Abstract Background After 30 years without a poliovirus case, a wild poliovirus type 1 outbreak was declared in Malawi on 16th February 2022. To improve detection of poliovirus transmission, the country implemented enhanced AFP surveillance by deploying Frontline Field Epidemiology Training Program (FETP) graduates who had received a three-month general epidemiology training. We describe the results from October 2022 to March 2023. Methods Ten districts with increased risk of polio transmission and suboptimal AFP surveillance performance indicators were identified for enhanced AFP surveillance. One FETP graduate already working in each priority district was selected to be trained on poliovirus epidemiology and AFP surveillance. FETP graduates conducted active case finding for AFP cases in 100 priority health facilities (defined by epidemiologic risk and population size), provided on-the-job training for health care workers, and sensitized community volunteers and traditional healers on AFP recognition and reporting. A senior technical coordinator provided supportive supervision to FETP graduates in all 10 districts. Results During the observation period, FETP graduates completed 811 (44%) of 1839 visits to priority health facilities and reported 84% (59/83) of all AFP cases in the priority districts. Eleven additional AFP cases were retrospectively identified during FETP graduates’ health facility register reviews. FETP graduates trained 5,047 health care workers and educated 2,093 community volunteers.Figure 2.Number of health care workers and community members that were educated by FETP graduates on AFP case detection and notification in the priority districts by visiting month, October 2022 - March 2023. Conclusion The enhanced surveillance contributed to almost half of all active case search visits, detected most AFP cases in the identified priority districts, and educated the community to improve poliovirus identification and reporting. Including FETP graduates to train the local public health workforce is an innovative approach in Malawi to build capacity, rapidly mobilize in-country staff, optimize the available resources, and strengthen surveillance during a novel disease outbreak. Disclosures All Authors: No reported disclosures

Background The B.1.1.529 (Omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the fourth COVID-19 pandemic wave across the southern African region, including Malawi. The seroprevalence of SARS-CoV-2 antibodies and their association with epidemiological trends of hospitalisations and deaths are needed to aid locally relevant public health policy decisions. Methods We conducted a population-based serosurvey from December 27, 2021 to January 17, 2022, in 7 districts across Malawi to determine the seroprevalence of SARS-CoV-2 antibodies. Serum samples were tested for antibodies against SARS-CoV-2 receptor binding domain using WANTAI SARS-CoV-2 Receptor Binding Domain total antibody commercial enzyme-linked immunosorbent assay (ELISA). We also evaluated COVID-19 epidemiologic trends in Malawi, including cases, hospitalisations and deaths from April 1, 2021 through April 30, 2022, collected using the routine national COVID-19 reporting system. A multivariable logistic regression model was developed to investigate the factors associated with SARS-CoV-2 seropositivity. Findings Serum samples were analysed from 4619 participants (57% female; 60% aged 18-50 years), of whom 878/ 3794 (23%) of vaccine eligible adults had received a single dose of any COVID-19 vaccine. The overall assay-adjusted seroprevalence was 83.7% (95% confidence interval (CI), 79.3%-93.4%). Seroprevalence was lowest among children <13 years of age (66%) and highest among adults 18-50 years of age (82%). Seroprevalence was higher among vaccinated compared to unvaccinated participants (1 dose, 94% vs. 77%, adjusted odds ratio 4.89 [95% CI, 3.43-7.22]; 2 doses, 97% vs. 77%, aOR 6.62 [95% CI, 4.14-11.3]). Urban residents were more likely to be seropositive than those from rural settings (91% vs. 78%, aOR 2.76 [95% CI, 2.16-3.55]). There was at least a two-fold reduction in the proportion of hospitalisations and deaths among the reported cases in the fourth wave compared to the third wave (hospitalisations, 10.7% (95% CI, 10.2-11.3) vs. 4.86% (95% CI, 4.52-5.23), p < 0.0001; deaths, 3.48% (95% CI, 3.18-3.81) vs. 1.15% (95% CI, 1.00-1.34), p < 0.0001). Interpretation We report reduction in proportion of hospitalisations and deaths from SARS-CoV-2 infections during the Omicron variant dominated wave in Malawi, in the context of high SARS-CoV-2 seroprevalence and low COVID-19 vaccination coverage. These findings suggest that COVID-19 vaccination policy in high seroprevalence settings may need to be amended from mass campaigns to targeted vaccination of reported at-risk populations. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

After 30 years of no polio cases reported in Malawi, on 17th February 2022, the government declared a polio outbreak following a confirmed 4-year-old child case of the disease in the nation’s capital, Lilongwe. This was the first case of wild poliovirus in Africa in more than five years after Africa was declared free of indigenous wild polio in August 2020. Laboratory analysis showed that the strain detected in Malawi was linked to that which had been circulating in Sindh Province of Pakistan.

Results of population-based age stratified seroepidemiological investigation in Malawi

Background. Hepatitis E virus (HEV) is responsible for outbreaks of acute jaundice in Africa and Asia, many of which occur among displaced people or in crisis settings. Although an efficacious vaccine for HEV has been developed, we lack key epidemiologic data needed to understand how best to use the vaccine for hepatitis E control in endemic countries. Methods. We conducted a systematic review of articles published on hepatitis E in low-income and lower-middle-income countries in Africa and Asia. We searched PubMed, Scopus, and Embase databases to identify articles with data on anti-HEV immunoglobulin (Ig)G seroprevalence, outbreaks of HEV, or risk factors for HEV infection, disease, or death, and all relevant data were extracted. Using these data we describe the evidence around temporal and geographical distribution of HEV transmission and burden. We estimated pooled age-specific seroprevalence and assessed the consistency in risk factor estimates. Results. We extracted data from 148 studies. Studies assessing anti-HEV IgG antibodies used 18 different commercial assays. Most cases of hepatitis E during outbreaks were not confirmed. Risk factor data suggested an increased likelihood of current or recent HEV infection and disease associated with fecal-oral transmission of HEV, as well as exposures to blood and animals. Conclusions. Heterogeneity in diagnostic assays used and exposure and outcome assessment methods hinder public health efforts to quantify burden of disease and evaluate interventions over time and space. Prevention tools such as vaccines are available, but they require a unified global strategy for hepatitis E control to justify widespread use.