Sierra Leone is vulnerable to a wide range of vector-borne diseases transmitted by mosquitoes, tsetse flies, black flies, and other vectors. Malaria, lymphatic filariasis, and onchocerciasis have posed the greatest threat and have received the most attention in terms of vector control and capacity for diagnosis. However, malaria infection rates remain high, and there is evidence of circulation of other vector-borne diseases, such as chikungunya and dengue, which may go undiagnosed and unreported. The limited understanding of the prevalence and transmission of these diseases restricts the capacity for predicting outbreaks, and impedes the planning of appropriate responses. We review the available literature and gather expert opinions from those working in the country to report on the status of vector-borne disease transmission and control in Sierra Leone, and present an assessment of the threats of these diseases. Our discussions highlight an absence of entomological testing for disease agents and the need for more investment in surveillance and capacity strengthening.

Although children and young adults are reportedly at lower risk for severe disease and death from infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), than are persons in other age groups (1), younger persons can experience infection and subsequently transmit infection to those at higher risk for severe illness (2-4). Although at lower risk for severe disease, some young adults experience serious illness, and asymptomatic or mild cases can result in sequelae such as myocardial inflammation (5). In the United States, approximately 45% of persons aged 18-22 years were enrolled in colleges and universities in 2019 (6). As these institutions reopen, opportunities for infection increase; therefore, mitigation efforts and monitoring reports of COVID-19 cases among young adults are important. During August 2-September 5, weekly incidence of COVID-19 among persons aged 18-22 years rose by 55.1% nationally; across U.S. Census regions,* increases were greatest in the Northeast, where incidence increased 144.0%, and Midwest, where incidence increased 123.4%. During the same period, changes in testing volume for SARS-CoV-2 in this age group ranged from a 6.2% decline in the West to a 170.6% increase in the Northeast. In addition, the proportion of cases in this age group among non-Hispanic White (White) persons increased from 33.8% to 77.3% during May 31-September 5. Mitigation and preventive measures targeted to young adults can likely reduce SARS-CoV-2 transmission among their contacts and communities. As colleges and universities resume operations, taking steps to prevent the spread of COVID-19 among young adults is critical (7).

In the wake of the Zika epidemic, there has been intensified interest in the surveillance and control of the arbovirus vectors Aedes aegypti and Aedes albopictus, yet many existing surveillance systems could benefit from improvements. Vector control programs are often directed by national governments, but are carried out at the local level, resulting in the discounting of spatial heterogeneities in ecology and epidemiology. Furthermore, entomological and epidemiological data are often collected by separate governmental entities, which can slow vector control responses to outbreaks. Colombia has adopted several approaches to address these issues. First, a web-based, georeferenced Aedes surveillance system called SIVIEN AEDES was developed to allow field entomologists to record vector abundance and insecticide resistance data. Second, autocidal gravid oviposition (AGO) traps are deployed as an alternative way to measure vector abundance. Third, data collected by SIVIEN AEDES are used to develop mathematical models predicting Ae. aegypti abundance down to a city block, thus allowing public health authorities to target interventions to specific neighborhoods within cities. Finally, insecticide resistance is monitored through bioassays and molecular testing in 15 high-priority cities, providing a comprehensive basis to inform decisions about insecticide use in different regions. The next step will be to synchronize SIVIEN AEDES data together with epidemiological and climatic data to improve the understanding of the drivers of local variations in arbovirus transmission dynamics. By integrating these surveillance data, health authorities will be better equipped to develop tailored and timely solutions to control and prevent Aedes-borne arbovirus outbreaks.

OBJECTIVE: To characterize work-related knee injuries treated in US emergency departments (EDs). METHODS: We characterized work-related knee injuries treated in EDs in 2007 and examined trends from 1998 to 2007 by using the National Electronic Injury Surveillance System-occupational supplement. RESULTS: In 2007, 184,300 (+/-54,000; 95% confidence interval) occupational knee injuries were treated in US EDs, accounting for 5% of the 3.4 (+/-0.9) million ED-treated occupational injuries. The ED-treated knee injury rate was 13 (+/-4) injuries per 10,000 full-time equivalent workers. Younger workers and older female workers had high rates. Strains/sprains and contusions/abrasions were common-frequently resulting from falls and bodily reaction/overexertion events. Knee injury rates declined from 1998 through 2007. CONCLUSIONS: Knee injury prevention should emphasize reducing falls and bodily reaction/overexertion events, particularly among all youth and older women.

Identification of human monkeypox cases during 2005 in southern Sudan (now South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa. The outbreak area, characterized by seasonally dry riverine grasslands, is not identified as environmentally suitable for MPXV transmission. We examined possible origins of this outbreak by performing phylogenetic analysis of genome sequences of MPXV isolates from the outbreak in Sudan and from differing localities. We also compared the environmental suitability of study localities for monkeypox transmission. Phylogenetically, the viruses isolated from Sudan outbreak specimens belong to a clade identified in the Congo Basin. This finding, added to the political instability of the area during the time of the outbreak, supports the hypothesis of importation by infected animals or humans entering Sudan from the Congo Basin, and person-to-person transmission of virus, rather than transmission of indigenous virus from infected animals to humans.

Sealpox, a zoonotic disease affecting pinnipeds (seals and sea lions), can occur among captive and convalescing animals. We surveyed 1 worker each from 11 marine mammal centers and interviewed 31 other marine mammal workers to ascertain their knowledge of and experience with sealpox virus and to identify factors associated with sealpox virus outbreaks among pinnipeds in marine rehabilitation facilities. Demographic and health data were obtained for 1,423 pinnipeds at the 11 facilities. Among the 23 animals in which sealpox was clinically diagnosed, 4 arrived at the facility ill, 11 became ill <5 weeks after arrival, and 2 became ill >5 weeks after arrival; the timing of illness onset was unknown for 6 animals. Most infections occurred in pinnipeds <1 year of age. Nine affected animals were malnourished; 4 had additional illnesses. Sealpox had also occurred among workers at 2 facilities. Sealpox is a noteworthy zoonosis of rehabilitating convalescing pinnipeds; workplace education can help to minimize risks for human infection.

Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic interventions. Implementation of pandemic interventions could be optimized by (1) culturally competent preparedness and response that address specific needs of racial/ethnic minority populations, (2) improvements in public health and community health safety net systems, (3) social policies that minimize economic burdens and improve compliance with isolation and quarantine, and (4) relevant, practical, and culturally and linguistically tailored communications.