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The 2017 plague outbreak in Madagascar was unprecedented in the African region, resulting in 2417 cases (498 confirmed, 793 probable and 1126 suspected) and 209 deaths by the end of the acute urban pneumonic phase of the outbreak. The Health Emergencies Programme of the WHO Regional Office for Africa together with the WHO Country Office and WHO Headquarters assisted the Ministry of Public Health of Madagascar in the rapid implementation of plague prevention and control measures while collecting and analysing quantitative and qualitative data to inform immediate interventions. We document the key findings of the evidence available to date and actions taken as a result. Based on the four goals of operational research - effective dissemination of results, peer-reviewed publication, changes to policy and practice and improvements in programme performance and health - we evaluate the use of evidence to inform response to the outbreak and describe lessons learned for future outbreak responses in the WHO African region. This article may not be reprinted or reused in any way in order to promote any commercial products or services. [ABSTRACT FROM AUTHOR]

Since January 2010 prospective strain typing on all positive TB samples able to be cultured has occurred. Recent infection is presumed if the strain of TB isolated from the case is indistinguishable from one or more others in the population studied. Recently infected cases are likely to be part of clusters. All data are currently preliminary. In London from January to September 2010, 2679 cases were reported to the London TB Register, 36% of which were culture confirmed. Of those that were culture confirmed 37% were in a cluster. Adults were more likely to be culture confirmed than children (37% vs 23%). While children may be less likely to be culture confirmed, those who were culture confirmed were more likely to be clustered (and so recently infected). Comparing children (0-15 year olds) to young adults (16-24 year olds), 70% compared to 40% were clustered (OR 3.49, p=0.003). Overall more clustering was noted among males (39% vs 33%, OR 1.28, p=0.08), white (40%) and black-Caribbean (47%) ethnic groups, UK born cases (42% vs 36%), and those with pulmonary (45% vs 30%) and sputum smear positive disease (56% vs 38%). More clustering was seen with those who had social risk factors: history of drug use (46%), homelessness (49%), imprisonment (47%), and alcohol abuse (46%). The majority were in clusters with <5 cases and therefore did not reach the HPA cluster investigation threshold of =5 cases in 24 months. Data will be presented for the entirety of 2010, therefore numbers are subject to change. [ABSTRACT FROM AUTHOR]

Objectives: Tuberculosis (TB) is a serious re-emergent public health problem in the UK. In response to rising case incidence a National TB Strain-Typing Service based on molecular strain-typing was established. This facilitates early detection and investigation of clusters, targeted public health action, and prevention of further transmission. We review the added public health value of investigating molecular TB strain-typed (ST) clusters., Methods: A structured questionnaire for each ST cluster investigated in England between 1 January 2010 and 30 June 2013 was completed. Questions related to epidemiological links and public health action and the perceived benefits of ST cluster investigation., Results: There were 278 ST cluster investigations (CIs) involving 1882 TB cases. Cluster size ranged from 2 to 92. CIs identified new epidemiological links in 36% of clusters; in 18% STs were discordant refuting transmission thought to have occurred. Additional public health action was taken following 23% of CI., Conclusions: We found positive benefits of TB molecular ST and CI, in identifying new epidemiological links between cases and taking public health action and in refuting transmission and saving resources. This needs to be translated to a decrease in transmission to provide evidence of public health value in this low prevalence high resource setting., (Copyright © 2019. Published by Elsevier Ltd.)

Objectives: Lassa fever (LF), a priority emerging pathogen likely to cause major epidemics, is endemic in much of West Africa and is difficult to distinguish from other viral hemorrhagic fevers, including Ebola virus disease (EVD). Definitive diagnosis requires laboratory confirmation, which is not widely available in affected settings. The public health action to contain a LF outbreak and the challenges encountered in an EVD-affected setting are reported herein., Methods: In February 2016, a rapid response team was deployed in Liberia in response to a cluster of LF cases. Active case finding, case investigation, contact tracing, laboratory testing, environmental investigation, risk communication, and community awareness raising were undertaken., Results: From January to June 2016, 53 suspected LF cases were reported through the Integrated Disease Surveillance and Response system (IDSR). Fourteen cases (26%) were confirmed for LF, 14 (26%) did not have a sample tested, and 25 (47%) were classified as not a case following laboratory analysis. The case fatality rate in the confirmed cases was 29%. One case of international exportation was reported from Sweden. Difficulties were identified in timely specimen collection, packaging, and transportation (in confirmed cases, the time from sample collection to sample result ranged from 2 to 64 days) and a lack of response interventions for early cases., Conclusions: The delay in response to this outbreak could have been related to a number of challenges in this EVD-affected setting: a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams, and build laboratory capacity. Prioritizing these actions will aid in the timely response to future outbreaks., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)