Background: Most infectious diseases present as acute febrile illness (AFI). Diagnostic gaps in most resource-constrained countries contribute to disproportionate disease burden, antimicrobial misuse, and poor epidemic preparedness. Understanding the etiology and epidemiology of AFI improves early warning systems for epidemic-prone pathogens and supports routine updates of the priority pathogen list. We describe the results of sentinel AFI surveillance in Nigeria. Methods: Hospital-based sentinel surveillance was implemented at Asokoro District Hospital, Abuja, and Nnamdi Azikiwe University Teaching Hospital, Anambra, from 29 March 2021 to 29 September 2022. Blood specimens from patients ≥2 years old with a temperature≥37.5°C or self-reported fever for 2-7 days of unknown etiology were tested using AFI TaqMan® Array Card (TAC) assays to detect 36 pathogens. Results: In this exploratory phase, only 393 of 2,155 specimens were tested due to limited funding and high TAC cost. The majority (62%) of participants tested were adults (246/393), and 52% were female (205/393). The top ten ranked pathogens of the 32 identified were West Nile virus (39%), Zika virus (17%), SARS-CoV-2 (16%), adenovirus (16%), Brucella (8%), Chikungunya virus (7%), Burkholderia (6%), Plasmodium vivax (6%), Plasmodium falciparum (6%), and Crimean Congo Hemorrhagic Fever virus (4%). Coinfections were detected in 45% (178/393) of patients; 24% (94/393) had two pathogens, 21% (84/393) had three or more, and one patient had eight. Conclusion: This pilot study of AFI etiologies in Nigeria suggests emerging and re-emerging viruses are more common than malaria parasites. Co-infection in nearly half of cases warrants further investigation and supports investment in multiplex testing to address diagnostic gaps. The utility of TAC for exploratory studies in low-income settings may be limited by its prohibitive cost. These findings emphasize the need for continued investment in cost-effective diagnostic technologies and enhanced multi-pathogen surveillance systems, essential to early detection and response to epidemic-prone infections.
Introduction: The National Public Health and Reference Laboratory (NPHRL) in 2024 reported an increase in measles and yellow fever specimen rejection which threatened timely outbreak detection and response. We conducted this study to systematically review and identify the root causes of these rejections at referring peripheral facilities to inform targeted public health interventions and strengthen the surveillance system. Methods: A mixed-methods study was conducted among six peripheral health facilities with the highest specimen rejection rates. These facilities are in the Upper West and Ashanti regions. A structured questionnaire was used to assess the knowledge and practices of health care workers within the facilities directly involved in measles and yellow fever specimen collection and handling. An independent onsite audit was also conducted using a structured checklist. Data was collected into a Microsoft Excel template, cleaned and analyzed using descriptive statistics and thematic comparison of self-reported practices versus audited realities. Participants comprised 14 laboratory personnel, laboratory managers, nurses, and disease control officers directly involved in measles and yellow fever specimen collection and handling. Results: A total of 15 health care workers were assessed. These consisted of 5 laboratory Scientists/Technicians,2 nurses, and 7 disease surveillance officers. Majority of staff 53.3% (8/15) had no training on specimen collection and handling. Up to 40.0% (6/15) of facilities lack effective sample transportation logistics and 86.7% (13/15) of facilities lacked temperature tracking tools during sample transportation. All facilities lacked specimen referral logs and a formal Corrective and Preventive Action (CAPA) system. Conclusion: High measles and yellow fever specimen rejection was due to lack of trained staff and sample management logistics at the selected facilities. Immediate remedial measure includes the establishment of a dedicated cold-chain logistics network to ensure specimen delivery within 72 hours and institution of a mandatory competency-based training linked to facility performance targets. Prioritizing these will improve specimen integrity and strengthen surveillance system.
Introduction: Neonatal mortality surveillance has not been prioritised in The Gambia, despite the global target of the SDGs to reduce the neonatal mortality rate to <12/1000 live births by 2030. The neonatal mortality rate in The Gambia is 29/1000 LBS. We conducted this study to describe the epidemiology of neonatal mortality at Edward Francis Small Teaching Hospital in The Gambia from January to December 2021. Methods: We conducted a cross-sectional study at EFSTH among neonates who died within the period under study. We extracted data from various sources in the hospital. We analyzed demographic variables, listed sources of data, and determined risk factors for death at a 95% confidence interval. Results: Of the 306 neonatal deaths in 2021, 161 (52.6%) were males; the median age was 2.4 days, with a range of 0.04-26 days. The neonatal mortality rate in EFSTH for the year was 69/1000 LBS. Spontaneous vaginal delivery was the mode of delivery for 242 (79.1%) of the neonates that died in the hospital. There were more than 174 (56.9%) preterm and 95 (35.3%) very low birth weight babies among the deaths. The leading cause of death was pneumonia among 89 (29.1%), while the least common cause of death was asphyxia, accounting for 22 (7.2%) deaths. Conclusion: We found that the neonatal mortality rate for the hospital is higher than the national one. More male neonates died, and the majority of mortalities occurred within the first day of life. More deaths occurred in the Western Regions. The leading cause of death among neonates was found to be pneumonia due to meconium aspiration or as a complication leading to respiratory distress syndrome, among others.
Poor storage of the polio vaccine in areas of inadequate or absent power to sustain the cold chain can compromise its potency. This study assessed the sustainability of bivalent Oral Polio vaccine (bOPV) potency using total viral titer and the color of the vaccine vial monitor (VVM) at different storage temperatures over time. Weekly vaccine titers were obtained until the VVM degraded to 100%. Fifty vials of bOPV tested before exposure had titers above 107.0 CCID50/mL (≥106.0 CCID50/0.1 mL), and VVM was rated at 0% degradation. At 2-4°C, 100% of the vaccine samples sustained potency for 6 months, and the color of VVM remained at 0% degradation after 3 months, but 10%, 20%, 20% after 4, 5, and 6 months, respectively. At 27-29°C, all the vaccine samples sustained potency at 1 week, 50% after 2 weeks, and their VVM were rated 10%, 20%, 40% and 100% after 1, 2, 3, and 4 weeks, respectively. The potency of the 50% of vaccine samples stored at 35-36°C remained stable for a week, with their VVM rated 10%, 50%, and 100% after storage for 1, 2, and 3 weeks, respectively. At atmospheric temperatures (22-44°C), the titers of all the vaccine samples dropped significantly, and VVM attained 100% degradation within a week. The potency of the bOPV was preserved under refrigeration for 6 months, at room temperature for 2 weeks, and at an incubator for a week and severely degraded at atmospheric temperatures within a week.
The ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) and Uganda has highlighted a persistent but often underappreciated challenge in outbreak response: disease control cannot succeed without community trust. Reports of attacks on Ebola treatment centres, hostility toward health workers and burial teams, and the escape of suspected patients from treatment facilities demonstrate how fear and mistrust can undermine outbreak control efforts. Drawing on lessons from previous Ebola outbreaks, this commentary argues that Risk Communication and Community Engagement (RCCE) should be recognised as a core public health intervention rather than a supporting activity. Sustained investment in trust-building, community participation, social science expertise, and community feedback systems is essential for effective outbreak preparedness and response. In Ebola response, trust is not merely a communication objective; it is a lifesaving intervention.
