Journal Article > CommentaryFull Text
Lancet. 30 November 2024; Volume 404 (Issue 10468); P2157.; DOI:10.1016/S0140-6736(24)02476-0
Hamad BA, Jamaluddine Z, Aly S, Salayma M, Asi Y, et al.
Lancet. 30 November 2024; Volume 404 (Issue 10468); P2157.; DOI:10.1016/S0140-6736(24)02476-0
Journal Article > Short ReportFull Text
Emerg Infect Dis. 1 August 2024; Volume 30 (Issue 8); 1677-1682.; DOI:10.3201/eid3008.231137
Ratnayake R, Knee J, Cumming O, Saidi JM, Rumedeka BB, et al.
Emerg Infect Dis. 1 August 2024; Volume 30 (Issue 8); 1677-1682.; DOI:10.3201/eid3008.231137
We evaluated the spatiotemporal clustering of rapid diagnostic test−positive cholera cases in Uvira, eastern Democratic Republic of the Congo. We detected spatiotemporal clusters that consistently overlapped with major rivers, and we outlined the extent of zones of increased risk that are compatible with the radii currently used for targeted interventions.
Conference Material > Abstract
Jamaluddine Z, Chen Z, Abukmail H, Aly S, Elnakib S, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/8ccHxF
INTRODUCTION
Since 7 October 2023, large-scale military operations in the Gaza Strip have resulted in an escalating public health crisis. Residents of Gaza are mostly displaced from their homes and living in overcrowded conditions with insufficient access to water, sanitation, and food, and health services have been considerably disrupted. To inform humanitarian and decision-making efforts, we aimed to estimate the project excess mortality from traumatic injuries, infectious diseases, maternal and newborn complications, and non-communicable diseases (NCDs) under different future scenarios.
METHODS
We used five different models to project excess deaths from February to August 2024, considering three scenarios: (1) an immediate and permanent ceasefire; (2) the status quo, reflecting conditions from mid-October 2023 to mid-January 2024; and (3) a further escalation of the conflict. Using publicly available data and expert consultations, our analysis projected excess deaths resulting under each scenario. A model was developed to determine increased malnutrition (as an underlying cause).
RESULTS
Without epidemics, the ceasefire scenario would result in 6550 excess deaths, rising to 58,260 under the status quo, and 74,290 under escalation. With epidemics, these projections rise to 11,580, 66,720, and 85,750, respectively. Under the ceasefire scenario, infectious diseases would be the main cause of excess deaths (1,520 excess deaths without epidemics and 6,550 with epidemics). Traumatic injuries followed by infectious diseases would be the main causes of excess deaths in both the status quo (53,450 due to traumatic injuries; 2,120 due to infectious diseases without epidemics and 10,590 including epidemics) and escalation scenarios (68,650 due to traumatic injuries; 2,720 due to infectious diseases without epidemics and 14,180 with epidemics). Our projections indicate that, even in the best-case ceasefire scenario, thousands of excess deaths would continue to occur, mainly due to the time it would take to improve water, sanitation, shelter conditions, and malnutrition, and restore functioning healthcare services in Gaza. While the total number of estimated excess deaths from maternal and neonatal causes are relatively small (100–330 excess deaths), every loss of a mother has severe consequences for family health and wellbeing. NCDs are projected to cause more deaths (1,680 (ceasefire) –2,680 (escalation) excess deaths) due to a heavily disrupted specialised health services and impeded access to treatment and medications.
CONCLUSION
These projections underscore the critical and urgent need for an immediate ceasefire to mitigate the alarming excess mortality in Gaza. The severity of the ceasefire scenario cannot be understated, with over 6–11 thousand excess deaths projected. Decision-makers must act swiftly to prevent further loss of life and address the dire humanitarian situation in Gaza.
Since 7 October 2023, large-scale military operations in the Gaza Strip have resulted in an escalating public health crisis. Residents of Gaza are mostly displaced from their homes and living in overcrowded conditions with insufficient access to water, sanitation, and food, and health services have been considerably disrupted. To inform humanitarian and decision-making efforts, we aimed to estimate the project excess mortality from traumatic injuries, infectious diseases, maternal and newborn complications, and non-communicable diseases (NCDs) under different future scenarios.
METHODS
We used five different models to project excess deaths from February to August 2024, considering three scenarios: (1) an immediate and permanent ceasefire; (2) the status quo, reflecting conditions from mid-October 2023 to mid-January 2024; and (3) a further escalation of the conflict. Using publicly available data and expert consultations, our analysis projected excess deaths resulting under each scenario. A model was developed to determine increased malnutrition (as an underlying cause).
RESULTS
Without epidemics, the ceasefire scenario would result in 6550 excess deaths, rising to 58,260 under the status quo, and 74,290 under escalation. With epidemics, these projections rise to 11,580, 66,720, and 85,750, respectively. Under the ceasefire scenario, infectious diseases would be the main cause of excess deaths (1,520 excess deaths without epidemics and 6,550 with epidemics). Traumatic injuries followed by infectious diseases would be the main causes of excess deaths in both the status quo (53,450 due to traumatic injuries; 2,120 due to infectious diseases without epidemics and 10,590 including epidemics) and escalation scenarios (68,650 due to traumatic injuries; 2,720 due to infectious diseases without epidemics and 14,180 with epidemics). Our projections indicate that, even in the best-case ceasefire scenario, thousands of excess deaths would continue to occur, mainly due to the time it would take to improve water, sanitation, shelter conditions, and malnutrition, and restore functioning healthcare services in Gaza. While the total number of estimated excess deaths from maternal and neonatal causes are relatively small (100–330 excess deaths), every loss of a mother has severe consequences for family health and wellbeing. NCDs are projected to cause more deaths (1,680 (ceasefire) –2,680 (escalation) excess deaths) due to a heavily disrupted specialised health services and impeded access to treatment and medications.
CONCLUSION
These projections underscore the critical and urgent need for an immediate ceasefire to mitigate the alarming excess mortality in Gaza. The severity of the ceasefire scenario cannot be understated, with over 6–11 thousand excess deaths projected. Decision-makers must act swiftly to prevent further loss of life and address the dire humanitarian situation in Gaza.
Conference Material > Slide Presentation
Jamaluddine Z, Chen Z, Abukmail H, Aly S, Elnakib S, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Vhb9PBkEqz
Conference Material > Poster
Allison LE, Alhaffar M, Checchi F, Abdelmagid N, Nor B, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/5JuSnV
Conference Material > Slide Presentation
van Zandvoort K, Bobe M, Hassan AM, Ismail M, Saed M, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/t9ve-m563
Conference Material > Abstract
van Zandvoort K, Bobe M, Buqul A, Ismail M, Saed M, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/cxek-yg24
INTRODUCTION
Despite a likely high burden of disease caused by Streptococcus pneumoniae in humanitarian crises, pneumococcal conjugate vaccines (PCV’s) are rarely used in such settings. Routine immunisation is rarely feasible in crises, and there is little evidence on alternative delivery strategies for PCV. We used modelling to evaluate the effects of different vaccination strategies within humanitarian crisis settings, aiming to identify those which could quickly reduce and sustain low transmission of vaccine serotypes.
METHODS
We conducted a nested carriage and contact survey in a camp for internally displaced people (IDP) in Somaliland to parameterise a transmission model and used it to assess the potential impact and optimal age targeting of PCV campaigns. We extrapolated this model to other representative humanitarian crisis settings: an acute-phase IDP camp, a protracted crisis in a rural setting, and an urban setting with mixed IDP and host communities. For each we explored the impact and efficiency of campaigns with different target age groups and dosing strategies.
ETHICS
This study was approved by the Ethics Review Boards of the London School of Hygiene and Tropical Medicine and the Republic of Somaliland Ministry of Health Development.
RESULTS
We found high prevalence of nasopharyngeal carriage of Streptococcus pneumoniae; 37% (95% confidence interval (CI), 32-42) in all ages, and 76% (95% CI, 70-82) in children <5 years in the Somaliland IDP camp. 53% (95% CI, 45-61) of serotypes are included in the PCV13 vaccine. People had, on average, 9 (9-10) contacts per day, with high mixing rates between children and intergenerational contacts in older age groups. Our model projects that, for the Somaliland IDP camp, a single PCV campaign including children <5 years can temporarily establish substantial herd protection, averting 37% (95% credible interval (CrI) 24-48) of invasive pneumococcal disease cases in the 2 years following the campaign. Extending age eligibility to children up to 10 or 15 years old could further increase this impact by 49% (95% CrI, 39-50) and 53% (95% CrI, 40-64) respectively. Increased migration rates and close contact with unvaccinated host populations reduces the impact. These factors might require wider age targeting and more frequent repeat campaigns until routine services could be re-established.
CONCLUSION
We show that PCV campaigns could be an effective option to reduce the burden of pneumococcal disease in humanitarian crises until routine immunisation can be implemented. Our results are based on modelled estimates, intervention studies are needed to evaluate their feasibility and effectiveness in real settings.
CONFLICTS OF INTEREST
None declared
Despite a likely high burden of disease caused by Streptococcus pneumoniae in humanitarian crises, pneumococcal conjugate vaccines (PCV’s) are rarely used in such settings. Routine immunisation is rarely feasible in crises, and there is little evidence on alternative delivery strategies for PCV. We used modelling to evaluate the effects of different vaccination strategies within humanitarian crisis settings, aiming to identify those which could quickly reduce and sustain low transmission of vaccine serotypes.
METHODS
We conducted a nested carriage and contact survey in a camp for internally displaced people (IDP) in Somaliland to parameterise a transmission model and used it to assess the potential impact and optimal age targeting of PCV campaigns. We extrapolated this model to other representative humanitarian crisis settings: an acute-phase IDP camp, a protracted crisis in a rural setting, and an urban setting with mixed IDP and host communities. For each we explored the impact and efficiency of campaigns with different target age groups and dosing strategies.
ETHICS
This study was approved by the Ethics Review Boards of the London School of Hygiene and Tropical Medicine and the Republic of Somaliland Ministry of Health Development.
RESULTS
We found high prevalence of nasopharyngeal carriage of Streptococcus pneumoniae; 37% (95% confidence interval (CI), 32-42) in all ages, and 76% (95% CI, 70-82) in children <5 years in the Somaliland IDP camp. 53% (95% CI, 45-61) of serotypes are included in the PCV13 vaccine. People had, on average, 9 (9-10) contacts per day, with high mixing rates between children and intergenerational contacts in older age groups. Our model projects that, for the Somaliland IDP camp, a single PCV campaign including children <5 years can temporarily establish substantial herd protection, averting 37% (95% credible interval (CrI) 24-48) of invasive pneumococcal disease cases in the 2 years following the campaign. Extending age eligibility to children up to 10 or 15 years old could further increase this impact by 49% (95% CrI, 39-50) and 53% (95% CrI, 40-64) respectively. Increased migration rates and close contact with unvaccinated host populations reduces the impact. These factors might require wider age targeting and more frequent repeat campaigns until routine services could be re-established.
CONCLUSION
We show that PCV campaigns could be an effective option to reduce the burden of pneumococcal disease in humanitarian crises until routine immunisation can be implemented. Our results are based on modelled estimates, intervention studies are needed to evaluate their feasibility and effectiveness in real settings.
CONFLICTS OF INTEREST
None declared
Protocol > Research Protocol
BMJ Open. 6 July 2022; Volume 12 (Issue 7); e061206.; DOI:10.1136/bmjopen-2022-061206
Ratnayake R, Peyraud N, Ciglenecki I, Gignoux EM, Lightowler M, et al.
BMJ Open. 6 July 2022; Volume 12 (Issue 7); e061206.; DOI:10.1136/bmjopen-2022-061206
INTRODUCTION
Cholera outbreaks in fragile settings are prone to rapid expansion. Case-area targeted interventions (CATIs) have been proposed as a rapid and efficient response strategy to halt or substantially reduce the size of small outbreaks. CATI aims to deliver synergistic interventions (eg, water, sanitation, and hygiene interventions, vaccination, and antibiotic chemoprophylaxis) to households in a 100-250 m 'ring' around primary outbreak cases.
METHODS AND ANALYSIS
We report on a protocol for a prospective observational study of the effectiveness of CATI. Médecins Sans Frontières (MSF) plans to implement CATI in the Democratic Republic of the Congo (DRC), Cameroon, Niger and Zimbabwe. This study will run in parallel to each implementation. The primary outcome is the cumulative incidence of cholera in each CATI ring. CATI will be triggered immediately on notification of a case in a new area. As with most real-world interventions, there will be delays to response as the strategy is rolled out. We will compare the cumulative incidence among rings as a function of response delay, as a proxy for performance. Cross-sectional household surveys will measure population-based coverage. Cohort studies will measure effects on reducing incidence among household contacts and changes in antimicrobial resistance.
ETHICS AND DISSEMINATION
The ethics review boards of MSF and the London School of Hygiene and Tropical Medicine have approved a generic protocol. The DRC and Niger-specific versions have been approved by the respective national ethics review boards. Approvals are in process for Cameroon and Zimbabwe. The study findings will be disseminated to the networks of national cholera control actors and the Global Task Force for Cholera Control using meetings and policy briefs, to the scientific community using journal articles, and to communities via community meetings.
Cholera outbreaks in fragile settings are prone to rapid expansion. Case-area targeted interventions (CATIs) have been proposed as a rapid and efficient response strategy to halt or substantially reduce the size of small outbreaks. CATI aims to deliver synergistic interventions (eg, water, sanitation, and hygiene interventions, vaccination, and antibiotic chemoprophylaxis) to households in a 100-250 m 'ring' around primary outbreak cases.
METHODS AND ANALYSIS
We report on a protocol for a prospective observational study of the effectiveness of CATI. Médecins Sans Frontières (MSF) plans to implement CATI in the Democratic Republic of the Congo (DRC), Cameroon, Niger and Zimbabwe. This study will run in parallel to each implementation. The primary outcome is the cumulative incidence of cholera in each CATI ring. CATI will be triggered immediately on notification of a case in a new area. As with most real-world interventions, there will be delays to response as the strategy is rolled out. We will compare the cumulative incidence among rings as a function of response delay, as a proxy for performance. Cross-sectional household surveys will measure population-based coverage. Cohort studies will measure effects on reducing incidence among household contacts and changes in antimicrobial resistance.
ETHICS AND DISSEMINATION
The ethics review boards of MSF and the London School of Hygiene and Tropical Medicine have approved a generic protocol. The DRC and Niger-specific versions have been approved by the respective national ethics review boards. Approvals are in process for Cameroon and Zimbabwe. The study findings will be disseminated to the networks of national cholera control actors and the Global Task Force for Cholera Control using meetings and policy briefs, to the scientific community using journal articles, and to communities via community meetings.
Journal Article > ResearchFull Text
J Clin Microbiol. 1 January 2005; Volume 43 (Issue 1); DOI:10.1128/JCM.43.1.442-444.2005
Pardini M, Varaine FFV, Iona E, Arzumanian E, Checchi F, et al.
J Clin Microbiol. 1 January 2005; Volume 43 (Issue 1); DOI:10.1128/JCM.43.1.442-444.2005
Recovery of Mycobacterium tuberculosis from sputa treated with cetyl-pyridinium chloride (CPC) and stored for 20 +/- 9 days was significantly higher than that from sputa that were untreated and processed by the N-acetyl-L-cisteine-NaOH method. Addition of CPC is useful for isolation of M. tuberculosis from sputa subjected to long-term storage received from remote areas of the world.
Journal Article > ResearchFull Text
Trans R Soc Trop Med Hyg. 21 October 2008; Volume 103 (Issue 3); DOI:10.1016/j.trstmh.2008.09.005
Balasegaram M, Young H, Chappuis F, Priotto G, Raguenaud ME, et al.
Trans R Soc Trop Med Hyg. 21 October 2008; Volume 103 (Issue 3); DOI:10.1016/j.trstmh.2008.09.005
This paper describes the effectiveness of first-line regimens for stage 2 human African trypanosomiasis (HAT) due to Trypanosoma brucei gambiense infection in nine Médecins Sans Frontières HAT treatment programmes in Angola, Republic of Congo, Sudan and Uganda. Regimens included eflornithine and standard- and short-course melarsoprol. Outcomes for 10461 naïve stage 2 patients fitting a standardised case definition and allocated to one of the above regimens were analysed by intention-to-treat analysis. Effectiveness was quantified by the case fatality rate (CFR) during treatment, the proportion probably and definitely cured and the Kaplan-Meier probability of relapse-free survival at 12 months and 24 months post admission. The CFR was similar for the standard- and short-course melarsoprol regimens (4.9% and 4.2%, respectively). The CFR for eflornithine was 1.2%. Kaplan-Meier survival probabilities varied from 71.4-91.8% at 1 year and 56.5-87.9% at 2 years for standard-course melarsoprol, to 73.0-91.1% at 1 year for short-course melarsoprol, and 79.9-97.4% at 1 year and 68.6-93.7% at 2 years for eflornithine. With the exception of one programme, survival at 12 months was >90% for eflornithine, whilst for melarsoprol it was <90% except in two sites. Eflornithine is recommended where feasible, especially in areas with low melarsoprol effectiveness.