Outbreaks of Streptococcus pneumoniae (Spn) meningitis are uncommon, typically more severe with high mortality. In Epi-week 4, 2023, Oti-Sud district in Togo reached for the first time, the epidemic threshold with 13 Spn cases despite the introduction of PCV13 into the routine EPI in 2014. The outbreak was investigated to describe its magnitude and document lessons learned to inform preparedness and response for future outbreaks. This cross-sectional study analyzed Spn meningitis outbreak data from Oti-Sud district (Savanes region), Epi-week 49, 2022 to Epi-week 23, 2023 to describe the attack and case fatality rates (AR CFR), patients’ sociodemographic and clinical characteristics across the district and its three surveillance zones (Z1, Z2 and Z3). Additionally, we analyzed routine surveillance data from Savanes region, Epi-week 1, 2016 to Epi-week 17, 2019 to compare Spn and Neisseria meningitis (Nm) case characteristics and scrutinized the Spn outbreak’s After Review Action report to document lessons learned. Meningitis’ case definitions and epidemic thresholds followed WHO guidelines. We performed descriptive analysis and summarized findings using median, ratio and proportions. Epidemic threshold was reached with a weekly AR of 10 cases per 100,000 population. A total of 153 cases was notified from Epi-week 49, 2022 to Epi-week 23, 2023 representing a cumulative AR of 117.4 and was 192.6 in Z1; Z2: 55.4 and Z3: 74.7. The cumulative CFR was 7.8
WHO recommends using health facility data to monitor interruptions in antiretroviral treatment (ART) engagement among people with HIV, which are an important factor driving patterns of unsuppressed HIV viral load and likely ongoing transmission. A challenge to understanding this is the complex, cyclical manner through which recipients of care (ROC) engage and disengage with ART. We leveraged two underutilized methods to describe these cyclical patterns among ROC at PEPFAR-supported health facilities in Côte d’Ivoire. We used electronic medical record data from 46 sites, spanning October 2017 through September 2022. ROC who enrolled in ART during the period, had at least one recorded visit, and did not die, stop treatment, or transfer out of the clinic were included. Engagement was assessed within 200-day intervals beginning at the ART start date; a ROC with a visit in an interval was categorized as engaged in that interval, and a ROC without a visit was placed within one of three categories of disengagement (disen1-disen3+) based on their status in prior intervals. We described longitudinal trajectories of engagement with sequence analysis frequency plots and likelihoods of transitioning between categories with Markov transition probability matrices. Among 5669 ROC who had four or more intervals (800+ days) of follow-up, 68% were female and the median age at ART initiation was 38 (IQR: 30-47). Over the 800-day period after initiation, 71% (n=4005) remained engaged throughout, 29% disengaged at some point, and 39% of disengaged ROC (n=650, 12% overall) reengaged at some point. At 800 days, 20% (n=1109) of ROC were disengaged, and 10% (n=555) were reengaged following a disengagement of at least 200 days (Figure 1). The probability of remaining engaged across any two consecutive intervals was 94%; the probability of transitioning to engagement dropped to 30% after one interval of disengagement and decreased with time spent disengaged. In the first systematic examination of cyclical engagement among ROC on ART in Côte d’Ivoire, our findings suggest that a substantial proportion of ROC experience cycling in the two years following ART initiation. Early outreach to ROC who disengage is critical to prevent ongoing loss to follow-up. All Authors: No reported disclosures
ObjectiveThis study aimed to characterize the factors influencing dietary diversity scores (DDS) of infants whose caregivers were classified as doers (those who fed a more diverse diet) and non-doers (those who fed a less diverse diet).MethodsThis study was conducted using a multiphase study design and guided by a biocultural framework. Phase 1. Interviews with community leaders (n = 13) and direct 6-h household observations (n = 10) were used to formatively explore factors influencing diet. Phase 2. A dietary assessment (n = 81) was used to determine dietary diversity of indexed infants. Phase 3. A biocultural survey and direct 3-h. observations were conducted among indexed infants (6-9 months) (n = 80) to understand the biocultural factors influencing infant DDS. Phase 4. Interviews (n = 34) were conducted among indexed caregivers to understand why and how biocultural factors shape infant DDS. Dietary data were analyzed, and biocultural survey variables were subjected to a forward stepwise linear regression. Textual data were analyzed to identify salient biocultural factors.ResultsFindings revealed that infants had an average DDS of 2. Having water access in the household, owning land for homestead food production, and feeding infants the same foods caregivers consume were positively associated with DDS. Conversely, adhering to food proscriptions was negatively associated with DDS. Most caregivers were food insecure and employed both food and non-food-based coping strategies to feed their infants.ConclusionDecreasing adherence to food rules, promoting homestead food production, and promoting non-food-based coping strategies may improve infant DDS in Guinea.
Background: Neutralising antibody titres are widely used as key immunogenicity endpoints in Ebola virus (EBOV) vaccine and monoclonal antibody clinical trials. However, direct comparison of results across studies remains challenging due to the use of heterogeneous neutralisation platforms, ranging from pseudotyped viruses to live EBOV assays. These limitations restrict assay standardisation, validation, scalability, and compliance with good clinical laboratory practice (GCLP), particularly in outbreak-prone and resource-limited settings. There is an unmet need for neutralisation assays that combine biological authenticity with clinical-trial compatibility. Methods: We developed and optimised a fluorescence-based microneutralisation assay using a biologically contained EBOV lacking the essential VP30 gene (EBOVΔVP30), enabling multi-cycle viral replication under containment level 2 conditions. Using a defined panel of serum samples from Ebola virus disease survivors and EBOV-negative controls, we benchmarked EBOVΔVP30 neutralisation titres against previously generated data obtained with wild-type EBOV and pseudotyped virus platforms. Assay performance was evaluated in terms of sensitivity, reproducibility, discrimination between positive and negative samples, and correlation with live virus neutralisation. Calibration was performed using the WHO International Standard for anti-EBOV immunoglobulin. Findings: The EBOVΔVP30 microneutralisation assay robustly distinguished EBOV survivor sera from negative controls (p < 0.0001) and demonstrated a strong correlation with live EBOV neutralisation titres (Spearman ρ = 0.8725). This correlation exceeded that observed for HIV-1-based pseudotyped assays and for the vesicular stomatitis virus-based platforms. The fluorescence-based read-out showed comparable sensitivity to conventional immunostaining, supporting its suitability for high-throughput and standardised implementation. Importantly, assay conditions were compatible with BSL-2 laboratories and GCLP-aligned workflows. Interpretation: Biologically contained EBOVΔVP30 provides a clinically relevant and scalable alternative to existing neutralisation platforms, bridging the gap between pseudotyped assays and wild-type virus testing. By improving biological relevance while maintaining accessibility and standardisation, this assay has the potential to enhance comparability of immunogenicity data across EBOV vaccine and therapeutic antibody (pre-)clinical trials, aligning with global outbreak preparedness and trial harmonisation objectives. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement MC received funds from Coalition of Epidemic Preparedness Innovations (CEPI) grant number H5R01920. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: All methods were carried out in accordance with the relevant guidelines and regulations under ethical approval from the Guinean Research Ethics Committee; No. 33/CNERS/15. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors
OBJECTIVE:To understand how current programmes and policies can be leveraged to improve maternal, infant, and young child nutrition outcomes (MIYCN) in Guinea. DATA COLLECTION METHODS:Study design. This study is part of a larger multiphase mixed methods study design. THEORETICAL FRAMEWORK:A systems framework developed by the United Nations Children's Fund (UNICEF) and an implementation science framework were used to guide this research. Phase 1. An in-depth literature review of current programme and policy documents (2019-2022) targeting MIYCN through the water, sanitation, and hygiene (WASH), health, food, and social protection systems in Guinea was conducted. Phase 2. Semi-structured interviews with stakeholders (n = 20) from each system were completed to explore stakeholders' knowledge related to pertinent programs and policies. Phase 3. Validation of findings was conducted using member checking. DATA ANALYSIS METHODS:Grey literature documents and interview findings were analysed using content analysis guided by the systems framework and implementation science framework, respectively. RESULTS:Policy documents across systems were all multisectoral and more than half (27/32) of evidence-based programme modalities across systems were included in policies. Most (28/32) evidence-based programme modalities were also being implemented in Guinea. Stakeholder interview findings revealed that programme implementation was the most salient barrier to operationalising evidence-based programme modalities. CONCLUSION:Findings from our study indicate that policy and programme frameworks are strong but improved financial planning and vertical and horizontal programme planning may create a stronger enabling environment to support MIYCN in Guinea.
