Publications by authors named "Lucille Blumberg"

93 Publications

SARS-CoV-2 cases reported from long-term residential facilities (care homes) in South Africa: a retrospective cohort study.

BMC Public Health 2022 May 24;22(1):1035. Epub 2022 May 24.

Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa.

Background: Globally, long-term care facilities (LTCFs) experienced a large burden of deaths during the COVID-19 pandemic. The study aimed to describe the temporal trends as well as the characteristics and risk factors for mortality among residents and staff who tested positive for SARS-CoV-2 in selected LTCFs across South Africa.

Method: We analysed data reported to the DATCOV sentinel surveillance system by 45 LTCFs. Outbreaks in LTCFs were defined as large if more than one-third of residents and staff had been infected or there were more than 20 epidemiologically linked cases. Multivariable logistic regression was used to assess risk factors for mortality amongst LTCF residents.

Results: A total of 2324 SARS-CoV-2 cases were reported from 5 March 2020 through 31 July 2021; 1504 (65%) were residents and 820 (35%) staff. Among LTCFs, 6 reported sporadic cases and 39 experienced outbreaks. Of those reporting outbreaks, 10 (26%) reported one and 29 (74%) reported more than one outbreak. There were 48 (66.7%) small outbreaks and 24 (33.3%) large outbreaks reported. There were 30 outbreaks reported in the first wave, 21 in the second wave and 15 in the third wave, with 6 outbreaks reporting between waves. There were 1259 cases during the first COVID-19 wave, 362 during the second wave, and 299 during the current third wave. The case fatality ratio was 9% (138/1504) among residents and 0.5% (4/820) among staff. On multivariable analysis, factors associated with SARS-CoV-2 mortality among LTCF residents were age 40-59 years, 60-79 years and ≥ 80 years compared to < 40 years and being a resident in a LTCF in Free State or Northern Cape compared to Western Cape. Compared to pre-wave 1, there was a decreased risk of mortality in wave 1, post-wave 1, wave 2, post-wave 2 and wave 3.

Conclusion: The analysis of SARS-CoV-2 cases in sentinel LTCFs in South Africa points to an encouraging trend of decreasing numbers of outbreaks, cases and risk for mortality since the first wave. LTCFs are likely to have learnt from international experience and adopted national protocols, which include improved measures to limit transmission and administer early and appropriate clinical care.
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http://dx.doi.org/10.1186/s12889-022-13403-6DOI Listing
May 2022

Clinical severity of COVID-19 in patients admitted to hospital during the omicron wave in South Africa: a retrospective observational study.

Lancet Glob Health 2022 Jul 18;10(7):e961-e969. Epub 2022 May 18.

National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Background: Up to the end of January, 2022, South Africa has had four recognisable COVID-19 pandemic waves, each predominantly dominated by one variant of concern: the ancestral strain with an Asp614Gly mutation during the first wave, the beta variant (B.1.351) during the second wave, the delta variant (B.1.617.2) during the third wave, and lastly, the omicron variant (B.1.1.529) during the fourth wave. We aimed to assess the clinical disease severity of patients admitted to hospital with SARS-CoV-2 infection during the omicron wave and compare the findings with those of the preceding three pandemic waves in South Africa.

Methods: We defined the start and end of each pandemic wave as the crossing of the threshold of weekly incidence of 30 laboratory-confirmed SARS-CoV-2 cases per 100 000 population. Hospital admission data were collected through an active national COVID-19-specific surveillance programme. We compared disease severity across waves by post-imputation random effect multivariable logistic regression models. Severe disease was defined as one or more of the following: acute respiratory distress, receipt of supplemental oxygen or mechanical ventilation, admission to intensive care, or death.

Findings: We analysed 335 219 laboratory-confirmed SARS-CoV-2 hospital admissions with a known outcome, constituting 10·4% of 3 216 179 cases recorded during the four waves. During the omicron wave, 52 038 (8·3%) of 629 617 cases were admitted to hospital, compared with 71 411 (12·9%) of 553 530 in the Asp614Gly wave, 91 843 (12·6%) of 726 772 in the beta wave, and 131 083 (10·0%) of 1 306 260 in the delta wave (p<0·0001). During the omicron wave, 15 421 (33·6%) of 45 927 patients admitted to hospital had severe disease, compared with 36 837 (52·3%) of 70 424 in the Asp614Gly wave, 57 247 (63·4%) of 90 310 in the beta wave, and 81 040 (63·0%) of 128 558 in the delta wave (p<0·0001). The in-hospital case-fatality ratio during the omicron wave was 10·7%, compared with 21·5% during the Asp614Gly wave, 28·8% during the beta wave, and 26·4% during the delta wave (p<0·0001). Compared with those admitted to hospital during the omicron wave, patients admitted during the other three waves had more severe clinical presentations (adjusted odds ratio 2·07 [95% CI 2·01-2·13] in the Asp614Gly wave, 3·59 [3·49-3·70] in the beta wave, and 3·47 [3·38-3·57] in the delta wave).

Interpretation: The trend of increasing cases and admissions across South Africa's first three waves shifted in the omicron wave, with a higher and quicker peak but fewer patients admitted to hospital, less clinically severe illness, and a lower case-fatality ratio compared with the preceding three waves. Omicron marked a change in the SARS-CoV-2 epidemic curve, clinical profile, and deaths in South Africa. Extrapolations to other populations should factor in differing vaccination and previous infection levels.

Funding: National Institute for Communicable Diseases.
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http://dx.doi.org/10.1016/S2214-109X(22)00114-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116895PMC
July 2022

COVID-19: Current Challenges and Future Perspectives.

Trop Med Infect Dis 2022 Jan 24;7(2). Epub 2022 Jan 24.

Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2131, South Africa.

This Special Issue focuses on recent global research on the current coronavirus (COVID-19) pandemic [...].
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http://dx.doi.org/10.3390/tropicalmed7020016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8879616PMC
January 2022

Population Immunity and Covid-19 Severity with Omicron Variant in South Africa.

N Engl J Med 2022 04 23;386(14):1314-1326. Epub 2022 Feb 23.

From the South African Medical Research Council Vaccine and Infectious Diseases Analytics Research Unit (S.A.M., G.K., N.D., C.K.M., A.J.N., P.C.M.) and African Leadership in Vaccinology Expertise (S.A.M., G.K.), University of the Witwatersrand, the National Institute for Communicable Diseases, National Health Laboratory Service (W.J., L.B., R.W.), and ResearchLinkMe (N.N.-M.), Johannesburg, the Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town (J.E.M.), and Right to Care, Centurion (L.B.) - all in South Africa.

Background: The B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified on November 25, 2021, in Gauteng province, South Africa. Data regarding the seroprevalence of SARS-CoV-2 IgG in Gauteng before the fourth wave of coronavirus disease 2019 (Covid-19), in which the omicron variant was dominant, are needed.

Methods: We conducted a seroepidemiologic survey from October 22 to December 9, 2021, in Gauteng to determine the seroprevalence of SARS-CoV-2 IgG. Households included in a previous seroepidemiologic survey (conducted from November 2020 to January 2021) were contacted; to account for changes in the survey population, there was a 10% increase in the households contacted, with the use of the same sampling framework. Dried-blood-spot samples were tested for IgG against SARS-CoV-2 spike protein and nucleocapsid protein with the use of quantitative assays. We also evaluated Covid-19 epidemiologic trends in Gauteng, including cases, hospitalizations, recorded deaths, and excess deaths from the start of the pandemic through January 12, 2022.

Results: Samples were obtained from 7010 participants, of whom 1319 (18.8%) had received a Covid-19 vaccine. The seroprevalence of SARS-CoV-2 IgG ranged from 56.2% (95% confidence interval [CI], 52.6 to 59.7) among children younger than 12 years of age to 79.7% (95% CI, 77.6 to 81.5) among adults older than 50 years of age. Vaccinated participants were more likely to be seropositive for SARS-CoV-2 than unvaccinated participants (93.1% vs. 68.4%). Epidemiologic data showed that the incidence of SARS-CoV-2 infection increased and subsequently declined more rapidly during the fourth wave than it had during the three previous waves. The incidence of infection was decoupled from the incidences of hospitalization, recorded death, and excess death during the fourth wave, as compared with the proportions seen during previous waves.

Conclusions: Widespread underlying SARS-CoV-2 seropositivity was observed in Gauteng before the omicron-dominant wave of Covid-19. Epidemiologic data showed a decoupling of hospitalizations and deaths from infections while omicron was circulating. (Funded by the Bill and Melinda Gates Foundation.).
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http://dx.doi.org/10.1056/NEJMoa2119658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8908853PMC
April 2022

The political theatre of the UK's travel ban on South Africa.

Lancet 2021 12 3;398(10318):2211-2213. Epub 2021 Dec 3.

African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.

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http://dx.doi.org/10.1016/S0140-6736(21)02752-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8641956PMC
December 2021

Epidemiology of SARS-CoV-2 infection and SARS-CoV-2 positive hospital admissions among children in South Africa.

Influenza Other Respir Viruses 2022 01 18;16(1):34-47. Epub 2021 Nov 18.

National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa.

Introduction: We describe epidemiology and outcomes of confirmed SARS-CoV-2 infection and positive admissions among children <18 years in South Africa, an upper-middle income setting with high inequality.

Methods: Laboratory and hospital COVID-19 surveillance data, 28 January - 19 September 2020 was used. Testing rates were calculated as number of tested for SARS-CoV-2 divided by population at risk; test positivity rates were calculated as positive tests divided by total number of tests. In-hospital case fatality ratio (CFR) was calculated based on hospitalized positive admissions with outcome data who died in-hospital and whose death was judged SARS-CoV-2 related by attending physician.

Findings: 315 570 children aged <18 years were tested for SARS-CoV-2; representing 8.9% of all 3 548 738 tests and 1.6% of all children in the country. Of children tested, 46 137 (14.6%) were positive. Children made up 2.9% (n = 2007) of all SARS-CoV-2 positive admissions to sentinel hospitals. Among children, 47 died (2.6% case-fatality). In-hospital deaths were associated with male sex [adjusted odds ratio (aOR) 2.18 (95% confidence intervals [CI] 1.08-4.40)] vs female; age <1 year [aOR 4.11 (95% CI 1.08-15.54)], age 10-14 years [aOR 4.20 (95% CI1.07-16.44)], age 15-17 years [aOR 4.86 (95% 1.28-18.51)] vs age 1-4 years; admission to a public hospital [aOR 5.07(95% 2.01-12.76)] vs private hospital and ≥1 underlying conditions [aOR 12.09 (95% CI 4.19-34.89)] vs none.

Conclusions: Children with underlying conditions were at greater risk of severe SARS-CoV-2 outcomes. Children > 10 years, those in certain provinces and those with underlying conditions should be considered for increased testing and vaccination.
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http://dx.doi.org/10.1111/irv.12916DOI Listing
January 2022

The importation and establishment of community transmission of SARS-CoV-2 during the first eight weeks of the South African COVID-19 epidemic.

EClinicalMedicine 2021 Sep 12;39:101072. Epub 2021 Aug 12.

Background: We describe the epidemiology of COVID-19 in South Africa following importation and during implementation of stringent lockdown measures.

Methods: Using national surveillance data including demographics, laboratory test data, clinical presentation, risk exposures (travel history, contacts and occupation) and outcomes of persons undergoing COVID-19 testing or hospitalised with COVID-19 at sentinel surveillance sites, we generated and interpreted descriptive statistics, epidemic curves, and initial reproductive numbers (Rt).

Findings: From 4 March to 30 April 2020, 271,670 SARS-CoV-2 PCR tests were performed (462 tests/100,000 persons). Of these, 7,892 (2.9%) persons tested positive (median age 37 years (interquartile range 28-49 years), 4,568 (58%) male, cumulative incidence of 13.4 cases/100,000 persons). Hospitalization records were found for 1,271 patients (692 females (54%)) of whom 186 (14.6%) died. Amongst 2,819 cases with data, 489/2819 (17.3%) travelled internationally within 14 days prior to diagnosis, mostly during March 2020 (466 (95%)). Cases diagnosed in April compared with March were younger (median age, 37 vs. 40 years), less likely female (38% vs. 53%) and resident in a more populous province (98% vs. 91%). The national initial was 2.08 (95% confidence interval (CI): 1.71-2.51).

Interpretation: The first eight weeks following COVID-19 importation were characterised by early predominance of imported cases and relatively low mortality and transmission rates. Despite stringent lockdown measures, the second month following importation was characterised by community transmission and increasing disease burden in more populous provinces.
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http://dx.doi.org/10.1016/j.eclinm.2021.101072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360332PMC
September 2021

Risk factors for COVID-19-related in-hospital mortality in a high HIV and tuberculosis prevalence setting in South Africa: a cohort study.

Lancet HIV 2021 09 4;8(9):e554-e567. Epub 2021 Aug 4.

Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.

Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15-49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19.

Methods: In this cohort study, we used data submitted to DATCOV, a national active hospital surveillance system for COVID-19 hospital admissions, for patients admitted to hospital with laboratory-confirmed SARS-CoV-2 infection between March 5, 2020, and March 27, 2021. Age, sex, race or ethnicity, and comorbidities (hypertension, diabetes, chronic cardiac disease, chronic pulmonary disease and asthma, chronic renal disease, malignancy in the past 5 years, HIV, and past and current tuberculosis) were considered as risk factors for COVID-19-related in-hospital mortality. COVID-19 in-hospital mortality, the main outcome, was defined as a death related to COVID-19 that occurred during the hospital stay and excluded deaths that occurred because of other causes or after discharge from hospital; therefore, only patients with a known in-hospital outcome (died or discharged alive) were included. Chained equation multiple imputation was used to account for missing data and random-effects multivariable logistic regression models were used to assess the role of HIV status and underlying comorbidities on COVID-19 in-hospital mortality.

Findings: Among the 219 265 individuals admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and known in-hospital outcome data, 51 037 (23·3%) died. Most commonly observed comorbidities among individuals with available data were hypertension in 61 098 (37·4%) of 163 350, diabetes in 43 885 (27·4%) of 159 932, and HIV in 13 793 (9·1%) of 151 779. Tuberculosis was reported in 5282 (3·6%) of 146 381 individuals. Increasing age was the strongest predictor of COVID-19 in-hospital mortality. Other factors associated were HIV infection (adjusted odds ratio 1·34, 95% CI 1·27-1·43), past tuberculosis (1·26, 1·15-1·38), current tuberculosis (1·42, 1·22-1·64), and both past and current tuberculosis (1·48, 1·32-1·67) compared with never tuberculosis, as well as other described risk factors for COVID-19, such as male sex; non-White race; underlying hypertension, diabetes, chronic cardiac disease, chronic renal disease, and malignancy in the past 5 years; and treatment in the public health sector. After adjusting for other factors, people with HIV not on antiretroviral therapy (ART; adjusted odds ratio 1·45, 95% CI 1·22-1·72) were more likely to die in hospital than were people with HIV on ART. Among people with HIV, the prevalence of other comorbidities was 29·2% compared with 30·8% among HIV-uninfected individuals. Increasing number of comorbidities was associated with increased COVID-19 in-hospital mortality risk in both people with HIV and HIV-uninfected individuals.

Interpretation: Individuals identified as being at high risk of COVID-19 in-hospital mortality (older individuals and those with chronic comorbidities and people with HIV, particularly those not on ART) would benefit from COVID-19 prevention programmes such as vaccine prioritisation as well as early referral and treatment.

Funding: South African National Government.
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http://dx.doi.org/10.1016/S2352-3018(21)00151-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336996PMC
September 2021

COVID-19 health passes: current status and prospects for a global approach.

J Travel Med 2021 10;28(7)

WHO Collaborating Center for Travellers' Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich 8001, Switzerland.

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http://dx.doi.org/10.1093/jtm/taab118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8385839PMC
October 2021

Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study.

Lancet Glob Health 2021 09 9;9(9):e1216-e1225. Epub 2021 Jul 9.

National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.

Background: The first wave of COVID-19 in South Africa peaked in July, 2020, and a larger second wave peaked in January, 2021, in which the SARS-CoV-2 501Y.V2 (Beta) lineage predominated. We aimed to compare in-hospital mortality and other patient characteristics between the first and second waves.

Methods: In this prospective cohort study, we analysed data from the DATCOV national active surveillance system for COVID-19 admissions to hospital from March 5, 2020, to March 27, 2021. The system contained data from all hospitals in South Africa that have admitted a patient with COVID-19. We used incidence risk for admission to hospital and determined cutoff dates to define five wave periods: pre-wave 1, wave 1, post-wave 1, wave 2, and post-wave 2. We compared the characteristics of patients with COVID-19 who were admitted to hospital in wave 1 and wave 2, and risk factors for in-hospital mortality accounting for wave period using random-effect multivariable logistic regression.

Findings: Peak rates of COVID-19 cases, admissions, and in-hospital deaths in the second wave exceeded rates in the first wave: COVID-19 cases, 240·4 cases per 100 000 people vs 136·0 cases per 100 000 people; admissions, 27·9 admissions per 100 000 people vs 16·1 admissions per 100 000 people; deaths, 8·3 deaths per 100 000 people vs 3·6 deaths per 100 000 people. The weekly average growth rate in hospital admissions was 20% in wave 1 and 43% in wave 2 (ratio of growth rate in wave 2 compared with wave 1 was 1·19, 95% CI 1·18-1·20). Compared with the first wave, individuals admitted to hospital in the second wave were more likely to be age 40-64 years (adjusted odds ratio [aOR] 1·22, 95% CI 1·14-1·31), and older than 65 years (aOR 1·38, 1·25-1·52), compared with younger than 40 years; of Mixed race (aOR 1·21, 1·06-1·38) compared with White race; and admitted in the public sector (aOR 1·65, 1·41-1·92); and less likely to be Black (aOR 0·53, 0·47-0·60) and Indian (aOR 0·77, 0·66-0·91), compared with White; and have a comorbid condition (aOR 0·60, 0·55-0·67). For multivariable analysis, after adjusting for weekly COVID-19 hospital admissions, there was a 31% increased risk of in-hospital mortality in the second wave (aOR 1·31, 95% CI 1·28-1·35). In-hospital case-fatality risk increased from 17·7% in weeks of low admission (<3500 admissions) to 26·9% in weeks of very high admission (>8000 admissions; aOR 1·24, 1·17-1·32).

Interpretation: In South Africa, the second wave was associated with higher incidence of COVID-19, more rapid increase in admissions to hospital, and increased in-hospital mortality. Although some of the increased mortality can be explained by admissions in the second wave being more likely in older individuals, in the public sector, and by the increased health system pressure, a residual increase in mortality of patients admitted to hospital could be related to the new Beta lineage.

Funding: DATCOV as a national surveillance system is funded by the National Institute for Communicable Diseases and the South African National Government.
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http://dx.doi.org/10.1016/S2214-109X(21)00289-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270522PMC
September 2021

Answer to Paredes et al. commenting on "COVID-19 vaccines under the International Health Regulations - We must use the WHO International Certificate of Vaccination or Prophylaxis".

Int J Infect Dis 2021 04 24;105:409-410. Epub 2021 Feb 24.

International Society of Travel Medicine, ISTM, Atlanta, USA; Harvard Medical School, Boston, USA; Travel Medicine Center, Mount Auburn Hospital, Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, USA.

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http://dx.doi.org/10.1016/j.ijid.2021.02.076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903148PMC
April 2021

COVID-19 vaccines under the International Health Regulations - We must use the WHO International Certificate of Vaccination or Prophylaxis.

Int J Infect Dis 2021 03 20;104:175-177. Epub 2021 Jan 20.

International Society of Travel Medicine, ISTM, Atlanta, USA; Harvard Medical School, Boston, USA; Travel Medicine Center, Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, USA.

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http://dx.doi.org/10.1016/j.ijid.2021.01.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817399PMC
March 2021

and Other spp. in Various Hosts in the Mnisi Community, Mpumalanga Province, South Africa.

Microorganisms 2020 Nov 18;8(11). Epub 2020 Nov 18.

Vectors and Vector-Borne Diseases Research Programme, Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria 0110, South Africa.

DNA samples from 74 patients with non-malarial acute febrile illness (AFI), 282 rodents, 100 cattle, 56 dogs and 160 ticks were screened for the presence of DNA using a quantitative PCR (qPCR) assay targeting the gene. The test detected both and sp. SA/ZAM dog DNA. Microbiome sequencing confirmed the presence of low levels of DNA in the blood of rodents, dogs and cattle, while high levels of and sp. SA/ZAM dog were detected in dogs. Directed sequencing of the 16S rRNA and genes in selected samples revealed the presence of DNA in humans, dogs and rodents and highlighted its importance as a possible contributing cause of AFI in South Africa. A number of recently described species and were also detected in the study. Phylogenetic analyses grouped sp. SA/ZAM dog into a distinct clade, with sufficient divergence from other species to warrant classification as a separate species. Until appropriate type-material can be deposited and the species is formally described, we will refer to this novel organism as sp. SA dog.
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http://dx.doi.org/10.3390/microorganisms8111812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698776PMC
November 2020

One Health for neglected tropical diseases.

Trans R Soc Trop Med Hyg 2021 01;115(2):182-184

SCI Foundation, London SE11 5DP, UK.

The forthcoming World Health Organization road map for neglected tropical diseases (NTDs) 2021-2030 recognises the complexity surrounding control and elimination of these 20 diseases of poverty. It emphasises the need for a paradigm shift from disease-specific interventions to holistic cross-cutting approaches coordinating with adjacent disciplines. The One Health approach exemplifies this shift, extending beyond a conventional model of zoonotic disease control to consider the interactions of human and animal health systems within their shared environment and the wider social and economic context. This approach can also promote sustainability and resilience within these systems. To achieve the global ambition on NTD elimination and control, political will, along with contextualised innovative scientific strategies, is required.
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http://dx.doi.org/10.1093/trstmh/traa117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842102PMC
January 2021

Human rabies associated with domestic cat exposures in South Africa, 1983-2018.

J S Afr Vet Assoc 2020 Jul 6;91(0):e1-e4. Epub 2020 Jul 6.

Center for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg.

No abstract available.
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http://dx.doi.org/10.4102/jsava.v91i0.2036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433215PMC
July 2020

Epidemiology of rabies cases among international travellers, 2013-2019: A retrospective analysis of published reports.

Travel Med Infect Dis 2020 Jul - Aug;36:101766. Epub 2020 Jun 7.

Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam, the Netherlands.

Background: Sixty cases of rabies in international travellers from 1990 to 2012 were previously reviewed. We present here an update of rabies cases in international travellers from 2013 to 2019.

Methods: We systematically reviewed the existing literature and collected 23 cases of rabies in individuals who crossed an international border between the time of infection and diagnosis, or who were infected following expatriation or migration.

Results: Most cases were in male adult travellers and diagnosed in Europe and the Middle East, with most exposures in Asia or in Africa. Migrants originating from rabies-endemic low-and-middle income countries and their descendants accounted for two thirds of cases. Other cases were in tourists, business travellers and expatriates. Median travel duration (excluding migration trip) was 60 days (range 7-240 days). Most cases were due to dog bites and most common clinical presentation was furious rabies. In most patients (74%), no rabies post-exposure prophylaxis (RPEP) was administered before rabies symptoms appeared. Other patients received incomplete RPEP series.

Conclusion: Rabies should be suspected in any patient with encephalitis or paralysis who travelled to, or migrated from a rabies-endemic country. Comprehensive information about a rabies risk should be given to travellers to rabies endemic countries, notably migrants visiting friends and relatives.
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http://dx.doi.org/10.1016/j.tmaid.2020.101766DOI Listing
August 2021

COVID-19-We urgently need to start developing an exit strategy.

Int J Infect Dis 2020 Jul 29;96:233-239. Epub 2020 Apr 29.

Division of Infectious Disease, Department of Medicine University Medicine Cluster, National University Hospital, Singapore. Electronic address:

Aim: The purpose of this perspective is to review the options countries have to exit the draconian "lockdowns" in a carefully staged manner.

Methods: Experts from different countries experiencing Corona Virus Infectious Disease 2019 (COVID-19) reviewed evidence and country-specific approaches and the results of their interventions.

Results: Three factors are essential: 1. Reintroduction from countries with ongoing community transmission; 2. The need for extensive testing capacity and widespread community testing, and 3. An adequate supply of personal protective equipment, PPE, to protect health care workers. Discussed at length are lifting physical distancing, how to open manufacturing and construction, logistics, and the opening of higher educational institutions and schools. The use of electronic surveillance is considered.

Conclusion: Each country should decide on the best path forward. However, we can learn from each other, and the approaches are, in reality, very similar.
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http://dx.doi.org/10.1016/j.ijid.2020.04.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188647PMC
July 2020

Coalition: Advocacy for prospective clinical trials to test the post-exposure potential of hydroxychloroquine against COVID-19.

One Health 2020 Jun 4;9:100131. Epub 2020 Apr 4.

Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, 46100, Valencia, Spain.

Our coalition of public health experts, doctors, and scientists worldwide want to draw attention to the need for high-quality evaluation protocols of the potential beneficial effect of hydroxychloroquine (HCQ) as a post-exposure drug for exposed people. In the absence of an approved, recognized effective pre or post-exposure prophylactic drug or vaccine for COVID-19, nor of any approved and validated therapeutic drug, coupled with social and political pressure raised by publicity both regarding the potential beneficial effect of hydroxychloroquine (HCQ) as well as potential risks from HCQ, we urge the immediate proper clinical trials. Specifically, we mean using HCQ for post-exposure of people with close contact with patients with positive COVID19 rtPCR, including home and medical caregivers. We have reviewed the mechanisms of antiviral effect of HCQ, the risk-benefit ratio taking into consideration the PK/PD of HCQ and the thresholds of efficacy. We have studied its use as an antimalarial, an antiviral, and an immunomodulating drug and concluded that the use of HCQ at doses matching that of the standard treatment of Systemic Lupus erythematous, which has proven safety and efficacy in terms of HCQ blood and tissue concentration adapted to bodyweight (2,3), at 6 mg/kg/day 1 (loading dose) followed by 5 mg/kg/ day, with a maximum limit of 600 mg/day in all cases should swiftly be clinically evaluated as a post-exposure drug for exposed people.
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http://dx.doi.org/10.1016/j.onehlt.2020.100131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7128742PMC
June 2020

Outbreak of Listeriosis in South Africa Associated with Processed Meat.

N Engl J Med 2020 02;382(7):632-643

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Background: An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.

Methods: We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type isolates. A case was defined as laboratory-confirmed infection during the period from June 11, 2017, to April 7, 2018.

Results: A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of ST6 infections.

Conclusions: This investigation showed that in a middle-income country with a high prevalence of HIV infection, caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.
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http://dx.doi.org/10.1056/NEJMoa1907462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301195PMC
February 2020

Extra time and penalties in the polio endgame.

Int J Infect Dis 2020 02 7;91:252-254. Epub 2020 Jan 7.

National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa.

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http://dx.doi.org/10.1016/j.ijid.2019.12.009DOI Listing
February 2020

Improving human rabies post-exposure prophylaxis.

Lancet Infect Dis 2019 12 27;19(12):1273-1274. Epub 2019 Sep 27.

LYSSA LLC, Atlanta, GA 30044, USA. Electronic address:

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http://dx.doi.org/10.1016/S1473-3099(19)30525-0DOI Listing
December 2019

Accelerated Immunodeficiency-associated Vaccine-derived Poliovirus Serotype 3 Sequence Evolution Rate in an 11-week-old Boy With X-linked Agammaglobulinemia and Perinatal Human Immunodeficiency Virus Exposure.

Clin Infect Dis 2020 01;70(1):132-135

Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg.

Primary B-cell immunodeficiencies are risk factors for the generation of vaccine-derived polioviruses. We report immunodeficiency-associated vaccine-derived poliovirus serotype 3 in an 11-week-old boy with X-linked agammaglobulinemia. Unique characteristics of this case include early age of presentation, high viral evolutionary rate, and the child's perinatal exposure to human immunodeficiency virus.
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http://dx.doi.org/10.1093/cid/ciz361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912151PMC
January 2020

Is the global measles resurgence a "public health emergency of international concern"?

Int J Infect Dis 2019 06 2;83:95-97. Epub 2019 May 2.

National Institute for Communicable Diseases, Johannesburg, South Africa.

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http://dx.doi.org/10.1016/j.ijid.2019.04.016DOI Listing
June 2019

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province, South Africa.

Zoonoses Public Health 2019 08 11;66(5):458-469. Epub 2019 Mar 11.

Division of Public Health Surveillance and Response, Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg, South Africa.

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii, the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities ("dip tanks") were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9-30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002-1.06). Twenty-one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58-45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49-43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001-0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non-significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.
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http://dx.doi.org/10.1111/zph.12577DOI Listing
August 2019
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