The East African Community (EAC) is experiencing an unprecedented, emerging mpox outbreak since July 2024 in five of eight partner states. We highlight rapid regional response measures, initiated August 2024 coordinated by EAC: field deployment of six mobile laboratories in Burundi, Rwanda, Uganda, Tanzania, Kenya, South Sudan to high-risk areas, donation of one mobile laboratory to Democratic Republic of the Congo and genomic monkeypox virus (MPXV) surveillance support. These interventions aim to limit local mpox spread and support international containment.

BACKGROUND: Residential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.
METHODS: In consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government\'s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.
RESULTS: In the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.
CONCLUSIONS: Under realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.

BACKGROUND: The implementation of digital disease surveillance systems at national levels in Africa have been challenged by many factors. These include user applicability, utility of IT features but also stable financial support. Funding closely intertwines with implementations in terms of geographical reach, disease focus, and sustainability. However, the practice of evidence sharing on geographical and disease coverage, costs, and funding sources for improving the implementation of these systems on the continent is unclear.
OBJECTIVE: To analyse the key characteristics and availability of evidence for implementing digital infectious disease surveillance systems in Africa namely their disease focus, geographical reach, cost reporting, and external funding support.
METHODS: We conducted a systematic review of peer-reviewed and grey literature for the period 2003 to 2022 (PROSPERO registration number: CRD42022300849). We searched five databases (PubMed, MEDLINE over Ovid, EMBASE, Web of Science, and Google Scholar) and websites of WHO, Africa CDC, and public health institutes of African countries. We mapped the distribution of projects by country; identified reported implementation cost components; categorised the availability of data on cost components; and identified supporting funding institutions outside Africa.
RESULTS: A total of 29 reports from 2,033 search results were eligible for analysis. We identified 27 projects implemented in 13 countries, across 32 sites. Of these, 24 (75%) were pilot projects with a median duration of 16 months, (IQR: 5-40). Of the 27 projects, 5 (19%) were implemented for HIV/AIDs and tuberculosis, 4 (15%) for malaria, 4 (15%) for all notifiable diseases, and 4 (15%) for One Health. We identified 17 cost components across the 29 reports. Of these, 11 (38%) reported quantified costs for start-up capital, 10 (34%) for health personnel compensation, 9 (31%) for training and capacity building, 8 (28%) for software maintenance, and 7(24%) for surveillance data transmission. Of 65 counts of external funding sources, 35 (54%) were governmental agencies, 15 (23%) foundations, and 7 (11%) UN agencies.
CONCLUSIONS: The evidence on costing data for the digitalisation of surveillance and outbreak response in the published literature is sparse in quantity, limited in detail, and without a standardised reporting format. Most initial direct project costs are substantially donor dependent, short lived, and thus unsustainable.

COVID-19 surveillance in Ukraine ceased after the Russian invasion of the country in 2022, on a background of low vaccination rates of 34.5% for two doses at this time. We conducted a modelling study to estimate the epidemic trajectory of SARS-COV-2 in Ukraine after the start of the war. We use a COVID-19 deterministic Susceptible-Exposed-Infected-Recovered (SEIR) model for Ukraine to estimate the impact of increased vaccination coverage and masking as public health interventions. We fit the model output to case notification data between 6 January and 25 February 2022, then we forecast the COVID-19 epidemic trajectory in different scenarios of mask use and vaccine coverage. In the best-case scenario, 69% of the Ukrainian population would have been infected in the first half of 2022. Increasing mask use from 50 to 80% reduces cases and deaths by 17% and 30% respectively, while increasing vaccination rates to 60% and 9.6% for two and three doses respectively results in a 3% reduction in cases and 28% in deaths. However, if vaccination is increased to a higher coverage of 80% with two doses and 12.8% with three, or mask effectiveness is reduced to 40%, increasing vaccination coverage is more effective. The loss of health services, displacement, and destruction of infrastructure will amplify the risk of COVID-19 in Ukraine and make vaccine programs less feasible. Masks do not need the health infrastructure or cold-chain logistics required for vaccines and are more feasible for rapid epidemic control during war. However, increasing vaccine coverage will save more lives. Vaccination of refugees who have fled to other countries can be more feasibly achieved.

The East African Community (EAC) grapples with many challenges in tackling infectious disease threats and antimicrobial resistance (AMR), underscoring the importance of regional and robust pathogen genomics capacities. However, a significant disparity exists among EAC Partner States in harnessing bacterial pathogen sequencing and data analysis capabilities for effective AMR surveillance and outbreak response. This study assesses the current landscape and challenges associated with pathogen next-generation sequencing (NGS) within EAC, explicitly focusing on World Health Organization (WHO) AMR-priority pathogens. The assessment adopts a comprehensive approach, integrating a questionnaire-based survey amongst National Public Health Laboratories (NPHLs) with an analysis of publicly available metadata on bacterial pathogens isolated in the EAC countries. In addition to the heavy reliance on third-party organizations for bacterial NGS, the findings reveal a significant disparity among EAC member States in leveraging bacterial pathogen sequencing and data analysis. Approximately 97% (n = 4,462) of publicly available high-quality bacterial genome assemblies of samples collected in the EAC were processed and analyzed by external organizations, mainly in Europe and North America. Tanzania led in-country sequencing efforts, followed by Kenya and Uganda. The other EAC countries had no publicly available samples or had all their samples sequenced and analyzed outside the region. Insufficient local NGS sequencing facilities, limited bioinformatics expertise, lack of adequate computing resources, and inadequate data-sharing mechanisms are among the most pressing challenges that hinder the EAC\'s NPHLs from effectively leveraging pathogen genomics data. These insights emphasized the need to strengthen microbial pathogen sequencing and data analysis capabilities within the EAC to empower these laboratories to conduct pathogen sequencing and data analysis independently. Substantial investments in equipment, technology, and capacity-building initiatives are crucial for supporting regional preparedness against infectious disease outbreaks and mitigating the impact of AMR burden. In addition, collaborative efforts should be developed to narrow the gap, remedy regional imbalances, and harmonize NGS data standards. Supporting regional collaboration, strengthening in-country genomics capabilities, and investing in long-term training programs will ultimately improve pathogen data generation and foster a robust NGS-driven AMR surveillance and outbreak response in the EAC, thereby supporting global health initiatives.

UNASSIGNED: We investigated an outbreak of Lassa fever that occurred in Ebonyi state, Southeast Nigeria from January to March 2018.
UNASSIGNED: The Emergency operational centre (EOC) model was used for the outbreak coordination. Cases and deaths were identified through the routine surveillance system. Blood specimens collected from suspected cases were sent for confirmation at the Virology Centre, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA). Active case search was instituted, and identified contacts of confirmed cases were followed up for the maximum incubation period of the disease. Other public health responses included infection prevention and control, communication and advocacy as well as case management. Data collected were analysed using the Epi info statistical software package.
UNASSIGNED: We identified 89 suspected Lassa Fever (LF) cases out of which 61 were confirmed. The mean age was 35±16.2 and the age group mostly affected was 30-39 years. More than half (59.7%) of the confirmed cases were females. The Case Fatality Rate (CFR) was 26.2% among the laboratory confirmed cases. Five of the deaths occurred among health care workers. Out of 325 contacts of the confirmed cases, 304(99.7%) completed the follow-up and only 1(0.3%) of them developed symptoms consistent with LF and was confirmed by the laboratory.
UNASSIGNED: The high CFR in those presenting late to the hospital underscores the need for intensive public enlightenment that encourages early presentation to hospital. Majority of the confirmed cases were primary cases, hence efforts should be intensified in breaking the chain of transmission in the animal-man interphase. Death of healthcare workers involved in management of Lassa fever raises the importance of providing life insurance for concerned healthcare workers.

As the Global Polio Eradication Initiative (GPEI) strategizes towards the final steps of eradication, routine immunization schedules evolve, and high-quality vaccination campaigns and surveillance systems remain essential. New tools are consistently being developed, such as the novel oral poliovirus vaccine to combat outbreaks more sustainably, as well as non-infectiously manufactured vaccines such as virus-like particle vaccines to eliminate the risk of resurgence of polio on the eve of a polio-free world. As the GPEI inches towards eradication, re-strategizing in the face of evolving challenges and preparing for unknown risks in the post-certification era are critical.

The aim of this study is to assess WHO/Eastern Mediterranean region (WHO/EMR) countries capacities, operations and outbreak response capabilities. Cross-sectional study was conducted targeting 22 WHO/EMR countries from May to June 2021. The survey covers 8 domains related to 15 milstones and key performance indicators (KPIs) for RRT. Responses were received from 14 countries. RRTs are adequately organised in 9 countries (64.3%). The mean retention rate of RRT members was 85.5% ± 22.6. Eight countries (57.1%) reported having standard operating procedures, but only three countries (21.4%) reported an established mechanism of operational fund allocation. In the last 6 months, 10,462 (81.9%) alerts were verified during the first 24 h. Outbreak response was completed by the submission of final RRT response reports in 75% of analysed outbreaks. Risk Communication and Community Engagement (RCCE) activities were part of the interventional response in 59.5% of recent outbreaks. Four countries (28.6%) reported an adequate system to assess RRTs operations. The baseline data highlights four areas to focus on: developing and maintaining the multidisciplinary nature of RRTs through training, adequate financing and timely release of funds, capacity and system building for implementing interventions, for instance, RCCE, and establishing national monitoring and evaluation systems for outbreak response.

UNASSIGNED: Disease surveillance is very crucial especially in high vulnerability settings like Pakistan. However, surveillance and outbreak response management are still evolving in the country and research studies are needed to assess the existing system.
UNASSIGNED: To assess the impact of integrated disease surveillance and response system (IDSRS) implemented by the provincial government to strengthen infectious disease surveillance and reporting in 6 districts of Pakistan in 2016.
UNASSIGNED: A baseline cross-sectional assessment of health facilities and the healthcare workforce was conducted in 2016 to identify needs and gaps in public sector health facilities and the health system of 6 selected districts of Khyber Pakhtunkhwa Province, Pakistan. This was followed by a 2018 endline survey of the same facilities using the same variables.
UNASSIGNED: Overall, there was improvement in district management and facility level performance (χ2 (1, 314) = 21.19, P < 0.001, V = 0.26). District level management improved significantly in areas with relatively lower Gross Domestic Product (GDP)? χ2(1, 154) = 30.41, P <0.001, V = 0.44). Facilitation domain variables improved in the lower GDP districts (χ2 (1, 74) = 5.76, P = 0.016, V = 0.28) and showed counterintuitive deterioration (χ2 (1, 74) = 4.80, P = 0.028, V = 0.25) in relatively higher GDP areas.
UNASSIGNED: IDSRS is effective in improving surveillance and response systems, however, its effectiveness appears to depend on locale-specific economies and can be enhanced by modifying the implementation approach. Better empowerment of the local workforce can contribute to such improvement.
تقييم أثر النظام المتكامل لترصُّد الأمراض والاستجابة لها على إدارة الترصُّد في مرافق الرعاية الصحية في باكستان.
ضياء الحق، شيراز فازيد، بشارات حسين، محمد فؤاد خان، عاصف بتاني، بلال بهراوار، عاصف بتاني، شاهين أفريدي.
UNASSIGNED: يُعَدُّ ترصُّد الأمراض أمر بالغ الأهمية، لا سيَّما في الأماكن المعرضة بشدة للخطر، مثل باكستان.
UNASSIGNED: هدفت هذه الدراسة الى تقييم النظام المتكامل لترصُّد الأمراض والاستجابة لها الذي تنفذه حكومة الإقليم بهدف تعزيز ترصُّد الأمراض المُعْدية والإبلاغ عنها في 6 مناطق في باكستان في عام 2016.
UNASSIGNED: استُخدم الإِحْصاء لجمع البيانات على مستوى المناطق، في حين استُخدم أسلوب أخذ العينات العشوائية الطبقية لاختيار 12 مرفقًا صحيًّا لتقييمها. واستُخدمت أداة منظمة الصحة العالمية لجمع البيانات. وأُدخلت البيانات ببرنامج Microsoft Excel وحُلِّلت بالإصدار 14,2 من برنامج STATA. واستُخدم التناظر التقريبي والتجانس الهامشي (ستيوارت-ماكسويل) لتقييم عدم التوافق بين متغيرات المؤشرات ما قبل تطبيقهما وما بعده.
UNASSIGNED: بشكل عام، كان هناك تحسُّن في أداء إدارة المناطق الصحية والأداء على مستوى المرافق (χ2 (314،1) = 21,19، القيمة الاحتمالية <001، التباين = 0,26). وتحسَّنت الإدارة على مستوى المناطق تحسنًا كبيرًا في المناطق ذات الناتج المحلي الإجمالي الأقل نسبيًّا (χ2 (154،1) 30,41، القيمة الاحتمالية <0,001، التباين = 0,44). وتحسَّنت متغيرات مجال التيسير في المناطق ذات الناتج المحلي الإجمالي الأدنى (χ2 (74،1) = 5,76، القيمة الاحتمالية = 0,16، التباين = 0,28) وأظهرت تراجعًا غير متوقع (χ2 (74،1) = 4,80، القيمة الاحتمالية = 0,28، التباين = 0,25) في المناطق ذات الناتج المحلي الإجمالي الأعلى نسبيًّا.
UNASSIGNED: يُعَد النظام المتكامل لترصُّد الأمراض والاستجابة لها فعَّالًًا في تحسين نُظُم الترصُّد والاستجابة، ولكن يبدو أن فعاليته تتوقف على الاقتصادات الخاصة بكل موقع، ويمكن تعزيزها بتعديل نهج التنفيذ. ويمكن أن تسهم زيادة تمكين القوى العاملة المحلية في هذا التحسين.
Évaluation de l\'impact du système de surveillance intégrée des maladies et de riposte sur la gestion de la surveillance au sein des établissements de santé au Pakistan.
UNASSIGNED: La surveillance des maladies constitue un enjeu crucial, en particulier dans les régions à forte vulnérabilité comme le Pakistan. Toutefois, la surveillance et la gestion de la riposte aux flambées épidémiques sont encore en évolution dans le pays et des études de recherche sont nécessaires pour évaluer le système existant.
UNASSIGNED: Déterminer l\'impact du système de surveillance intégrée des maladies et de riposte mis en place par le gouvernement provincial pour renforcer la surveillance et la notification des maladies infectieuses dans six districts du Pakistan au cours de l\'année 2016.
UNASSIGNED: Une évaluation transversale initiale des établissements et des personnels de santé a été réalisée en 2016 pour identifier les besoins et les lacunes des établissements sanitaires du secteur public et du système de santé de six districts sélectionnés de la province de Khyber Pakhtunkhwa (Pakistan). Cette évaluation a été suivie d\'une enquête finale en 2018 auprès des mêmes établissements en utilisant les mêmes variables.
UNASSIGNED: Dans l\'ensemble, une amélioration a été constatée en ce qui concerne la gestion des districts et la performance des établissements (χ2 (1,314) = 21,19, p < 0,001, v = 0,26). La gestion au niveau des districts s\'est nettement améliorée dans les zones où le produit intérieur brut (PIB) est relativement plus faible (χ2 (1,154) = 30,41, p < 0,001, v = 0,44). Les variables du domaine de facilitation ont affiché une amélioration dans les districts où le PIB est plus faible (χ2 (1,74) = 5,76, p = 0,016, v = 0,28), mais elles se sont paradoxalement dégradées (χ2 (1,74) = 4,80, p = 0,028, v = 0,25) dans les zones où le PIB est relativement plus élevé.
UNASSIGNED: Le système de surveillance intégrée des maladies et de riposte est efficace pour renforcer les systèmes de ce genre. Toutefois, son efficacité semble dépendre des économies spécifiques locales et peut être améliorée en modifiant la méthode de mise en œuvre. Une meilleure autonomisation du personnel local peut y contribuer.

BACKGROUND: The 2022-2023 period marked the largest global Mpox outbreak, with Latin America\'s situation notably underexplored. This study aims to estimate Mpox\'s instantaneous reproduction number (R(t)), analyze epidemiological trends, and map vaccination efforts in six Latin American countries.
METHODS: Utilizing Pan American Health Organization Mpox surveillance data, we examined demographic characteristics, cumulative incidence rates, and epidemic curves, calculated R(t) with weekly sliding windows for each country, alongside a review of vaccination initiatives.
RESULTS: From 2022 to 2023, 25,503 Mpox cases and 71 deaths were reported across Argentina, Brazil, Chile, Colombia, Mexico and Peru, with a significant majority (91.8%-98.5%) affecting men, with a mean age of 32-35 years. Maximum R(t) values varied across countries: Argentina (2.63; 0.85 to 5.39), Brazil (3.13; 2.61 to 3.69), Chile (2.91; 1.55 to 4.70), Colombia (3.15; 2.07 to 4.44), Mexico (2.28; 1.18 to 3.75), and Peru (2.84; 2.33 to 3.40). The epidemic\'s peak occurred between August and September 2022 with R(t) values subsequently dropping below 1. From November 2022, and as of February 2024, only Chile, Peru, and Brazil had initiated Mpox vaccination campaigns, with Colombia launching a Clinical Trial.
CONCLUSIONS: The peak of the Mpox epidemic in the studied countries occurred before the commencement of vaccination programs. This trend may be then partly attributed to a combination of behavioral modifications in key affected communities and contact tracing local programs. Therefore, the proportion of the at-risk population that remains susceptible is still uncertain, highlighting the need for continued surveillance and evaluation of vaccination strategies.