Background Malaria remains a major public health concern in the Democratic Republic of the Congo (DRC) and its control is affected by recurrent conflicts. Médecins Sans Frontières (MSF) initiated several studies to better understand the unprecedented incidence of malaria to effectively target and implement interventions in emergency settings. The current study evaluated the main vector species involved in malaria transmission and their resistance to insecticides, with the aim to propose the most effective tools and strategies for control of local malaria vectors. Methods This study was performed in 52 households in Shamwana (Katanga, 2014), 168 households in Baraka (South Kivu, 2015) and 269 households in Kashuga (North Kivu, 2017). Anopheles vectors were collected and subjected to standardized Word Health Organization (WHO) and Center for Disease Control (CDC) insecticide susceptibility bioassays. Mosquito species determination was done using PCR and Plasmodium falciparum infection in mosquitoes was assessed by ELISA targeting circumsporozoite protein. Results Of 3517 Anopheles spp. mosquitoes collected, Anopheles gambiae sensu lato (s.l.) (29.6%) and Anopheles funestus (69.1%) were the main malaria vectors. Plasmodium falciparum infection rates for An. gambiae s.l. were 1.0, 2.1 and 13.9% for Shamwana, Baraka and Kashuga, respectively. Anopheles funestus showed positivity rates of 1.6% in Shamwana and 4.4% in Baraka. No An. funestus were collected in Kashuga. Insecticide susceptibility tests showed resistance development towards pyrethroids in all locations. Exposure to bendiocarb, malathion and pirimiphos-methyl still resulted in high mosquito mortality. Conclusions This is one of only few studies from these conflict areas in DRC to report insecticide resistance in local malaria vectors. The data suggest that current malaria prevention methods in these populations are only partially effective, and require additional tools and strategies. Importantly, the results triggered MSF to consider the selection of a new insecticide for indoor residual spraying (IRS) and a new long-lasting insecticide-treated net (LLIN). The reinforcement of correct usage of LLINs and the introduction of targeted larviciding were also included as additional vector control tools as a result of the studies.
Libya is a major transit and destination country for international migration. UN agencies estimates 571,464 migrants, refugees and asylum seekers in Libya in 2021; among these, 3,934 people are held in detention. We aimed to describe morbidities and water, hygiene, and sanitation (WHS) conditions in detention in Tripoli, Libya. We conducted a retrospective analysis of data collected between July 2018 and December 2019, as part of routine monitoring within an Médecins Sans Frontières (MSF) project providing healthcare and WHS support for migrants, refugees and asylum seekers in some of the official detention centres (DC) in Tripoli. MSF had access to 1,630 detainees in eight different DCs on average per month. Only one DC was accessible to MSF every single month. The size of wall openings permitting cell ventilation failed to meet minimum standards in all DCs. Minimum standards for floor space, availability of water, toilets and showers were frequently not met. The most frequent diseases were acute respiratory tract infections (26.9%; 6,775/25,135), musculoskeletal diseases (24.1%; 6,058/25,135), skin diseases (14.1%; 3,538/25,135) and heartburn and reflux (10.0%; 2,502/25,135). Additionally, MSF recorded 190 cases of violence-induced wounds and 55 cases of sexual and gender-based violence. During an exhaustive nutrition screening in one DC, linear regression showed a reduction in mid-upper arm circumference (MUAC) of 2.5mm per month in detention (95%-CI 1.3–3.7, p<0.001). Detention of men, women and children continues to take place in Tripoli. Living conditions failed to meet minimum requirements. Health problems diagnosed at MSF consultations reflect the living conditions and consist largely of diseases related to overcrowding, lack of water and ventilation, and poor diet. Furthermore, every month that people stay in detention increases their risk of malnutrition. The documented living conditions and health problems call for an end of detention and better protection of migrants, refugees and asylum seekers in Libya.
Background: Crimean-Congo haemorrhagic fever virus (CCHFV) is a member of the Nairovirus genus belonging to the family Bunyaviridae, which consists of diverse RNA viruses. CCHFV has the propensity to cause nosocomial infections with a high fatality rate and is endemic in South Africa. Handling of the virus requires biosafety level 4 (BSL-4) conditions, which limits diagnostic capacity. Advances in molecular techniques have allowed preparation of safe recombinant antigens that are useful in diagnosis and serosurveillance of CCHFV. The purpose of this study was to examine the global nucleic acid and amino acid diversity between isolates worldwide; clone and express a recombinant CCHFV nucleoprotein (NP) from a southern African CCHFV and distantly related Greek CCHFV strain and determine the antigenic cross-reactivity between the two isolates.Methods & Materials: Phylogenetic analyses based on NP gene of 45 isolates was performed. Nucleotide sequence diversity and amino acid diversity between groups, within groups and pairwise distances were calculated. A previously expressed codon optimized NP from a South African isolate, SPU 415/85 was subcloned into pColdTF vector and was expressed in a bacterial system. Similarly, the gene encoding the NP of a Greek isolate AP92 was codon optimized and expressed in Escherichia coli host cells. Recombinant NP were used to develop in house ELISA to detect IgG antibody against CCHFV in South African patients who survived infection Results: Phylogenetic analyses using nucleotide and amino acid sequences of the NP revealed six different groups. The most diverse strain, AP92, displayed the greatest amino acid difference with SPU415/85 (8.7%). Both proteins were expressed with the aid of a chaperone and were purified from the soluble phase. A total of 14/14 sera reacted with the South African recombinant NP and 13/14 reacted with the Greek recombinant NP. The cross reactivity suggests the presence of highly conserved epitopes.Conclusion: Phylogenetic analyses reveal a high genetic diversity and lower amino acid diversity which suggested synonymous changes in nucleotides, resulting in fewer differences at protein level. The serological cross-reactivity of the two NP antigens suggests that recombinant antigens prepared from geographically specific CCHFV strains will have diagnostic and epidemiological applications worldwide.
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