1
views
0
recommends
+1 Recommend
4 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Advancing detection and response capacities for emerging and re-emerging pathogens in Africa

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.

          Related collections

          Most cited references11

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

          The SARS-CoV-2 epidemic in southern Africa has been characterized by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, while the second and third waves were driven by the Beta (B.1.351) and Delta (B.1.617.2) variants, respectively 1–3 . In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron, B.1.1.529) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, which are predicted to influence antibody neutralization and spike function 4 . Here we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            A Randomized, Controlled Trial of Ebola Virus Disease Therapeutics

            Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial

              Background Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19. Methods This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups not reported here). The trial team, site staff, and patients were masked to treatment allocation. Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19 up to 28 days post-random assignment on the basis of intention to treat. Modified intention to treat explored patients receiving at least 24 h of treatment before a primary outcome event and per-protocol analysis explored patients with a high level adherence (>80%). We used a Bayesian analytic framework to establish the effects along with probability of success of intervention compared with placebo. The trial is registered at ClinicalTrials.gov (NCT04727424) and is ongoing. Findings The study team screened 9803 potential participants for this trial. The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo. The average age of participants was 50 years (range 18–102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 [11%] of 741 vs 119 [16%] of 756); relative risk [RR] 0·68; 95% Bayesian credible interval [95% BCI]: 0·52–0·88), with a probability of superiority of 99·8% surpassing the prespecified superiority threshold of 97·6% (risk difference 5·0%). Of the composite primary outcome events, 87% were hospitalisations. Findings for the primary outcome were similar for the modified intention-to-treat analysis (RR 0·69, 95% BCI 0·53–0·90) and larger in the per-protocol analysis (RR 0·34, 95% BCI, 0·21–0·54). There were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group in the primary intention-to-treat analysis (odds ratio [OR] 0·68, 95% CI: 0·36–1·27). There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01–0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups. Interpretation Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital. Funding FastGrants and The Rainwater Charitable Foundation. Translation For the Portuguese translation of the abstract see Supplementary Materials section.
                Bookmark

                Author and article information

                Journal
                Lancet Infect Dis
                Lancet Infect Dis
                The Lancet. Infectious Diseases
                Elsevier Ltd.
                1473-3099
                1474-4457
                20 December 2022
                20 December 2022
                Affiliations
                [a ]Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
                [b ]Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
                [c ]Department of Medicine, Division of Infectious Diseases, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
                [d ]School for Data Science and Computational Thinking, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
                [e ]Centre for Epidemic Response and Innovation, Faculty of Science and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
                [f ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [g ]Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
                [h ]University Teaching Hospital, Butare, Rwanda
                [i ]University of Global Health Equity, Kigali, Rwanda
                [j ]Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
                [k ]School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
                [l ]Platform Life Sciences, Vancouver, BC, Canada
                [m ]Department of Real World and Advanced Analytics, Vancouver, Cytel, Vancouver, BC, Canada
                [n ]Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
                [o ]Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
                [p ]Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
                [q ]Department of Population Health Sciences, Weill Cornell Medicine, NY, USA
                [r ]Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
                [s ]Center for Human Genetics, University of Rwanda, Kigali, Rwanda
                [t ]Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
                [u ]National Institute for Bio-Medical Research, Kinshasa, Democratic Republic of the Congo
                [v ]University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
                [w ]Fondation Congolaise pour la Recherche Médicale, Brazzaville, Republic of the Congo
                [x ]Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
                [y ]Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, UK
                [z ]NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
                Author notes
                [* ]Correspondence to: Prof Jean B Nachega, Department of Epidemiology and Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA 15261, USA
                [†]

                Contributed equally

                Article
                S1473-3099(22)00723-X
                10.1016/S1473-3099(22)00723-X
                10023168
                36563700
                fa938cde-85f3-4163-bf92-166ae58e4e44
                © 2022 Elsevier Ltd. All rights reserved.

                Elsevier has created a Monkeypox Information Center (https://www.elsevier.com/connect/monkeypox-information-center) in response to the declared public health emergency of international concern, with free information in English on the monkeypox virus. The Monkeypox Information Center is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its monkeypox related research that is available on the Monkeypox Information Center - including this research content - immediately available in publicly funded repositories, with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the Monkeypox Information Center remains active.

                History
                Categories
                Personal View

                Infectious disease & Microbiology
                Infectious disease & Microbiology

                Comments

                Comment on this article