Lassa fever (LF), a haemorrhagic illness caused by the Lassa fever virus (LASV), is endemic in West Africa and causes 5000 fatalities every year. The true prevalence and incidence rates of LF are unknown as infections are often asymptomatic, clinical presentations are varied, and surveillance systems are not robust. The aim of the Enable Lassa research programme is to estimate the incidences of LASV infection and LF disease in five West African countries. The core protocol described here harmonises key study components, such as eligibility criteria, case definitions, outcome measures, and laboratory tests, which will maximise the comparability of data for between-country analyses.
METHOD
We are conducting a prospective cohort study in Benin, Guinea, Liberia, Nigeria (three sites), and Sierra Leone from 2020 to 2023, with 24 months of follow-up. Each site will assess the incidence of LASV infection, LF disease, or both. When both incidences are assessed the LASV cohort (n min = 1000 per site) will be drawn from the LF cohort (n min = 5000 per site). During recruitment participants will complete questionnaires on household composition, socioeconomic status, demographic characteristics, and LF history, and blood samples will be collected to determine IgG LASV serostatus. LF disease cohort participants will be contacted biweekly to identify acute febrile cases, from whom blood samples will be drawn to test for active LASV infection using RT-PCR. Symptom and treatment data will be abstracted from medical records of LF cases. LF survivors will be followed up after four months to assess sequelae, specifically sensorineural hearing loss. LASV infection cohort participants will be asked for a blood sample every six months to assess LASV serostatus (IgG and IgM).
DISCUSSION
Data on LASV infection and LF disease incidence in West Africa from this research programme will determine the feasibility of future Phase IIb or III clinical trials for LF vaccine candidates.
During the 2018–2020 Ebola virus disease (EVD) outbreak, residents in Goma, Democratic Republic of the Congo, were offered a two-dose prophylactic EVD vaccine. This was the first study to evaluate the safety of this vaccine in pregnant women. Adults, including pregnant women, and children aged ≥1 year old were offered the Ad26.ZEBOV (day 0; dose 1), MVA-BN-Filo (day 56; dose 2) EVD vaccine through an open-label clinical trial. In total, 20,408 participants, including 6635 (32.5%) children, received dose 1. Fewer than 1% of non-pregnant participants experienced a serious adverse event (SAE) following dose 1; one SAE was possibly related to the Ad26.ZEBOV vaccine. Of the 1221 pregnant women, 371 (30.4%) experienced an SAE, with caesarean section being the most common event. No SAEs in pregnant women were considered related to vaccination. Of 1169 pregnancies with a known outcome, 55 (4.7%) ended in a miscarriage, and 30 (2.6%) in a stillbirth. Eleven (1.0%) live births ended in early neonatal death, and five (0.4%) had a congenital abnormality. Overall, 188/891 (21.1%) were preterm births and 79/1032 (7.6%) had low birth weight. The uptake of the two-dose regimen was high: 15,328/20,408 (75.1%). The vaccine regimen was well-tolerated among the study participants, including pregnant women, although further data, ideally from controlled trials, are needed in this crucial group.
Infection with SARS-CoV-2 can lead to a detectable serological immune response even though extent of its protection is still not yet well known. We report long duration and resurgence of SARS-CoV-2 in patients with COVID-19.
METHODS
We included a cohort of 99 participants from our non-blinded non-randomized evaluation of COVID-19 tests in Cameroon. Demographic and clinical information was collected from participants including self-reported age, race, ethnicity, and gender. Qualitative data was described as proportions while quantitative data was described with means and accompanying ranges.
RESULTS
Duration of PCR for SARS-CoV-2 positivity was found to range from 4 – 81 days, with mean duration of 32.8 days in patients with PCR-positive. We also identified 4 participants who also had SARS-CoV-2 resurgence within a three-month period.
CONCLUSION
These observations raise questions on clinical decision to release COVID-19 cases from isolation after 14 days.
In early 2020, Niger’s Ministry of Health (MoH) launched a system for collecting and investigating Covid-19 alerts. This system was paper based and used unstructured data sharing via text messages, hence did not allow for rapid and exhaustive data collection or effective investigation of alerts. Consequently, MSF teams were unable to accurately assess Covid-19 epidemiology in Niger, affecting decision-making about what support to offer and where. Covid-19 patients were not being diagnosed until in the late stages of disease, or would never be diagnosed at all. Hence, MSF teams feared care would not be effective. Epicentre and the MSF Foundation collaborated with Medic, a not-for-profit organisation designing open- source digital tools for healthcare, to develop an electronic tool to improve receipt and investigation of Covid-19 alerts in Niger. We aimed to collect structured data, to increase the number of alerts investigated, and to improve the timeliness and completeness of investigations. This would facilitate earlier diagnosis of symptomatic disease, earlier orientation of patients towards care, and improve accurate and timely epidemiological reporting.
METHODS
The digital platform, Alerte Covid-19, replaced the existing paper-based system. Patients and health workers across Niger were instructed to phone a national MoH hotline to report suspected cases. Each alert was registered on the digital platform; this then guides users to determine if investigation is necessary, and allocates alerts to a regional alert centre. Investigation teams follow up alerts via patient testing, direct patients towards relevant care, and report Covid-19 test results and the outcome of positive cases in the digital platform. The platform links to dashboards to provide an overview of alerts and outcomes at regional and national levels.
ETHICS
This description/evaluation of an innovation project did not involve human participants or their data; the MSF Ethics Framework for Innovation was used to help identify and mitigate potential harms.
RESULTS
The hotline service handles up to 6,000 calls per day, 5% of which are Covid-19 related and most require investigation. From May 2020 to November 2021, 11,295 Covid19-related alerts were received, of which 10,100 were investigated and 9,386 tested. Timeliness was improved from several days to a few hours and data was more structured and complete.
CONCLUSION
Implementation of Alerte Covid-19 is ongoing. Success of the project to date has triggered further work to develop a digital platform to improve the processing of alerts for other epidemic-prone diseases in Niger. It is hoped this will enable earlier and more effective epidemic responses by MoH and MSF teams. The use of such digital tools is feasible, low-cost, and can impact on epidemic surveillance in low-income settings.
CONFLICTS OF INTEREST
None declared.