Conference Material > Slide Presentation
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/Rcembdt4Bk
Conference Material > Abstract
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Scientific Day International 2024. 16 May 2024; DOI:10.57740/utH6tREN
INTRODUCTION
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.
Inpatient Therapeutic Feeding Centre (ITFC) in Abs General Hospital, Yemen, provides nutrition treatment and management of medical complications to children affected by the humanitarian crisis in Abs and surrounding areas. In the past 2 years, the monthly mortality rate for children younger than 14 years averaged at 2.5–5% during non-peak months (Médecins Sans Frontières [MSF] indicator threshold for ITFC is 5%), but it increased to 7% during the peak months. We aimed to describe ITFC patients’ demographic, anthropometric, and clinical variables, and assess their association with inpatient mortality.
METHODS
We conducted an unmatched case-control study with patients aged <14 years who attended IFTC between January and December 2022. Cases were patients for whom the ITFC exit was recorded as “death” (n=106), and controls were those with the exit recorded as “discharged”, selected via systematic random sampling (n=218). Descriptive statistics were performed for all variables. We assessed associations with mortality by calculating adjusted odds ratios (aORs) via multivariable logistic regression, controlling for factors significant in the univariable analysis.
RESULTS
About 77% of patients were aged ≥6 months (71/106 cases and 178/218 controls). Gender distribution was even in both groups. The median mid-upper arm circumference was 88 mm in patients aged <6 months and 104 mm in those aged ≥6 months; 89% of the patients had weight-for-height Z score of <–3. The most common diagnoses at death were pneumonia (38%), gastroenteritis (24%), and sepsis (23%). Patients who lived at the three districts to the north of Abs had significantly higher odds of death (crude ORs 3.47, 3.64, and 6.07) than patients from Abs districts. Having shock (aOR 29.2, 95% CI 6.61–151), hypoglycaemia (9.33, 2.98–32.2), and sepsis (7.52, 2.60–24.1) were strongly associated with inpatient mortality. Other significant risk factors for mortality included age (aOR 1.07, 1.03–1.11), high paediatric early warning score (1.14, 1.01–1.30), being given intravenous fluid without documented shock (3.64, 1.20–12.6), respiratory distress (4.36, 1.47–13.8), congenital heart disease (5.44, 1.42–22.5), and hepatomegaly (6.78, 1.45–36.0). Several medical complications were found exclusively among deceased patients (e.g., electrolyte disturbance, hypothermia, and coma). Among those who received rehydration treatment (n=280), plan B with ReSoMal was the least used plan (15%).
CONCLUSION
We identified important demographic and clinical factors associated with ITFC mortality. Geographical disparity suggests a need for healthcare gap and access evaluation to the affected regions. Prompt recognition of shock, hypoglycaemia, sepsis, and other significant clinical factors would enable early intervention and closer patient monitoring. Lastly, this study highlights the importance of adherence to fluid management guideline.
Conference Material > Poster
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/ahq9-t438
Conference Material > Video
Yang SL, Gonzalez M, Hazaea Mohammed HA, Lim SY, Ferreras E, et al.
MSF Paediatric Days 2024. 3 May 2024
Journal Article > ResearchFull Text
Vaccine. 9 June 2022; Volume S0264-410X (Issue 22); 00552-7.; DOI:10.1016/j.vaccine.2022.04.093
Lightowler M, Manangazira P, Nackers F, Van Herp M, Phiri I, et al.
Vaccine. 9 June 2022; Volume S0264-410X (Issue 22); 00552-7.; DOI:10.1016/j.vaccine.2022.04.093
BACKGROUND
Zimbabwe suffers from regular outbreaks of typhoid fever (TF), worse since 2017. Most cases were in Harare and a vaccination campaign with Typhoid Conjugate Vaccine (TCV) was conducted in March 2019. The vaccine effectiveness (VE) was assessed against culture-confirmed S. Typhi in children six months to 15 years and in individuals six months to 45 years in Harare.
METHODS
A matched case-control study was conducted in three urban suburbs of Harare targeted by the TCV vaccination campaign. Suspected TF cases were enrolled prospectively in four health facilities and were matched to facility (1:1) and community (1:5) controls.
FINDINGS
Of 504 suspected cases from July 2019 to March 2020, 148 laboratory-confirmed TF cases and 153 controls confirmed-negative were identified. One hundred and five (47 aged six months to 15 years) cases were age, sex, and residence matched with 105 facility-based controls while 96 cases were matched 1:5 by age, sex, and immediate-neighbour with 229 community controls.
The adjusted VE against confirmed TF was 75% (95%CI: 1–94, p = 0.049) compared to facility controls, and 84% (95%CI: 57–94, p < 0.001) compared to community controls in individuals six months to 15 years. The adjusted VE against confirmed TF was 46% (95%CI: 26–77, p = 0.153) compared to facility controls, and 67% (95%CI: 35–83, p = 0.002) compared to community controls six months to 45 years old.
INTERPRETATION
This study confirms that one vaccine dose of TCV is effective to control TF in children between six months and 15 years old in an African setting.
Zimbabwe suffers from regular outbreaks of typhoid fever (TF), worse since 2017. Most cases were in Harare and a vaccination campaign with Typhoid Conjugate Vaccine (TCV) was conducted in March 2019. The vaccine effectiveness (VE) was assessed against culture-confirmed S. Typhi in children six months to 15 years and in individuals six months to 45 years in Harare.
METHODS
A matched case-control study was conducted in three urban suburbs of Harare targeted by the TCV vaccination campaign. Suspected TF cases were enrolled prospectively in four health facilities and were matched to facility (1:1) and community (1:5) controls.
FINDINGS
Of 504 suspected cases from July 2019 to March 2020, 148 laboratory-confirmed TF cases and 153 controls confirmed-negative were identified. One hundred and five (47 aged six months to 15 years) cases were age, sex, and residence matched with 105 facility-based controls while 96 cases were matched 1:5 by age, sex, and immediate-neighbour with 229 community controls.
The adjusted VE against confirmed TF was 75% (95%CI: 1–94, p = 0.049) compared to facility controls, and 84% (95%CI: 57–94, p < 0.001) compared to community controls in individuals six months to 15 years. The adjusted VE against confirmed TF was 46% (95%CI: 26–77, p = 0.153) compared to facility controls, and 67% (95%CI: 35–83, p = 0.002) compared to community controls six months to 45 years old.
INTERPRETATION
This study confirms that one vaccine dose of TCV is effective to control TF in children between six months and 15 years old in an African setting.
Journal Article > ResearchFull Text
Epidemiol Infect. 13 March 2020; Volume 148; DOI:10.1017/S095026882000062X
Ferreras E, Blake A, Chewe O, Mwaba J, Zulu G, et al.
Epidemiol Infect. 13 March 2020; Volume 148; DOI:10.1017/S095026882000062X
We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7–97.8) in the MCC study, 80.2% (95% CI: 16.9–95.3) in the TNCC design and 89.4% (95% CI: 64.6–96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.
Journal Article > ResearchFull Text
Bull World Health Organ. 19 October 2017; Volume 96 (Issue 2); 86-93.; DOI:10.2471/BLT.16.189241
Poncin M, Zulu G, Voûte C, Ferreras E, Muleya CM, et al.
Bull World Health Organ. 19 October 2017; Volume 96 (Issue 2); 86-93.; DOI:10.2471/BLT.16.189241
OBJECTIVE
To describe the implementation and feasibility of an innovative mass vaccination strategy - based on single-dose oral cholera vaccine - to curb a cholera epidemic in a large urban setting.
METHOD
In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.
FINDINGS
Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign - 2.31 United States dollars (US$) per dose - included the relatively low cost of local delivery - US$ 0.41 per dose.
CONCLUSION
We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.
To describe the implementation and feasibility of an innovative mass vaccination strategy - based on single-dose oral cholera vaccine - to curb a cholera epidemic in a large urban setting.
METHOD
In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.
FINDINGS
Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign - 2.31 United States dollars (US$) per dose - included the relatively low cost of local delivery - US$ 0.41 per dose.
CONCLUSION
We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.
Journal Article > ResearchFull Text
Trop Med Int Health. 31 May 2018; Volume 23 (Issue 8); 834-840.; DOI:10.1111/tmi.13084
Mwaba J, Ferreras E, Chizema Kawesha E, Mwimbe D, Tafirenyika F, et al.
Trop Med Int Health. 31 May 2018; Volume 23 (Issue 8); 834-840.; DOI:10.1111/tmi.13084
OBJECTIVE
To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak.
METHODS
RDT and bacterial culture were performed on site using fresh stools collected from cholera suspected cases, and from stools enriched in alkaline peptone water. Dried stool samples on filter paper were tested for V. cholerae by PCR in Lusaka (as part of a laboratory technology transfer project) and at a reference laboratory in Paris, France. A sample was considered positive for cholera by the reference standard if any of the culture or PCR tests was positive for V. cholerae O1 or O139.
RESULTS
Among the 170 samples tested with SD Bioline and compared to the reference standard, the RDT showed a sensitivity of 90.9% (95% CI: 81.3-96.6) and specificity of 95.2% (95% CI: 89.1-98.4). After enrichment, the sensitivity was 95.5% (95% CI: 87.3-99.1) and specificity 100% (95% CI: 96.5-100).
CONCLUSION
The observed sensitivity and specificity were within recommendations set by the Global Task Force for Cholera Control on the use of cholera RDT (sensitivity = 90%; specificity = 85%). Although the sample size was small, our findings suggest that the SD Bioline RDT could be used in the field to rapidly alert public health officials to the likely presence of cholera cases when an outbreak is suspected.
To assess the performance of the SD Bioline Cholera Ag O1/O139 rapid diagnostic test (RDT) compared to a reference standard combining culture and PCR for the diagnosis of cholera cases during an outbreak.
METHODS
RDT and bacterial culture were performed on site using fresh stools collected from cholera suspected cases, and from stools enriched in alkaline peptone water. Dried stool samples on filter paper were tested for V. cholerae by PCR in Lusaka (as part of a laboratory technology transfer project) and at a reference laboratory in Paris, France. A sample was considered positive for cholera by the reference standard if any of the culture or PCR tests was positive for V. cholerae O1 or O139.
RESULTS
Among the 170 samples tested with SD Bioline and compared to the reference standard, the RDT showed a sensitivity of 90.9% (95% CI: 81.3-96.6) and specificity of 95.2% (95% CI: 89.1-98.4). After enrichment, the sensitivity was 95.5% (95% CI: 87.3-99.1) and specificity 100% (95% CI: 96.5-100).
CONCLUSION
The observed sensitivity and specificity were within recommendations set by the Global Task Force for Cholera Control on the use of cholera RDT (sensitivity = 90%; specificity = 85%). Although the sample size was small, our findings suggest that the SD Bioline RDT could be used in the field to rapidly alert public health officials to the likely presence of cholera cases when an outbreak is suspected.
Journal Article > ResearchFull Text
PLOS One. 30 August 2019; Volume 14 (Issue 8); DOI:10.1371/journal.pone.0219040
Ferreras E, Matopo B, Chizema Kawesha E, Chewe O, Mzyece H, et al.
PLOS One. 30 August 2019; Volume 14 (Issue 8); DOI:10.1371/journal.pone.0219040
BACKGROUND:
In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign.
METHODS:
Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling.
RESULTS:
The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose.
CONCLUSIONS:
The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign.
METHODS:
Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling.
RESULTS:
The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose.
CONCLUSIONS:
The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.
Journal Article > ReviewFull Text
Lancet Infect Dis. 17 July 2017; Volume 17 (Issue 10); DOI:10.1016/S1473-3099(17)30359-6
Bi Q, Ferreras E, Pezzoli L, Legros D, Ivers LI, et al.
Lancet Infect Dis. 17 July 2017; Volume 17 (Issue 10); DOI:10.1016/S1473-3099(17)30359-6