Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Arunmozhi B [original query] |
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Kenya's experience implementing event-based surveillance during the COVID-19 pandemic
Ndegwa L , Ngere P , Makayotto L , Patel NN , Nzisa L , Otieno N , Osoro E , Oreri E , Kiptoo E , Maigua S , Crawley A , Clara AW , Arunmozhi Balajee S , Munyua P , Herman-Roloff A . BMJ Glob Health 2023 8 (12) Event-based surveillance (EBS) can be implemented in most settings for the detection of potential health threats by recognition and immediate reporting of predefined signals. Such a system complements existing case-based and sentinel surveillance systems. With the emergence of the COVID-19 pandemic in early 2020, the Kenya Ministry of Health (MOH) modified and expanded an EBS system in both community and health facility settings for the reporting of COVID-19-related signals. Using an electronic reporting tool, m-Dharura, MOH recorded 8790 signals reported, with 3002 (34.2%) verified as events, across both community and health facility sites from March 2020 to June 2021. A subsequent evaluation found that the EBS system was flexible enough to incorporate the addition of COVID-19-related signals during a pandemic and maintain high rates of reporting from participants. Inadequate resources for follow-up investigations to reported events, lack of supportive supervision for some community health volunteers and lack of data system interoperability were identified as challenges to be addressed as the EBS system in Kenya continues to expand to additional jurisdictions. |
COVID-19 response by the Hopi Tribe: impact of systems improvement during the first wave on the second wave of the pandemic.
Humeyestewa D , Burke RM , Kaur H , Vicenti D , Jenkins R , Yatabe G , Hirschman J , Hamilton J , Fazekas K , Leslie G , Sehongva G , Honanie K , Tu'tsi E , Mayer O , Rose MA , Diallo Y , Damon S , Zilversmit Pao L , McCraw HM , Talawyma B , Herne M , Nuvangyaoma TL , Welch S , Balajee SA . BMJ Glob Health 2021 6 (5) The Hopi Tribe is a sovereign nation home to ~7500 Hopi persons living primarily in 12 remote villages. The Hopi Tribe, like many other American Indian nations, has been disproportionately affected by COVID-19. On 18 May 2020, a team from the US Centers for Disease Control and Prevention (CDC) was deployed on the request of the tribe in response to increases in COVID-19 cases. Collaborating with Hopi Health Care Center (the reservation's federally run Indian Health Service health facility) and CDC, the Hopi strengthened public health systems and response capacity from May to August including: (1) implementing routine COVID-19 surveillance reporting; (2) establishing the Hopi Incident Management Authority for rapid coordination and implementation of response activities across partners; (3) implementing a community surveillance programme to facilitate early case detection and educate communities on COVID-19 prevention; and (4) applying innovative communication strategies to encourage mask wearing, hand hygiene and physical distancing. These efforts, as well as community adherence to mitigation measures, helped to drive down cases in August. As cases increased in September-November, the improved capacity gained during the first wave of the pandemic enabled the Hopi leadership to have real-time awareness of the changing epidemiological landscape. This prompted rapid response coordination, swift scale up of health communications and redeployment of the community surveillance programme. The Hopi experience in strengthening their public health systems to better confront COVID-19 may be informative to other indigenous peoples as they also respond to COVID-19 within the context of disproportionate burden. |
Testing early warning and response systems through a full-scale exercise in Vietnam.
Clara A , Dao ATP , Tran Q , Tran PD , Dang TQ , Nguyen HT , Tran QD , Rzeszotarski P , Talbert K , Stehling-Ariza T , Veasey F , Clemens L , Mounts AW , Lofgren H , Balajee SA , Do TT . BMC Public Health 2021 21 (1) 409 BACKGROUND: Simulation exercises can functionally validate World Health Organization (WHO) International Health Regulations (IHR 2005) core capacities. In 2018, the Vietnam Ministry of Health (MOH) conducted a full-scale exercise (FSX) in response to cases of severe viral pneumonia with subsequent laboratory confirmation for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to evaluate the country's early warning and response capabilities for high-risk events. METHODS: An exercise planning team designed a complex fictitious scenario beginning with one case of severe viral pneumonia presenting at the hospital level and developed all the materials required for the exercise. Actors, controllers and evaluators were trained. In August 2018, a 3-day exercise was conducted in Quang Ninh province and Hanoi city, with participation of public health partners at the community, district, province, regional and national levels. Immediate debriefings and an after-action review were conducted after all exercise activities. Participants assessed overall exercise design, conduction and usefulness. RESULTS: FSX findings demonstrated that the event-based surveillance component of the MOH surveillance system worked optimally at different administrative levels. Detection and reporting of signals at the community and health facility levels were appropriate. Triage, verification and risk assessment were successfully implemented to identify a high-risk event and trigger timely response. The FSX identified infection control, coordination with internal and external response partners and process documentation as response challenges. Participants positively evaluated the exercise training and design. CONCLUSIONS: This exercise documents the value of exercising surveillance capabilities as part of a real-time operational scenario before facing a true emergency. The timing of this exercise and choice of disease scenario was particularly fortuitous given the subsequent appearance of COVID-19. As a result of this exercise and subsequent improvements made by the MOH, the country may have been better able to deal with the emergence of SARS-CoV-2 and contain it. |
Notes from the Field: Development of an Enhanced Community-Focused COVID-19 Surveillance Program - Hopi Tribe, June‒July 2020.
Jenkins R , Burke RM , Hamilton J , Fazekas K , Humeyestewa D , Kaur H , Hirschman J , Honanie K , Herne M , Mayer O , Yatabe G , Balajee SA . MMWR Morb Mortal Wkly Rep 2020 69 (44) 1660-1661 The Hopi Tribe, a sovereign nation in northeastern Arizona, includes approximately 7,500 persons within 12 rural villages (1). During April 11–June 15, 2020, the Hopi Health Care Center (HHCC, an Indian Health Services facility) reported 136 cases of coronavirus disease 2019 (COVID-19) among Hopi residents; 27 (20%) patients required hospitalization (J Hirschman, MD, CDC, personal communication, June 2020). Contact tracing of Hopi COVID-19 cases identified delayed seeking of care and testing by persons experiencing COVID-19–compatible signs and symptoms*; inconsistent adherence to recommended mitigation measures,† such as mask-wearing and social distancing; and limited knowledge of the roles of testing, isolation, and quarantine procedures§ (2). Based on these findings, the Hopi Tribe Department of Health and Human Services (DHHS) collaborated with HHCC to develop a community-focused program to enhance COVID-19 surveillance and deliver systematic health communications to the communities. This report describes the surveillance program and findings from two field tests.¶ |
A SARS-CoV-2 Outbreak Illustrating the Challenges in Limiting the Spread of the Virus - Hopi Tribe, May-June 2020.
Hirschman J , Kaur H , Honanie K , Jenkins R , Humeyestewa DA , Burke RM , Billy TM , Mayer O , Herne M , Anderson M , Bhairavabhotla R , Yatabe G , Balajee SA . MMWR Morb Mortal Wkly Rep 2020 69 (44) 1654-1659 On June 3, 2020, a woman aged 73 years (patient A) with symptoms consistent with coronavirus disease 2019 (COVID-19) (1) was evaluated at the emergency department of the Hopi Health Care Center (HHCC, an Indian Health Services facility) and received a positive test result for SARS-CoV-2, the virus that causes COVID-19. The patient's symptoms commenced on May 27, and a sibling (patient B) of the patient experienced symptom onset the following day. On May 23, both patients had driven together and spent time in a retail store in Flagstaff, Arizona. Because of their similar exposures, symptom onset dates, and overlapping close contacts, these patients are referred to as co-index patients. The co-index patients had a total of 58 primary (i.e., direct) and secondary contacts (i.e., contacts of a primary contact); among these, 27 (47%) received positive SARS-CoV-2 test results. Four (15%) of the 27 contacts who became ill were household members of co-index patient B, 14 (52%) had attended family gatherings, one was a child who might have transmitted SARS-CoV-2 to six contacts, and eight (30%) were community members. Findings from the outbreak investigation prompted the HHCC and Hopi Tribe leadership to strengthen community education through community health representatives, public health nurses, and radio campaigns. In communities with similar extended family interaction, emphasizing safe ways to stay in touch, along with wearing a mask, frequent hand washing, and physical distancing might help limit the spread of disease. |
Strengthening laboratory surveillance of viral pathogens: Experiences and lessons learned building next-generation sequencing capacity in Ghana.
Marine RL , Ntim NAA , Castro CJ , Attiku KO , Pratt D , Duker E , Agbosu E , Ng TFF , Gatei W , Obodai E , Odoom JK , Walker CL , Rota PA , Oberste MS , Ampofo WK , Balajee SA . Int J Infect Dis 2019 81 231-234 ![]() ![]() OBJECTIVES: To demonstrate the feasibility of applying next-generation sequencing (NGS) in medium-resource reference laboratories in Africa to enhance global disease surveillance. METHODS: A training program was developed to support implementation of NGS at Noguchi Memorial Institute for Medical Research (NMIMR), University of Ghana. The program was divided into two training stages, first at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, followed by on-site training at NMIMR for a larger cohort of scientists. RESULTS: Self-assessment scores for topics covered during the NGS training program were higher post-training relative to pre-training. During the NGS Training II session at NMIMR, six enterovirus isolates from acute flaccid paralysis cases in Ghana were successfully sequenced by trainees, including two echovirus 6, two echovirus 11 and one echovirus 13. Another genome was an uncommon type (EV-B84), which has not been reported in Africa since its initial discovery from a Cote d'Ivoire specimen in 2003. CONCLUSIONS: The success at NMIMR provides an example of how to approach transferring of NGS methods to international laboratories. There is great opportunity for collaboration between institutes that have genomics expertise to ensure effectiveness and long-term success of global NGS capacity building programs. |
Evaluation of the field performance of ImmunoCard STAT! rapid diagnostic test for rotavirus in Dadaab refugee camp and at the Kenya-Somalia Border
Ope M , Nyoka R , Unshur A , Oyier FO , Mowlid SA , Owino B , Ochieng SB , Okello CI , Montgomery JM , Wagacha B , Galev A , Abdow A , Esona MD , Tate J , Fitter D , Cookson ST , Arunmozhi B , Marano N . Am J Trop Med Hyg 2017 96 (6) 1302-1306 Rotavirus commonly causes diarrhea in children, leading to hospitalization and even death. Rapid diagnostic tests are feasible alternatives for determining rotavirus outbreaks in refugee camps that have inadequate laboratory capacity.We evaluated the field performance of ImmunoCard STAT! Rotavirus (ICS-RV) in Dadaab Refugee Camp and at the Kenya-Somalia border. From May to December 2014, we prospectively enrolled children aged < 5 years hospitalized with acute diarrhea, defined as >= 3 episodes of loose stool in 24 hours for < 7 days. Stool samples were collected and tested by trained surveillance clerks using ICS-RV per manufacturer's instructions. The field performance characteristics of ICS-RV were evaluated against the gold standard test, PremierTM Rotaclone enzyme immunoassay. The operational characteristics were evaluated usingWorld Health Organization (WHO) ASSURED criteria to determine whether ICS-RV is appropriate as a point-of-care test by administering a standard questionnaire and observing surveillance clerks performing the test. We enrolled 213 patients with a median age of 10 months (range = 1-48); 58.2%weremale. A total of 71 (33.3%) and 60 (28.2%) patients tested positive for rotavirus infection by immunoassay and ICS-RV, respectively. The sensitivity, specificity, and positive and negative predictive values of ICS-RV compared with the immunoassay were 83.1% (95% confidence interval [CI] = 72.3-91.0), 99.3% (95% CI = 96.1-100), 98.3% (95% CI = 91.1-100), and 92.1% (95% CI = 86.6-95.5), respectively. The ICS-RV fulfilled theWHO ASSURED criteria for point-of-care testing. ICS-RV is a field-ready point-of-care test with good field performance and operational characteristics. It can be useful in determining rotavirus outbreaks in resource-limited settings. |
Detection of mucormycetes and other pathogenic fungi in formalin fixed paraffin embedded and fresh tissues using the extended region of 28S rDNA.
Gade L , Hurst S , Balajee SA , Lockhart SR , Litvintseva AP . Med Mycol 2016 55 (4) 385-395 ![]() Molecular methods of detection based on DNA-sequencing of the internal transcribed spacer 1 and 2 (ITS1 and ITS2) or 5' end region of 28S (D1-D2 region) of ribosomal RNA gene (rDNA) have been used extensively for molecular identification and detection of fungal infections. However, these regions are not always informative for identification of mucormycetes and other rare fungal pathogens as they often contain large introns, heterogenic regions, and/or cannot be PCR-amplified using broad range fungal PCR primers. In addition, because of the difficulties of recovering intact fungal DNA from human specimens, smaller regions of DNA are more useful for the direct detection of fungal DNA in tissues and fluids. In this study, we investigated the utility of 12F/13R PCR primers targeting a 200-230 bp region of the extended 28S region of rDNA for molecular identification of fungal DNA in formalin fixed paraffin embedded tissues and other clinical specimens. We demonstrated that this region can be successfully used for identification of all genera and some species of clinically relevant mucormycetes, as well as other medically important fungi, such as Aspergillus, Fusarium, Coccidioides, and Cryptococcus We also demonstrated that PCR amplification and direct sequencing of the extended 28S region of rDNA was more sensitive compared to targeting the ITS2 region, as we were able to detect and identify mucormycetes and other fungal pathogens in tissues from patients with histopathological and/or culture evidence of fungal infections that were negative with PCR using ITS-specific primers. |
Rotavirus Group A Genotypes Detected Through Diarrheal Disease Surveillance in Haiti, 2012.
Esona MD , Buteau J , Lucien MA , Joseph GA , Leshem E , Boncy J , Katz MA , Bowen MD , Balajee SA . Am J Trop Med Hyg 2015 93 (1) 54-6 ![]() Samples collected in 2012 through diarrheal disease surveillance in Haiti were tested for rotavirus by enzyme immunoassay and real time RT-PCR and positive samples were genotyped. The predominant genotypes were G1P[8] (29% prevalence) and G9P[8] (21%). The observed genotype prevalence is similar to that reported previously for other Caribbean countries. |
Mucormycosis outbreak associated with hospital linens.
Duffy J , Harris J , Gade L , Sehulster L , Newhouse E , O'Connell H , Noble-Wang J , Rao C , Balajee SA , Chiller T . Pediatr Infect Dis J 2014 33 (5) 472-6 ![]() BACKGROUND: Mucormycosis is an invasive fungal infection with a high fatality rate. We investigated an outbreak of mucormycosis in a pediatric hospital to determine routes of pathogen transmission from the environment and prevent additional infections. METHODS: A case was defined as a hospital-onset illness consistent with mucormycosis, confirmed by culture or histopathology. Case-patient medical records were reviewed for clinical course and exposure to items and locations within the hospital. Environmental samples were collected from air and surfaces. Fungal isolates collected from case-patients and the environment were identified using DNA sequencing. RESULTS: Five case-patients had hospital-associated cutaneous mucormycosis over an eleven month period; all subsequently died. Three case-patients had conditions known to be associated with susceptibility to mucormycosis, while two had cardiac conditions with persistent acidosis. The cases occurred on several different wards throughout the hospital, and hospital linens were the only exposure identified as common to the case-patients. Rhizopus species were recovered from 26 (42%) of 62 environmental samples from clean linens and associated areas, and from one (4%) of 25 samples from non-linen-related items. Case-patients were infected with Rhizopusdelemar, which was also isolated from cultures of clean linens and clean linen delivery bins from the off-site laundry facility. CONCLUSIONS: Hospital linens were identified as a vehicle that carried Rhizopusdelemar into contact with susceptible patients. Fungal species identification using DNA-based methods is useful for corroborating epidemiologic links in hospital outbreak investigations. Hospital linens should be laundered, packaged, shipped, and stored in a manner that minimizes exposure to environmental contaminants. |
Development of a loop-mediated isothermal amplification method for detection of Histoplasma capsulatum DNA in clinical samples.
Scheel CM , Zhou Y , Theodoro RC , Abrams B , Balajee SA , Litvintseva AP . J Clin Microbiol 2013 52 (2) 483-8 ![]() Improved methods for detection of Histoplasma capsulatum are needed in endemic regions with limited resources, where delayed diagnosis of progressive disseminated histoplasmosis (PDH) results in high mortality. We have investigated the use of a loop-mediated isothermal amplification (LAMP) assay to facilitate rapid, inexpensive, molecular diagnosis of this disease. Primers for LAMP were designed to amplify the Hcp100 locus of H. capsulatum. Sensitivity and limit of detection were evaluated using DNA extracted from 91 clinical isolates of known geographic subspecies, while assay specificity was determined using DNA extracted from 50 other fungi and Mycobacterium tuberculosis. Urines (n = 6) collected from HIV-positive individuals with culture and antigen-proven histoplasmosis were evaluated using the LAMP assay. Specimens from healthy persons (n = 10) without evidence of histoplasmosis were used as assay controls. The Hcp100 LAMP was 100% sensitive and specific when tested with DNA extracted from culture isolates. The median limit of detection was <= 30 genomes (Range: 1-30) for all but one geographic subspecies. The LAMP detected Hcp100 in 67% (4/6) of antigen-positive urines, and was negative for Hcp100 in all healthy control urines. We have shown that the Hcp100 LAMP is a rapid, affordable assay that can be used to expedite culture confirmation of H. capsulatum in PDH-endemic regions. Further, our results indicate proof-of-concept that the assay can be used to detect Histoplasma DNA in urine. Further evaluation of this assay using body fluids from a larger patient population is warranted. |
Molecular analyses of Fusarium isolates recovered from a cluster of invasive mold infections in a Brazilian hospital.
Scheel CM , Hurst SF , Barreiros G , Akiti T , Nucci M , Balajee SA . BMC Infect Dis 2013 13 49 ![]() BACKGROUND: Invasive fusariosis (IF) is a rare but often fatal fungal infection in immunosuppressed patients. In 2007, cases of IF above the expected epidemiologic baseline were detected in the hematology ward of a hospital in Rio de Janeiro, Brazil. Possible sources of infection were investigated by performing environmental sampling and patient isolate collection, followed by molecular typing. Isolates from dermatology patients with superficial fusariosis were included in the study for comparison to molecular types found in the community. METHODS: Environmental sampling focused on water-related sources in and around the hematology ward. Initially, we characterized 166 clinical and environmental isolates using the Fusarium translation elongation factor 1alpha (EF-1alpha) genetic locus. Isolates included 68 collected from water-related sources in the hospital environment, 55 from 18 hematology patients, and 43 from the skin/nails of 40 outpatients seen at the hospital dermatology clinic. Multi-locus sequence typing was performed on Fusarium solani species complex (FSSC) species 1 and 2 isolates to investigate their relatedness further. RESULTS: Most of the hematology samples were FSSC species 2, with species type FSSC 2-d the most commonly isolated from these patients. Most of the outpatient dermatology samples were also FSSC 2, with type 2-d again predominating. In contrast, environmental isolates from water sources were mostly Fusarium oxysporum species complex (FOSC) and those from air samples mostly Fusarium incarnatum-equiseti species complex (FIESC). A third of the environmental samples were FSSC, with species types FSSC 1-a and FSSC 1-b predominating. CONCLUSIONS: Fusarium isolate species types from hematology patient infections were highly similar to those recovered from dermatology patients in the community. Four species types (FSSC 1-a, 1-b, 2-d and 2-f) were shared between hematology patients and the environment. Limitations in environmental sampling do not allow for nosocomial sources of infection to be ruled out. Future studies will focus on environmental factors that may have influenced the prevalence of FSSC fusariosis in this hematology ward. |
Multilocus sequence typing of Histoplasma capsulatum in formalin-fixed paraffin-embedded tissues from cats living in non-endemic regions reveals a new phylogenetic clade.
Balajee SA , Hurst SF , Chang LS , Miles M , Beeler E , Hale C , Kasuga T , Benedict K , Chiller T , Lindsley MD . Med Mycol 2012 51 (4) 345-51 ![]() Infections caused by Histoplasma capsulatum are found most often in endemic regions of North, Central, and South America. H. capsulatum has been divided into eight geographic clades by multi-locus sequence typing (MLST). Recently, one isolate and five formalin-fixed paraffin-embedded (FFPE) tissue samples were received from six of 15 suspected cases of histoplasmosis in cats residing in areas not known to be endemic for H. capsulatum. Polymerase chain reaction (PCR) amplification and sequence analysis of the rDNA ITS-2 region confirmed the diagnosis of H. capsulatum. Since these cases were not, as noted, from the accepted endemic areas, it was of interest to understand the molecular epidemiology of these isolates. Results of molecular analysis indicated that the H. capsulatum recovered from the cats were most closely related to the North American-1 clade, but clustered separately outside this clade, suggesting that the H. capsulatum infecting the animals may represent a separate clade or phylogenetic species. This study also demonstrated the utility of obtaining valuable molecular subtype data directly from archived FFPE tissue blocks, particularly when a fungus culture was not performed or is otherwise unavailable. |
Global population structure of Aspergillus terreus inferred by ISSR typing reveals geographical subclustering.
Neal CO , Richardson AO , Hurst SF , Tortorano AM , Viviani MA , Stevens DA , Balajee SA . BMC Microbiol 2011 11 203 ![]() ![]() BACKGROUND: Aspergillus terreus causes invasive aspergillosis (IA) in immunocompromised individuals and can be the leading cause of IA in certain medical centers. We examined a large isolate collection (n = 117) for the presence of cryptic A. terreus species and employed a genome scanning method, Inter-Simple Sequence Repeat (ISSR) PCR to determine A. terreus population structure. RESULTS: Comparative sequence analyses of the calmodulin locus revealed the presence of the recently recognized species A. alabamensis (n = 4) in this collection. Maximum parsimony, Neighbor joining, and Bayesian clustering of the ISSR data from the 113 sequence-confirmed A. terreus isolates demonstrated that one clade was composed exclusively of isolates from Europe and another clade was enriched for isolates from the US. CONCLUSIONS: This study provides evidence of a population structure linked to geographical origin in A. terreus. |
Azole resistance in Aspergillus fumigatus isolates from the ARTEMIS global surveillance study is primarily due to the TR/L98H mutation in the cyp51A gene.
Lockhart SR , Frade JP , Etienne KA , Pfaller MA , Diekema DJ , Balajee SA . Antimicrob Agents Chemother 2011 55 (9) 4465-8 ![]() We surveyed 497 isolates of Aspergillus fumigatus collected 2008-2009 as part of the ARTEMIS global surveillance study for elevated MIC values to itraconazole, voriconazole and posaconazole. Sequencing of the cyp51A gene revealed that 8/29 isolates with elevated MIC values to one or more triazole, all originating in China, contained the TR/L98H mutation associated with resistant European isolates of A. fumigatus. This is the first time the TR/L98H mutation has been identified outside of Europe. |
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