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INTRODUCTION: rubella is vaccine-preventable and vaccination is the most cost-effective approach to control the disease and avoid the management of congenital rubella syndrome cases. Ghana introduced the rubella vaccine into the routine immunization program in 2013. Since then there have not been any evaluation of the epidemiology of rubella. We determined the disease trends and the population demographics of rubella cases, in the Ghana national measles case-based surveillance system. METHODS: we reviewed the measles case-based surveillance data from 2007 to 2017. Descriptive data statistics was done and expressed as frequencies and proportions. Chi-square test was used to establish associations. RESULTS: a total of 11,483 suspected cases for measles received and tested for measles IgM antibodies and 1,137(12.98%) confirmed positive for the period. Of these 10,077 were negative and 250 indeterminate for measles and tested for rubella and 2,090 (20.23%) confirmed positive for rubella IgM antibodies. More females (21.45%) were affected than males (19.48%). Majority of the confirmed positives were recorded in the urban areas. Children aged 15 years or less were mostly affected. There was a statistical difference between incidence cases and sex (χ2=6.03, p-value = 0.014), or age (χ2=283.56, p-value < 0.001) or area (χ2= 6.17, p-value = 0.013). Most infections occurred during the dry season. CONCLUSION: children less than 15 years were mostly affected with majority being females. The highest incidence of cases was before the rains and occurred mostly in urban areas. The incidence of cases has declined significantly with the introduction of the rubella vaccine.
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Sarampión/epidemiología , Vacuna contra la Rubéola/administración & dosificación , Rubéola (Sarampión Alemán)/epidemiología , Vacunación , Adolescente , Distribución por Edad , Niño , Preescolar , Femenino , Ghana/epidemiología , Humanos , Programas de Inmunización , Inmunoglobulina M/inmunología , Incidencia , Masculino , Vigilancia de la Población , Rubéola (Sarampión Alemán)/prevención & control , Estaciones del Año , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. OBJECTIVES: This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. METHODS: A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. RESULTS: The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. CONCLUSIONS AND IMPLICATIONS OF FINDINGS: These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.
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Enfermedades Transmisibles/epidemiología , Brotes de Enfermedades/prevención & control , Vigilancia en Salud Pública , África/epidemiología , HumanosRESUMEN
BACKGROUND: The countries of West Africa are largely portrayed as cholera endemic, although the dynamics of outbreaks in this region of Africa remain largely unclear. METHODOLOGY/PRINCIPAL FINDINGS: To understand the dynamics of cholera in a major portion of West Africa, we analyzed cholera epidemics from 2009 to 2015 from Benin to Mauritania. We conducted a series of field visits as well as multilocus variable tandem repeat analysis and whole-genome sequencing analysis of V. cholerae isolates throughout the study region. During this period, Ghana accounted for 52% of the reported cases in the entire study region (coastal countries from Benin to Mauritania). From 2009 to 2015, we found that one major wave of cholera outbreaks spread from Accra in 2011 northwestward to Sierra Leone and Guinea in 2012. Molecular epidemiology analysis confirmed that the 2011 Ghanaian isolates were related to those that seeded the 2012 epidemics in Guinea and Sierra Leone. Interestingly, we found that many countries deemed "cholera endemic" actually suffered very few outbreaks, with multi-year lulls. CONCLUSIONS/SIGNIFICANCE: This study provides the first cohesive vision of the dynamics of cholera epidemics in a major portion of West Africa. This epidemiological overview shows that from 2009 to 2015, at least 54% of reported cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. These findings may serve as a guide to better target cholera prevention and control efforts in the identified cholera hotspots in West Africa.