Macha Research

Influenza, RSV and SARS-CoV-2 surveillance in rural Zambia from 2019-2021

Tue, 16 May 2023 10:43:46 GMT

Influenza, RSV and SARS-CoV-2 surveillance in rural Zambia from 2019-2021

Morris Sianyinda¹ Edgar Simulundu1, Mutinta Hamahuwa1, Pamela Sinywimaanzi1, Mathias Muleka1, Passwell Munachoonga1, Hellen Matakala1, Juliet Morales2, Katherine Fenstermacher3, Richard Rothman3, Andrew Pekosz4, Mwaka Monze5, Phil Thuma1, Catherine Sutcliffe2,6
1Macha Research Trust, Zambia; 2Dept International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH); 3Dept Emergency Medicine, Johns Hopkins School of Medicine; 4Dept Molecular Microbiology and Immunology, JHBSPH; 5University Teaching Hospital, Zambia; 6Dept Epidemiology, JHBSPH,

Background
•    Respiratory infections are a major cause of morbidity and mortality globally but are relatively understudied in sub-Saharan Africa, particularly in rural areas
•    Surveillance for respiratory viruses, including influenza A, influenza B, and respiratory syncytial virus (RSV) was initiated in December 2018 in Macha, Zambia as part of the Johns Hopkins Center for Excellence in Influenza Research and Surveillance (CEIRS)
•    In 2020, SARS-CoV-2 emerged and caused a global pandemic, with mitigation measures disrupting circulation of respiratory pathogens
The ongoing surveillance in Macha provided the opportunity to understand the burden of respiratory pathogens before
Objectives
1.    To assess the burden of influenza A virus, influenza B virus, RSV and SARS COV-2 in Macha viruses in Macha before and during the COVID-19 pandemic before and during the COVID-19 pandemic
2.    To assess the burden of other respiratory
Materials and Methods

AREA VIEW OF MACHA

MACHA HOSPITAL

Setting: Macha is located in Southern Province, Zambia and is a rural area (population density: 25-45 residents per km ² ).

• Surveillance:

• Respiratory surveillance was initiated in Dec 2018 at Macha Hospital

• All patients attending the outpatient clinic were screened for influenza-like illness (ILI; fever + cough/sore throat)

• An age-stratified sample of patients with ILI were enrolled each week

• A nasopharyngeal swab was collected

• Laboratory testing:

• Swabs were tested onsite for RSV, influenza A/B virus, and SARS-CoV-2 using the GeneXpert platform

• Swabs were shipped to Johns Hopkins and tested for rhinovirus/enterovirus, parainfluenza virus, metapneumovirus, human coronaviruses (non-SARS-CoV-2), and adenovirus using the BioFire or Genmark ePlex respiratory panel

• Analysis: Monthly and annual pathogen prevalence among outpatients with ILI was estimated using survey sampling weights for 2019, 2020, and 2021

Results

• The number of OPD visits was similar in 2019 and 2020 but decreased in 2021 due to a decrease in visits in the middle of the year (Fig 1A)

• The proportion of OPD patients with ILI decreased from 16.9% in 2019 to 6.9% in 2021 (Fig 1B)

Figure 1: Outpatient visits and influenza-like-illness, 2019-2021

Patients with ILI were enrolled: 555 in 2019; 463 in 2020; and 417 in 2021
In 2019, influenza and RSV were detected in distinct parts of the year: RSV in the beginning; influenza A virus in the middle; and influenza B virus in the later part of the year
In 2020,no cases of influenza virus and only a few RSV cases were detected
In 2021 the viruses returned and at a similar level and timing to 2019
The first SARS-CoV-2 infection in Macha was identified in December 2020, and SARS-CoV-2 was detected at low levels throughout 2021

Figure 2: Prevalence of influenza, RSV, and SARS-CoV-2 among outpatients with influenza-like illness, 2019-2021

graph

The prevalence of influenza virus and RSV was highest among children (Fig 3A-C)
The prevalence of SARS-CoV-2 was highest among adults (Fig 3D)

Figure 3: Age-stratified pathogen, 2019-2021prevalence among outpatients with influenza-like illness

Other respiratory pathogens were detected throughout 2019-2021 with no distinct patterns (Fig 4)

Figure 4: Prevalence of other respiratory viruses among outpatients with influenza-like illness, 2019-2021

CONCLUSION

In summary, this area has a significant burden of respiratory infections
COVID-19 mitigation measures reduced the burden of influenza and RSV in 2020
Once initial measures were eased in late 2020, they returned to prior levels in 2021 and co-circulated with SARS-CoV-2

Acknowledgements

This work was supported by NIH contract HHSN272201400007C.

We would like to thank the Macha Research Trust, Johns Hopkins University, University Teaching Hospital and Macha Hospital teams for their assistance with the study.

Highlights from the 2017 World Malaria Day

Mon, 27 Mar 2023 08:28:00 GMT

Highlights from the 2017 World Malaria Day

On 25 April, 2017, 11 members of the MRT malaria team successfully participated in the World Malaria Day celebration held at the National Malaria Elimination Centre in Lusaka.

The National Malaria Elimination Center (NMEC) assigned us a Kiosk where we could disseminate some of our study findings through poster displays as well as demonstrations of our research capacity as an institution. We were also given the responsibility of testing the guest of honor, the Minister of Health for malaria. He only ended up touring our stand and inquiring about our work. The minister reaffirmed his desire to pay MRT a visit as he had heard a lot about the work that was being done there.

MRT Staff During March Past

Aside from commemorating the day the event also served to launch the rebranded National Malaria Control Center into a National Malaria Elimination Center. It also served as a launch of the National Elimination Strategic Plan and Insecticide Treated Net (ITN) mass distribution.

The Honorable Minister of Health, Dr Chitalu Chilufya visiting the MRT Kiosk

Unveiling of Malaria Elimination STG 2017-2021

Limonty and Japhet explaining the use of a rotator to visitors to the stand

UN Resident Coordinator, Janet Rogan, pointed out that the rate of new malaria infections between 2010 and 2016 was at 20%. She commended the Zambian government for the strides made in malaria control and the importance of prevention if elimination is to be achieved. She also commended the government for the increase allocation funds resulting in 60% coverage by ITNs, 40% IRS coverage and 50% reduction in reported incidence and mortality. She also recommended aero spraying in Lusaka to further reduce the Malaria incidence. She concluded by calling on individual participation, responsibility and combined effort in the elimination of Malaria.

Launch of Mass distribution

In the speech given by the US Ambassadors representative Christopher Kraft, it was reported that according eleventh Presidential Malaria Initiative (PMI) report, Zambia had seen a 55% reduction of malaria in under five children with a total of 201M dollars PMI funds being used to procure 8 Million ITNs, 20Million RDTs, 60Million IRS as well as train 1600 Community Health Workers (CHW). One Community Health Worker’s, Musongo, Mirriam Chisamba‘s, contribution was particularly noted as a model for CHW.

UNDP country representative participates in a Zambian traditional Dance

In the speech read on behalf of the President the Minister of Health reaffirmed the theme (Global -end Malaria for good, adapted-Malaria ends with me) by pointing out that newly launched National Malaria Elimination Strategic plan which would help eliminate malaria using the following steps:

Increase vector control
Indoor Residual Spraying (IRS)

By conducting IRS to scale (100% coverage)

Use of DDT where it can work

Use innovation to control cost of IRS by leveraging institutions such as schools

Prompt procurement of IRS materials

Increase to two cycles one in September 2017 followed by another in March 2018

Insecticide treated Nets (ITN)

By increasing ITN coverage

10.2 Million ITNs (26M dollars) to be distributed Distribution through schools and public places

Malaria Case Management

Increase human resource for diagnosis at not only at tertiary level

Mass Drug Administration (MDA)

In selected places –southern Province and Lunga district

Malaria in Pregnancy (MIP)

Increase access to high risk individuals with Intermittent Preventative Treatment ( ITP) and Antenatal care (ANC)

Vector Control -Larval Source Management
Malaria Elimination officers

At districts and Sub-district level

To work with other districts officer and supervisors CHW

Research activities

Commissioned the Molecular lab at NMEC

He acknowledge the importance of working with partners such as MACEPA and Macha Research Trust in ensuring implementation of evidence based policies.

He concluded by stating that the Zambians government’s plan is to have evidence for elimination of Malaria by 2018 and to achieve elimination by 2021.