The recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV) vaccine is the only vaccine recommended for use to respond to Zaire ebolavirus outbreaks by SAGE. A single ring vaccination trial found the efficacy to be 100%; however, no estimates of real-world effectiveness have yet been published.
METHODS
We conducted a retrospective test-negative case-control analysis to estimate effectiveness of rVSV-ZEBOV vaccination against Ebola virus disease (EVD) during the 2018 - 2020 epidemic in the Democratic Republic of the Congo (DRC), using data on suspected cases collected at Ebola treatment centres. Missing data were imputed using multivariate imputation. Among those who reported contact with an Ebola case before symptom onset, each EVD-positive case was matched to one EVD-negative control by sex, age, health zone and month of symptom onset. Effectiveness was then estimated from the odds ratio of being vaccinated vs. unvaccinated among cases and controls, after adjusting for the matching factors.
RESULTS
The primary study population contained 309 cases and controls each, on average, of which between 11 and 23 cases (3.6– 7.4%) and between 48 and 80 controls (16 – 26%) were recorded as vaccinated at least ten days before symptom onset. We found rVSV-ZEBOV vaccination at least ten days before symptom onset was 84% effective against developing EVD (95% credible interval [70%, 92%]). There was no apparent difference in effectiveness by sex, age, or due to a change in vaccination protocol.
CONCLUSION
This study is the first to estimate real-world effectiveness of rVSV-ZEBOV vaccination EVD during the second largest EVD outbreak ever recorded. Our findings confirm that rVSV-ZEBOV vaccination is highly protective against developing EVD and support its reactive, targeted use in at-risk people during future outbreaks.
BACKGROUND
Fighting erupted on 15 April 2023 in Sudan between the army and the paramilitary Rapid Support Forces. By September 2023, more than 420,000 people had fled to Chad. To describe the health status of the displaced populations in camps in eastern Chad, several surveys were realised. We describe retrospective crude and under five mortality rates, reported causes of death and frequency and type of violence events experienced by displaced populations in three camps in eastern Chad.
METHODS
Cross-sectional surveys were carried out in August and September 2023 in Toumtouma, Ourang and Arkoum camps. Each survey included retrospective mortality and frequency and type of violent events experienced. All surveys considered a pre-crisis and crisis phase.
RESULTS
In all sites, the crude mortality rate (CMR) was significantly higher in the crisis phase than in the pre-crisis phase. The CMR was particularly elevated in Ourang camp (CMR: 2.25 deaths/10,000 people/day [95% CI: 1.77 - 2.74] in the crisis phase versus CMR: 0.11 deaths/10,000 people/day [95% CI: 0.02 - 0.20] in the pre-crisis phase). Violence was the leading self-reported cause of death in all sites. Among households in Ourang, more than 90 percent originating from El Geneina, more than 1 in 10 of all men aged 30 and over died of violent causes. In Toumtouma, Ourang and Arkoum camps, the overall frequency of violence among households was 3.3%, 11.7% and 4.4% respectively, with beatings and shooting most frequently cited.
CONCLUSIONS
In the three camps investigated, excess mortality was observed among households during the crisis phase, with excess mortality primarily linked to violence among men. The population in Ourang camp, largely from El Geneina, appears to have been particularly affected by the violence, with CMR 20 times higher than in the pre-crisis period and mortality rates exceeding the standard emergency threshold (1 death/10,000 people/day).
KEY MESSAGE
Several cross-sectional surveys were carried out among displaced populations arriving in Chad. We provide epidemiological evidence of the high rates of mortality and violence since the start of the conflict in Sudan.
BACKGROUND
Mobility of people living with HIV (PWH) among urban population in Goma and the fisherfolk community in western Uganda can serve as a barrier to retention in care. To address this challenge, MSF supported MoH in deployment of WHO recommended Differentiated Services Delivery Models (DSDM), especially Community ART groups (CAG) where clients form groups and rotate drug pick-up. In these studies, we aimed to explore retention-in-care, viral load coverage and suppression among PWH enrolled in DSDM and describe acceptability and satisfaction of these models in Goma, DRC and Kasese, Uganda.
METHODS
In both contexts, we carried out a retrospective cohort analysis complemented by a cross-sectional survey in Goma and a qualitative survey in Kasese. For the cohort analysis, we examined the characteristics of PWH enrolled in DSDM. Utilizing Kaplan-Meier survival analysis, we estimated retention in care and calculated viral coverage and suppression rates at 12 months post-model initiation. In Goma, we administered a satisfaction questionnaire to a subset of the active cohort, while in Kasese, we conducted interviews and facilitated focus group discussions to document the acceptability and relevance of DSDM.
RESULTS
In total, 1950 PWH in Goma and 1773 PWH in Kasese were included in the cohort analyses. After one year of model initiation, more than 90% of PWH enrolled in MSF-supported DSDM were retained in care (94.1% among PWH in Goma and 97.6% in Kasese). Of PWH who retained in care at 1-year, proportion of virally suppressed PWH was high in both contexts (96.4% in Goma and 97.0% in Goma). PWH and healthcare providers expressed positive sentiments towards DSMD, acknowledging their utility in enhancing convenience and reducing transport expenses for ART access. Moreover, they noted benefits such as decreased waiting times, alleviation of overcrowding and workload at healthcare facilities, as well as the role of DSDM in mitigating stigma and fostering responsibility sharing among group members.
CONCLUSION
Although great progress has been made in the fight against the HIV epidemic in recent years, a one-size-fits-all approach to caring for people living with HIV is no longer appropriate. The findings from these evaluations underscore the effectiveness of tailored, differentiated services, which maintain high retention rates in care, even within mobile communities, while also garnering strong acceptability. It is imperative to consider integrating DSDM into routine programming for chronic illnesses. By adapting clinical care to suit the lifestyles of PWH, such models can offer enhanced support to patients, ultimately improving health outcomes.