Ernest Tambo

Deciphering emerging Zika and dengue viral epidemics: Implications for global maternal-child health burden.

Summary Since its discovery in 1947 in Uganda and control and eradication efforts have aimed at its vectors (Aedes mosquitoes) in Latin America in the 1950s, an absolute neglect of Zika programs and interventions has been documented in Aedes endemic and epidemic-prone countries. The current unprecedented Zika viral epidemics and rapid spread in the Western hemisphere pose a substantial global threat, with associated anxiety and consequences. The lack of safe and effective drugs and vaccines against Zika or dengue epidemics further buttresses the realization from the West Africa Ebola outbreak that most emerging disease-prone countries are still poorly prepared for an emergency response. This paper examines knowledge gaps in both emerging and neglected arthropod-borne flavivirus infectious diseases associated with poverty and their implications for fostering local, national and regional emerging disease preparedness, effective and robust surveillance–response systems, sustained control and eventual elimination. Strengthening the regional and Global Health Flavivirus Surveillance-Response Network (GHFV-SRN) with other models of socio-economic, climatic, environmental and ecological mitigation and adaptation strategies will be necessary to improve evidence-based national and global maternal–child health agenda and action plans.

Outwitting dengue threat and epidemics resurgence in Asia-Pacific countries: strengthening integrated dengue surveillance, monitoring and response systems.

Dengue is still a substantial vector-borne viral disease threat and burden of public health importance worldwide. This situation is complicated by dengue virus unprecedented resurgence and persistence of varied serotypes in endemic-prone areas, and man-made and natural activities consequences that promote vector emergence, transmission dynamics and spread across the Asia-Pacific region. There is an urgent need to strengthen operational and contextual surveillance-response research in improving early detection of active reservoir detection, novel drug in case management and quality evidence-based response including the deployment of dengue mass vaccination. Moreover, sustained mapping and watching of dengue risk factors or determinants, performance and outcome indicators of control or elimination programs effectiveness in defining minimum effective data towards community knowledge-based decision-making policy and effective response packages is imperative. Moreover, implementation of a robust, integrated dengue early warning surveillance, monitoring and response systems metrics is required for evidence-based, timely and cost-effective contextual mitigation strategies, and innovative interventions.

Addressing knowledge gaps in molecular, sero-surveillance and monitoring approaches on Zika epidemics and other arbovirus co-infections: A structured review

Globalization, with consequent increased travel and trade, rapid urbanization and growing weather variation events due to climate change has contributed to the recent unprecedented Zika virus (ZIKV) pandemic. This has emphasized the pressing need for local, national, regional and global community collaborative proactiveness, leadership and financial investment resilience in research and development. This paper addresses the potential knowledge gaps and impact of early detection and monitoring approaches on ZIKV epidemics and related arboviral infections steered towards effective prevention and smart response strategies. We advocate for the development and validation of robust field and point of care diagnostic tools that are more sensitive, specific and cost effective for use in ZIKV epidemics and routine pathophysiology surveillance and monitoring systems as an imperative avenue in understanding Zika-related and other arbovirus trends and apply genomic and proteomic characterisation approaches in guiding annotation efforts in order to design and implement public health burden mitigation and adaptation strategies.

Rebuilding transformation strategies in post-Ebola epidemics in Africa.

Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national ‘One Health’ approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.

Global invasive Cochliobolus species: cohort of destroyers with implications in food losses and insecurity in the twenty-first century

Matching the global food demand by 2050 and to ensure the stability of food security in over than 99 countries, it is necessary to scale up the production of food such as sorghum, wheat, rice, maize and sugarcane which are however natural hosts of Cochliobolus species. Cochliobolus species major epidemics such as the Great Bengal famine, Southern corn leaf blight, and Northern leaf spot blight were associated with substantial economic losses in the past decades. Thus, there is an urgent need to establish a specific coordinated global surveillance program for the migration of invasive Cochliobolus species, planning contextual control programs engaging all agricultural stakeholders and information sharing in real time for prevention of disastrous Cochliobolus disease outbreak effects. We discuss pertinent outcome of interactions of cash crops with Cochliobolus species having devastating impact on the livelihood of farmers and food security. While post-genomic era elucidated prominent differences among Cochliobolus heterostrophus, C. carbonum, C. victoriae, C. lunatus and C. miyabeanus, their destructive potentials and implications in food losses remained unearthed. Intriguingly, the annual colossal losses caused by Cochliobolus species in the production perspective of sorghum, wheat, rice, maize, cassava and soybean is estimated over 10 billion USD worldwide. This paper provides a comprehensive analysis of the invasive Cochliobolus species distribution and diversity, evolving pathogenicity, persistent diseases, threats and epidemics, consequences on food crops production and increasing global food insecurity issues.

Re-emerging Lassa fever outbreaks in Nigeria: Re-enforcing “One Health” community surveillance and emergency response practice

We evaluated the impact of man-made conflict events and climate change impact in guiding evidence-based community “One Health” epidemiology and emergency response practice against re-/emerging epidemics. Increasing evidence of emerging and re-emerging zoonotic diseases including recent Lassa fever outbreaks in almost 20 states in Nigeria led to 101 deaths and 175 suspected and confirmed cases since August 2015. Of the 75 laboratory confirmed cases, 90 deaths occurred representing 120% laboratory-confirmed case fatality. The outbreak has been imported into neighbouring country such as Benin, where 23 deaths out of 68 cases has also been reported. This study assesses the current trends in re-emerging Lassa fever outbreak in understanding spatio-geographical reservoir(s), risk factors pattern and Lassa virus incidence mapping, inherent gaps and raising challenges in health systems. It is shown that Lassa fever peak endemicity incidence and prevalence overlap the dry season (within January to March) and reduced during the wet season (of May to November) annually in Sierra Leone, Senegal to Eastern Nigeria. We documented a scarcity of consistent data on rodent (reservoirs)-linked Lassa fever outbreak, weak culturally and socio-behavioural effective prevention and control measures integration, weak or limited community knowledge and awareness to inadequate preparedness capacity and access to affordable case management in affected countries. Hence, robust sub/regional leadership commitment and investment in Lassa fever is urgently needed in building integrated and effective community “One Health” surveillance and rapid response approach practice coupled with pest management and phytosanitation measures against Lassa fever epidemic. This offers new opportunities in understanding human-animal interactions in strengthening Lassa fever outbreak early detection and surveillance, warning alerts and rapid response implementation in vulnerable settings. Leveraging on Africa CDC centre, advances in cloud-sourcing and social media tools and solutions is core in developing and integrating evidence-based and timely risk communication, and reporting systems in improving contextual community-based immunization and control decision making policy to effectively defeat Lassa fever outbreak and other emerging pandemics public health emergencies in Africa and worldwide.

Ethical, legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.

Invasive Aspergillus terreus morphological transitions and immunoadaptations mediating antifungal resistance

Background and aims Aspergillus terreus Thom is a pathogen of public health and agricultural importance for its seamless abilities to expand its ecological niche. The aim of this study was holistically to investigate A. terreus morphological and immunoadaptations and their implication in antifungal resistance and proliferation during infection. Materials and methods In-depth unstructured mining of relevant peer-reviewed literature was performed for A. terreus morphological, immune, resistance, and genetic diversity based on the sequenced calmodulin-like gene. Results Accessory conidia and phialidic conidia produced by A. terreus confer discrete anti-fungal resistance that ensures survivability during therapies. Interestingly, by producing unique metabolites such as Asp–melanin and terretonin, A. terreus is capable of hijacking macrophages and scavenging iron, respectively. As such, A. terreus has established a rare mechanism to mitigate phagocytosis and swing the interaction dynamics in favor of its proliferation and survival in hosts. Conclusion It is further unraveled that besides A. terreus genetic diversity, morphological, biochemical, and immunologic adaptations associated with conidia germination and discharge of chemical signals during infection enable masking of the host defense as an integral part of its strategy to survive and rapidly colonize hosts.

Relationship between tropical endemic limbo-conjunctivitis and intestinal helminths in a population of Cameroonian children

Abstract Background: Tropical endemic limbo-conjunctivitis (TELC) is an allergic limbo-conjunctivitis, very common in children of tropical areas, and often characterized by ocular morbidity. Several studies were devoted to the study of the epidemiological and clinical aspects of TELC in Africa but in Cameroon, no study has ever been conducted on its association with intestinal helminths. The objective of our work was to investigate the association between TELC and intestinal helminths in pupils of Njombe–Cameroon. Methods: We conducted a cross-sectional study from January to September 2014. Random consecutive sampling was carried out. Selected pupils underwent a comprehensive eye examination, and their stool sample was examined using the KATO-KATZ technic to search for helminths eggs. Statistical tests were used for data analysis (p-value <0.05). Results: Two hundred and fifty-three students were enrolled. Thirty-six (14.2%) were affected by TELC. The average age of children with TELC was 9 ± 2 years (range: 4–13 years) with a male predominance (p = 0.001). Conjunctival hyperemia (88.9%) was the major clinical sign with a predominance of limbic clinical form (58.4%). The prevalence of intestinal helminths was 28.1% in the general population vs. 33.3% in participants with TELC. TELC was not associated with intestinal helminths. Conclusion: The prevalence of TELC (14.2%) is low in our study. Male sex was associated to TELC. The overall frequency of intestinal helminth infection was 28.1% and the one amongst patients with TELC was 33.3%. Despite the presence of intestinal helminth infection in our population, it was not associated with TELC.

HIV and sexually transmitted co-infections among sex workers in the Southern African economic region

Background: The Southern African Development Community (SADC) economic block is the most affected region by HIV epidemic in Sub-Saharan Africa (SSA). Despite programmatic interventions, HIV infections remain unprecedentedly high among female sex workers (FSW) in the region. This review assesses the HIV burden and the drivers associated with FSW in the SADC region. Methods: We systematically extracted and analyzed HIV burden and other sexually transmitted infections (STIs) research data on FSW indexed in various journal platform and reports from governmental and nongovernmental organizations between 2003 and 2015. Meta-analysis technique was used to estimate the pooled prevalence of the HIV burden among FSW in the region. Results: Of the 192 peer-reviewed articles and reports addressing HIV burden, only 21 articles met eligibility criteria totaling 14998 FSW. The combined overall pool HIV prevalence was estimated at 42.0% (95% CI 0.41–0.43). The estimated pooled HIV prevalence ranged from 16% (95% CI 0.13–18) in Democratic Republic of Congo, 59% (95% CI 0.57–0.62) in South Africa and 71% (95% CI 0.65–0.76) in Malawi. The most common STIs reported were syphilis, Chlamydia, and gonorrhea with little emphasis on viruses. Structural factors such as stigma and discrimination, access to healthcare services and various socioeconomic and political barriers impeded treatment and prevention. Conclusion: The HIV prevalence among FSW was 5–30 times higher when compared to the overall female reproductive age population in the SADC region. This signifies and necessitates increase evidence based HIV/STIs research and programs among FSW in the SADC region.