83 results on '"Eric Osoro"'
Search Results
2. Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017–2019
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Harriet Mirieri, Ruth Nduati, Jeanette Dawa, Lydia Okutoyi, Eric Osoro, Cyrus Mugo, Dalton Wamalwa, Hafsa Jin, Dufton Mwaengo, Nancy Otieno, Doris Marwanga, Mufida Shabibi, Peninah Munyua, John Kinuthia, Erin Clancey, Marc-Alain Widdowson, M. Kariuki Njenga, Jennifer R. Verani, and Irene Inwani
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Adverse birth outcomes ,Preterm birth ,Small for gestational age ,Stillbirth ,Miscarriage ,Microcephaly ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Introduction Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. Methods From October 2017 to July 2019, pregnant women
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- 2024
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3. Widening geographic range of Rift Valley fever disease clusters associated with climate change in East Africa
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Robert F Breiman, Luke Nyakarahuka, Marianne Mureithi, Eric Osoro, Silvia Situma, Evans Omondi, Marshal Mutinda Mweu, Matthew Muturi, Athman Mwatondo, Jeanette Dawa, Limbaso Konongoi, Samoel Khamadi, Erin Clancey, Eric Lofgren, Isaac Ngere, Barnabas Bakamutumaho, Allan Muruta, John Gachohi, Samuel O Oyola, M Kariuki Njenga, and Deepti Singh
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Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background Recent epidemiology of Rift Valley fever (RVF) disease in Africa suggests growing frequency and expanding geographic range of small disease clusters in regions that previously had not reported the disease. We investigated factors associated with the phenomenon by characterising recent RVF disease events in East Africa.Methods Data on 100 disease events (2008–2022) from Kenya, Uganda and Tanzania were obtained from public databases and institutions, and modelled against possible geoecological risk factors of occurrence including altitude, soil type, rainfall/precipitation, temperature, normalised difference vegetation index (NDVI), livestock production system, land-use change and long-term climatic variations. Decadal climatic variations between 1980 and 2022 were evaluated for association with the changing disease pattern.Results Of 100 events, 91% were small RVF clusters with a median of one human (IQR, 1–3) and three livestock cases (IQR, 2–7). These clusters exhibited minimal human mortality (IQR, 0–1), and occurred primarily in highlands (67%), with 35% reported in areas that had never reported RVF disease. Multivariate regression analysis of geoecological variables showed a positive correlation between occurrence and increasing temperature and rainfall. A 1°C increase in temperature and a 1-unit increase in NDVI, one months prior were associated with increased RVF incidence rate ratios of 1.20 (95% CI 1.1, 1.2) and 1.93 (95% CI 1.01, 3.71), respectively. Long-term climatic trends showed a significant decadal increase in annual mean temperature (0.12–0.3°C/decade, p
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- 2024
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4. A protracted cholera outbreak in Nairobi City County accentuated by mass gathering events, Kenya, 2017.
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Philip Ngere, Daniel Langat, Isaac Ngere, Jeanette Dawa, Emmanuel Okunga, Carolyne Nasimiyu, Catherine Kiama, Peter Lokamar, Carol Ngunu, Lyndah Makayotto, M Kariuki Njenga, and Eric Osoro
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Medicine ,Science - Abstract
Cholera continues to cause many outbreaks in low and middle-income countries due to inadequate water, sanitation, and hygiene services. We describe a protracted cholera outbreak in Nairobi City County, Kenya in 2017. We reviewed the cholera outbreak line lists from Nairobi City County in 2017 to determine its extent and factors associated with death. A suspected case of cholera was any person aged >2 years old who had acute watery diarrhea, nausea, or vomiting, whereas a confirmed case was where Vibrio cholerae was isolated from the stool specimen. We summarized cases using means for continuous variables and proportions for categorical variables. Associations between admission status, sex, age, residence, time to care seeking, and outbreak settings; and cholera associated deaths were assessed using odds ratio (OR) with 95% confidence interval (CI). Of the 2,737 cholera cases reported, we analyzed 2,347 (85.7%) cases including 1,364 (58.1%) outpatients, 1,724 (73.5%) not associated with mass gathering events, 1,356 (57.8%) male and 2,202 (93.8%) aged ≥5 years, and 35 deaths (case fatality rate: 1.5%). Cases were reported from all the Sub Counties of Nairobi City County with an overall county attack rate of 50 per 100,000 people. Vibrio cholerae Ogawa serotype was isolated from 78 (34.8%) of the 224 specimens tested and all isolates were sensitive to tetracycline and levofloxacin but resistant to amikacin. The odds of cholera-related deaths was lower among outpatient cases (aOR: 0.35; [95% CI: 0.17-0.72]), age ≥5 years old (aOR: 0.21 [95% CI: 0.09-0.55]), and mass gathering events (aOR: 0.26 [95% CI: 0.07-0.91]) while threefold higher odds among male (aOR: 3.04 [95% CI: 1.30-7.13]). Nairobi City County experienced a protracted and widespread cholera outbreak with a high case fatality rate in 2017.
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- 2024
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5. Acute febrile illness in Kenya: Clinical characteristics and pathogens detected among patients hospitalized with fever, 2017-2019.
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Jennifer R Verani, Eric Ng' Eno, Elizabeth A Hunsperger, Peninah Munyua, Eric Osoro, Doris Marwanga, Godfrey Bigogo, Derrick Amon, Melvin Ochieng, Paul Etau, Victor Bandika, Victor Zimbulu, John Kiogora, John Wagacha Burton, Emmanuel Okunga, Aaron M Samuels, Kariuki Njenga, Joel M Montgomery, and Marc-Alain Widdowson
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Medicine ,Science - Abstract
Acute febrile illness (AFI) is a common reason for healthcare seeking and hospitalization in Sub-Saharan Africa and is often presumed to be malaria. However, a broad range of pathogens cause fever, and more comprehensive data on AFI etiology can improve clinical management, prevent unnecessary prescriptions, and guide public health interventions. We conducted surveillance for AFI (temperature ≥38.0°C
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- 2024
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6. Higher livestock abortion burden in arid and semi-arid lands, Kenya, 2019–2020
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John Gachohi, Peris Njoki, Eddy Mogoa, Fredrick Otieno, Mathew Muturi, Athman Mwatondo, Isaac Ngere, Jeanette Dawa, Carolyne Nasimiyu, Eric Osoro, Bernard Bett, and Kariuki Njenga
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Medicine ,Science - Published
- 2024
7. Kenya’s experience implementing event-based surveillance during the COVID-19 pandemic
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Alexey W Clara, Linus Ndegwa, Philip Ngere, Lyndah Makayotto, Neha N Patel, Liku Nzisa, Nancy Otieno, Eric Osoro, Eunice Oreri, Elizabeth Kiptoo, Susan Maigua, Adam Crawley, S. Arunmozhi Balajee, Peninah Munyua, and Amy Herman-Roloff
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Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Event-based surveillance (EBS) can be implemented in most settings for the detection of potential health threats by recognition and immediate reporting of predefined signals. Such a system complements existing case-based and sentinel surveillance systems. With the emergence of the COVID-19 pandemic in early 2020, the Kenya Ministry of Health (MOH) modified and expanded an EBS system in both community and health facility settings for the reporting of COVID-19-related signals. Using an electronic reporting tool, m-Dharura, MOH recorded 8790 signals reported, with 3002 (34.2%) verified as events, across both community and health facility sites from March 2020 to June 2021. A subsequent evaluation found that the EBS system was flexible enough to incorporate the addition of COVID-19-related signals during a pandemic and maintain high rates of reporting from participants. Inadequate resources for follow-up investigations to reported events, lack of supportive supervision for some community health volunteers and lack of data system interoperability were identified as challenges to be addressed as the EBS system in Kenya continues to expand to additional jurisdictions.
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- 2023
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8. Healthcare-seeking behavior for respiratory illnesses in Kenya: implications for burden of disease estimation
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Gideon O. Emukule, Eric Osoro, Bryan O. Nyawanda, Isaac Ngere, Daniel Macharia, Godfrey Bigogo, Nancy A. Otieno, Sandra S. Chaves, M. Kariuki Njenga, and Marc-Alain Widdowson
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Behavior ,Burden ,Healthcare seeking ,Healthcare utilization ,Kakamega ,Marsabit ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Understanding healthcare-seeking patterns for respiratory illness can help improve estimation of disease burden and target public health interventions to control acute respiratory disease in Kenya. Methods We conducted a cross-sectional survey to determine healthcare utilization patterns for acute respiratory illness (ARI) and severe pneumonia in four diverse counties representing urban, peri-urban, rural mixed farmers, and rural pastoralist communities in Kenya using a two-stage (sub-locations then households) cluster sampling procedure. Healthcare seeking behavior for ARI episodes in the last 14 days, and severe pneumonia in the last 12 months was evaluated. Severe pneumonia was defined as reported cough and difficulty breathing for > 2 days and report of hospitalization or recommendation for hospitalization, or a danger sign (unable to breastfeed/drink, vomiting everything, convulsions, unconscious) for children
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- 2023
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9. Prevalence and functional profile of SARS-CoV-2 T cells in asymptomatic Kenyan adults
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Taraz Samandari, Joshua B. Ongalo, Kimberly D. McCarthy, Richard K. Biegon, Philister A. Madiega, Anne Mithika, Joseph Orinda, Grace M. Mboya, Patrick Mwaura, Omu Anzala, Clayton Onyango, Fredrick O. Oluoch, Eric Osoro, Charles-Antoine Dutertre, Nicole Tan, Shou Kit Hang, Smrithi Hariharaputran, David C. Lye, Amy Herman-Roloff, Nina Le Bert, and Antonio Bertoletti
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COVID-19 ,Infectious disease ,Medicine - Abstract
Background SARS-CoV-2 infection in Africa has been characterized by a less severe disease profile than what has been observed elsewhere, but the profile of SARS-CoV-2–specific adaptive immunity in these mainly asymptomatic patients has not, to our knowledge, been analyzed.Methods We collected blood samples from residents of rural Kenya (n = 80), who had not experienced any respiratory symptoms or had contact with individuals with COVID-19 and had not received COVID-19 vaccines. We analyzed spike-specific antibodies and T cells specific for SARS-CoV-2 structural (membrane, nucleocapsid, and spike) and accessory (ORF3a, ORF7, ORF8) proteins. Pre-pandemic blood samples collected in Nairobi (n = 13) and blood samples from mild-to-moderately symptomatic COVID-19 convalescent patients (n = 36) living in the urban environment of Singapore were also studied.Results Among asymptomatic Africans, we detected anti-spike antibodies in 41.0% of the samples and T cell responses against 2 or more SARS-CoV-2 proteins in 82.5% of samples examined. Such a pattern was absent in the pre-pandemic samples. Furthermore, distinct from cellular immunity in European and Asian COVID-19 convalescents, we observed strong T cell immunogenicity against viral accessory proteins (ORF3a, ORF8) but not structural proteins, as well as a higher IL-10/IFN-γ cytokine ratio profile.Conclusions The high incidence of T cell responses against different SARS-CoV-2 proteins in seronegative participants suggests that serosurveys underestimate SARS-CoV-2 prevalence in settings where asymptomatic infections prevail. The functional and antigen-specific profile of SARS-CoV-2–specific T cells in African individuals suggests that environmental factors can play a role in the development of protective antiviral immunity.Funding US Centers for Disease Control and Prevention, Division of Global Health Protection; the Singapore Ministry of Health’s National Medical Research Council (COVID19RF3-0060, COVID19RF-001, COVID19RF-008, MOH-StaR17Nov-0001).
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- 2023
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10. Anthrax hotspot mapping in Kenya support establishing a sustainable two-phase elimination program targeting less than 6% of the country landmass
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John Gachohi, Bernard Bett, Fredrick Otieno, Eddy Mogoa, Peris Njoki, Mathew Muturi, Athman Mwatondo, Eric Osoro, Isaac Ngere, Jeanette Dawa, Carolyne Nasimiyu, Harry Oyas, Obadiah Njagi, Samuel Canfield, Jason Blackburn, and Kariuki Njenga
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Medicine ,Science - Abstract
Abstract Using data collected from previous (n = 86) and prospective (n = 132) anthrax outbreaks, we enhanced prior ecological niche models (ENM) and added kernel density estimation (KDE) approaches to identify anthrax hotspots in Kenya. Local indicators of spatial autocorrelation (LISA) identified clusters of administrative wards with a relatively high or low anthrax reporting rate to determine areas of greatest outbreak intensity. Subsequently, we modeled the impact of vaccinating livestock in the identified hotspots as a national control measure. Anthrax suitable areas included high agriculture zones concentrated in the western, southwestern and central highland regions, consisting of 1043 of 1450 administrative wards, covering 18.5% country landmass, and hosting 30% of the approximately 13 million cattle population in the country. Of these, 79 wards covering 5.5% landmass and hosting 9% of the cattle population fell in identified anthrax hotspots. The rest of the 407 administrative wards covering 81.5% of the country landmass, were classified as low anthrax risk areas and consisted of the expansive low agricultural arid and semi-arid regions of the country that hosted 70% of the cattle population, reared under the nomadic pastoralism. Modelling targeted annual vaccination of 90% cattle population in hotspot administrative wards reduced > 23,000 human exposures. These findings support an economically viable first phase of anthrax control program in low-income countries where the disease is endemic, that is focused on enhanced animal and human surveillance in burden hotspots, followed by rapid response to outbreaks anchored on public education, detection and treatment of infected humans, and ring vaccination of livestock. Subsequently, the global anthrax elimination program focused on sustained vaccination and surveillance in livestock in the remaining few hotspots for a prolonged period (> 10 years) may be implemented.
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- 2022
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11. Prevalence of microcephaly and Zika virus infection in a pregnancy cohort in Kenya, 2017–2019
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Eric Osoro, Irene Inwani, Cyrus Mugo, Elizabeth Hunsperger, Jennifer R. Verani, Victor Omballa, Dalton Wamalwa, Chulwoo Rhee, Ruth Nduati, John Kinuthia, Hafsa Jin, Lydia Okutoyi, Dufton Mwaengo, Brian Maugo, Nancy A. Otieno, Harriet Mirieri, Mufida Shabibi, Peninah Munyua, M. Kariuki Njenga, and Marc-Alain Widdowson
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Zika virus ,Microcephaly ,Pregnancy ,Kenya ,Medicine - Abstract
Abstract Background Zika virus (ZIKV), first discovered in Uganda in 1947, re-emerged globally in 2013 and was later associated with microcephaly and other birth defects. We determined the incidence of ZIKV infection and its association with adverse pregnancy and fetal outcomes in a pregnancy cohort in Kenya. Methods From October 2017 to July 2019, we recruited and followed up women aged ≥ 15 years and ≤ 28 weeks pregnant in three hospitals in coastal Mombasa. Monthly follow-up included risk factor questions and a blood sample collected for ZIKV serology. We collected anthropometric measures (including head circumference), cord blood, venous blood from newborns, and any evidence of birth defects. Microcephaly was defined as a head circumference (HC)
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- 2022
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12. Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya's new 2022-2030 cholera elimination plan.
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Catherine Kiama, Emmanuel Okunga, Annastacia Muange, Doris Marwanga, Daniel Langat, Francis Kuria, Patrick Amoth, Ian Were, John Gachohi, Nolluscus Ganda, Marion Martinez Valiente, M Kariuki Njenga, Eric Osoro, and Joan Brunkard
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.
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- 2023
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13. Human brucellosis in Baringo County, Kenya: Evaluating the diagnostic kits used and identifying infecting Brucella species.
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Nelly M A Waringa, Lilian W Waiboci, Lilly Bebora, Peter W Kinyanjui, Philemon Kosgei, Stella Kiambi, and Eric Osoro
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Medicine ,Science - Abstract
Human brucellosis diagnosis has been a challenge in Brucella-endemic areas. In Kenya, diagnosis is usually carried out using Febrile Brucella Antigen agglutination test (FBAT) whose performance is not well documented. This paper reports on the sensitivity and specificity of the FBAT used for brucellosis diagnosis on blood samples/serum collected in three healthcare facilities in Baringo County, Kenya, and on Brucella species present in the study area. The FBAT test results at the hospitals were used to guide patient management. Patients who visited the hospital's laboratory with a clinician's request for brucellosis testing also filled a questionnaire to assess knowledge and attitudes associated with transmission of the disease in the study area. The remaining serum samples were tested again using FBAT and Rose Bengal Plate Test (RBPT) within a month of blood collection at the University Nairobi Laboratory. The two rapid tests were then compared, with respect to brucellosis diagnostic sensitivity and specificity. To identify infecting Brucella species, a proportion 43% (71/166) of the blood clots were analyzed by multiplex polymerase chain reaction (PCR) using specific primers for B. abortus, B. melitensis, B. ovis and B. suis. Out of 166 serum samples tested, 26.5% (44/166) were positive using FBAT and 10.2% (17/166) positive using RBPT. The sensitivity and specificity of FBAT compared to RBPT was 76.47% and 71.19%, respectively while the positive and negative predictive values were 29.55% and 96.72%, respectively. The FBAT showed higher positivity then RBPT. The difference in sensitivity and specificity of FBAT and RBPTs was relatively low. The high FBAT positivity rate would be indication of misdiagnosis; this would lead to incorrect treatment. Brucella abortus was detected from 9.9% (7/71) of the blood clots tested; no other Brucella species were detected. Thus human brucellosis, in Baringo was mainly caused by B. abortus.
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- 2023
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14. High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya
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Isaac Ngere, Jeanette Dawa, Elizabeth Hunsperger, Nancy Otieno, Moses Masika, Patrick Amoth, Lyndah Makayotto, Carolyne Nasimiyu, Bronwyn M. Gunn, Bryan Nyawanda, Ouma Oluga, Carolyne Ngunu, Harriet Mirieri, John Gachohi, Doris Marwanga, Patrick K. Munywoki, Dennis Odhiambo, Moshe D. Alando, Robert F. Breiman, Omu Anzala, M. Kariuki Njenga, Marc Bulterys, Amy Herman-Roloff, and Eric Osoro
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COVID-19 pandemic ,SARS-CoV-2 ,Seroprevalence ,Disease underreporting ,Infection underestimation ,Infectious and parasitic diseases ,RC109-216 - Abstract
ABSTRACT: Background: The lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. Methods: A population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths. Results: Among 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs. Conclusion: Over one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.
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- 2021
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15. Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries
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Xavier Carbonell-Estrany, Eric A. F Simões, Louis J Bont, Angela Gentile, Nusrat Homaira, Marcelo Comerlato Scotta, Renato T Stein, Juan P Torres, Jarju Sheikh, Shobha Broor, Najwa Khuri-Bulos, D James Nokes, Patrick K Munywoki, Quique Bassat, Arun K Sharma, Sudha Basnet, Maria Garba, Joanne De Jesus-Cornejo, Socorro P Lupisan, Marta C Nunes, Maduja Divarathna, John R Fullarton, Barry S Rodgers-Gray, Ian Keary, Mark Donald C Reñosa, Charl Verwey, David P Moore, Faseeha Noordeen, Sushil Kabra, Marynéa Silva do Vale, Rolando Paternina-De La Ossa, Cristina Mariño, Josep Figueras-Aloy, Leonard Krilov, Eitan Berezin, Heather J Zar, Krishna Paudel, Marco Aurelio Palazzi Safadi, Ghassan Dbaibo, Imane Jroundi, Runa Jha, Rukshan A. M Rafeek, Rossiclei de Souza Pinheiro, Marianne Bracht, Rohitha Muthugala, Marcello Lanari, Federico Martinón-Torres, Ian Mitchell, Grace Irimu, Apsara Pandey, Anand Krishnan, Asuncion Mejias, Marcela Santos Corrêa da Costa, Shrijana Shrestha, Jeffrey M Pernica, Felipe Cotrim de Carvalho, Rose E Jalango, Hafsat Ibrahim, Atana Ewa, Gabriela Ensinck, Rolando Ulloa-Gutierrez, Alexandre Lopes Miralha, Maria Florencia Lucion, Md Zakiul Hassan, Zubair Akhtar, Mohammad Abdul Aleem, Fahmida Chowdhury, Pablo Rojo, Charles Sande, Abednego Musau, Khalequ Zaman, Luiza Helena, Falleiros Arlant, Prakash Ghimire, April Price, Kalpana Upadhyay Subedi, Helena Brenes-Chacon, Doli Rani Goswami, Mohammed Ziaur Rahman, Mohammad Enayet Hossain, Mohammod Jobayer Chisti, Nestor E Vain, Audrey Lim, Aaron Chiu, Jesse Papenburg, Maria del Valle Juarez, Thamarasi Senaratne, Shiyamalee Arunasalam, Tor A Strand, Adaeze Ayuk, Olufemi Ogunrinde, Lohanna Valeska de Sousa Tavares, Comfort Garba, Bilkisu I Garba, Jeanette Dawa, Michelle Gordon, Eric Osoro, Charles N Agoti, Bryan Nyawanda, Mwanajuma Ngama, Collins Tabu, Joseph L Mathew, Andrew Cornacchia, Ganesh Kumar Rai, Amita Jain, Mateus Sfoggia Giongo, and Bosco A Paes
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RSV ,developing countries ,burden ,diagnostics ,management ,prevention ,Pediatrics ,RJ1-570 - Abstract
IntroductionThe high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures.MethodsA global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management.ResultsNinety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision.ConclusionSeven key actions for improving RSV prevention and management in LMICs are proposed.
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- 2022
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16. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020 [version 2; peer review: 2 approved]
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Terrence Q Lo, Elizabeth Hunsperger, Amy Herman-Roloff, Eric Osoro, M Kariuki Njenga, Godfrey Bigogo, Peninah Munyua, Cynthia Ombok, Ruth Njoroge, Gilbert Kikwai, Dennis Odhiambo,, Patrick K Munywoki, Caroline Nasimiyu, Moshe Dayan Alando, Nancy Otieno, Caroline A Ochieng, Immaculate Mutisya, Isaac Ngere, Jeanette Dawa, Mike Powel Osita, Alice Ouma, Clifford Odour, and Bonventure Juma
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Population-based ,Households ,Serosurvey ,Serology ,IgM and IgG ,SARS-CoV-2 ,eng ,Medicine ,Science - Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27th November and 5th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children (
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- 2022
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17. Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya.
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Sylvia Omulo, Margaret Oluka, Loice Achieng, Eric Osoro, Rosaline Kinuthia, Anastasia Guantai, Sylvia Adisa Opanga, Marion Ongayo, Linus Ndegwa, Jennifer R Verani, Eveline Wesangula, Jarred Nyakiba, Jones Makori, Wilson Sugut, Charles Kwobah, Hanako Osuka, M Kariuki Njenga, Douglas R Call, Guy H Palmer, Daniel VanderEnde, and Ulzii-Orshikh Luvsansharav
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Medicine ,Science - Abstract
Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children
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- 2022
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18. Near-Complete SARS-CoV-2 Seroprevalence among Rural and Urban Kenyans despite Significant Vaccine Hesitancy and Refusal
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Carolyne Nasimiyu, Isaac Ngere, Jeanette Dawa, Patrick Amoth, Ouma Oluga, Carol Ngunu, Harriet Mirieri, John Gachohi, Moshe Dayan, Nzisa Liku, Ruth Njoroge, Raymond Odinoh, Samuel Owaka, Samoel A. Khamadi, Samson L. Konongoi, Sudi Galo, Linet Elamenya, Marianne Mureithi, Omu Anzala, Robert Breiman, Eric Osoro, and M. Kariuki Njenga
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COVID-19 vaccine ,vaccine hesitancy ,vaccine refusal ,herd immunity ,SARS-CoV-2 seroprevalence ,Medicine - Abstract
Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6–91.2%), including 96.7% (95% CI, 95.2–97.9%) among urban and 83.6% (95% CI, 80.6–86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to 75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants.
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- 2022
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19. Risk factors for human brucellosis among a pastoralist community in South-West Kenya, 2015
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Mathew Muturi, Austine Bitek, Athman Mwatondo, Eric Osoro, Doris Marwanga, Zeinab Gura, Phillip Ngere, Zipporah Nganga, S. M. Thumbi, and Kariuki Njenga
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Brucellosis ,Risk factors ,Kenya ,Medicine ,Biology (General) ,QH301-705.5 ,Science (General) ,Q1-390 - Abstract
Abstract Objective Brucellosis is one of the top five priority zoonosis in Kenya because of the socio-economic burden of the disease, especially among traditional, livestock keeping communities. We conducted a 1 year, hospital based, unmatched case–control study to determine risk factors for brucellosis among Maasai pastoralists of Kajiado County in 2016. A case was defined by a clinical criteria; fever or history of fever and two clinical signs suggestive of brucellosis and a positive competitive enzyme-linked immunosorbent assay test (c-ELISA). A control was defined as patients visiting the study facility with negative c-ELISA. Unconditional logistic regression was used to study association between exposure variables and brucellosis using odds ratios (OR) and 95% confidence intervals (CI). Results Forty-three cases and 86 controls were recruited from a population of 4792 individuals in 801 households. The mean age for the cases was 48.7 years while that of the controls was 37.6 years. The dominant gender for both cases (62.7%) and controls (58.1%) groups was female. Regular consumption of un-boiled raw milk and assisting animals in delivery were significantly associated with brucellosis by OR 7.7 (95% CI 1.5–40.1) and OR 3.7 (95% CI 1.1–13.5), respectively.
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- 2018
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20. Zoonotic disease research in East Africa
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Naomi Kemunto, Eddy Mogoa, Eric Osoro, Austin Bitek, M. Kariuki Njenga, and S. M. Thumbi
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Zoonoses ,East Africa ,Endemic ,Epidemic ,Research ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background The East African region is endemic with multiple zoonotic diseases and is one of the hotspots for emerging infectious zoonotic diseases with reported multiple outbreaks of epidemic diseases such as Ebola, Marburg and Rift Valley Fever. Here we present a systematic assessment of published research on zoonotic diseases in the region and thesis research in Kenya to understand the regional research focus and trends in publications, and estimate proportion of theses research transitioning to peer-reviewed journal publications. Methods We searched PubMed, Google Scholar and African Journals Online databases for publications on 36 zoonotic diseases identified to have occurred in the East Africa countries of Burundi, Ethiopia, Kenya, Tanzania, Rwanda and Uganda, for the period between 1920 and 2017. We searched libraries and queried online repositories for masters and PhD theses on these diseases produced between 1970 and 2016 in five universities and two research institutions in Kenya. Results We identified 771 journal articles on 22, and 168 theses on 21 of the 36 zoonotic diseases investigated. Research on zoonotic diseases increased exponentially with the last 10 years of our study period contributing more than half of all publications 460 (60%) and theses 102 (61%) retrieved. Endemic diseases were the most studied accounting for 656 (85%) and 150 (89%) of the publication and theses studies respectively, with publications on epidemic diseases associated with outbreaks reported in the region or elsewhere. Epidemiological studies were the most common study types but limited to cross-sectional studies while socio-economics were the least studied. Only 11% of the theses research transitioned to peer-review publications, taking an average of 2.5 years from theses production to manuscript publication. Conclusion Our findings demonstrate increased attention to zoonotic diseases in East Africa but reveal the need to expand the scope, focus and quality of studies to adequately address the public health, social and economic threats posed by zoonoses.
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- 2018
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21. High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015.
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Peninah Munyua, Eric Osoro, Elizabeth Hunsperger, Isaac Ngere, Mathew Muturi, Athman Mwatondo, Doris Marwanga, Philip Ngere, Rebekah Tiller, Clayton O Onyango, Kariuki Njenga, and Marc-Alain Widdowson
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
BackgroundBrucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya.MethodsBetween February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population.ResultsWe enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months- 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28-53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence.ConclusionWe report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community.
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- 2021
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22. High real-time reporting of domestic and wild animal diseases following rollout of mobile phone reporting system in Kenya.
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M Kariuki Njenga, Naomi Kemunto, Samuel Kahariri, Lindsey Holmstrom, Harry Oyas, Keith Biggers, Austin Riddle, John Gachohi, Mathew Muturi, Athman Mwatondo, Francis Gakuya, Isaac Lekolool, Rinah Sitawa, Michael Apamaku, Eric Osoro, Marc-Alain Widdowson, and Peninah Munyua
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Medicine ,Science - Abstract
BackgroundTo improve early detection of emerging infectious diseases in sub-Saharan Africa (SSA), many of them zoonotic, numerous electronic animal disease-reporting systems have been piloted but not implemented because of cost, lack of user friendliness, and data insecurity. In Kenya, we developed and rolled out an open-source mobile phone-based domestic and wild animal disease reporting system and collected data over two years to investigate its robustness and ability to track disease trends.MethodsThe Kenya Animal Biosurveillance System (KABS) application was built on the Java® platform, freely downloadable for android compatible mobile phones, and supported by web-based account management, form editing and data monitoring. The application was integrated into the surveillance systems of Kenya's domestic and wild animal sectors by adopting their existing data collection tools, and targeting disease syndromes prioritized by national, regional and international animal and human health agencies. Smartphone-owning government and private domestic and wild animal health officers were recruited and trained on the application, and reports received and analyzed by Kenya Directorate of Veterinary Services. The KABS application performed automatic basic analyses (frequencies, spatial distribution), which were immediately relayed to reporting officers as feedback.ResultsOf 697 trained domestic animal officers, 662 (95%) downloaded the application, and >72% of them started reporting using the application within three months. Introduction of the application resulted in 2- to 14-fold increase in number of disease reports when compared to the previous year (relative risk = 14, CI 13.8-14.2, p90% of the reports, with respiratory, gastrointestinal and skin diseases constituting >85% of the reports. Herbivore wildlife (zebra, buffalo, elephant, giraffe, antelopes) accounted for >60% of the wildlife disease reports, followed by carnivores (lions, cheetah, hyenas, jackals, and wild dogs). Deaths, traumatic injuries, and skin diseases were most reported in wildlife.ConclusionsThis open-source system was user friendly and secure, ideal for rolling out in other countries in SSA to improve disease reporting and enhance preparedness for epidemics of zoonotic diseases.
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- 2021
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23. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030 [version 2; peer review: 4 approved]
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Austine O Bitek, Eric Osoro, Peninah M Munyua, Mark Nanyingi, Yvonne Muthiani, Stella Kiambi, Mathew Muturi, Athman Mwatondo, Rees Muriithi, Sarah Cleaveland, Katie Hampson, M. Kariuki Njenga, PM Kitala, and SM Thumbi
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Medicine ,Science - Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 – 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya’s strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya’s Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970’s, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970’s, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950’s and the early 1970’s slowed rabies spread. The rapid spread with peak rabies cases in the 1980’s coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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- 2019
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24. A hundred years of rabies in Kenya and the strategy for eliminating dog-mediated rabies by 2030 [version 1; peer review: 3 approved, 1 approved with reservations]
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Austine O Bitek, Eric Osoro, Peninah M Munyua, Mark Nanyingi, Yvonne Muthiani, Stella Kiambi, Mathew Muturi, Athman Mwatondo, Rees Muriithi, Sarah Cleaveland, Katie Hampson, M. Kariuki Njenga, PM Kitala, and SM Thumbi
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Medicine ,Science - Abstract
Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 – 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya’s strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya’s Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970’s, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970’s, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950’s and the early 1970’s slowed rabies spread. The rapid spread with peak rabies cases in the 1980’s coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.
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- 2018
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25. Enhanced surveillance for Rift Valley Fever in livestock during El Niño rains and threat of RVF outbreak, Kenya, 2015-2016.
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Harry Oyas, Lindsey Holmstrom, Naomi P Kemunto, Matthew Muturi, Athman Mwatondo, Eric Osoro, Austine Bitek, Bernard Bett, Jane W Githinji, Samuel M Thumbi, Marc-Alain Widdowson, Peninah M Munyua, and M Kariuki Njenga
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
In mid-2015, the United States' Pandemic Prediction and Forecasting Science and Technical Working Group of the National Science and Technology Council, Food and Agriculture Organization Emergency Prevention Systems, and Kenya Meteorological Department issued an alert predicting a high possibility of El-Niño rainfall and Rift Valley Fever (RVF) epidemic in Eastern Africa.In response to the alert, the Kenya Directorate of Veterinary Services (KDVS) carried out an enhanced syndromic surveillance system between November 2015 and February 2016, targeting 22 RVF high-risk counties in the country as identified previously through risk mapping. The surveillance collected data on RVF-associated syndromes in cattle, sheep, goats, and camels from >1100 farmers through 66 surveillance officers. During the 14-week surveillance period, the KDVS received 10,958 reports from participating farmers and surveillance officers, of which 362 (3.3%) had at least one syndrome. The reported syndromes included 196 (54.1%) deaths in young livestock, 133 (36.7%) abortions, and 33 (9.1%) hemorrhagic diseases, with most occurring in November and December, the period of heaviest rainfall. Of the 69 herds that met the suspect RVF herd definition (abortion in flooded area), 24 (34.8%) were defined as probable (abortions, mortalities in the young ones, and/or hemorrhagic signs) but none were confirmed.This surveillance activity served as an early warning system that could detect RVF disease in animals before spillover to humans. It was also an excellent pilot for designing and implementing syndromic surveillance in animals in the country, which is now being rolled out using a mobile phone-based data reporting technology as part of the global health security system.
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- 2018
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26. Suspected Rabies in Humans and Animals, Laikipia County, Kenya
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Mark Obonyo, James M. Akoko, Austine B. Orinde, Eric Osoro, Waqo Gufu Boru, Ian Njeru, and Eric M. Fèvre
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Rabies ,zoonoses ,viruses ,cost ,vaccine ,vaccination ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2016
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27. Prioritization of Zoonotic Diseases in Kenya, 2015.
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Peninah Munyua, Austine Bitek, Eric Osoro, Emily G Pieracci, Josephat Muema, Athman Mwatondo, Mathew Kungu, Mark Nanyingi, Radhika Gharpure, Kariuki Njenga, and Samuel M Thumbi
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Medicine ,Science - Abstract
IntroductionZoonotic diseases have varying public health burden and socio-economic impact across time and geographical settings making their prioritization for prevention and control important at the national level. We conducted systematic prioritization of zoonotic diseases and developed a ranked list of these diseases that would guide allocation of resources to enhance their surveillance, prevention, and control.MethodsA group of 36 medical, veterinary, and wildlife experts in zoonoses from government, research institutions and universities in Kenya prioritized 36 diseases using a semi-quantitative One Health Zoonotic Disease Prioritization tool developed by Centers for Disease Control and Prevention with slight adaptations. The tool comprises five steps: listing of zoonotic diseases to be prioritized, development of ranking criteria, weighting criteria by pairwise comparison through analytical hierarchical process, scoring each zoonotic disease based on the criteria, and aggregation of scores.ResultsIn order of importance, the participants identified severity of illness in humans, epidemic/pandemic potential in humans, socio-economic burden, prevalence/incidence and availability of interventions (weighted scores assigned to each criteria were 0.23, 0.22, 0.21, 0.17 and 0.17 respectively), as the criteria to define the relative importance of the diseases. The top five priority diseases in descending order of ranking were anthrax, trypanosomiasis, rabies, brucellosis and Rift Valley fever.ConclusionAlthough less prominently mentioned, neglected zoonotic diseases ranked highly compared to those with epidemic potential suggesting these endemic diseases cause substantial public health burden. The list of priority zoonotic disease is crucial for the targeted allocation of resources and informing disease prevention and control programs for zoonoses in Kenya.
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- 2016
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28. Establishing a One Health office in Kenya
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Murithi Mbabu, Ian Njeru, Sarah File, Eric Osoro, Stella Kiambi, Austine Bitek, Peter Ithondeka, Salome Kairu-Wanyoike, Shanaaz Sharif, Eric Gogstad, Francis Gakuya, Kaitlin Sandhaus, Peninah Munyua, Joel Montgomery, Robert Breiman, Carol Rubin, and Kariuki Njenga
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one health (oh) ,zoonoses ,animal health ,human health ,Medicine - Abstract
A One Health (OH) approach that integrates human,animal and environmental approaches to management of zoonotic diseases has gained momentum in the last decadeas part of a strategy to prevent and control emerging infectious diseases. However, there are few examples of howan OH approach can be established in a country. Kenya establishment of an OH office, referred to asthe Zoonotic Disease Unit (ZDU) in 2011. The ZDU bridges theanimal and human health sectors with a senior epidemiologist deployed from each ministry; and agoal of maintaining collaboration at the animal and human health interface towards better prevention and control of zoonoses.The country is adding an ecologist to the ZDU to ensure that environmental risks are adequately addressed in emerging disease control.
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- 2014
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29. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020 [version 2; peer review: 2 approved]
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Patrick K Munywoki, Caroline Nasimiyu, Moshe Dayan Alando, Nancy Otieno, Cynthia Ombok, Ruth Njoroge, Gilbert Kikwai, Dennis Odhiambo,, Mike Powel Osita, Alice Ouma, Clifford Odour, Bonventure Juma, Caroline A Ochieng, Immaculate Mutisya, Isaac Ngere, Jeanette Dawa, Eric Osoro, M Kariuki Njenga, Godfrey Bigogo, Peninah Munyua, Terrence Q Lo, Elizabeth Hunsperger, and Amy Herman-Roloff
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Research Article ,Articles ,Population-based ,Households ,Serosurvey ,Serology ,IgM and IgG ,SARS-CoV-2 ,COVID-19 ,urban informal settlement ,Kibera ,Kenya - Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27 th November and 5 th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children ( Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.
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- 2022
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30. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020 [version 1; peer review: 1 approved, 1 approved with reservations]
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Patrick K Munywoki, Caroline Nasimiyu, Moshe Dayan Alando, Nancy Otieno, Cynthia Ombok, Ruth Njoroge, Gilbert Kikwai, Dennis Odhiambo,, Mike Powel Osita, Alice Ouma, Clifford Odour, Bonventure Juma, Caroline A Ochieng, Immaculate Mutisya, Isaac Ngere, Jeanette Dawa, Eric Osoro, M Kariuki Njenga, Godfrey Bigogo, Peninah Munyua, Terrence Q Lo, Elizabeth Hunsperger, and Amy Herman-Roloff
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Research Article ,Articles ,Population-based ,Households ,Serosurvey ,Serology ,IgM and IgG ,SARS-CoV-2 ,COVID-19 ,urban informal settlement ,Kibera ,Kenya - Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27 th November and 5 th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children ( Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.
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- 2021
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31. Anti-inflammatory SARS-CoV-2 T cell immunity in asymptomatic seronegative Kenyan adults
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Taraz Samandari, Joshua Ongalo, Kim McCarthy, Richard K. Biegon, Philister Madiega, Anne Mithika, Joseph Orinda, Grace M. Mboya, Patrick Mwaura, Omu Anzala, Clayton Onyango, Fredrick O. Oluoch, Eric Osoro, Charles-Antoine Dutertre, Nicole Tan, Shou Kit Hang, Smrithi Hariharaputran, David C Lye, Amy Herman-Roloff, Nina Le Bert, and Antonio Bertoletti
- Abstract
Antibodies are used to estimate prevalence of past infection. However, T cell responses against SARS-CoV-2 may more accurately define prevalence because SARS-CoV-2-specific antibodies wane. In November-December 2021, we studied serological and cellular immune responses in residents of rural Kenya who had not experienced any respiratory symptom nor had contact with COVID-19 cases. Among participants we detected anti-spike antibodies in 41.0% and T cell responses against ≥2 SARS-CoV-2 proteins in 82.5%, which implies that serosurveys underestimate SARS-CoV-2 prevalence in settings where asymptomatic infections prevail. Distinct from cellular immunity in European and Asian COVID-19 convalescents, strong T cell immunogenicity was observed against viral accessory proteins in these asymptomatic Africans, as well as a higher IL-10/IFN-γ ratio cytokine profile, suggesting that environmental or genetic factors modulate pro-inflammatory responses.FundingU.S. Centers for Disease Control and Prevention, Division of Global Health Protection. Singapore Ministry of Health’s National Medical Research Council under its COVID-19 Research Fund (COVID19RF3-0060, COVID19RF-001 and COVID19RF-008) and the Singapore Ministry of Health’s National Medical Research Council MOH-000019 (MOH-StaR17Nov-0001).
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- 2023
32. Characterization of COVID-19 cases in the early phase (March to July 2020) of the pandemic in Kenya
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Philip Ngere, Joyce Onsongo, Daniel Langat, Elizabeth Nzioka, Faith Mudachi, Samuel Kadivane, Bernard Chege, Elvis Kirui, Ian Were, Stephen Mutiso, Amos Kibisu, Josephine Ihahi, Gladys Mutethya, Trufosa Mochache, Peter Lokamar, Waqo Boru, Lyndah Makayotto, Emmanuel Okunga, Nollascus Ganda, Adam Haji, Carolyne Gathenji, Winfred Kariuki, Eric Osoro, Kadondi Kasera, Francis Kuria, Rashid Aman, Juliet Nabyonga, and Patrick Amoth
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Male ,SARS-CoV-2 ,Health Policy ,Public Health, Environmental and Occupational Health ,Humans ,COVID-19 ,Female ,Comorbidity ,Kenya ,Pandemics ,Aged - Abstract
Kenya detected the first case of COVID-19 on March 13, 2020, and as of July 30, 2020, 17 975 cases with 285 deaths (case fatality rate (CFR) = 1.6%) had been reported. This study described the cases during the early phase of the pandemic to provide information for monitoring and response planning in the local context.We reviewed COVID-19 case records from isolation centres while considering national representation and the WHO sampling guideline for clinical characterization of the COVID-19 pandemic within a country. Socio-demographic, clinical, and exposure data were summarized using median and mean for continuous variables and proportions for categorical variables. We assigned exposure variables to socio-demographics, exposure, and contact data, while the clinical spectrum was assigned outcome variables and their associations were assessed.A total of 2796 case records were reviewed including 2049 (73.3%) male, 852 (30.5%) aged 30-39 years, 2730 (97.6%) Kenyans, 636 (22.7%) transporters, and 743 (26.6%) residents of Nairobi City County. Up to 609 (21.8%) cases had underlying medical conditions, including hypertension (n = 285 (46.8%)), diabetes (n = 211 (34.6%)), and multiple conditions (n = 129 (21.2%)). Out of 1893 (67.7%) cases with likely sources of exposure, 601 (31.8%) were due to international travel. There were 2340 contacts listed for 577 (20.6%) cases, with 632 contacts (27.0%) being traced. The odds of developing COVID-19 symptoms were higher among case who were aged above 60 years (odds ratio (OR) = 1.99, P = 0.007) or had underlying conditions (OR = 2.73, P 0.001) and lower among transport sector employees (OR = 0.31, P 0.001). The odds of developing severe COVID-19 disease were higher among cases who had underlying medical conditions (OR = 1.56, P 0.001) and lower among cases exposed through community gatherings (OR = 0.27, P 0.001). The odds of survival of cases from COVID-19 disease were higher among transport sector employees (OR = 3.35, P = 0.004); but lower among cases who were aged ≥60 years (OR = 0.58, P = 0.034) and those with underlying conditions (OR = 0.58, P = 0.025).The early phase of the COVID-19 pandemic demonstrated a need to target the elderly and comorbid cases with prevention and control strategies while closely monitoring asymptomatic cases.
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- 2022
33. Imported SARS-COV-2 Variants of Concern Drove Spread of Infections Across Kenya During the Second Year of the Pandemic
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Carolyne Nasimiyu, Damaris Matoke-Muhia, Gilbert K. Rono, Eric Osoro, Daniel O. Ouso, J. Milkah Mwangi, Nicholas Mwikwabe, Kelvin Thiong’o, Jeanette Dawa, Isaac Ngere, John Gachohi, Samuel Kariuki, Evans Amukoye, Marianne Mureithi, Philip Ngere, Patrick Amoth, Ian Were, Lyndah Makayotto, Vishvanath Nene, Edward O. Abworo, M. Kariuki Njenga, Stephanie N. Seifert, and Samuel O. Oyola
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General Earth and Planetary Sciences ,COVID-19 pandemic ,variants of concern ,attack rates ,General Environmental Science - Abstract
BackgroundUsing classical and genomic epidemiology, we tracked the COVID-19 pandemic in Kenya over 23 months to determine the impact of SARS-CoV-2 variants on its progression.MethodsSARS-CoV-2 surveillance and testing data were obtained from the Kenya Ministry of Health, collected daily from 306 health facilities. COVID-19-associated fatality data were also obtained from these health facilities and communities. Whole SARS-CoV-2 genome sequencing were carried out on 1241 specimens.ResultsOver the pandemic duration (March 2020 - January 2022) Kenya experienced five waves characterized by attack rates (AR) of between 65.4 and 137.6 per 100,000 persons, and intra-wave case fatality ratios (CFR) averaging 3.5%, two-fold higher than the national average COVID-19 associated CFR. The first two waves that occurred before emergence of global variants of concerns (VoC) had lower AR (65.4 and 118.2 per 100,000). Waves 3, 4, and 5 that occurred during the second year were each dominated by multiple introductions each, of Alpha (74.9% genomes), Delta (98.7%), and Omicron (87.8%) VoCs, respectively. During this phase, government-imposed restrictions failed to alleviate pandemic progression, resulting in higher attack rates spread across the country.ConclusionsThe emergence of Alpha, Delta, and Omicron variants was a turning point that resulted in widespread and higher SARS-CoV-2 infections across the country.
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- 2022
34. Why is There Low Morbidity and Mortality of COVID-19 in Africa?
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Mark Nanyingi, Bronwyn M. Gunn, M. Kariuki Njenga, Jeanette Dawa, C. F. Otieno, Isaac Ngere, Michael Letko, Eric Osoro, and John Gachohi
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2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,030231 tropical medicine ,Population ,Perspective Piece ,Betacoronavirus ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Virology ,Pandemic ,Humans ,education ,Pandemics ,Weather ,education.field_of_study ,SARS-CoV-2 ,COVID-19 ,Infectious Diseases ,Geography ,Africa ,Parasitology ,Age distribution ,Morbidity ,Coronavirus Infections ,Demography - Abstract
Three months since the detection of the first COVID-19 case in Africa, almost all countries of the continent continued to report lower morbidity and mortality than the global trend, including Europe and North America. We reviewed the merits of various hypotheses advanced to explain this phenomenon, including low seeding rate, effective mitigation measures, population that is more youthful, favorable weather, and possible prior exposure to a cross-reactive virus. Having a youthful population and favorable weather appears compelling, particularly their combined effect; however, progression of the pandemic in the region and globally may dispel these in the coming months.
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- 2020
35. Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya
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Cyrus Mugo, Ruth Nduati, Eric Osoro, Bryan O Nyawanda, Harriet Mirieri, Elizabeth Hunsperger, Jennifer R Verani, Hafsa Jin, Dufton Mwaengo, Brian Maugo, James Machoki, Nancy A Otieno, Cynthia Ombok, Mufida Shabibi, Lydia Okutoyi, John Kinuthia, Marc Alain Widdowson, Kariuki Njenga, Irene Inwani, and Dalton Wamalwa
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Infant, Newborn ,Pregnancy Outcome ,HIV Infections ,Kenya ,Abortion, Spontaneous ,Pregnancy Complications ,Infectious Diseases ,Anti-Retroviral Agents ,Pregnancy ,Immunology and Allergy ,Humans ,Premature Birth ,Female ,Pregnancy Complications, Infectious - Abstract
Background The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear. Methods Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status. Results Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth ( Conclusions Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes.
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- 2021
36. Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya
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Sylvia Omulo, Margaret Oluka, Loice Achieng, Eric Osoro, Rosaline Kinuthia, Anastasia Guantai, Sylvia Adisa Opanga, Marion Ongayo, Linus Ndegwa, Jennifer R. Verani, Eveline Wesangula, Jarred Nyakiba, Jones Makori, Wilson Sugut, Charles Kwobah, Hanako Osuka, M. Kariuki Njenga, Douglas R. Call, Guy H. Palmer, Daniel VanderEnde, and Ulzii-Orshikh Luvsansharav
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Male ,Multidisciplinary ,Hospitals, Public ,Prevalence ,Humans ,Female ,Child ,Kenya ,Referral and Consultation ,Anti-Bacterial Agents - Abstract
Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.
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- 2021
37. sssHigh seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya
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Nancy A. Otieno, Elizabeth Hunsperger, Jeanette Dawa, Lyndah Makayotto, Omu Anzala, Patrick Amoth, Bronwyn M. Gunn, Eric Osoro, Isaac Ngere, Amy Herman-Roloff, M. Kariuki Njenga, Ouma Oluga, Robert F. Breiman, Dennis Odhiambo, Marc Bulterys, Doris Marwanga, Moshe Alando, Bryan O. Nyawanda, John Gachohi, Carolyne Nasimiyu, Moses Masika, Harriet K. Mirieri, Patrick K. Munywoki, and Carolyne Ngunu
- Subjects
Microbiology (medical) ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population structure ,High seroprevalence ,COVID-19 pandemic ,Infectious and parasitic diseases ,RC109-216 ,Antibodies, Viral ,Article ,law.invention ,law ,Seroepidemiologic Studies ,Seroprevalence ,Medicine ,Humans ,seroprevalence ,business.industry ,SARS-CoV-2 ,COVID-19 ,General Medicine ,infection underestimation ,Middle Aged ,Kenya ,Infectious Diseases ,Transmission (mechanics) ,Multiple factors ,Cross-Sectional Studies ,Test performance ,disease underreporting ,business ,Demography - Abstract
Background The lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. Methods A population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths. Results Among 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs. Conclusion Over one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.
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- 2021
38. Seroprevalence and risk factors of SARS-CoV-2 infection in an urban informal settlement in Nairobi, Kenya, December 2020
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Clifford Odour, M. Kariuki Njenga, Isaac Ngere, Ruth Njoroge, Caroline Ochieng, Mike Powel Osita, Elizabeth Hunsperger, Amy Herman-Roloff, Bonventure Juma, Godfrey Bigogo, Eric Osoro, Immaculate Mutisya, Terrence Q Lo, Caroline Nasimiyu, Jeanette Dawa, Peninah Munyua, Dennis Odhiambo, Nancy A. Otieno, Patrick K. Munywoki, Alice Ouma, Cynthia Ombok, Gilbert K. Kikwai, and Moshe Alando
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Adult ,medicine.medical_specialty ,COVID-19 Vaccines ,viruses ,Population ,Logistic regression ,Antibodies, Viral ,General Biochemistry, Genetics and Molecular Biology ,Odds ,Risk Factors ,Seroepidemiologic Studies ,Pandemic ,Medicine ,Seroprevalence ,Humans ,General Pharmacology, Toxicology and Pharmaceutics ,education ,Child ,Socioeconomic status ,Pandemics ,education.field_of_study ,General Immunology and Microbiology ,business.industry ,SARS-CoV-2 ,Public health ,virus diseases ,COVID-19 ,General Medicine ,Overcrowding ,biochemical phenomena, metabolism, and nutrition ,Kenya ,digestive system diseases ,Child, Preschool ,Spike Glycoprotein, Coronavirus ,business ,Demography - Abstract
Introduction: Urban informal settlements may be disproportionately affected by the COVID-19 pandemic due to overcrowding and other socioeconomic challenges that make adoption and implementation of public health mitigation measures difficult. We conducted a seroprevalence survey in the Kibera informal settlement, Nairobi, Kenya, to determine the extent of SARS-CoV-2 infection. Methods: Members of randomly selected households from an existing population-based infectious disease surveillance (PBIDS) provided blood specimens between 27th November and 5th December 2020. The specimens were tested for antibodies to the SARS-CoV-2 spike protein. Seroprevalence estimates were weighted by age and sex distribution of the PBIDS population and accounted for household clustering. Multivariable logistic regression was used to identify risk factors for individual seropositivity. Results: Consent was obtained from 523 individuals in 175 households, yielding 511 serum specimens that were tested. The overall weighted seroprevalence was 43.3% (95% CI, 37.4 – 49.5%) and did not vary by sex. Of the sampled households, 122(69.7%) had at least one seropositive individual. The individual seroprevalence increased by age from 7.6% (95% CI, 2.4 – 21.3%) among children ( Conclusion: In densely populated urban settings, close to half of the individuals had an infection to SARS-CoV-2 after eight months of the COVID-19 pandemic in Kenya. This highlights the importance to prioritize mitigation measures, including COVID-19 vaccine distribution, in the crowded, low socioeconomic settings.
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- 2021
39. Seroprevalence of influenza A virus in pigs and low risk of acute respiratory illness among pig workers in Kenya
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Jeremiah Nyaundi, Athman Mwatondo, Doris Marwanga, Kariuki Njenga, Mathew Muturi, Shirley Lidechi, Eric Osoro, and Zipporah Ng’ang’a
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Adult ,Male ,Veterinary medicine ,Adolescent ,Swine ,010501 environmental sciences ,Antibodies, Viral ,medicine.disease_cause ,01 natural sciences ,Poultry ,Virus ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Orthomyxoviridae Infections ,Risk Factors ,Seroepidemiologic Studies ,Zoonoses ,Influenza, Human ,Pandemic ,Influenza A virus ,Animals ,Humans ,Medicine ,Seroprevalence ,Pig farming ,030212 general & internal medicine ,Child ,0105 earth and related environmental sciences ,Swine Diseases ,Acute respiratory illness ,business.industry ,Transmission (medicine) ,Incidence ,Incidence (epidemiology) ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,General Medicine ,Middle Aged ,Kenya ,Relative risk ,Pharynx ,RNA, Viral ,Female ,Pig workers ,business ,Research Article - Abstract
Background Influenza A viruses pose a significant risk to human health because of their wide host range and ability to reassort into novel viruses that can cause serious disease and pandemics. Since transmission of these viruses between humans and pigs can be associated with occupational and environmental exposures, we investigated the association between occupational exposure to pigs, occurrence of acute respiratory illness (ARI), and influenza A virus infection. Methods The study was conducted in Kiambu County, the county with the highest level of intensive small-scale pig farming in Kenya. Up to 3 participants (> 2 years old) per household from pig-keeping and non-pig-keeping households were randomly recruited and followed up in 2013 (Sept-Dec) and 2014 (Apr-Aug). Oropharyngeal (OP) and nasopharyngeal (NP) swabs were collected from participants with ARI at the time of study visit. For the animal study, nasal and oropharyngeal swabs, and serum samples were collected from pigs and poultry present in enrolled households. The human and animal swab samples were tested for viral nucleic acid by RT-PCR and sera by ELISA for antibodies. A Poisson generalized linear mixed-effects model was developed to assess the association between pig exposure and occurrence of ARI. Results Of 1137 human participants enrolled, 625 (55%) completed follow-up visits including 172 (27.5%) pig workers and 453 (72.5%) non-pig workers. Of 130 human NP/OP swabs tested, four (3.1%) were positive for influenza A virus, one pig worker, and three among non-pig workers. Whereas none of the 4462 swabs collected from pig and poultry tested positive for influenza A virus by RT-PCR, 265 of 4273 (6.2%) of the sera tested positive for virus antibodies by ELISA, including 11.6% (230/1990) of the pigs and 1.5% (35/2,283) of poultry. The cumulative incidence of ARI was 16.9% among pig workers and 26.9% among the non-pig workers. The adjusted risk ratio for the association between being a pig worker and experiencing an episode of ARI was 0.56 (95% CI [0.33, 0.93]), after adjusting for potential confounders. Conclusions Our findings demonstrate moderate seropositivity for influenza A virus among pigs, suggesting the circulation of swine influenza virus and a potential for interspecies transmission.
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- 2019
40. High incidence of human brucellosis in a rural Pastoralist community in Kenya, 2015
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Isaac Ngere, Doris Marwanga, Eric Osoro, Athman Mwatondo, Mathew Muturi, Peninah Munyua, Marc-Alain Widdowson, Clayton Onyango, Kariuki Njenga, Elizabeth Hunsperger, Rebekah Tiller, and Philip Ngere
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Male ,Rural Population ,Bacterial Diseases ,Epidemiology ,RC955-962 ,Fevers ,Pathology and Laboratory Medicine ,Polymerase Chain Reaction ,Geographical Locations ,Medical Conditions ,0302 clinical medicine ,Interquartile range ,Surveys and Questionnaires ,Zoonoses ,Arctic medicine. Tropical medicine ,Medicine and Health Sciences ,030212 general & internal medicine ,Enzyme-Linked Immunoassays ,Child ,Animal Management ,biology ,Incidence (epidemiology) ,Agriculture ,Antibodies, Bacterial ,Bacterial Pathogens ,Infectious Diseases ,Medical Microbiology ,Child, Preschool ,Cohort ,Population study ,Female ,Pathogens ,Public aspects of medicine ,RA1-1270 ,Research Article ,Neglected Tropical Diseases ,Adult ,medicine.medical_specialty ,Livestock ,Adolescent ,030231 tropical medicine ,Pastoralism ,Enzyme-Linked Immunosorbent Assay ,Brucella ,Research and Analysis Methods ,Microbiology ,Brucellosis ,Young Adult ,03 medical and health sciences ,Signs and Symptoms ,Internal medicine ,medicine ,Humans ,Serologic Tests ,Immunoassays ,Microbial Pathogens ,Bacteria ,business.industry ,Organisms ,Public Health, Environmental and Occupational Health ,Infant ,Biology and Life Sciences ,Tropical Diseases ,medicine.disease ,biology.organism_classification ,Kenya ,Case definition ,Health Care ,Immunoglobulin M ,Health Care Facilities ,Immunoglobulin G ,People and Places ,Africa ,Immunologic Techniques ,Clinical Medicine ,business - Abstract
Background Brucellosis occurs globally with highly variable incidence in humans from very low in North America and Western Europe to high in the Middle East and Asia. There are few data in Sub-Saharan Africa. This study estimated the incidence of human brucellosis in a pastoralist community in Kenya. Methods Between February 2015 and January 2016, we enrolled persons living in randomly selected households in Kajiado County. Free health care was offered at three facilities in the study area. Those who met the study clinical case definition completed a standardized questionnaire on demographics, clinical history and presentation. A blood sample was collected and tested by Rose Bengal test (RBT), then later tested at the Kenya Medical Research Institute laboratory for Brucella IgG and IgM by ELISA. Those who tested positive by both RBT and ELISA (IgG or IgM antibodies) were classified as confirmed while those that only tested positive for IgG or IgM antibodies were classified as probable. Further, sera were tested by polymerase chain reaction using a TaqMan Array Card (TAC) for a panel of pathogens causing AFI including Brucella spp. Annual incidence of brucellosis was calculated as the number of confirmed cases in one year/total number in the study population. Results We enrolled a cohort of 4746 persons in 804 households. Over half (52.3%) were males and the median age was 18 years (Interquartile range (IQR) 9 months– 32 years). A total of 236 patients were enrolled at three health facilities; 64% were females and the median age was 40.5 years (IQR 28–53 years). Thirty-nine (16.5%) were positive for Brucella antibodies by IgG ELISA, 5/236 (2.1%) by IgM ELISA and 4/236 (1.7%) by RBT. Ten percent (22/217) were positive by TAC. We confirmed four (1.7%) brucellosis cases giving an annual incidence of 84/100,000 persons/year (95% CI 82, 87). The incidence did not significantly vary by gender, age and location of residence. Conclusion We report a high incidence of brucellosis in humans among members of this pastoralist community. Brucellosis was the most common cause of febrile illness in this community., Author summary Brucellosis is a bacterial disease that affects both humans and animals. Humans get infected via ingestion of unpasteurized animal products from infected animals and direct contact during animal abortions and deliveries. Infected animals shed bacteria for life through milk and during deliveries posing a risk to those with occupational exposure to infected animals. As such, human disease is disproportionately high in regions with high prevalence of animal brucellosis. While human brucellosis is distributed globally, incidence is low in North America and Western Europe and high in Asia and the Middle East where the disease is endemic. Data from Africa are scarce. We set out to estimate the incidence of brucellosis in a pastoralist community with documented high Brucella sero-prevalence in humans and livestock. We followed up a cohort of 804 households for one year and tested household members who became ill in three designated health facilities. We estimated an incidence of 84 cases per 100,000 persons per year in this community. We also found that Brucella was the most common pathogen among persons who had febrile illness highlighting the importance of this pathogen in this rural pastoralist community. No brucellosis intervention measures were being implemented.
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- 2021
41. High Seroprevalence of SARS-CoV-2 Eight Months After Introduction in Nairobi, Kenya
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Isaac A. Ngere, Jeanette Dawa, Elizabeth Hunsperger, Nancy Otieno, Moses Masika, Patrick Amoth, Lyndah Makayotto, Carolyne Nasimiyu, Bronwyn Mei Gunn, Bryan Nyawanda, Ouma Oluga, Carolyne Ngunu, Harriet Mirieri, John Gachohi, Doris Marwanga, Patrick Munywoki, Dennis Odhiambo, Moshe Dayan Alando, Robert Breiman, Omu Anzala, M. Kariuki Njenga, Marc Bulterys, Amy Herman-Roloff, and Eric Osoro
- Subjects
Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pandemic ,Declaration ,High seroprevalence ,Seroprevalence ,Medicine ,Logistic regression ,Institutional review board ,business ,Demography - Abstract
Background: The lower-than-expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. We set out to estimate the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. Methods: We conducted a population based cross-sectional survey using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for IgM and IgG antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Risk factors were determined using logistic regression and Infection fatality ratios (IFRs) calculated by comparing our estimates to reported cases and deaths. Findings: Of 1,164 individuals from 527 households tested, the adjusted seroprevalence was 34·7% (95%CI 31·8-37·6), indicating that approximately 1·5 million Nairobi residents had been infected. Some 261 (49·5%) households had at least one positive participant, and positivity rates increased in more densely populated areas (spearman’s r=0·63; p=0·009). Individuals aged 20-59 years had up to 2-fold higher seropositivity when compared to those aged 0-9 years or ≥60 years. The IFR was 40 per 100,000 infections, with individuals ≥40 years old having higher IFRs. Interpretation: Over one third of Nairobi residents in half of the households were infected by November 2020, indicating extensive transmission in the city, comparable to countries reporting more severe forms of the pandemic. However, the IFR was >10-fold lower than that reported in Europe and the United States, supporting the perceived low morbidity and mortality in sub–Saharan Africa. Funding Statement: Funding was provided by the US National Institutes of Health (NIH), grant number U01AI151799, through the Centre for Research in Emerging Infectious Diseases – East and Central Africa (CREID-ECA). Declaration of Interests: The authors declare that they have no competing interests Ethics Approval Statement: This study was reviewed and approved by the Kenya Medical Research Institute Scientific and Ethical Review Committee (number SSC 4098), National Commission for Science Technology and Innovation (number 827570), U.S. CDC (number CGH-ET-4/12/21-f3b82), and a reliance approval provided by Washington State University Institutional Review Board based on in-country ethical reviews as provided for in Code of Federal Regulations (45 C.F.R part 46 and 21 C.F.R. part 56). Administrative approval was provided by the Kenya MoH and Nairobi City County administration. All participants provided written consent prior to enrollment.
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- 2021
42. High MERS-CoV seropositivity associated with camel herd profile, husbandry practices and household socio-demographic characteristics in Northern Kenya
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Marc-Alain Widdowson, Athman Mwatondo, Matthew Muturi, Peninah Munyua, J. Oyugi, B. Bodha, Kariuki Njenga, John Gachohi, W. Jaoko, Natalie J. Thornburg, J. Harcourt, Elizabeth Hunsperger, Eric Osoro, B. Okotu, and Isaac Ngere
- Subjects
Adult ,Male ,endocrine system ,Camelus ,Epidemiology ,Middle East respiratory syndrome coronavirus ,Cross-sectional study ,Socio demographics ,Context (language use) ,medicine.disease_cause ,Antibodies, Viral ,Seroepidemiologic Studies ,Surveys and Questionnaires ,Zoonoses ,medicine ,Seroprevalence ,Animals ,Humans ,Animal Husbandry ,Transients and Migrants ,Family Characteristics ,Original Paper ,seroprevalence ,business.industry ,Age Factors ,Animal husbandry ,Antibodies, Neutralizing ,Kenya ,Infectious Diseases ,Geography ,Cross-Sectional Studies ,nomadic communities ,Socioeconomic Factors ,Herd ,Middle East Respiratory Syndrome Coronavirus ,Educational Status ,Regression Analysis ,Livestock ,Female ,business ,Coronavirus Infections ,Demography - Abstract
Despite high exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), the predictors for seropositivity in the context of husbandry practices for camels in Eastern Africa are not well understood. We conducted a cross-sectional survey to describe the camel herd profile and determine the factors associated with MERS-CoV seropositivity in Northern Kenya. We enrolled 29 camel-owning households and administered questionnaires to collect herd and household data. Serum samples collected from 493 randomly selected camels were tested for anti-MERS-CoV antibodies using a microneutralisation assay, and regression analysis used to correlate herd and household characteristics with camel seropositivity. Households reared camels (median = 23 camels and IQR 16–56), and at least one other livestock species in two distinct herds; a home herd kept near homesteads, and a range/fora herd that resided far from the homestead. The overall MERS-CoV IgG seropositivity was 76.3%, with no statistically significant difference between home and fora herds. Significant predictors for seropositivity (P ⩽ 0.05) included camels 6–10 years old (aOR 2.3, 95% CI 1.0–5.2), herds with ⩾25 camels (aOR 2.0, 95% CI 1.2–3.4) and camels from Gabra community (aOR 2.3, 95% CI 1.2–4.2). These results suggest high levels of virus transmission among camels, with potential for human infection.
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- 2020
43. The Zika Virus Individual Participant Data Consortium
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Guilherme Calvet, Albert Ko, Elizabeth Brickley, Mauricio Nogueira, João Paulo Souza, Eric Osoro, Jackeline Alger, Freddy Perez, Carlos Hernan Becerra Mojica, Philippe MAYAUD, Lauren Maxwell, Saulo Passos, Isadora De Siqueira, Adriana Tami, Azucena Bardají Alonso, Elena Marbán-Castro, Thomas Debray, Mitermayer Reis, and Virology
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medicine.medical_specialty ,congenital Zika syndrome ,data sharing ,lcsh:Medicine ,Zika virus ,Miscarriage ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Environmental health ,Epidemiology ,Health care ,medicine ,Global health ,prognostic model ,030212 general & internal medicine ,emerging pathogen ,microcephaly ,Pregnancy ,030505 public health ,General Immunology and Microbiology ,biology ,business.industry ,Communication ,lcsh:R ,Public Health, Environmental and Occupational Health ,biology.organism_classification ,medicine.disease ,individual participant data meta-analysis ,prediction model ,Infectious Diseases ,Family planning ,Relative risk ,0305 other medical science ,business - Abstract
This commentary describes the creation of the Zika Virus Individual Participant Data Consortium, a global collaboration to address outstanding questions in Zika virus (ZIKV) epidemiology through conducting an individual participant data meta-analysis (IPD-MA). The aims of the IPD-MA are to (1) estimate the absolute and relative risks of miscarriage, fetal loss, and short- and long-term sequelae of fetal exposure; (2) identify and quantify the relative importance of different sources of heterogeneity (e.g., immune profiles, concurrent flavivirus infection) for the risk of adverse fetal, infant, and child outcomes among infants exposed to ZIKV in utero; and (3) develop and validate a prognostic model for the early identification of high-risk pregnancies and inform communication between health care providers and their patients and public health interventions (e.g., vector control strategies, antenatal care, and family planning programs). By leveraging data from a diversity of populations across the world, the IPD-MA will provide a more precise estimate of the risk of adverse ZIKV-related outcomes within clinically relevant subgroups and a quantitative assessment of the generalizability of these estimates across populations and settings. The ZIKV IPD Consortium effort is indicative of the growing recognition that data sharing is a central component of global health security and outbreak response.
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- 2020
44. Knowledge and attitude of Kenyan healthcare workers towards pandemic influenza disease and vaccination: 9 years after the last influenza pandemic
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Sandra S. Chaves, Linus Ndegwa, Joseph S. Bresee, Gideon O. Emukule, Fred Andayi, Peter Muturi, Rosalia Kalani, Edwina Anyango, Philip Muthoka, Malembe S. Ebama, Eduardo Azziz-Baumgartner, Eric Osoro, and Fredrick Otiato
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medicine.medical_specialty ,Kenya ,Health Knowledge, Attitudes, Practice ,Attitude of Health Personnel ,Health Personnel ,education ,030231 tropical medicine ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Influenza A Virus, H1N1 Subtype ,Surveys and Questionnaires ,Health care ,Pandemic ,Influenza, Human ,Medicine ,Humans ,030212 general & internal medicine ,Pandemics ,General Veterinary ,General Immunology and Microbiology ,business.industry ,Transmission (medicine) ,Vaccination ,Public Health, Environmental and Occupational Health ,virus diseases ,Patient Acceptance of Health Care ,Infectious Diseases ,Cross-Sectional Studies ,Influenza Vaccines ,Family medicine ,Preparedness ,Molecular Medicine ,Health education ,business - Abstract
Background Healthcare workers (HCWs) are at high risk of exposure and transmission of infectious respiratory pathogens like influenza. Despite the potential benefits, safety and efficacy of influenza vaccination, vaccines are still underutilized in Africa, including among HCWs. Method From May-June 2018, we conducted a cross-sectional, self-administered, written survey among HCWs from seven counties in Kenya and assessed their knowledge attitudes and perceptions towards pandemic influenza disease and vaccination. Using regression models, we assessed factors that were associated with the HCW’s knowledge of pandemic influenza and vaccination. Results A total of 2,035 HCWs, representing 49% of the targeted respondents from 35 health facilities, completed the question. Sixty eight percent of the HCWs had ever heard of pandemic influenza, and 80.0% of these were willing to receive pandemic influenza vaccine if it was available. On average, Kenyan HCWs correctly answered 55.0% (95% CI 54.0–55.9) of the questions about pandemic influenza and vaccination. Physicians (65.6%, 95% CI 62.5–68.7) and pharmacists (61.7%, 95% CI 57.9–65.5) scored higher compared to nurses (53.1%, 95% CI 51.7–54.5). HCWs with 5 or more years of work experience (55.8, 95% CI 54.5–57.0) had marginally higher knowledge scores compared to those with less experience (53.9%, 95% CI 52.5–55.3). Most participants who were willing to receive pandemic influenza vaccine did so to protect their relatives (88.7%) or patients (85.9%). Conclusion Our findings suggest moderate knowledge of pandemic influenza and vaccination by HCWs in Kenya, which varied by cadre and years of work experience. These findings highlight the need for continued in-service health education to increase the HCW’s awareness and knowledge of pandemic influenza to increase acceptance of influenza vaccination in the case of a pandemic.
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- 2020
45. Comparison of knowledge, attitude, and practices of animal and human brucellosis between nomadic pastoralists and non-pastoralists in Kenya
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Sylvia Omulo, Bernard K. Bett, Eric Ogolla, Peninah Munyua, Eric Osoro, M. Kariuki Njenga, Samuel M. Thumbi, Marc-Alain Widdowson, Mathew Muturi, Isaac Ngere, Austine Bitek, and Doris Marwanga
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Adult ,Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,040301 veterinary sciences ,030231 tropical medicine ,Pastoralism ,Brucellosis ,0403 veterinary science ,03 medical and health sciences ,Risk-Taking ,0302 clinical medicine ,Seroepidemiologic Studies ,Surveys and Questionnaires ,medicine ,Animals ,Humans ,Seroprevalence ,Socioeconomics ,Transients and Migrants ,Family Characteristics ,Farmers ,business.industry ,lcsh:Public aspects of medicine ,Public health ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,04 agricultural and veterinary sciences ,Middle Aged ,medicine.disease ,Antibodies, Bacterial ,Brucella ,Kenya ,Stratified sampling ,Risky practices ,Knowledge ,Agriculture ,Female ,Livestock ,business ,Mixed farming ,Research Article - Abstract
Background The seroprevalence of brucellosis among nomadic pastoralists and their livestock in arid lands is reported to be over10-fold higher than non-pastoralists farmers and their livestock in Kenya. Here, we compared the seroprevalence of nomadic pastoralists and mixed farming with their knowledge of the disease and high-risk practices associated with brucellosis infection. Methods Across-sectional study was conducted in two counties - Kiambu County where farmers primarily practice smallholder livestock production and crop farming, and Marsabit County where farmers practice nomadic pastoral livestock production. Stratified random sampling was applied, in which sublocations were initially selected based on predominant livestock production system, before selecting households using randomly generated geographical coordinates. In each household, up to three persons aged 5 years and above were randomly selected, consented, and tested for Brucella spp IgG antibodies. A structured questionnaire was administered to the household head and selected individuals on disease knowledge and risky practices among the pastoralists and mixed farmers compared. Multivariable mixed effects logistic regression model was used to assess independent practices associated with human Brucella spp. IgG seropositivity. Results While the majority (74%) of pastoralist households had little to no formal education when compared to mixed (8%), over 70% of all households (pastoralists and mixed farmers) had heard of brucellosis and mentioned its clinical presentation in humans. However, fewer than 30% of all participants (pastoralists and mixed farmers) knew how brucellosis is transmitted between animals and humans or how its transmission can be prevented. Despite their comparable knowledge, significantly more seropositive pastoralists compared to mixed farmers engaged in risky practices including consuming unboiled milk (79.5% vs 1.7%, p p < 0.001), assisting in animal birth (43.0% vs 9.3%, p < 0.001), and handling raw hides (30.6% vs 5.5%, p < 0.001)., Conclusion Nomadic pastoralists are more likely to engage in risky practices that promote Brucella Infection, probably because of their occupation and culture, despite having significant knowledge of the disease.
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- 2020
46. Recurrent Anthrax Outbreaks in Humans, Livestock, and Wildlife in the Same Locality, Kenya, 2014–2017
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M. Kariuki Njenga, Obadiah N. Njagi, Bernard K. Bett, Francis Gakuya, Peninah Munyua, Isaac Lekolool, Athman Mwatondo, Mathew Muturi, Harry Oyas, Austine Bitek, Alice Bett, S. Mwangi Thumbi, Eric Osoro, and John Gachohi
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0301 basic medicine ,medicine.medical_specialty ,Livestock ,Buffaloes ,Gastrointestinal Diseases ,030231 tropical medicine ,030106 microbiology ,Attack rate ,Wildlife ,Endangered species ,Cattle Diseases ,Animals, Wild ,Disease Outbreaks ,Anthrax ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Virology ,Environmental health ,Epidemiology ,medicine ,Animals ,Humans ,Spores, Bacterial ,biology ,business.industry ,Mortality rate ,Outbreak ,Articles ,Skin Diseases, Bacterial ,biology.organism_classification ,Kenya ,Survival Analysis ,Bacillus anthracis ,Infectious Diseases ,Parasitology ,Cattle ,business - Abstract
Epidemiologic data indicate a global distribution of anthrax outbreaks associated with certain ecosystems that promote survival and viability of Bacillus anthracis spores. Here, we characterized three anthrax outbreaks involving humans, livestock, and wildlife that occurred in the same locality in Kenya between 2014 and 2017. Clinical and epidemiologic data on the outbreaks were collected using active case finding and review of human, livestock, and wildlife health records. Information on temporal and spatial distribution of prior outbreaks in the area was collected using participatory epidemiology. The 2014–2017 outbreaks in Nakuru West subcounty affected 15 of 71 people who had contact with infected cattle (attack rate = 21.1%), including seven with gastrointestinal, six with cutaneous, and two with oropharyngeal forms of the disease. Two (13.3%) gastrointestinal human anthrax cases died. No human cases were associated with infected wildlife. Of the 54 cattle owned in 11 households affected, 20 died (attack rate = 37%). The 2015 outbreak resulted in death of 10.5% of the affected herbivorous wildlife at Lake Nakuru National Park, including 745 of 4,500 African buffaloes (species-specific mortality rate = 17%) and three of 18 endangered white rhinos (species-specific mortality rate = 16%). The species mortality rate ranged from 1% to 5% for the other affected wildlife species. Participatory epidemiology identified prior outbreaks between 1973 and 2011 in the same area. The frequency and severity of outbreaks in this area suggests that it is an anthrax hotspot ideal for investigating risk factors associated with long-term survival of anthrax spores and outbreak occurrence.
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- 2018
47. Point-Prevalence Surveys of Antibiotic Use at Three Large Public Hospitals in Kenya
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Jones Makori, Charles Kwobah, Hanako Osuka, Loice Ombajo, Rosaline Kinuthia, M. Kariuki Njenga, Daniel VanderEnde, Eric Osoro, Ulzii-Oshikh Luvsansharav, Wilson Sugut, Evelyn Wesangula, Sylvia Omulo, Jarred Nyakiba, Douglas R. Call, Margaret Oluka, Jennifer R. Verani, Guy H. Palmer, Linus Ndegwa, Anastasia N. Guantai, and Sylvia Opanga
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Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,business.industry ,medicine.drug_class ,Antibiotics ,Prevalence ,Amoxicillin ,Meropenem ,Infectious Diseases ,Internal medicine ,Medicine ,Infection control ,Antimicrobial stewardship ,Medical prescription ,business ,Empiric therapy ,medicine.drug - Abstract
Background: Antibiotics are the most prescribed medicines worldwide, accounting for 20%–30% of total drug expenditures in most settings. Antimicrobial stewardship activities can provide guidance for the most appropriate antibiotic use. Objective: In an effort to generate baseline data to guide antimicrobial stewardship recommendations, we conducted point-prevalence surveys at 3 hospitals in Kenya. Methods: Sites included referral hospitals located in Nairobi (2,000 beds), Eldoret (900 beds) and Mombasa (700 beds). [Results are presented in this order.] Hospital administrators, heads of infection prevention and control units, and laboratory department heads were interviewed about ongoing antimicrobial stewardship activities, existing infection prevention and control programs, and microbiology diagnostic capacities. Patient-level data were collected by a clinical or medical officer and a pharmacist. A subset of randomly selected, consenting hospital patients was enrolled, and data were abstracted from their medical records, treatment sheets, and nursing notes using a modified WHO point-prevalence survey form. Results: Overall, 1,071 consenting patients were surveyed from the 3 hospitals (n = 579, n = 263, and n = 229, respectively) of whom >60% were aged >18 years and 53% were female. Overall, 489 of 1,071 of patients (46%) received ≥1 antibiotic, of whom 254 of 489 (52%) received 1 antibiotic, 201 of 489 (41%) received 2 antibiotics, 31 of 489 (6%) received 3 antibiotics, and 3 of 489 (1%) received 4 antibiotics. Antibiotic use was higher among those aged Conclusions: The prevalence of antibiotic use found by our study was 46%, generally lower than the rates reported in 3 similar studies from other African countries, which ranged from 56% to 65%. However, these survey findings indicate that ample opportunities exist for improving antimicrobial stewardship efforts in Kenya considering the high usage of empiric therapy and low microbiologic diagnostic utilization.Funding: NoneDisclosures: None
- Published
- 2020
48. No Serologic Evidence of Middle East Respiratory Syndrome Coronavirus Infection Among Camel Farmers Exposed to Highly Seropositive Camel Herds: A Household Linked Study, Kenya, 2013
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Marcel A. Müller, Christian Drosten, Austine Bitek, M. Kariuki Njenga, Benjamin Meyer, Eric Osoro, Samuel M. Thumbi, Erik Lattwein, Rees M. Murithi, Peninah Munyua, Marc-Alain Widdowson, and Victor M. Corman
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Adult ,Male ,endocrine system ,Veterinary medicine ,Camelus ,Adolescent ,Cross-sectional study ,Middle East respiratory syndrome coronavirus ,030231 tropical medicine ,Pastoralism ,Antibodies, Viral ,medicine.disease_cause ,Serology ,Milking ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Plaque reduction neutralization test ,Seroepidemiologic Studies ,Virology ,Prevalence ,Animals ,Humans ,Medicine ,Seroprevalence ,030212 general & internal medicine ,Child ,Aged ,Disease Reservoirs ,Aged, 80 and over ,Farmers ,business.industry ,Articles ,Middle Aged ,Kenya ,Cross-Sectional Studies ,Infectious Diseases ,Child, Preschool ,Immunoglobulin G ,Middle East Respiratory Syndrome Coronavirus ,Herd ,Female ,Parasitology ,Coronavirus Infections ,business - Abstract
High seroprevalence of Middle East respiratory syndrome coronavirus (MERS-CoV) among camels has been reported in Kenya and other countries in Africa. To date, the only report of MERS-CoV seropositivity among humans in Kenya is of two livestock keepers with no known contact with camels. We assessed whether persons exposed to seropositive camels at household level had serological evidence of infection. In 2013, 760 human and 879 camel sera were collected from 275 and 85 households respectively in Marsabit County. Data on human and animal demographics and type of contact with camels were collected. Human and camel sera were tested for anti-MERS-CoV IgG using a commercial enzyme-linked immunosorbent assay (ELISA) test. Human samples were confirmed by plaque reduction neutralization test (PRNT). Logistic regression was used to identify factors associated with seropositivity. The median age of persons sampled was 30 years (range: 5-90) and 50% were males. A quarter (197/760) of the participants reported having had contact with camels defined as milking, feeding, watering, slaughtering, or herding. Of the human sera, 18 (2.4%) were positive on ELISA but negative by PRNT. Of the camel sera, 791 (90%) were positive on ELISA. On univariate analysis, higher prevalence was observed in female and older camels over 4 years of age (P < 0.05). On multivariate analysis, only age remained significantly associated with increased odds of seropositivity. Despite high seroprevalence among camels, there was no serological confirmation of MERS-CoV infection among camel pastoralists in Marsabit County. The high seropositivity suggests that MERS-CoV or other closely related virus continues to circulate in camels and highlights ongoing potential for animal-to-human transmission.
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- 2017
49. Seroprevalence and Factors Associated withCoxiella burnetiiInfection in Small Ruminants in Baringo County, Kenya
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S. Wanyoike, Mark Nanyingi, S. Karanja, J. Muema, Meshack Obonyo, Eric Osoro, Austine Bitek, and Samuel M. Thumbi
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Veterinary medicine ,medicine.medical_specialty ,040301 veterinary sciences ,Epidemiology ,030231 tropical medicine ,Sheep Diseases ,Q fever ,Nomadic pastoralism ,Logistic regression ,law.invention ,0403 veterinary science ,03 medical and health sciences ,0302 clinical medicine ,Seroepidemiologic Studies ,law ,Zoonoses ,Animals ,Medicine ,Seroprevalence ,Goat Diseases ,Sheep ,General Veterinary ,General Immunology and Microbiology ,biology ,business.industry ,Goats ,Public Health, Environmental and Occupational Health ,04 agricultural and veterinary sciences ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Kenya ,Infectious Diseases ,Transmission (mechanics) ,Herd ,Q Fever ,business - Abstract
Summary To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity (P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations (P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal–human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region.
- Published
- 2017
50. Successes and challenges of the One Health approach in Kenya over the last decade
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M. Kariuki Njenga, Robert F. Breiman, Peninah Munyua, Athman Mwatondo, Joel M. Montgomery, Elkanah Otiang, Austine Bitek, Godfrey Bigogo, Mathew Muturi, Marc-Alain Widdowson, Clayton Onyango, John Neatherlin, Sara A. Lowther, Eric Osoro, Fredrick Ade, Norah Musee, APH - Global Health, Graduate School, and AII - Infectious diseases
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medicine.medical_specialty ,Economic growth ,030209 endocrinology & metabolism ,Communicable Diseases, Emerging ,Disease Outbreaks ,Zoonosis ,03 medical and health sciences ,0302 clinical medicine ,Zoonoses ,Correspondence ,Global health ,Animals ,Humans ,Medicine ,One Health ,030212 general & internal medicine ,Rift Valley fever ,Epidemics ,2. Zero hunger ,Antiinfective agent ,business.industry ,lcsh:Public aspects of medicine ,Public health ,1. No poverty ,Public Health, Environmental and Occupational Health ,Capacity building ,lcsh:RA1-1270 ,medicine.disease ,Workforce development ,Kenya ,3. Good health ,Preparedness ,Public Health ,Cross-sectoral collaboration global health security ,business ,Program Evaluation - Abstract
More than 75% of emerging infectious diseases are zoonotic in origin and a transdisciplinary, multi-sectoral One Health approach is a key strategy for their effective prevention and control. In 2004, US Centers for Disease Control and Prevention office in Kenya (CDC Kenya) established the Global Disease Detection Division of which one core component was to support, with other partners, the One Health approach to public health science. After catalytic events such as the global expansion of highly pathogenic H5N1 and the 2006 East African multi-country outbreaks of Rift Valley Fever, CDC Kenya supported key Kenya government institutions including the Ministry of Health and the Ministry of Agriculture, Livestock, and Fisheries to establish a framework for multi-sectoral collaboration at national and county level and a coordination office referred to as the Zoonotic Disease Unit (ZDU). The ZDU has provided Kenya with an institutional framework to highlight the public health importance of endemic and epidemic zoonoses including RVF, rabies, brucellosis, Middle East Respiratory Syndrome Coronavirus, anthrax and other emerging issues such as anti-microbial resistance through capacity building programs, surveillance, workforce development, research, coordinated investigation and outbreak response. This has led to improved outbreak response, and generated data (including discovery of new pathogens) that has informed disease control programs to reduce burden of and enhance preparedness for endemic and epidemic zoonotic diseases, thereby enhancing global health security. Since 2014, the Global Health Security Agenda implemented through CDC Kenya and other partners in the country has provided additional impetus to maintain this effort and Kenya’s achievement now serves as a model for other countries in the region. Significant gaps remain in implementation of the One Health approach at subnational administrative levels; there are sustainability concerns, competing priorities and funding deficiencies.
- Published
- 2019
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