Marburg Virus Disease

马尔堡病毒病
  • 文章类型: Journal Article
    马尔堡病毒(MARV),丝状病毒,1967年在马尔堡首次被发现,德国,贝尔格莱德,前南斯拉夫。从那以后,MARV在非洲部分地区引起了人类疾病的零星爆发,病死率很高,最大的疫情发生在2004/05年安哥拉。从2021年到2023年,几内亚发生了MARV疫情,加纳,几内亚,坦桑尼亚,强调将其流行区扩展到新的地理区域。目前没有批准的针对MARV的疫苗或疗法,但是几种候选疫苗在临床前研究中显示出了希望。我们通过给仓鼠接种单剂量的腺病毒(ChAdOx-1MARV)疫苗,同时比较了三种疫苗平台,一种基于甲病毒复制子的RNA(LION-MARV)疫苗,或重组水泡性口炎病毒(VSV-MARV)疫苗,都表达MARV糖蛋白作为抗原。接种后4周用仓鼠适应的MARV进行致命攻击导致VSV-MARV和LION-MARV组和ChAdOx-1MARV组的83%的保护。对抗原特异性体液反应及其功能的评估揭示了疫苗平台依赖性的差异,特别是在Fc效应子功能中。
    Marburg virus (MARV), a filovirus, was first identified in 1967 in Marburg, Germany, and Belgrade, former Yugoslavia. Since then, MARV has caused sporadic outbreaks of human disease with high case fatality rates in parts of Africa, with the largest outbreak occurring in 2004/05 in Angola. From 2021 to 2023, MARV outbreaks occurred in Guinea, Ghana, New Guinea, and Tanzania, emphasizing the expansion of its endemic area into new geographical regions. There are currently no approved vaccines or therapeutics targeting MARV, but several vaccine candidates have shown promise in preclinical studies. We compared three vaccine platforms simultaneously by vaccinating hamsters with either a single dose of an adenovirus-based (ChAdOx-1 MARV) vaccine, an alphavirus replicon-based RNA (LION-MARV) vaccine, or a recombinant vesicular stomatitis virus-based (VSV-MARV) vaccine, all expressing the MARV glycoprotein as the antigen. Lethal challenge with hamster-adapted MARV 4 weeks after vaccination resulted in uniform protection of the VSV-MARV and LION-MARV groups and 83% of the ChAdOx-1 MARV group. Assessment of the antigen-specific humoral response and its functionality revealed vaccine-platform-dependent differences, particularly in the Fc effector functions.
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  • 文章类型: Journal Article
    马尔堡病毒(MARV)是一种动物来源的高毒力病毒,是致死性感染(称为马尔堡病毒病[MVD])的原因,病死率为24%至90%。虽然潜在的非人畜共患病毒传播途径似乎是合理的,风险尚未完全确定。这里,我们描述了MARV在人群中传播的方式,主要关注性传播的潜力。此外,我们讨论了应采取的一些措施,以尽量减少病毒的性传播风险,并提出了关于性传播风险的未来研究议程。
    从这个角度来看,我们搜索了四个电子数据库(即,PubMed,Scopus,WebofScience,和GoogleScholar),并包括自1967年首次鉴定该病毒以来发表的最相关的研究。我们使用了“马尔堡病毒”,\"\"马尔堡病毒病,“”精液,\"\"性传播病毒,\"\"性传播,\"和\"新发传染病\"作为关键字。
    MARV通过与受感染的动物(最重要的是蝙蝠)和最近被诊断出患有这种疾病或死于这种疾病的个体的直接和间接接触而传播给人类。以前曾怀疑通过性接触传播病毒(仅从男性到其性伴侣)。研究表明,该病毒在相对较长的时间内主要存在于生精小管内的睾丸支持细胞中,并通过精液释放(在某些报告中,感染发作后>200天),两者都可能威胁性健康。除了男人,从理论上讲,女性可以,虽然不太可能导致这种疾病的性传播。
    MVD,然而,很少,可以通过性爱,在这方面,男人似乎是主要的载体。建议采取预防对策和进行安全性行为,以降低人际传播的风险。
    UNASSIGNED: Marburg virus (MARV) is a highly virulent virus of animal origin and the cause of a lethal infection (known as Marburg virus disease [MVD]) with a case-fatality ratio ranging from 24% to 90%. While the potential nonzoonotic routes of virus spread are plausible, the risk is not yet fully determined. Here, we described the ways by which MARV spreads within the human population focusing mainly on the potential of sexual transmission. In addition, we addressed some measures that should be taken to minimize the risk of sexual spread of the virus and proposed a future research agenda on the risk of sexual transmission.
    UNASSIGNED: For this perspective, we searched four electronic databases (i.e., PubMed, Scopus, Web of Science, and Google Scholar) and included the most relevant studies published since the first identification of the virus in 1967. We used \"Marburg virus,\" \"Marburg virus disease,\" \"Seminal fluid,\" \"Sexually-transmitted virus,\" \"Sexual transmission,\" and \"Emerging infectious disease\" as keywords.
    UNASSIGNED: MARV is transmitted to humans via both direct and indirect contact with infected animals (most importantly bats) and individuals who have recently been diagnosed with or died of the disease. The virus transmission through sexual contact has been previously suspected (exclusively from men to their sexual partners). Studies suggest that this virus persists predominantly in testicular Sertoli cells within seminiferous tubules over a relatively long period and is released through seminal fluid (in some reports >200 days post onset of infection) both could potentially threaten sexual health. In addition to men, women could theoretically, although less probably contribute to the sexual transmission of the disease.
    UNASSIGNED: MVD, however, rarely, could be passed through sex, and men appear to be the main carriers in this regard. Taking preventive countermeasures and practicing safe sex are recommended to reduce the risk of interhuman transmission.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    马尔堡病毒(MARV)是一种高度传染性和毒性的病原体,属于丝状病毒科。MARV在人类和非人类灵长类动物中引起严重的出血热。由于其剧毒性质,预防性方法对其控制是有希望的。目前没有批准的针对MARV的药物或疫苗,管理主要包括支持性护理,以治疗症状和预防并发症。我们的目的是使用免疫信息学研究设计一种针对MARV的新型多表位疫苗(MEV)。在这项研究中,使用各种蛋白质(VP35、VP40和糖蛋白前体)并选择潜在的表位。CTL和HTL表位覆盖了79.44%和70.55%的全球人口,分别。设计的MEV构建体稳定并在大肠杆菌中表达(E.大肠杆菌)宿主。物理化学性质也是可接受的。MARVMEV候选物可以预测综合免疫反应,例如体液和细胞的免疫反应。此外,预测了与toll样受体3(TLR3)及其激动剂(β-防御素)的有效相互作用。需要使用进一步的体外和体内研究来验证这些结果。
    Marburg virus (MARV) is a highly contagious and virulent agent belonging to Filoviridae family. MARV causes severe hemorrhagic fever in humans and non-human primates. Owing to its highly virulent nature, preventive approaches are promising for its control. There is currently no approved drug or vaccine against MARV, and management mainly involves supportive care to treat symptoms and prevent complications. Our aim was to design a novel multi-epitope vaccine (MEV) against MARV using immunoinformatics studies. In this study, various proteins (VP35, VP40 and glycoprotein precursor) were used and potential epitopes were selected. CTL and HTL epitopes covered 79.44% and 70.55% of the global population, respectively. The designed MEV construct was stable and expressed in Escherichia coli (E. coli) host. The physicochemical properties were also acceptable. MARV MEV candidate could predict comprehensive immune responses such as those of humoral and cellular in silico. Additionally, efficient interaction to toll-like receptor 3 (TLR3) and its agonist (β-defensin) was predicted. There is a need for validation of these results using further in vitro and in vivo studies.
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  • 文章类型: Journal Article
    病毒性出血热(VHF)对人类健康构成重大威胁。近年来,由埃博拉病毒引起的VHF爆发,马尔堡病毒和拉萨病毒在西非和中非造成了大量的发病率和死亡率。2022年,由苏丹病毒引起的乌干达埃博拉疫情导致164例病例,55例死亡。2023年,在赤道几内亚和坦桑尼亚确认了马尔堡病爆发,导致超过49例确诊或疑似病例;其中41例是致命的。对这些VHF的防护没有明确的关联,阻碍靶向疫苗的发展。因此,所开发的任何疫苗应诱导针对这些病毒的强的和优选持久的体液和细胞免疫。理想情况下,这种免疫力也应该交叉保护免受病毒变异,已知在动物水库中循环并引起人类疾病。我们利用了两个病毒载体疫苗平台,腺病毒(ChAdOx1)和改良的安卡拉痘苗(MVA),开发针对三种丝状病毒(埃博拉病毒,苏丹病毒,马尔堡病毒)和沙粒病毒(拉沙病毒)。这些平台技术一直证明了在人类中诱导强大的细胞和体液抗原特异性免疫的能力。最近推出了许可的ChAdOx1-nCoV19/AZD1222。这里,我们证明我们的多病原体疫苗能引起强大的细胞和体液免疫,诱导不同范围的趋化因子和细胞因子,最重要的是,在致命的埃博拉病毒之后提供保护,苏丹病毒和马尔堡病毒在小动物模型中的挑战。
    Viral haemorrhagic fevers (VHF) pose a significant threat to human health. In recent years, VHF outbreaks caused by Ebola, Marburg and Lassa viruses have caused substantial morbidity and mortality in West and Central Africa. In 2022, an Ebola disease outbreak in Uganda caused by Sudan virus resulted in 164 cases with 55 deaths. In 2023, a Marburg disease outbreak was confirmed in Equatorial Guinea and Tanzania resulting in over 49 confirmed or suspected cases; 41 of which were fatal. There are no clearly defined correlates of protection against these VHF, impeding targeted vaccine development. Any vaccine developed should therefore induce strong and preferably long-lasting humoral and cellular immunity against these viruses. Ideally this immunity should also cross-protect against viral variants, which are known to circulate in animal reservoirs and cause human disease. We have utilized two viral vectored vaccine platforms, an adenovirus (ChAdOx1) and Modified Vaccinia Ankara (MVA), to develop a multi-pathogen vaccine regime against three filoviruses (Ebola virus, Sudan virus, Marburg virus) and an arenavirus (Lassa virus). These platform technologies have consistently demonstrated the capability to induce robust cellular and humoral antigen-specific immunity in humans, most recently in the rollout of the licensed ChAdOx1-nCoV19/AZD1222. Here, we show that our multi-pathogen vaccines elicit strong cellular and humoral immunity, induce a diverse range of chemokines and cytokines, and most importantly, confers protection after lethal Ebola virus, Sudan virus and Marburg virus challenges in a small animal model.
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  • 文章类型: Journal Article
    马尔堡病毒病(MVD)是一种高度传染性疾病,病死率高达90%,特别影响资源有限的国家,在这些国家实施感染预防和控制(IPC)措施具有挑战性。本文分享了坦桑尼亚如何提高预防和控制高度传染性疾病的能力的经验,以及在2023年该国首次发生的MVD疾病爆发期间如何利用这种能力。2016年及以后的几年,坦桑尼亚进行了自我和外部评估,发现IPC应对高度传染性疾病的能力有限。为了弥补这些差距,采取了一些举措,包括通过制定和传播准则来加强IPC的准备情况,对医疗机构的评估,支持性监督和指导,物资采购,以及环境的翻新或建设,以支持IPC的实施。2023年3月21日,官方确认并宣布MVD,此前已有五名患者死于该疾病。MVD主要通过接触传播,并出现严重症状,这使得患者护理和预防具有挑战性,尤其是在资源有限的环境中。然而,使用训练有素的劳动力;进行了IPC快速需求评估,确定具体差距。根据结果;实施了指导计划,制定了具体的政策和指导方针,安全措施得到加强,该地区的所有埋葬活动都受到了监督,患者和工作人员都在所有设施中接受了监测。截至2023年6月1日疫情应对结束,共确认接触者212人,只有三人死亡。透析和手动真空抽吸等侵入性手术可防止感染患者死亡,以前不鼓励的程序。总之,这一经验强调了在控制高度传染性疾病方面严格遵守IPC实践的至关重要性.针对低收入国家的建议包括激励医疗保健提供者和改善工作条件,以增强在充满挑战的环境中的承诺。本报告为通过实施IPC措施准备和解决高度传染性疾病暴发提供了宝贵的见解和实际干预措施。
    Marburg viral disease (MVD) is a highly infectious disease with a case fatality rate of up to 90%, particularly impacting resource-limited countries where implementing Infection Prevention and Control (IPC) measures is challenging. This paper shares the experience of how Tanzania has improved its capacity to prevent and control highly infectious diseases, and how this capacity was utilized during the outbreak of the MVD disease that occurred for the first time in the country in 2023.In 2016 and the subsequent years, Tanzania conducted self and external assessments that revealed limited IPC capacity in responding to highly infectious diseases. To address these gaps, initiatives were undertaken, including the enhancement of IPC readiness through the development and dissemination of guidelines, assessments of healthcare facilities, supportive supervision and mentorship, procurement of supplies, and the renovation or construction of environments to bolster IPC implementation.The official confirmation and declaration of MVD on March 21, 2023, came after five patients had already died of the disease. MVD primarily spreads through contact and presents with severe symptoms, which make patient care and prevention challenging, especially in resource-limited settings. However, with the use of a trained workforce; IPC rapid needs assessment was conducted, identifying specific gaps. Based on the results; mentorship programs were carried out, specific policies and guidelines were developed, security measures were enhanced, all burial activities in the area were supervised, and both patients and staff were monitored across all facilities. By the end of the outbreak response on June 1, 2023, a total of 212 contacts had been identified, with the addition of only three deaths. Invasive procedures like dialysis and Manual Vacuum Aspiration prevented some deaths in infected patients, procedures previously discouraged.In summary, this experience underscores the critical importance of strict adherence to IPC practices in controlling highly infectious diseases. Recommendations for low-income countries include motivating healthcare providers and improving working conditions to enhance commitment in challenging environments. This report offers valuable insights and practical interventions for preparing for and addressing highly infectious disease outbreaks through implementation of IPC measures.
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  • 文章类型: Journal Article
    马尔堡病毒感染与人类病死率高达90%有关,但迄今为止,没有批准的疫苗或单克隆抗体(mAb)对策。这里,我们用属于马尔堡的丝状病毒糖蛋白(GP)抗原的多价组合免疫恒河猴,苏丹,和埃博拉病毒产生针对它们的单特异性和交叉反应性抗体反应。从产生最高滴度的马尔堡病毒GP特异性中和抗体的动物中,我们使用异源Ravn病毒GP探针对单个记忆B细胞进行分选,并克隆和表征了一组34mAb,属于28个独特谱系。通过重叠pepscan和结合竞争分析评估抗体特异性。揭示了大约三分之一的谱系映射到保守的受体结合区,包括通过阴性染色电子显微镜证实的针对该区域的有效中和谱系。其他谱系靶向GP2上的保护区,而其他谱系被发现具有交叉丝状病毒反应性。我们的研究促进了对正马尔伯病毒糖蛋白抗原性的理解,并进一步努力开发针对这些致命病毒的候选抗体对策。
    目的:马尔堡病毒是1967年在人类中首次出现的丝状病毒,可引起严重的出血热,平均病死率约为50%。尽管mAb对策已被批准用于临床治疗相关的埃博拉病毒,目前没有批准的针对马尔堡病毒的对策。我们成功地从用丝状病毒抗原的多价组合免疫的猕猴中分离出一组正马尔伯病毒GP特异性mAb。我们的分析显示,面板中大约一半的抗体映射到糖蛋白上的区域,以防止感染,包括宿主细胞受体结合结构域和膜锚定亚基上的保护区域。组中的其他抗体表现出广泛的丝状病毒GP识别。我们的研究描述了针对正马尔伯病毒和其他丝状病毒GP的多种交叉反应性猕猴抗体的发现,并为进一步的研究和开发提供了候选的免疫治疗剂。
    Marburg virus infection in humans is associated with case fatality rates that can reach up to 90%, but to date, there are no approved vaccines or monoclonal antibody (mAb) countermeasures. Here, we immunized Rhesus macaques with multivalent combinations of filovirus glycoprotein (GP) antigens belonging to Marburg, Sudan, and Ebola viruses to generate monospecific and cross-reactive antibody responses against them. From the animal that developed the highest titers of Marburg virus GP-specific neutralizing antibodies, we sorted single memory B cells using a heterologous Ravn virus GP probe and cloned and characterized a panel of 34 mAbs belonging to 28 unique lineages. Antibody specificities were assessed by overlapping pepscan and binding competition analyses, revealing that roughly a third of the lineages mapped to the conserved receptor binding region, including potent neutralizing lineages that were confirmed by negative stain electron microscopy to target this region. Additional lineages targeted a protective region on GP2, while others were found to possess cross-filovirus reactivity. Our study advances the understanding of orthomarburgvirus glycoprotein antigenicity and furthers efforts to develop candidate antibody countermeasures against these lethal viruses.
    OBJECTIVE: Marburg viruses were the first filoviruses characterized to emerge in humans in 1967 and cause severe hemorrhagic fever with average case fatality rates of ~50%. Although mAb countermeasures have been approved for clinical use against the related Ebola viruses, there are currently no approved countermeasures against Marburg viruses. We successfully isolated a panel of orthomarburgvirus GP-specific mAbs from a macaque immunized with a multivalent combination of filovirus antigens. Our analyses revealed that roughly half of the antibodies in the panel mapped to regions on the glycoprotein shown to protect from infection, including the host cell receptor binding domain and a protective region on the membrane-anchoring subunit. Other antibodies in the panel exhibited broad filovirus GP recognition. Our study describes the discovery of a diverse panel of cross-reactive macaque antibodies targeting orthomarburgvirus and other filovirus GPs and provides candidate immunotherapeutics for further study and development.
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  • 文章类型: Journal Article
    马尔堡病毒病(MVD)对全球健康构成重大威胁,缺乏有效的抗病毒药物和目前的支持治疗提供有限的治疗选择。这篇迷你评论探讨了针对MVD的新型抗病毒策略的新兴景观,专注于目前正在开发的有前途的疗法。我们深入研究直接作用的抗病毒方法,包括靶向病毒进入的小分子抑制剂,复制,和组装,连同核酸反义和RNA干扰策略。还考虑了针对宿主的抗病毒药物,包括免疫调节剂,如干扰素和细胞因子/趋化因子调节剂,广谱抗病毒药物,以及恢复期血浆和基于抗体的疗法。然后,本文研究了新型疗法的临床前和临床开发,突出用于抗病毒评估的体外和体内模型,安全性和有效性评估,以及临床试验的关键阶段。认识到耐药性和病毒逃逸的挑战,小型综述强调了联合治疗策略的潜力,并强调需要快速诊断工具来优化治疗开始.最后,我们讨论了公共卫生准备和公平获得这些有前途的治疗方法对于实现有效的MVD控制和全球卫生安全的重要性.这篇小型综述全面介绍了MVD抗病毒药物的新兴领域,强调这些新方法重塑MVD治疗和预防未来的潜力。
    Marburg virus disease (MVD) presents a significant global health threat, lacking effective antivirals and with current supportive care offering limited therapeutic options. This mini review explores the emerging landscape of novel antiviral strategies against MVD, focusing on promising therapeutics currently in the development pipeline. We delve into direct-acting antiviral approaches, including small molecule inhibitors targeting viral entry, replication, and assembly, alongside nucleic acid antisense and RNA interference strategies. Host-targeting antivirals are also considered, encompassing immune modulators like interferons and cytokine/chemokine modulators, broad-spectrum antivirals, and convalescent plasma and antibody-based therapies. The paper then examines preclinical and clinical development for the novel therapeutics, highlighting in vitro and in vivo models for antiviral evaluation, safety and efficacy assessments, and the critical stages of clinical trials. Recognizing the challenges of drug resistance and viral escape, the mini review underscores the potential of combination therapy strategies and emphasizes the need for rapid diagnostic tools to optimize treatment initiation. Finally, we discuss the importance of public health preparedness and equitable access to these promising therapeutics in achieving effective MVD control and global health security. This mini review presents a comprehensive overview of the burgeoning field of MVD antivirals, highlighting the potential of these novel approaches to reshape the future of MVD treatment and prevention.
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  • 文章类型: English Abstract
    Marburg virus disease (MVD) is a dreadful but exceptional disease. Formerly mainly identified in Uganda, Angola and the Democratic Republic of Congo, it has recently appeared in the Republic of Guinea, Ghana, Equatorial Guinea and Tanzania, adding West Africa to the affected regions. Humans become infected through exposure to bats Roussettus aegyptiacus or during unprotected care of infected people. Five cases are linked to travellers, the last one dates to 2008 and involved a visit to caves colonized by bats. At present, there is no specific treatment or vaccine. Despite its rarity, adventurous travelers should be aware of the risks of exposure and avoid entering places inhabited by bats.
    La maladie à virus Marburg est une maladie redoutable mais exceptionnelle. Autrefois identifiée en Ouganda, Angola et République démocratique du Congo, elle a récemment fait son apparition en République de Guinée, au Ghana, en Guinée équatoriale et en Tanzanie, ajoutant l’Afrique de l’Ouest aux régions touchées. Les humains s’infectent lors d’une exposition avec les chauves-souris roussettes d’Égypte ou lors de la prise en charge sans protection de personnes infectées. Cinq cas sont liés à des voyageurs, le dernier remonte à 2008 et était associé à la visite de grottes colonisées par des roussettes d’Égypte. Actuellement, il n’existe aucun traitement spécifique ni vaccin. Malgré sa rareté, les voyageurs aventureux doivent être informés des risques d’exposition et éviter de pénétrer dans des lieux habités par des chauves-souris.
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  • 文章类型: Journal Article
    目标:马尔堡病毒,以前被称为马尔堡出血热,是一种严重且经常致命的疾病,会影响人类。这项研究旨在开发和验证法国问卷,以评估知识,态度,马尔堡病毒病(FKAP-MVD)的实践。
    方法:使用匿名在线调查,通过各种平台和电子邮件分发。数据来自布基纳法索,几内亚,刚果民主共和国,塞内加尔。
    方法:为了进行研究,使用了匿名在线调查,通过Facebook等各种平台分发,Twitter,WhatsApp,和电子邮件。该调查已上传到Google表格上,以方便数据收集。数据来自布基纳法索,几内亚,刚果民主共和国,塞内加尔。
    结果:在510名参与者的总样本中,60.0%为男性,他们的平均年龄是28.41±6.32岁,38.0%已婚,86.6%的人居住在城市地区,64.1%的人受过大学教育。问卷具有良好的内部一致性;Cronbach'sα为0.87。知识与态度的相关性为0.002,知识与实践的相关性为0.204,实践与态度的相关性相对较弱,为-0.060。这表明问卷的有效性存在差异。KMO值为0.91表示充足程度很高,这表明该数据适用于因子分析。Sphericity的Bartlett检验得出的大约χ2值为4016.890,自由度为300,P值为0.0001。验证性因子分析揭示了三个领域的25个问题。归一化的卡方值为1.224。拟合优度指数(GFI)为0.902,比较拟合指数(CFI)为0.982,近似均方根误差(RMSEA)为0.033,均方根残差(RMR)为0.062。这些值表明模型与数据的良好拟合。
    结论:一般来说,所开发的调查问卷在告知与MVD相关的公共卫生举措和干预措施方面具有重要潜力.
    OBJECTIVE: Marburg virus, previously referred to as Marburg hemorrhagic fever, is a highly severe and frequently fatal illness that affects humans. This study aimed to develop and validate a French questionnaire to assess knowledge, attitude, and practice toward Marburg virus disease (FKAP-MVD).
    METHODS: An anonymous online survey was used, which was distributed through various platforms and emails. Data were collected from Burkina Faso, Guinea, the Democratic Republic of Congo, and Senegal.
    METHODS: To conduct the study, an anonymous online survey was used, which was distributed through various platforms such as Facebook, Twitter, WhatsApp, and emails. The survey was uploaded onto a Google form to facilitate data collection. Data were collected from Burkina Faso, Guinea, the Democratic Republic of Congo, and Senegal.
    RESULTS: Of the total sample of 510 participants, 60.0% were male, their mean age was 28.41 ± 6.32 years, 38.0% were married, 86.6% resided in urban areas and 64.1% had a university education. The questionnaire had good internal consistency; Cronbach\'s alpha was 0.87. The correlation between knowledge and attitude was 0.002, the correlation between knowledge and practice was 0.204, and the correlation between practice and attitude was relatively weak and negative at -0.060. This indicates the divergent validity of the questionnaire. The KMO value of 0.91 indicates a high level of adequacy, suggesting that the data are suitable for factor analysis. The Bartlett test of Sphericity yielded an approximate χ2 value of 4016.890 with 300 degrees of freedom and a P-value of 0.0001. The confirmatory factor analysis revealed 25 questions in three domains. The normed chi-square value is 1.224. The goodness of Fit Index (GFI) is 0.902, the Comparative Fit Index (CFI) is 0.982, the Root Mean Square Error of Approximation (RMSEA) is 0.033, and the Root Mean Square Residual (RMR) is 0.062. These values indicate a good fit of the model to the data.
    CONCLUSIONS: In general, the developed questionnaire has significant potential to inform public health initiatives and interventions related to MVD.
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