Sciences ,Laboratory ,Clinical Science and Epidemiology ,Automation ,0302 clinical medicine ,Chickenpox ,Medicine ,Multiplex ,030212 general & internal medicine ,Viral ,Dried blood ,Immunoassay ,Indirect immunofluorescence ,medicine.diagnostic_test ,Biological Sciences ,QR1-502 ,assay validation ,multiplex assay ,Infectious Diseases ,Democratic Republic of the Congo ,Infection ,Research Article ,Biotechnology ,Analyte ,medicine.medical_specialty ,Mumps measles rubella ,030231 tropical medicine ,Rubella ,Measles ,Sensitivity and Specificity ,Microbiology ,Antibodies ,Vaccine Related ,03 medical and health sciences ,Humans ,Medical physics ,MMRV ,Molecular Biology ,Mumps ,Automation, Laboratory ,business.industry ,Prevention ,Reproducibility of Results ,medicine.disease ,Emerging Infectious Diseases ,Good Health and Well Being ,Luminescent Measurements ,Immunization ,Dried Blood Spot Testing ,business - Abstract
The critical evaluation of immunization programs is key to identifying areas of suboptimal vaccination coverage, monitoring activities, and aiding development of public health policy. For evaluation of vaccine effectiveness, direct antibody binding assay methods, including enzyme immunoassay, enzyme-linked fluorescence assays, and indirect immunofluorescence assay, are most commonly used for detection of IgG antibodies. However, despite their well-demonstrated, reliable performance, they can be labor-intensive and time-consuming and require separate assays for each individual marker. This necessitates increased sample volumes, processing time, and personnel, which may limit assessment to a few key targets in resource-limited settings, that is, low- and middle-income locations where funding for public health or general infrastructure that directly impacts public health is restricted, limiting access to equipment, infrastructure, and trained personnel. One solution is a multiplexed immunoassay, which allows for the detection of multiple analytes in a single reaction for increased efficiency and rapid surveillance of infectious diseases in limited-resource settings. Thus, the scope of the project precluded a full validation, and here we present abbreviated validation studies demonstrating adequate sensitivity, specificity, and reproducibility., Here we describe baseline validation studies and field performance of a research-use-only chemiluminescent multiplex serology panel for measles, mumps, rubella, and varicella-zoster virus used with dried blood spots in support of the 2013–2014 Democratic Republic of the Congo Demographic and Health Survey. Characterization of the panel using U.S. FDA-cleared commercial kits shows good concordance for measles, mumps, rubella, and varicella-zoster with average sensitivity across assays of 94.9% and an average specificity of 91.4%. As expected, performance versus available standards validated for plaque-reduction assays does not provide a 1:1 correspondence with international units and yet demonstrates excellent linearity (average Hill’s slope = 1.02) and ∼4 logs of dynamic range. In addition, for the four assays, the multiplexed format allowed for inclusion of three positive and two negative controls for each sample. A prototype Dynex Multiplier chemiluminescent automated immunoassay instrument with a charge-coupled device camera provided a rugged and robust processing and data acquisition platform. Performance of a multiplex instrument for serological testing in a substantially resource-limited environment shows excellent reproducibility, minimal cross-reactivity, and a clear discrimination between specific assays and should be considered a viable option for future serosurveys. IMPORTANCE The critical evaluation of immunization programs is key to identifying areas of suboptimal vaccination coverage, monitoring activities, and aiding development of public health policy. For evaluation of vaccine effectiveness, direct antibody binding assay methods, including enzyme immunoassay, enzyme-linked fluorescence assays, and indirect immunofluorescence assay, are most commonly used for detection of IgG antibodies. However, despite their well-demonstrated, reliable performance, they can be labor-intensive and time-consuming and require separate assays for each individual marker. This necessitates increased sample volumes, processing time, and personnel, which may limit assessment to a few key targets in resource-limited settings, that is, low- and middle-income locations where funding for public health or general infrastructure that directly impacts public health is restricted, limiting access to equipment, infrastructure, and trained personnel. One solution is a multiplexed immunoassay, which allows for the detection of multiple analytes in a single reaction for increased efficiency and rapid surveillance of infectious diseases in limited-resource settings. Thus, the scope of the project precluded a full validation, and here we present abbreviated validation studies demonstrating adequate sensitivity, specificity, and reproducibility.
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- 2019
28. Evaluation of the influenza sentinel surveillance system in the Democratic Republic of Congo, 2012-2015
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Saleh Muhemedi, Jean-Claude Changachanga, Benoit Kebela Ilunga, Jean-Jacques Muyembe Tamfum, Stefano Tempia, Léonie Kitoko Manya, Hugo Kavunga-Membo, Pelagie Diambalula Babakazo, Emile Okitolonda Wemakoy, Wally Disasuani, Edith Nkwembe, Leopold Lubula, and Joelle Kabamba-Tshilobo
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medicine.medical_specialty ,030231 tropical medicine ,Orthomyxoviridae ,Psychological intervention ,Representativeness heuristic ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,Epidemiology ,Influenza, Human ,medicine ,Humans ,030212 general & internal medicine ,Evaluation ,Surveillance ,biology ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,lcsh:RA1-1270 ,biology.organism_classification ,Democratic Republic of Congo ,Influenza ,3. Good health ,Data Accuracy ,Data quality ,Democratic Republic of the Congo ,Biostatistics ,business ,Sentinel Surveillance ,Qualitative research ,Research Article - Abstract
Background The World Health Organization recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data about the performance of established influenza surveillance systems are limited in Africa, including in the Democratic Republic of Congo (DRC). Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza sentinel surveillance system (ISSS) in DRC during 2012–2015. The performance of the system was evaluated using eight surveillance attributes: (i) data quality and completeness for key variables, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability and (viii) utility. For each attribute, specific indicators were developed and described using quantitative and qualitative methods. Scores for each indicator were as follows: Results During 2012–2015, we enrolled and tested 4339 patients with influenza-like illness (ILI) and 2869 patients with severe acute respiratory illness (SARI) from 11 sentinel sites situated in 5 of 11 provinces. Influenza viruses were detected in 446 (10.3%) samples from patients with ILI and in 151 (5.5%) samples from patients with SARI with higher detection during December–May. Data quality and completeness was > 90% for all evaluated indicators. Other strengths of the system were timeliness, simplicity, stability and utility that scored > 70% each. Representativeness, flexibility and acceptability had moderate performance. It was reported that the ISSS contributed to: (i) a better understanding of the epidemiology, circulating patterns and proportional contribution of influenza virus among patients with ILI or SARI; (ii) acquisition of new key competences related to influenza surveillance and diagnosis; and (iii) continuous education of surveillance staff and clinicians at sentinel sites about influenza. However, due to limited resources no actions were undertaken to mitigate the impact of seasonal influenza epidemics. Conclusions The system performed overall satisfactorily and provided reliable and timely data about influenza circulation in DRC. The simplicity of the system contributed to its stability. A better use of the available data could be made to inform and promote prevention interventions especially among the most vulnerable groups.
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- 2019
29. The Differential Impact of Violence on Ebola Virus Disease Transmission: A Mathematical Modeling Study of the 2018-2019 Outbreak in the Democratic Republic of the Congo
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Seth Blumberg, Caitlin A. Moe, Thomas M. Lietman, Jean Jacques Muyembe-Tamfum, Eugene T Richardson, George W. Rutherford, Travis C. Porco, J. Daniel Kelly, Cyrus Sinai, Emile Okitolonda-Wemakoy, Mathais Mossoko, Nicole A. Hoff, S. Rae Wannier, Bernice Selo, and Anne W. Rimoin
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Politics ,Ebola virus ,media_common.quotation_subject ,Cohort ,medicine ,Declaration ,Outbreak ,Disease ,medicine.disease_cause ,Democracy ,Demography ,media_common ,Differential impact - Abstract
Background: Violence can impact Ebola virus disease (EVD) transmission in the current outbreak in the eastern Democratic Republic of the Congo (DRC). We hypothesized that violent events targeted against the Ebola response will be associated with more EVD transmission than untargeted events. Methods: We used a dynamic cohort of individuals who lived in Ebola-affected and unaffected health zones in DRC from April 2018 to August 2019. The time-varying exposure was the number of violent events, as defined by the Armed Conflict Location & Event Data Project (ACLED) database, that occurred in each health zone over a series of days. These violent events were categorized into "Ebola-targeted" vs. "Ebola-untargeted", and further sub-categorized by "civilians," "military or politics," or "protests." The outcome variable was the estimated daily reproduction number (Rest) by health zone, which was estimated from daily EVD case counts (from DRC Ministry of Health) by the Wallinga-Teunis method. We fit a linear time-series regression to model the relationship of violent events and R comparing EVD-affected and unaffected health zones. Findings: The average Rest was 1.06 (95% confidence interval [CI]: 1.02-1.11). We found an overall change in R of 0.035 (95% CI: 0.020-0.050) among Ebola-affected compared to unaffected health zones. Violent events targeting the Ebola response were associated with an increase in Rest of 0.098 (95% CI: 0.064-0.132) while untargeted, violent events had a smaller effect (0.022, 95% CI: 0.005-0.038). Additional analyses showed the increase in Rest was primarily driven by Ebola-targeted civilian events and, to a lesser extent, by Ebola-untargeted military, political, or protest events. Interpretation: These findings suggest that civilian acts of violence directly targeted against the Ebola response efforts had the largest impact on EVD transmission. To a lesser extent, untargeted military, political, or protest events also had an impact. Funding Statement: This work was supported by National Institute of Allergy and Infectious Disease (K08 grant number AI139361 to ETR; K23 grant number AI135037 to JDK) and National Institute of General Medical Sciences (R01 grant number GM130900 to TCP, JDK, and ETR). Declaration of Interests: The authors stated: "None to declare." Ethics Approval Statement: The authors stated: "Data were publicly available and de-identified, so ethics committee approval was not needed."
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- 2019
30. Projections of Ebola outbreak size and duration with and without vaccine use in Équateur, Democratic Republic of Congo, as of May 27, 2018
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Cyrus Sinai, Travis C. Porco, Patrick Mukadi, Mathais Mossoko, Lee Worden, Anne W. Rimoin, S. Rae Wannier, Nicole A. Hoff, Sarah F Ackley, Bernice Selo, Emile Okitolonda-Wemakoy, George W. Rutherford, Jean Jacques Muyembe-Tamfum, Thomas M. Lietman, Eugene T Richardson, Xianyun Chen, Daozhou Gao, J. Daniel Kelly, and Schieffelin, John
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RNA viruses ,and promotion of well-being ,Viral Diseases ,Epidemiology ,medicine.disease_cause ,Pathology and Laboratory Medicine ,law.invention ,Disease Outbreaks ,0302 clinical medicine ,Mathematical and Statistical Techniques ,Theoretical ,Models ,law ,Statistics ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Vaccines ,Multidisciplinary ,Mathematical Models ,Vaccination ,Regression analysis ,General Medicine ,Vaccination and Immunization ,3. Good health ,Transmission (mechanics) ,Infectious Diseases ,3.4 Vaccines ,Medical Microbiology ,Filoviruses ,Viral Pathogens ,Ebola ,Viruses ,Physical Sciences ,Democratic Republic of the Congo ,Medicine ,Pathogens ,Infection ,General Agricultural and Biological Sciences ,Ebola Virus ,Research Article ,Neglected Tropical Diseases ,medicine.medical_specialty ,Infectious Disease Control ,General Science & Technology ,Science ,030231 tropical medicine ,Immunology ,Biology ,Research and Analysis Methods ,Microbiology ,Ebola Hemorrhagic Fever ,General Biochemistry, Genetics and Molecular Biology ,Vaccine Related ,03 medical and health sciences ,Virology ,medicine ,Humans ,Microbial Pathogens ,Viral Hemorrhagic Fevers ,Ebola virus ,Hemorrhagic Fever Viruses ,Prevention ,Organisms ,Prediction interval ,Outbreak ,Biology and Life Sciences ,Viral Vaccines ,Hemorrhagic Fever, Ebola ,Models, Theoretical ,Prevention of disease and conditions ,Tropical Diseases ,Probability Theory ,Probability Distribution ,Good Health and Well Being ,Emerging Infectious Diseases ,Hemorrhagic Fever ,Immunization ,Preventive Medicine ,Mathematics - Abstract
As of May 27, 2018, 6 suspected, 13 probable and 35 confirmed cases of Ebola virus disease (EVD) had been reported in Équateur Province, Democratic Republic of Congo. We used reported case counts and time series from prior outbreaks to estimate the total outbreak size and duration with and without vaccine use. We modeled Ebola virus transmission using a stochastic branching process model that included reproduction numbers from past Ebola outbreaks and a particle filtering method to generate a probabilistic projection of the outbreak size and duration conditioned on its reported trajectory to date; modeled using high (62%), low (44%), and zero (0%) estimates of vaccination coverage (after deployment). Additionally, we used the time series for 18 prior Ebola outbreaks from 1976 to 2016 to parameterize the Thiel-Sen regression model predicting the outbreak size from the number of observed cases from April 4 to May 27. We used these techniques on probable and confirmed case counts with and without inclusion of suspected cases. Probabilistic projections were scored against the actual outbreak size of 54 EVD cases, using a log-likelihood score. With the stochastic model, using high, low, and zero estimates of vaccination coverage, the median outbreak sizes for probable and confirmed cases were 82 cases (95% prediction interval [PI]: 55, 156), 104 cases (95% PI: 58, 271), and 213 cases (95% PI: 64, 1450), respectively. With the Thiel-Sen regression model, the median outbreak size was estimated to be 65.0 probable and confirmed cases (95% PI: 48.8, 119.7). Among our three mathematical models, the stochastic model with suspected cases and high vaccine coverage predicted total outbreak sizes closest to the true outcome. Relatively simple mathematical models updated in real time may inform outbreak response teams with projections of total outbreak size and duration.
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- 2019
31. Changes in childhood vaccination coverage over time in the Democratic Republic of the Congo
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Alvan Cheng, Angie Ghanem, Anna Bratcher, Jean Jacques Muyembe Tamfum, Vivian H. Alfonso, Emile Okitolonda Wemakoy, Patrick Mukadi, Anne W. Rimoin, Sue Gerber, Hayley R. Ashbaugh, Reena H. Doshi, Guillaume Ngoie Mwamba, Adva Gadoth, Nicole A. Hoff, and Angelillo, Italo Francesco
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Viral Diseases ,and promotion of well-being ,Vaccination Coverage ,Cross-sectional study ,Psychological intervention ,Pediatrics ,Geographical locations ,Families ,0302 clinical medicine ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Child ,Children ,media_common ,Pediatric ,Vaccines ,education.field_of_study ,Multidisciplinary ,Vaccination ,Child Health ,Vaccination and Immunization ,Democracy ,Infectious Diseases ,Geography ,3.4 Vaccines ,Child, Preschool ,Democratic Republic of the Congo ,Medicine ,Vaccine-preventable diseases ,Infection ,Research Article ,Infectious Disease Control ,General Science & Technology ,media_common.quotation_subject ,Science ,Immunology ,030231 tropical medicine ,Population ,Measles ,Vaccine Related ,03 medical and health sciences ,Clinical Research ,medicine ,Humans ,education ,Preschool ,Immunization Programs ,Prevention ,Infant, Newborn ,Biology and Life Sciences ,Infant ,medicine.disease ,Newborn ,Prevention of disease and conditions ,Cross-Sectional Studies ,Good Health and Well Being ,Immunization ,Age Groups ,Conjugate Vaccines ,People and Places ,Africa ,Population Groupings ,Preventive Medicine ,Poliomyelitis ,Demography - Abstract
Despite increased vaccination rates, the burden, morbidity and mortality associated with vaccine preventable diseases remains high. In the Democratic Republic of the Congo (DRC), potentially unreliable data and geographically varied program provision call for a better understanding of vaccination coverage and its changes over time at the country and province level. To assess changes in the proportion of children who were fully vaccinated over time in the DRC, vaccination histories for children 12–59 months of age were obtained from both the 2007 and 2013–2014 Demographic and Health Surveys (DHS). Changes were assessed, both at the country- and province-levels, to identify potential geographic variations. Vaccination coverage improved 70% between the DHS waves: 26% compared to 44% of 12–59 month-old children met full vaccination criteria in 2007 and 2013–2014, respectively (n2007 = 3032 and n2013-14 = 6619). Similarly, there was an overall trend across both DHS waves where as year of birth increased, so did vaccination coverage. There was geographic variation in immunization changes with most central and eastern provinces increasing in coverage and most northern, western and southern provinces having decreased vaccination coverage at the second time point. Using nationally representative data, we identified significant changes over time in vaccination coverage which may help to inform future policy, interventions and research to improve vaccination rates among children in the DRC. This study is the first of its kind for the population of DRC and provides an important initial step towards better understanding trends in vaccination coverage over time.
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- 2019
32. Real-time projections of epidemic transmission and estimation of vaccination impact during an Ebola virus disease outbreak in Northeastern Democratic Republic of Congo
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L Worden, John Daniel Kelly, Thomas M. Lietman, Hoff Na, Musene K, Emile Okitolonda-Wemakoy, Travis C. Porco, Rae Wannier, Jean-Jacque Muyembe-Tamfum, Mathias Mossoko, Bernice Selo, Anne W. Rimoin, and George W. Rutherford
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Vaccination ,Geography ,Ebola virus ,medicine ,Negative binomial distribution ,Outbreak ,Prediction interval ,Regression analysis ,medicine.disease_cause ,Contact tracing ,Demography ,Sierra leone - Abstract
BackgroundAs of February 25, 2019, 875 cases of Ebola virus disease (EVD) were reported in North Kivu and Ituri Provinces, Democratic Republic of Congo. Since the beginning of October, the outbreak has largely shifted into regions in which active armed conflict has occurred, and in which EVD cases and their contacts have been difficult for health workers to reach. We used available data on the current outbreak with case-count time series from prior outbreaks to project the short-term and long-term course of the outbreak.MethodsFor short- and long-term projections, we modeled Ebola virus transmission using a stochastic branching process that assumes gradually quenching transmission rates estimated from past EVD outbreaks, with outbreak trajectories conditioned on agreement with the course of the current outbreak, and with multiple levels of vaccination coverage. We used two regression models to estimate similar projection periods. Short- and long-term projections were estimated using negative binomial autoregression and Theil-Sen regression, respectively. We also used Gott’s rule to estimate a baseline minimum-information projection. We then constructed an ensemble of forecasts to be compared and recorded for future evaluation against final outcomes. From August 20, 2018 to February 25, 2019, short-term model projections were validated against known case counts.ResultsDuring validation of short-term projections, from one week to four weeks, we found models consistently scored higher on shorter-term forecasts. Based on case counts as of February 25, the stochastic model projected a median case count of 933 cases by February 18 (95% prediction interval: 872–1054) and 955 cases by March 4 (95% prediction interval: 874–1105), while the auto-regression model projects median case counts of 889 (95% prediction interval: 876–933) and 898 (95% prediction interval: 877–983) cases for those dates, respectively. Projected median final counts range from 953 to 1,749. Although the outbreak is already larger than all past Ebola outbreaks other than the 2013–2016 outbreak of over 26,000 cases, our models do not project that it is likely to grow to that scale. The stochastic model estimates that vaccination coverage in this outbreak is lower than reported in its trial setting in Sierra Leone.ConclusionsOur projections are concentrated in a range up to about 300 cases beyond those already reported. While a catastrophic outbreak is not projected, it is not ruled out, and prevention and vigilance are warranted. Prospective validation of our models in real time allowed us to generate more accurate short-term forecasts, and this process may prove useful for future real-time short-term forecasting. We estimate that transmission rates are higher than would be seen under target levels of 62% coverage due to contact tracing and vaccination, and this model estimate may offer a surrogate indicator for the outbreak response challenges.Author summaryAs of February 25, 2019, 875 cases of Ebola virus disease (EVD) were reported in North Kivu and Ituri Provinces, Democratic Republic of Congo. Since the beginning of October 2018, the outbreak has largely shifted into regions in which active armed conflict has been reported, and in which EVD cases and their contacts have been difficult for health workers to reach. We used an ensemble of models to estimate EVD transmission rates and to forecast the short- and long-term course of the outbreak. Our models project that a final size of roughly up to 300 additional cases is most likely, and estimate that transmission rates are higher than would be seen under optimal levels of contact tracing and vaccination. While a catastrophic outbreak is not projected, is it not ruled out, and prevention and vigilance are warranted.
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- 2018
33. Vaccinating against monkeypox in the Democratic Republic of the Congo
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Beatrice Nguete, Andrea M. McCollum, Jean-Jacques Muyembe Tamfum, Benjamin Monroe, Christine M. Hughes, Brett W. Petersen, Mary G. Reynolds, Robert Shongo Lushima, Joelle Kabamba, and Emile Okitolonda Wemakoy
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0301 basic medicine ,Rural Population ,viruses ,Health Personnel ,030106 microbiology ,Disease ,Vaccines, Attenuated ,Article ,03 medical and health sciences ,Monkeypox ,Immunogenicity, Vaccine ,Risk Factors ,Virology ,Environmental health ,Health care ,Medicine ,Animals ,Humans ,Monkeypox virus ,Smallpox vaccine ,Pharmacology ,Clinical Trials as Topic ,biology ,business.industry ,Transmission (medicine) ,Vaccination ,Human monkeypox ,virus diseases ,medicine.disease ,biology.organism_classification ,Disease control ,Occupational Diseases ,030104 developmental biology ,Democratic Republic of the Congo ,Health Resources ,business ,Smallpox Vaccine - Abstract
Healthcare-associated transmission of monkeypox has been observed on multiple occasions in areas where the disease is endemic. Data collected by the US Centers for Disease Control and Prevention (CDC) from an ongoing CDC-supported program of enhanced surveillance in the Tshuapa Province of the Democratic Republic of the Congo, where the annual incidence of human monkeypox is estimated to be 3.5-5/10,000, suggests that there is approximately one healthcare worker infection for every 100 confirmed monkeypox cases. Herein, we describe a study that commenced in February 2017, the intent of which is to evaluate the effectiveness, immunogenicity, and safety of a third-generation smallpox vaccine, IMVAMUNE®, in healthcare personnel at risk of monkeypox virus (MPXV) infection. We describe procedures for documenting exposures to monkeypox virus infection in study participants, and outline lessons learned that may be of relevance for studies of other investigational medical countermeasures in hard to reach, under-resourced populations.
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- 2018
34. Correction: Vol. 22, No. 6
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Elisabeth Pukuta, Lynda Osadebe, Daniel Mukadi, Jeffrey B. Doty, Pierre Lokwa Bomponda, Leisha Diane Nolen, Robert Shongo Lushima, Benjamin Monroe, Jacques Likofata, Toutou Likafi, Jacques Katomba, Marcel Pie Balilo, Jean Malekani, Andrea M. McCollum, Joelle Kabamba, Benoit Kebela Ilunga, Stomy Karhemere, Jules Inonga Lokota, Emile Okitolonda Wemakoy, Beatrice Nguete, Jean-Jacques Muyembe Tamfum, Mary G. Reynolds, Christine M. Hughes, and Frida N’Kawa
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0301 basic medicine ,Microbiology (medical) ,Veterinary medicine ,Epidemiology ,viruses ,animal diseases ,Attack rate ,lcsh:Medicine ,orthopoxvirus ,lcsh:Infectious and parasitic diseases ,Incubation period ,law.invention ,03 medical and health sciences ,Monkeypox ,monkeypox virus ,law ,parasitic diseases ,Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo ,medicine ,lcsh:RC109-216 ,Orthopoxvirus ,erratum ,biology ,business.industry ,Research ,lcsh:R ,Zoonosis ,transmission ,virus diseases ,Correction ,Outbreak ,respiratory system ,incubation ,zoonosis ,biology.organism_classification ,medicine.disease ,030104 developmental biology ,Infectious Diseases ,Transmission (mechanics) ,Correction: Vol. 22, No. 6 ,Africa ,Democratic Republic of the Congo ,monkeypox ,Monkeypox virus ,business ,errata - Abstract
During the outbreak, 50% of household members living with an infected person developed symptom of monkeypox infection., A 600-fold increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.
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- 2016
35. The national and provincial burden of medically attended influenza-associated influenza-like illness and severe acute respiratory illness in the Democratic Republic of Congo, 2013-2015
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Leopold Lubula, Jean-Jacques Muyembe Tamfum, Benoit Kebela Ilunga, Pélagie Babakazo, Léonie Kitoko Manya, Joelle Kabamba-Tshilobo, Edith Nkwembe, Jean-Claude Changachanga, Emile Okitolonda Wemakoy, Wally Disasuani, Naomi Mitongo, Hugo Kavunga-Membo, Stefano Tempia, and Saleh Muhemedi
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Male ,Pediatrics ,Epidemiology ,burden ,0302 clinical medicine ,Risk Factors ,Health care ,Ambulatory Care ,Prevalence ,030212 general & internal medicine ,Prospective Studies ,Child ,Respiratory Tract Infections ,Aged, 80 and over ,education.field_of_study ,influenza‐like illness ,Incidence (epidemiology) ,Middle Aged ,3. Good health ,severe acute respiratory illness ,Hospitalization ,Infectious Diseases ,Child, Preschool ,Democratic Republic of the Congo ,Female ,Original Article ,influenza ,Pulmonary and Respiratory Medicine ,Adult ,medicine.medical_specialty ,Surveillance data ,Adolescent ,030231 tropical medicine ,Population ,03 medical and health sciences ,Young Adult ,medicine ,Humans ,education ,Aged ,Influenza-like illness ,Respiratory illness ,business.industry ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,Original Articles ,medicine.disease ,Democratic Republic of Congo ,Pneumonia ,business ,Facilities and Services Utilization - Abstract
BACKGROUND Estimates of influenza-associated outpatient consultations and hospitalizations are severely limited in low- and middle-income countries, especially in Africa. METHODS We conducted active prospective surveillance for influenza-like illness (ILI) and severe acute respiratory illness (SARI) at 5 healthcare facilities situated in Kinshasa Province during 2013-2015. We tested upper respiratory tract samples for influenza viruses using a reverse transcription-polymerase chain reaction assay. We estimated age-specific numbers and rates of influenza-associated ILI outpatient consultations and SARI hospitalizations for Kinshasa Province using a combination of administrative and influenza surveillance data. These estimates were extrapolated to each of the remaining 10 provinces accounting for provincial differences in prevalence of risk factors for pneumonia and healthcare-seeking behavior. Rates were reported per 100 000 population. RESULTS During 2013-2015, the mean annual national number of influenza-associated ILI outpatient consultations was 1 003 212 (95% Confidence Incidence [CI]: 719 335-1 338 050 - Rate: 1205.3; 95% CI: 864.2-1607.5); 199 839 (95% CI: 153 563-254 759 - Rate: 1464.0; 95% CI: 1125.0-1866.3) among children aged
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- 2018
36. Real-time projections of Ebola outbreak size and duration with and without vaccine use in Équateur, Democratic Republic of Congo, as of May 27, 2018
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Cyrus Sinai, Rae Wannier, Thomas M. Lietman, George W. Rutherford, Nicole A. Hoff, Bernice Selo, Patrick Mukadi, Sarah F Ackley, Mathais Mossoko, Xianyun Chen, Anne W. Rimoin, Jean Jacques Muyembe-Tamfum, Eugene T Richardson, Daozhou Gao, J. Daniel Kelly, Travis C. Porco, Emile Okitolonda-Wemakoy, and Lee Worden
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medicine.medical_specialty ,Ebola virus ,030231 tropical medicine ,Prediction interval ,Outbreak ,Regression analysis ,medicine.disease_cause ,3. Good health ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Transmission (mechanics) ,Geography ,law ,Epidemiology ,medicine ,Credible interval ,030212 general & internal medicine ,Duration (project management) ,Demography - Abstract
BackgroundAs of May 27, 2018, 54 cases of Ebola virus disease (EVD) were reported in Équateur Province, Democratic Republic of Congo. We used reported case counts and time series from prior outbreaks to estimate the current outbreak size and duration with and without vaccine use.MethodsWe modeled Ebola virus transmission using a stochastic branching process model with a negative binomial distribution, using both estimates of reproduction number R declining from supercritical to subcritical derived from past Ebola outbreaks, as well as a particle filtering method to generate a probabilistic projection of the future course of the outbreak conditioned on its reported trajectory to date; modeled using 0%, 44%, and 62% estimates of vaccination coverage. Additionally, we used the time series for 18 prior Ebola outbreaks from 1976 to 2016 to parameterize a regression model predicting the outbreak size from the number of observed cases from April 4 to May 27.ResultsWith the stochastic transmission model, we projected a median outbreak size of 78 EVD cases (95% credible interval: 52, 125.4), 86 cases (95% credible interval: 53, 174.3), and 91 cases (95% credible interval: 52, 843.5), using 62%, 44%, and 0% estimates of vaccination coverage. With the regression model, we estimated a median size of 85.0 cases (95% prediction interval: 53.5, 216.6).ConclusionsThis outbreak has the potential to be the largest outbreak in DRC since 2007. Vaccines are projected to limit outbreak size and duration but are only part of prevention, control, and care strategies.
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- 2018
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37. Association of Previous Measles Infection With Markers of Acute Infectious Disease Among 9- to 59-Month-Old Children in the Democratic Republic of the Congo
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Hayley R, Ashbaugh, James D, Cherry, Nicole A, Hoff, Reena H, Doshi, Vivian H, Alfonso, Adva, Gadoth, Patrick, Mukadi, Stephen G, Higgins, Roger, Budd, Christina, Randall, Emile, Okitolonda-Wemakoy, Jean Jacques, Muyembe-Tamfum, Sue K, Gerber, and Anne W, Rimoin
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Diarrhea ,Immunosuppression Therapy ,fever ,immunosuppression ,Immunization Programs ,Vaccination ,Infant ,Original Articles ,Infections ,cough ,Child, Preschool ,Immunoglobulin G ,Democratic Republic of the Congo ,Humans ,measles ,Biomarkers - Abstract
Background Transient immunosuppression and increased susceptibility to other infections after measles infection is well known, but recent studies have suggested the occurrence of an “immune amnesia” that could have long-term immunosuppressive effects. Methods We examined the association between past measles infection and acute episodes of fever, cough, and diarrhea among 2350 children aged 9 to 59 months whose mothers were selected for interview in the 2013–2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey (DHS). Classification of children who had had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained via dried-blood-spot analysis with a multiplex immunoassay. The association with time since measles infection and fever, cough, and diarrhea outcomes was also examined. Results The odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25–2.60) among children for whom measles was reported compared to children with no history of measles. Measles vaccination demonstrated a protective association against selected clinical markers of acute infectious diseases. Conclusion Our results suggest that measles might have a long-term effect on selected clinical markers of acute infectious diseases among children aged 9 to 59 months in the DRC. These findings support the immune-amnesia hypothesis suggested by others and underscore the need for continued evaluation and improvement of the DRC’s measles vaccination program., In this study, we assessed the association of previous measles infection with episodes of fever, cough, or diarrhea in a low-vaccine-coverage resource-poor area, and our results suggest that measles infection might have a long-term effect on markers of acute infectious disease in our study population.
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- 2018
38. Serologic Evidence of Ebolavirus Infection in a Population With No History of Outbreaks in the Democratic Republic of the Congo
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Jean-Jacques Muyembe-Tamfum, Je-Nie Phue, Vivian H. Alfonso, Linda L. Wright, Anne W. Rimoin, Nicole A. Hoff, Joseph Shiloach, Benoit Ilunga Kebela, Sabue Mulangu, Neville K. Kisalu, Hadar Marcus, Reena H. Doshi, Prime Mulembakani, Emile Okitolonda-Wemakoy, and Nancy J. Sullivan
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Male ,Rural Population ,0301 basic medicine ,Zaire ebolavirus ,Multivariate analysis ,serology ,medicine.disease_cause ,Antibodies, Viral ,Medical and Health Sciences ,Serology ,Disease Outbreaks ,0302 clinical medicine ,Seroepidemiologic Studies ,80 and over ,Immunology and Allergy ,Viral ,Child ,Aged, 80 and over ,education.field_of_study ,seroprevalence ,Geography ,Age Factors ,Biological Sciences ,Middle Aged ,Ebolavirus ,Healthy Volunteers ,Editorial Commentary ,Infectious Diseases ,Child, Preschool ,Ebola ,Democratic Republic of the Congo ,Female ,Infection ,Adult ,Adolescent ,030231 tropical medicine ,Population ,Ebola virus disease ,Microbiology ,Antibodies ,Vaccine Related ,Young Adult ,03 medical and health sciences ,Major Articles and Brief Reports ,Sex Factors ,Clinical Research ,Biodefense ,medicine ,Seroprevalence ,Humans ,Preschool ,education ,Aged ,Behavior ,Ebola virus ,business.industry ,Prevention ,Infant, Newborn ,Infant ,Outbreak ,Environmental Exposure ,Hemorrhagic Fever, Ebola ,Newborn ,Emerging Infectious Diseases ,Good Health and Well Being ,030104 developmental biology ,Immunoglobulin G ,Hemorrhagic Fever ,business ,Demography - Abstract
Background Previous studies suggest that cases of Ebola virus disease (EVD) may go unreported because they are asymptomatic or unrecognized, but evidence is limited by study designs and sample size. Methods A large population-based survey was conducted (n = 3415) to assess animal exposures and behaviors associated with Ebolavirus antibody prevalence in rural Kasai Oriental province of the Democratic Republic of Congo (DRC). Fourteen villages were randomly selected and all healthy individuals ≥1 year of age were eligible. Results Overall, 11% of subjects tested positive for Zaire Ebolavirus (EBOV) immunoglobulin G antibodies. Odds of seropositivity were higher for study participants older than 15 years of age and for males. Those residing in Kole (closer to the outbreak site) tested positive at a rate 1.6× higher than Lomela, with seropositivity peaking at a site located between Kole and Lomela. Multivariate analyses of behaviors and animal exposures showed that visits to the forest or hunting and exposure to rodents or duikers predicted a higher likelihood of EBOV seropositivity. Conclusions These results provide serologic evidence of Ebolavirus exposure in a population residing in non-EBOV outbreak locations in the DRC and define statistically significant activities and animal exposures that associate with EBOV seropositivity.
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- 2018
39. Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases
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Jeffrey B. Doty, Ekaterine Khmaladze, Miriam Shiferaw, Otar Parkadze, Theresa Kanter, Marina Donduashvili, Leopold Mulumba, Joelle Kabamba, Meseret Bekele, Andrea A. McCollum, Linda Lucy Boulanger, Juliette Morgan, Kasahun Tafese, Abyot Bekele, Mary G. Reynolds, Emile Okitolonda Wemakoy, Giorgi Maghlakelidze, Jean Malekani, Abraham Haile, and Jean-Jacques Muyembe
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Microbiology (medical) ,Capacity Building ,Georgia ,National Health Programs ,Epidemiology ,Ecology (disciplines) ,030231 tropical medicine ,Frameworks for Preventing, Detecting, and Controlling Zoonotic Diseases ,lcsh:Medicine ,public health program implementation ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Monkeypox ,0302 clinical medicine ,program design ,Public health surveillance ,medicine ,Animals ,Humans ,Public Health Surveillance ,prevention and control ,lcsh:RC109-216 ,030212 general & internal medicine ,global health security ,Government ,Animal health ,Research ,lcsh:R ,Health Plan Implementation ,Capacity building ,Republic of Georgia ,medicine.disease ,United States ,zoonoses ,Infectious Diseases ,Risk analysis (engineering) ,Congo ,Democratic Republic of the Congo ,Program Design Language ,Business ,Intersectoral Collaboration ,Ethiopia - Abstract
Preventing zoonotic diseases requires coordinated actions by government authorities responsible for human and animal health. Constructing the frameworks needed to foster intersectoral collaboration can be approached in many ways. We highlight 3 examples of approaches to implement zoonotic disease prevention and control programs. The first, rabies control in Ethiopia, was implemented using an umbrella approach: a comprehensive program designed for accelerated impact. The second, a monkeypox program in Democratic Republic of the Congo, was implemented in a stepwise manner, whereby incremental improvements and activities were incorporated into the program. The third approach, a pathogen discovery program, applied in the country of Georgia, was designed to characterize and understand the ecology, epidemiology, and pathogenesis of a new zoonotic pathogen. No one approach is superior, but various factors should be taken into account during design, planning, and implementation.
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- 2017
40. Assessing the cost-effectiveness of different measles vaccination strategies for children in the Democratic Republic of Congo
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Philip Eckhoff, Jean-Jacques Muyembe-Tafum, Alvan Cheng, Sue Gerber, Reena H. Doshi, Gerald F. Kominski, Patrick Mukadi, Nicole A. Hoff, Emile Okitolonda Wemakoy, Calixte Shidi, and Anne W. Rimoin
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and promotion of well-being ,Cost effectiveness ,Cost-Benefit Analysis ,Medical and Health Sciences ,0302 clinical medicine ,030212 general & internal medicine ,Child ,Pediatric ,Vaccination ,Biological Sciences ,Infectious Diseases ,3.4 Vaccines ,Child, Preschool ,Democratic Republic of the Congo ,Molecular Medicine ,Vaccine-preventable diseases ,Infection ,Adolescent ,030231 tropical medicine ,Measles Vaccine ,Rubella ,Measles ,Vaccine Related ,03 medical and health sciences ,Environmental health ,Virology ,medicine ,Humans ,Preschool ,Disease burden ,Immunization Schedule ,General Veterinary ,General Immunology and Microbiology ,Agricultural and Veterinary Sciences ,business.industry ,Immunization Programs ,Prevention ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,medicine.disease ,Newborn ,Democratic Republic of Congo ,Prevention of disease and conditions ,Good Health and Well Being ,Immunization ,Immunology ,Cost-effectiveness ,Measles vaccine ,business - Abstract
IntroductionOne of the goals of the Global Measles and Rubella Strategic Plan is the reduction in global measles mortality, with high measles vaccination coverage as one of its core components. While measles mortality has been reduced more than 79%, the disease remains a major cause of childhood vaccine preventable disease burden globally. Measles immunization requires a two-dose schedule and only countries with strong, stable immunization programs can rely on routine services to deliver the second dose. In the Democratic Republic of Congo (DRC), weak health infrastructure and lack of provision of the second dose of measles vaccine necessitates the use of supplementary immunization activities (SIAs) to administer the second dose.MethodsWe modeled three vaccination strategies using an age-structured SIR (Susceptible-Infectious-Recovered) model to simulate natural measles dynamics along with the effect of immunization. We compared the cost-effectiveness of two different strategies for the second dose of Measles Containing Vaccine (MCV) to one dose of MCV through routine immunization services over a 15-year time period for a hypothetical birth cohort of 3 million children.ResultsCompared to strategy 1 (MCV1 only), strategy 2 (MCV2 by SIA) would prevent a total of 5,808,750 measles cases, 156,836 measles-related deaths and save U.S. $199 million. Compared to strategy 1, strategy 3 (MCV2 by RI) would prevent a total of 13,232,250 measles cases, 166,475 measles-related deaths and save U.S. $408 million.DiscussionVaccination recommendations should be tailored to each country, offering a framework where countries can adapt to local epidemiological and economical circumstances in the context of other health priorities. Our results reflect the synergistic effect of two doses of MCV and demonstrate that the most cost-effective approach to measles vaccination in DRC is to incorporate the second dose of MCV in the RI schedule provided that high enough coverage can be achieved.
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- 2017
41. Field evaluation of measles vaccine effectiveness among children in the Democratic Republic of Congo
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Audry Mulumba, Jean-Jacques Muyembe, Nicole A. Hoff, Sue Gerber, Calixte Shidi, Benoit Kebela Ilunga, Anne W. Rimoin, Emile Okitolonda-Wemakoy, Reena H. Doshi, and Patrick Mukadi
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Male ,Pediatrics ,medicine.medical_specialty ,Measles Vaccine ,Population ,Measles ,Disease Outbreaks ,Risk Factors ,Environmental health ,medicine ,Humans ,Risk factor ,education ,education.field_of_study ,General Veterinary ,General Immunology and Microbiology ,business.industry ,Public Health, Environmental and Occupational Health ,Infant ,Outbreak ,medicine.disease ,Vaccination ,Treatment Outcome ,Infectious Diseases ,Immunoglobulin M ,Immunization ,Case-Control Studies ,Child, Preschool ,Democratic Republic of the Congo ,Molecular Medicine ,Female ,Vaccine-preventable diseases ,Measles vaccine ,business - Abstract
Background Large-scale measles outbreaks in areas with high administrative vaccine coverage rates suggest the need to re-evaluate measles prevention and control in the Democratic Republic of Congo (DRC). Monitoring of measles Vaccine Effectiveness (VE) is a useful measure of quality control in immunization programs. We estimated measles VE among children aged 12–59 months in the Democratic Republic of Congo (DRC) using laboratory surveillance data from 2010–2012. Methods We used the case-based surveillance system with laboratory confirmation to conduct a case-control study using the test negative design. Cases and controls were selected based on presence ( n = 1044) or absence ( n = 1335) of measles specific antibody IgM or epidemiologic linkage. Risk factors for measles were assessed using unconditional logistic regression, stratified by age. Results Among children 12–59 months, measles vaccination was protective against measles [aOR (95% C)], 0.20 (0.15–0.26) and estimated VE was 80% (95% CI 74–85%). Year of diagnosis, 2011: 6.02 (4.16–8.72) and 2012; 8.31 (5.57–12.40) was a risk factor for measles when compared to 2010. Compared to Kinshasa, children in Bas-Congo, Kasai-Oriental, Maniema and South Kivu provinces all had higher odds of developing measles. Measles VE was similar for children 12–23 months and 24–59 months (80% and 81% respectively). Conclusions Repeated occurrences of measles outbreaks and lower than expected VE estimates suggest the need to further evaluate measles vaccine efficacy and improve vaccine delivery strategies in DRC.
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- 2015
42. Predictors of measles vaccination coverage among children 6-59 months of age in the Democratic Republic of the Congo
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Hayley R, Ashbaugh, Nicole A, Hoff, Reena H, Doshi, Vivian H, Alfonso, Adva, Gadoth, Patrick, Mukadi, Emile, Okitolonda-Wemakoy, Jean Jacques, Muyembe-Tamfum, Sue K, Gerber, James D, Cherry, and Anne W, Rimoin
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Male ,Vaccination Coverage ,Immunization Programs ,Measles Vaccine ,Vaccination ,Infant ,Article ,Routine immunization ,Logistic Models ,Socioeconomic Factors ,Child, Preschool ,parasitic diseases ,Democratic Republic of the Congo ,Odds Ratio ,Humans ,Female ,Measles - Abstract
Highlights • DRC’s overall measles vaccination coverage level of 70% is too low to halt the spread of measles. • Socioeconomic variables and residence are associated with vaccination coverage disparities. • Vaccination coverage and data quality are linked, and as such, dated records must be increased., Background Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013–2014 DRC Demographic and Health Survey (DHS). Methods We examined vaccination coverage of 6947 children aged 6–59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence. Results Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas. Conclusions Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control.
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- 2017
43. Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system
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Hayley R. Ashbaugh, Adva Gadoth, Patrick Mukadi, Reena H. Doshi, Jean-Jacques Muyembe, Nicole A. Hoff, Brandon Kuang, Cyrus Sinai, Benoit Ilunga Kebela, Vivian H. Alfonso, Anne W. Rimoin, Emile Okitolonda Wemakoy, and Mathias Mossoko
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0301 basic medicine ,Clinical Decision-Making ,Disease ,medicine.disease_cause ,Typhoid fever ,Viral hemorrhagic fever ,Disease Outbreaks ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Epidemics ,Disease surveillance ,Ebola virus ,business.industry ,Public Health, Environmental and Occupational Health ,Outbreak ,Hemorrhagic Fever, Ebola ,medicine.disease ,Ebolavirus ,030104 developmental biology ,Infectious Diseases ,Population Surveillance ,Democratic Republic of the Congo ,Optometry ,Parasitology ,Medical emergency ,business ,Laboratories ,Malaria - Abstract
BACKGROUND Ebola virus disease (EVD) can be clinically severe and highly fatal, making surveillance efforts for early disease detection of paramount importance. In areas with limited access to laboratory testing, the Integrated Disease Surveillance and Response (IDSR) strategy in the Democratic Republic of Congo (DRC) may be a vital tool in improving outbreak response. METHODS Using DRC IDSR data from the nation's four EVD outbreak periods from 2007-2014, we assessed trends of Viral Hemorrhagic Fever (VHF) and EVD differential diagnoses reportable through IDSR. With official case counts from active surveillance of EVD outbreaks, we assessed accuracy of reporting through the IDSR passive surveillance system. RESULTS Although the active and passive surveillance represent distinct sets of data, the two were correlated, suggesting that passive surveillance based only on clinical evaluation may be a useful predictor of true cases prior to laboratory confirmation. There were 438 suspect VHF cases reported through the IDSR system and 416 EVD cases officially recorded across the outbreaks examined. CONCLUSION Although collected prior to official active surveillance cases, case reporting through the IDSR during the 2007, 2008 and 2012 outbreaks coincided with official EVD epidemic curves. Additionally, all outbreak areas experienced increases in suspected cases for both malaria and typhoid fever during EVD outbreaks, underscoring the importance of training health care workers in recognising EVD differential diagnoses and the potential for co-morbidities.
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- 2017
44. Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018–2019
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S. Rae Wannier, Mathias Mossoko, Bernice Selo, Jean Jacques Muyembe-Tamfum, Nicole A. Hoff, Eugene T Richardson, J. Daniel Kelly, Thomas M. Lietman, Emile Okitolonda-Wemakoy, Anne W. Rimoin, Steve Ahuka-Mundeke, Bathe Njoloko, Travis C. Porco, Eduardo Amezcua, Placide Mbala-Kingebeni, George W. Rutherford, James Holland Jones, Cyrus Sinai, and Lee Worden
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Epidemiology ,medicine.disease_cause ,law.invention ,Disease Outbreaks ,0302 clinical medicine ,law ,030212 general & internal medicine ,media_common ,Violence Research ,Democracy ,Justice and Strong Institutions ,West african ,Transmission (mechanics) ,Geography ,Infectious Diseases ,Ebola ,Public Health and Health Services ,Democratic Republic of the Congo ,Christian ministry ,Infection ,media_common.quotation_subject ,030231 tropical medicine ,Clinical Sciences ,Ebola virus disease ,Violence ,Microbiology ,Article ,lcsh:Infectious and parasitic diseases ,Time ,Vaccine Related ,03 medical and health sciences ,Virology ,Biodefense ,medicine ,Humans ,lcsh:RC109-216 ,Peace ,Ebola virus ,Prevention ,Public Health, Environmental and Occupational Health ,Outbreak ,Geospatial ,Hemorrhagic Fever, Ebola ,Democratic Republic of Congo ,Good Health and Well Being ,Emerging Infectious Diseases ,Africa ,Hemorrhagic Fever ,Parasitology ,Mathematical modeling ,Quenching rate ,Demography - Abstract
Introduction: As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. Methods: We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018–2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. Results: As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013–2016 West African outbreak. Conclusion: The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak. Keywords: Ebola virus disease, Outbreak, Mathematical modeling, Geospatial, Democratic Republic of Congo, Africa
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- 2019
45. Severe Acute Respiratory Illness Deaths in Sub-Saharan Africa and the Role of Influenza: A Case Series From 8 Countries
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Juno Thomas, J.J. Lutwama, Robert S. Heyderman, Thelma Williams, Amal Barakat, Joelle Kabamba Tshilobo, Dean Everett, Ndahwouh Talla Nzussouo, Elibariki R. Mwakapeje, Meredith McMorrow, Norosoa Harline Razanajatovo, Moses Chilombe, Emile Okitolonda Wemakoy, Marietjie Venter, Marc-Alain Widdowson, Stefano Tempia, Henry Njuguna, Jazmin Duque, Marcelina Mponela, Kathryn E. Lafond, Cheryl Cohen, Gideon O. Emukule, Joshua A. Mott, Joseph Rukelibuga, Lilian W. Waiboci, Thierry Nyatanyi, Jean-Michel Heraud, Soatianana Rajatonirina, Adam L. Cohen, Centers for Disease Control and Prevention [Atlanta] (CDC), Centers for Disease Control and Prevention, Kinshasa School of Public Health, Centers for Disease Control and Prevention [Kenya], Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP), University of Malawi, Ministry of Health [Morocco], Rwanda Biomedical Center (RBC), University of the Witwatersrand [Johannesburg] (WITS), Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases [Johannesburg] (NICD), University of Pretoria [South Africa], Ministry of Health and Social Welfare, Uganda Virus Research Institute, and This work was supported by the CDC (all countries that provided data for this analysis are supported via a cooperative agreement for influenza surveillance), Institut Pasteur (core funding to Madagascar), and the Wellcome Trust (core funding to the Malawi-Liverpool-Wellcome Trust Clinical Research Programme).
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Pediatrics ,medicine.disease_cause ,0302 clinical medicine ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,MESH: Child ,Case fatality rate ,Immunology and Allergy ,030212 general & internal medicine ,Young adult ,Child ,Respiratory Tract Infections ,Cause of death ,MESH: Aged ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,MESH: Middle Aged ,biology ,Respiratory tract infections ,MESH: Influenza, Human ,MESH: Infant, Newborn ,Bacterial Infections ,Middle Aged ,MESH: Infant ,3. Good health ,Infectious Diseases ,MESH: Young Adult ,Child, Preschool ,Population Surveillance ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Rhinovirus ,influenza ,Adult ,medicine.medical_specialty ,Sub saharan ,Adolescent ,MESH: Bacterial Infections ,030231 tropical medicine ,Orthomyxoviridae ,Article ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,MESH: Population Surveillance ,03 medical and health sciences ,Young Adult ,Age Distribution ,Environmental health ,Influenza, Human ,medicine ,Humans ,human ,MESH: Africa South of the Sahara ,MESH: Age Distribution ,Africa South of the Sahara ,Aged ,MESH: Adolescent ,Respiratory illness ,MESH: Humans ,business.industry ,MESH: Child, Preschool ,Infant, Newborn ,Infant ,MESH: Adult ,[SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology ,biology.organism_classification ,mortality ,MESH: Respiratory Tract Infections ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
Item does not contain fulltext BACKGROUND: Data on causes of death due to respiratory illness in Africa are limited. METHODS: From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI)-associated deaths identified from influenza surveillance during 2009-2012. RESULTS: Twenty-three countries (82%) responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37 714 SARI cases, and 3091 (8.2%; range by country, 5.1%-25.9%) tested positive for influenza virus. There were 1073 deaths (2.8%; range by country, 0.1%-5.3%) reported, among which influenza virus was detected in 57 (5.3%). Case-fatality proportion (CFP) was higher among countries with systematic death reporting than among those with sporadic reporting. The influenza-associated CFP was 1.8% (57 of 3091), compared with 2.9% (1016 of 34 623) for influenza virus-negative cases (P < .001). Among 834 deaths (77.7%) tested for other respiratory pathogens, rhinovirus (107 [12.8%]), adenovirus (64 [6.0%]), respiratory syncytial virus (60 [5.6%]), and Streptococcus pneumoniae (57 [5.3%]) were most commonly identified. Among 1073 deaths, 402 (37.5%) involved people aged 0-4 years, 462 (43.1%) involved people aged 5-49 years, and 209 (19.5%) involved people aged >/=50 years. CONCLUSIONS: Few African countries systematically collect data on outcomes of people hospitalized with respiratory illness. Stronger surveillance for deaths due to respiratory illness may identify risk groups for targeted vaccine use and other prevention strategies.
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- 2015
46. Novel simian foamy virus infections from multiple monkey species in women from the Democratic Republic of Congo
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Walid Heneine, Anupama Shankar, Shaohua Tang, Debra L. Hanson, Emile Okitolonda Wemakoy, Steve Ahuka-Mundeke, William M. Switzer, HaoQiang Zheng, Anne W. Rimoin, Ubald Tamoufe, Matthew LeBreton, Prime Mulembakani, Martine Peeters, Linda L. Wright, Amandine Esteban, Nathan D. Wolfe, Ahidjo Ayouba, Jean Jacques Muyembe-Tamfum, Nicole A. Hoff, and Cyrille F. Djoko
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viruses ,Simian foamy virus ,Simian ,law.invention ,Zoonosis ,law ,Zoonoses ,Primate ,Child ,Phylogeny ,Polymerase chain reaction ,Aged, 80 and over ,Emerging ,Public health ,education.field_of_study ,Retrovirus ,biology ,Monkey Diseases ,Middle Aged ,Viral Load ,Transmission (mechanics) ,Infectious Diseases ,Congo ,Child, Preschool ,Female ,Viral load ,Adult ,lcsh:Immunologic diseases. Allergy ,Adolescent ,Population ,Colobus ,biology.animal ,Virology ,parasitic diseases ,medicine ,Animals ,Humans ,Transmission ,Women ,education ,Aged ,Research ,Infant ,biochemical phenomena, metabolism, and nutrition ,medicine.disease ,biology.organism_classification ,Africa ,Immunology ,lcsh:RC581-607 ,Retroviridae Infections - Abstract
Background Zoonotic transmission of simian retroviruses in Central Africa is ongoing and can result in pandemic human infection. While simian foamy virus (SFV) infection was reported in primate hunters in Cameroon and Gabon, little is known about the distribution of SFV in Africa and whether human-to-human transmission and disease occur. We screened 3,334 plasmas from persons living in rural villages in central Democratic Republic of Congo (DRC) using SFV-specific EIA and Western blot (WB) tests. PCR amplification of SFV polymerase sequences from DNA extracted from buffy coats was used to measure proviral loads. Phylogenetic analysis was used to define the NHP species origin of SFV. Participants completed questionnaires to capture NHP exposure information. Results Sixteen (0.5%) samples were WB-positive; 12 of 16 were from women (75%, 95% confidence limits 47.6%, 92.7%). Sequence analysis detected SFV in three women originating from Angolan colobus or red-tailed monkeys; both monkeys are hunted frequently in DRC. NHP exposure varied and infected women lived in distant villages suggesting a wide and potentially diverse distribution of SFV infections across DRC. Plasmas from 22 contacts of 8 WB-positive participants were all WB negative suggesting no secondary viral transmission. Proviral loads in the three women ranged from 14 – 1,755 copies/105 cells. Conclusions Our study documents SFV infection in rural DRC for the first time and identifies infections with novel SFV variants from Colobus and red-tailed monkeys. Unlike previous studies, women were not at lower risk for SFV infection in our population, providing opportunities for spread of SFV both horizontally and vertically. However, limited testing of close contacts of WB-positive persons did not identify human-to-human transmission. Combined with the broad behavioral risk and distribution of NHPs across DRC, our results suggest that SFV infection may have a wider geographic distribution within DRC. These results also reinforce the potential for an increased SFV prevalence throughout the forested regions of Africa where humans and simians co-exist. Our finding of endemic foci of SFV infection in DRC will facilitate longitudinal studies to determine the potential for person-to-person transmissibility and pathogenicity of these zoonotic retroviral infections.
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47. Correction: Zoonotic risk factors associated with seroprevalence of Ebola virus GP antibodies in the absence of diagnosed Ebola virus disease in the Democratic Republic of Congo.
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Anna Bratcher, Nicole A Hoff, Reena H Doshi, Adva Gadoth, Megan Halbrook, Patrick Mukadi, Kami Musene, Benoit Ilunga-Kebela, D'Andre Spencer, Matthew S Bramble, David McIlwain, J Daniel Kelly, Daniel Mukadi, Placide Mbala Kingebeni, Steve Ahuka, Emile Okitolonda-Wemakoy, Jean -Jacques Muyembe-Tamfum, and Anne W Rimoin
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
[This corrects the article DOI: 10.1371/journal.pntd.0009566.].
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- 2022
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48. Tetanus seroprotection among children in the Democratic Republic of the Congo, 2013-2014.
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Alvan Cheng, Angie Ghanem-Uzqueda, Nicole A Hoff, Hayley Ashbaugh, Reena H Doshi, Patrick Mukadi, Roger Budd, Stephen G Higgins, Christina Randall, Sue Gerber, Michel Kabamba, Guilluame Ngoie Mwamba, Emile Okitolonda-Wemakoy, Jean Jacques Muyembe-Tanfum, and Anne W Rimoin
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Medicine ,Science - Abstract
BackgroundTetanus is a potentially fatal disease that is preventable through vaccination. While the Democratic Republic of the Congo (DRC) has continued to improve implementing routine vaccination activities throughout the country, they have struggled to maintain high childhood vaccine coverage. This study aims to examine the seroprevalence of tetanus in children 6 to 59 months to identify areas for intervention and improvement of vaccination coverage.MethodsIn collaboration with the 2013-2014 Demographic and Health Survey, we assessed the seroprevalence of tetanus antibodies among children in the DRC. Dried blood spot samples collected from children 6-59 months of age were processed using a prototype DYNEX Multiplier® chemiluminescent automated immunoassay instrument with a multiplex measles, mumps, rubella, varicella and tetanus assay. Multivariable logistic regression was used to determine factors associated with tetanus vaccination and seroprotection.ResultsOverall, 36.1% of children 6-59 months of age reported receiving at least 1 dose of tetanus vaccine while 28.7% reported receiving 3 doses; tetanus seroprotection was 40%. Increasing age in children was associated with decreased tetanus seroprotection, but increased number tetanus vaccinations received. Factors related to increased tetanus seroprotection included number of children in the household, wealth index of the family, urban residence compared to rural, level of maternal education, and province and geography.ConclusionsOur findings in this nationally representative sample indicate that serology biomarkers may help identify children who are not fully immunized to tetanus more accurately than reported vaccination. While children may be captured for routine immunization activities, as children age, decreasing seroprevalence may indicate additional need to bolster routine vaccination activities and documentation of vaccination in school aged children. Additionally, the study highlights gaps in rural residential areas and vaccination coverage based on maternal education, indicating that policies targeting maternal education and awareness could improve the coverage and seroprevalence of tetanus antibodies in the DRC.
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- 2022
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49. Real-time predictions of the 2018–2019 Ebola virus disease outbreak in the Democratic Republic of the Congo using Hawkes point process models
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J. Daniel Kelly, Junhyung Park, Ryan J. Harrigan, Nicole A. Hoff, Sarita D. Lee, Rae Wannier, Bernice Selo, Mathias Mossoko, Bathe Njoloko, Emile Okitolonda-Wemakoy, Placide Mbala-Kingebeni, George W. Rutherford, Thomas B. Smith, Steve Ahuka-Mundeke, Jean Jacques Muyembe-Tamfum, Anne W. Rimoin, and Frederic Paik Schoenberg
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Infectious and parasitic diseases ,RC109-216 - Abstract
As of June 16, 2019, an Ebola virus disease (EVD) outbreak has led to 2136 reported cases in the northeastern region of the Democratic Republic of the Congo (DRC). As this outbreak continues to threaten the lives and livelihoods of people already suffering from civil strife and armed conflict, relatively simple mathematical models and their short-term predictions have the potential to inform Ebola response efforts in real time. We applied recently developed non-parametrically estimated Hawkes point processes to model the expected cumulative case count using daily case counts from May 3, 2018, to June 16, 2019, initially reported by the Ministry of Health of DRC and later confirmed in World Health Organization situation reports. We generated probabilistic estimates of the ongoing EVD outbreak in DRC extending both before and after June 16, 2019, and evaluated their accuracy by comparing forecasted vs. actual outbreak sizes, out-of-sample log-likelihood scores and the error per day in the median forecast. The median estimated outbreak sizes for the prospective thee-, six-, and nine-week projections made using data up to June 16, 2019, were, respectively, 2317 (95% PI: 2222, 2464); 2440 (95% PI: 2250, 2790); and 2544 (95% PI: 2273, 3205). The nine-week projection experienced some degradation with a daily error in the median forecast of 6.73 cases, while the six- and three-week projections were more reliable, with corresponding errors of 4.96 and 4.85 cases per day, respectively. Our findings suggest the Hawkes point process may serve as an easily-applied statistical model to predict EVD outbreak trajectories in near real-time to better inform decision-making and resource allocation during Ebola response efforts. Keywords: Ebola virus disease, Hawkes point process, Mathematical modeling, Democratic Republic of Congo, Compartmental models
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- 2019
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50. Projections of epidemic transmission and estimation of vaccination impact during an ongoing Ebola virus disease outbreak in Northeastern Democratic Republic of Congo, as of Feb. 25, 2019.
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Lee Worden, Rae Wannier, Nicole A Hoff, Kamy Musene, Bernice Selo, Mathias Mossoko, Emile Okitolonda-Wemakoy, Jean Jacques Muyembe Tamfum, George W Rutherford, Thomas M Lietman, Anne W Rimoin, Travis C Porco, and J Daniel Kelly
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundAs of February 25, 2019, 875 cases of Ebola virus disease (EVD) were reported in North Kivu and Ituri Provinces, Democratic Republic of Congo. Since the beginning of October 2018, the outbreak has largely shifted into regions in which active armed conflict has occurred, and in which EVD cases and their contacts have been difficult for health workers to reach. We used available data on the current outbreak, with case-count time series from prior outbreaks, to project the short-term and long-term course of the outbreak.MethodsFor short- and long-term projections, we modeled Ebola virus transmission using a stochastic branching process that assumes gradually quenching transmission rates estimated from past EVD outbreaks, with outbreak trajectories conditioned on agreement with the course of the current outbreak, and with multiple levels of vaccination coverage. We used two regression models to estimate similar projection periods. Short- and long-term projections were estimated using negative binomial autoregression and Theil-Sen regression, respectively. We also used Gott's rule to estimate a baseline minimum-information projection. We then constructed an ensemble of forecasts to be compared and recorded for future evaluation against final outcomes. From August 20, 2018 to February 25, 2019, short-term model projections were validated against known case counts.ResultsDuring validation of short-term projections, from one week to four weeks, we found models consistently scored higher on shorter-term forecasts. Based on case counts as of February 25, the stochastic model projected a median case count of 933 cases by February 18 (95% prediction interval: 872-1054) and 955 cases by March 4 (95% prediction interval: 874-1105), while the auto-regression model projects median case counts of 889 (95% prediction interval: 876-933) and 898 (95% prediction interval: 877-983) cases for those dates, respectively. Projected median final counts range from 953 to 1,749. Although the outbreak is already larger than all past Ebola outbreaks other than the 2013-2016 outbreak of over 26,000 cases, our models do not project that it is likely to grow to that scale. The stochastic model estimates that vaccination coverage in this outbreak is lower than reported in its trial setting in Sierra Leone.ConclusionsOur projections are concentrated in a range up to about 300 cases beyond those already reported. While a catastrophic outbreak is not projected, it is not ruled out, and prevention and vigilance are warranted. Prospective validation of our models in real time allowed us to generate more accurate short-term forecasts, and this process may prove useful for future real-time short-term forecasting. We estimate that transmission rates are higher than would be seen under target levels of 62% coverage due to contact tracing and vaccination, and this model estimate may offer a surrogate indicator for the outbreak response challenges.
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- 2019
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