"This is most likely not the correct vaccine": Analyzing COVID-19's viral spread and vaccine anxieties in Ghana, Cameroon, and Malawi.

Following the successful development of vaccines for COVID-19, attention turned to the problem of vaccine access. However, in contexts where vaccines are available, hesitancy remains a major problem. Informed theoretically by the scholarship on vaccine anxiety, this paper uses a qualitative research approach that included 144 semi-structured interviews to investigate how social and political dynamics shaped people's perspectives in particular environments in Ghana, Cameroon, and Malawi about COVID-19's viral spread and COVID-19 vaccines. Vaccines and the viral spread of COVID-19 are related to political tensions and class-related fractures in particular contexts, and how the public interprets COVID-19's viral spread and engages with vaccination is based on people's social and political environment and their experience. Subjectivities are also rooted in coloniality. Vaccine confidence goes beyond clinical and regulatory authority approvals, and encompasses forces that are economic, social, and political in nature. Thus, an exclusive focus on technical prescriptions for enhancing vaccine uptake will not achieve significant positive results.

Spread of SARS-CoV-2 Infection in Adult Populations in Cameroon: A Repeated Cross-Sectional Study Among Blood Donors in the Cities of Yaoundé and Douala.

Over a period of about 9 months, we conducted three serosurveys in the two major cities of Cameroon to determine the prevalence of SARS-COV-2 antibodies and to identify factors associated with seropositivity in each survey. We conducted three independent cross-sectional serosurveys of adult blood donors at the Central Hospital in Yaoundé (CHY), the Jamot Hospital in Yaoundé (JHY) and at the Laquintinie Hospital in Douala (LHD) who consented in writing to participate. Before blood sampling, a short questionnaire was administered to participants to collect their sociodemographic and clinical characteristics. We included a total of 743, 1202, and 1501 participants in the first (January 25-February 15, 2021), second (May 03-28, 2021), and third (November 29-December 31, 2021) surveys, respectively. The adjusted seroprevalence increased from 66.3% (95% CrI 61.1-71.3) in the first survey to 87.2% (95% CrI 84.0-90.0) in the second survey, and 98.4% (95% CrI 96.8-99.7) in the third survey. In the first survey, study site, participant occupation, and comorbid conditions were associated with SARS-CoV-2 seropositivity, whereas only study site remained associated in the second survey. None of the factors studied was significantly associated with seropositivity in the third survey. Together, the data suggest a rapid initial spread of SARS-CoV-2 in the study population, independent of the sociodemographic parameters assessed.

Epidemiological situation of SARS-CoV-2 infection in Douala, the most populated and highly heterogeneous town of Cameroon: a post-vaccination update.

This study aimed at providing an update of SARS-CoV-2 epidemiology in Douala, the most populated and highly heterogeneous town of Cameroon. A hospital-based cross sectional study was conducted from January to September 2022. A questionnaire was used to collect sociodemographic, anthropometric, and clinical data. Retrotranscriptase quantitative polymerase chain reaction was used to detect SARS-CoV-2 in nasopharyngeal samples. Of the 2354 individuals approached, 420 were included. The mean age of patients was 42.3 ± 14.4 years (range 21 - 82). The prevalence of SARS-CoV-2 infection was 8.1%. The risk of infection with SARS-CoV-2 was increased more than seven times in patients aged ≥ 70 years old (aRR = 7.12, p = 0.001), more than six times in married (aRR = 6.60, p = 0.02), more than seven times in those having completed secondary studies (aRR = 7.85, p = 0.02), HIV-positive patients (aRR = 7.64, p < 0.0001) and asthmatic patients (aRR = 7.60, p = 0.003), and more than nine times in those seeking health care regularly (aRR = 9.24, p = 0.001). In contrast, the risk of SARS-CoV-2 infection was reduced by 86% in patients attending Bonassama hospital (aRR = 0.14, p = 0.04), by 93% in patients of blood group B (aRR = 0.07, p = 0.04), and by 95% in COVID-19 vaccinated participants (aRR = 0.05, p = 0.005). There is need for ongoing surveillance of SARS-CoV-2 in Cameroon, given the position and importance of Douala.

Viral co-infection with human respiratory syncytial virus in suspected acute and severe respiratory tract infections during COVID-19 pandemic in Yaoundé, Cameroon, 2020-2021.

BACKGROUND: Acute lower respiratory tract infections (ALRIs) are one one of the leading causes of morbidity and mortality among people of all ages worldwide, particularly in low- and middle-income countries (LMICs). The purpose of this study was to determine epidemiological characteristics of respiratory viruses in acute respiratory infection (ARI) patients during the COVID-19 pandemic in Yaoundé, Cameroon. METHODS: Patients were monitored for respiratory symptoms as part of the surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viral infections. Patients of all ages with respiratory symptoms less than 5 days were considered. Sociodemographic and clinical data as well as nasopharyngeal samples was collected from patients. Nasopharyngeal samples were tested for SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) using real-time reverse-transcription polymerase chain reaction methods. Virus distribution and demographic data were analyzed with R version 2.15.1. RESULTS: From July 2020 to October 2021, 1120 patients were included. The overall viral detection rate was 32.5%, including 9.5% for RSV, 12.6% for influenza virus and 12.8% for SARS-CoV-2. Co-infections were detected in 6.9% of positive cases. While RSV and influenza virus showed seasonal trends, SARS-CoV-2 was detected throughout the study period. CONCLUSION: We found that during COVID-19 pandemic, respiratory viruses play an important role in etiology of influenza-like illness in Cameroon, and this observation was true for patients of all ages.

Facility-led community based approach in Mamfe health district, Cameroon: a differentiated service delivery option in complex humanitarian settings.

BACKGROUND: The government of Cameroon's 2017 operational guidelines for the implementation of the "test and treat" strategy expressly incorporates and prescribes the differentiated service delivery (DSD) model with testing and treatment services being decentralized and task shifted at community level. However, express guidance on DSD approach in conflict situations, characterized by pressure on existing health systems remains a limitation. The outbreak of COVID-19 further confounded humanitarian responses for fear of spread. Facility-led community-based approach (FLCBA) was employed as a model of care in addressing DSD for HIV in conflict-affected settings within the COVID-19 context. METHODS: A retrospective quantitative cross-sectional study was conducted in Mamfe District Hospital. Descriptive statistics was used to evaluate the implementation of FLCBA as a DSD model from April 2021 to June 2022 along the clinical cascades. Data were collected using a chart abstraction template from the respective registers. Analyses were done using Microsoft excel 2010. RESULTS: In 15 months, a total number of 4707 (2142 males, 2565 females) people were screened for HIV and 3795 (1661 males, 2134 females) eligible individuals were tested. Out of the 11 targeted health areas, 208 (5.5%) new positive cases were identified, all (100%) of whom were linked to care and treatment. During this period, 61% (34/55) targeted missing clients were tracked through this means among which 31 were defaulters and 3 LTFU. Of the 196 target clients for FLCBA, eligible for viral load sample collection, 142 (72%) samples were collected. CONCLUSIONS: The FLCBA as an integral primary health care delivery package is an efficient and effective variant of DSD for conflict settings; however it requires bravery of health care providers.

Pre-existing immunity to SARS-CoV-2 before the COVID-19 pandemic era in Cameroon: A comparative analysis according to HIV-status.

Background: The lower burden of COVID-19 in tropical settings may be due to preexisting cross-immunity, which might vary according to geographical locations and potential exposure to other pathogens. We sought to assess the overall prevalence of SARS-CoV-2 antibodies and determine SARS-CoV-2 seropositivity according to HIV-status before the COVID-19 pandemic era. Methods: A cross-sectional and comparative study was conducted at the Chantal BIYA International Reference Centre (CIRCB) on 288 stored plasma samples (163 HIV-positive versus 125 HIV-negative); all collected in 2017-2018, before the COVID-19 pandemic era. Abbott Panbio™ COVID-19 IgG/IgM assay was used for detecting SARS-CoV-2 immunoglobulin G (IgG) and M (IgM). Among people living with HIV (PLHIV), HIV-1 viral load and TCD4 cell count (LTCD4) were measured using Abbott Real Time PCR and BD FACSCalibur respectively. Statistical analyses were performed, with p<0.05 considered statistically significant. Results: The median [IQR] age was 25 [15-38] years. Overall seropositivity to SARS-CoV-2 antibodies was 13.5% (39/288) of which 7.3% (21) was IgG, 7.3% (21) IgM and 1.0% (3) IgG/IgM. According to HIV-status in the study population, SARS-CoV-2 seropositivity was 11.0% (18/163) among HIV-positive versus 16.8% (21/125) among HIV-negative respectively, p=0.21. Specifically, IgG was 6.1% (10/163) versus 8.8% (11/125), p=0.26; IgM was 5.5% (9/163) versus 9.6%, (12/125), p=0.13 and IgG/IgM was 0.6% (1/163) versus 1.6% (2/125) respectively. Among PLHIV, SARS-CoV-2 seropositivity according to CD4 count was 9.2% (≥500 cells/µL) versus 1.8% (200-499 cells/µL), (OR=3.5; p=0.04) and 0.6% (<200 cells/µL), (OR=17.7; p<0.01). According to viral load, SARS-CoV-2 seropositivity was 6.7% (≥40 copies/mL) versus 4.9% (<40 copies/mL), (OR= 3.8; p<0.01). Conclusion: Before COVID-19 in Cameroon, cross-reactive antibodies to SARS-CoV-2 were in circulation, indicating COVID-19 preexisting immunity. This preexisting immunity may contribute in attenuating disease severity in tropical settings like Cameroon. Of relevance, COVID-19 preexisting immunity is lower with HIV-infection, specifically with viral replication and poor CD4-cell count. As poor CD4-count leads to lower cross-reactive antibodies (regardless of viral load), people living with HIV appear more vulnerable to COVID-19 and should be prioritized for vaccination.

Insights into Predictors of Vaccine Hesitancy and Promoting Factors in Childhood Immunization Programs-A Cross-Sectional Survey in Cameroon.

BACKGROUND: Vaccination is claimed to be a key intervention against the COVID-19 pandemic. A major challenge today is to increase vaccine acceptance as vaccine hesitancy has delayed the eradication of polio. This study aimed to identify predictors associated with vaccine acceptance in the context of the Expanded Program on Immunization among parents of children between the ages of 12 to 23 months in the Foumbot district, Cameroon. METHODS: The design of this study is a cross-sectional survey. A total of 160 mothers of children between the ages of 12 to 23 months were selected using a simple random sampling technique. A pre-tested structured questionnaire was used for data collection. Incomplete vaccination status was considered "vaccine hesitancy". Data was analyzed along with 95% confidence intervals and the p-value < 0.05. The results showed 60% vaccine acceptance and 40% vaccine hesitancy. Factors such as age-appropriate vaccination, knowledge of vaccine-preventable diseases (VPD), and religion were associated with vaccine acceptance. CONCLUSION: Poor knowledge of VPDs is a matter of concern as it contributes to vaccine hesitancy. The study findings provide the basis to heighten health education, the public perceived threat of the VPDs, and the consequences if no measures are taken to ensure health.

Comparative Performance of Serological (IgM/IgG) and Molecular Testing (RT-PCR) of COVID-19 in Three Private Universities in Cameroon during the Pandemic.

BACKGROUND: COVID-19 remains a rapidly evolving and deadly pandemic worldwide. This necessitates the continuous assessment of existing diagnostic tools for a robust, up-to-date, and cost-effective pandemic response strategy. We sought to determine the infection rate (PCR-positivity) and degree of spread (IgM/IgG) of SARS-CoV-2 in three university settings in Cameroon Method: Study volunteers were recruited from November 2020 to July 2021 among COVID-19 non-vaccinated students in three Universities from two regions of Cameroon (West and Centre). Molecular testing was performed by RT-qPCR on nasopharyngeal swabs, and IgM/IgG antibodies in plasma were detected using the Abbott Panbio IgM/IgG rapid diagnostic test (RDT) at the Virology Laboratory of CREMER/IMPM/MINRESI. The molecular and serological profiles were compared, and p < 0.05 was considered statistically significant. RESULTS: Amongst the 291 participants enrolled (mean age 22.59 ± 10.43 years), 19.59% (57/291) were symptomatic and 80.41% (234/291) were asymptomatic. The overall COVID-19 PCR-positivity rate was 21.31% (62/291), distributed as follows: 25.25% from UdM-Bangangte, 27.27% from ISSBA-Yaounde, and 5% from IUEs/INSAM-Yaounde. Women were more affected than men (28.76% [44/153] vs. 13.04% [18/138], p < 0.0007), and had higher seropositivity rates to IgM+/IgG+ (15.69% [24/153] vs. 7.25% [10/138], p < 0.01). Participants from Bangangté, the nomadic, and the "non-contact cases" primarily presented an active infection compared to those from Yaoundé (p= 0.05, p = 0.05, and p = 0.01, respectively). Overall IgG seropositivity (IgM-/IgG+ and IgM+/IgG+) was 24.4% (71/291). A proportion of 26.92% (7/26) presenting COVID-19 IgM+/IgG- had negative PCR vs. 73.08% (19/26) with positive PCR, p < 0.0001. Furthermore, 17.65% (6/34) with COVID-19 IgM+/IgG+ had a negative PCR as compared to 82.35% with a positive PCR (28/34), p < 0.0001. Lastly, 7.22% (14/194) with IgM-/IgG- had a positive PCR. CONCLUSION: This study calls for a rapid preparedness and response strategy in higher institutes in the case of any future pathogen with pandemic or epidemic potential. The observed disparity between IgG/IgM and the viral profile supports prioritizing assays targeting the virus (nucleic acid or antigen) for diagnosis and antibody screening for sero-surveys.

Evaluation of archived drug resistance mutations in HIV-1 DNA among vertically infected adolescents under antiretroviral treatment in Cameroon: Findings during the COVID-19 pandemic.

BACKGROUND: With the success of antiretroviral therapy (ART), children born with HIV are more likely to reach adolescence. However, frequent non-adherence to ART in adolescents living with HIV (ALHIV) leads to viral replication. Notably, a viraemic infection might lead to archived drug resistance mutations (ADRMs). Hence, within the context of the COVID-19 pandemic, we aimed to compare the patterns of ADRMs in viraemic and non-viraemic vertically infected ALHIV and to assess their immunity to and diagnosis of SARS-CoV-2. METHODS: A comparative study was conducted among COVID-19-unvaccinated ALHIV receiving ART in Yaoundé-Cameroon over the period October 2021 to March 2022. Plasma HIV-RNA was measured using Abbott® m2000rt; HIV-1 genotyping was performed on buffy-coat (HIV-1 DNA) and ADRMs were interpreted using HIVdb.v9.0.1. Patterns of HIV-1 ADRMs were compared between viraemic (≥ 1.60 log10 HIV-1 RNA copies/ml) and non-viraemic (< 1.60 log10 copies/ml) individuals. SARS-CoV-2 antibodies were assessed on whole blood using Abbott Panbio COVID-19 immunoglobulin G/M (IgG/IgM) rapid test and COVID-19 polymerase chain reaction test was performed using nasopharyngeal swab samples. RESULTS: Of the 60 ALHIV [aged 17 (16-19) years, 51.6% female], median ART duration was 14 (12-16) years; 31/55 (56.3%) were exposed to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART (of whom 19/31 transitioned to dolutegravir-based ART in 2020) and 24/55 (43.6%) were on second-line ART. Forty-two out of 60 (70.0%) ALHIV were non-viraemic; 43/60 (71.6%) were successfully sequenced. Overall the ADRM rate was 62.7% (27/43), with 69.2% (9/13) viraemic and 60.0% (18/30) non-viraemic (p = 0.56). NNRTI-ADRMs were significantly higher among viraemic ALHIV (69.2% vs. 46.7%, p = 0.030). Regarding immunity, those with CD4 nadir < 350 cells/µl had significantly higher rates of ADRMs [adjusted odds ratio (aOR) = 3.20 (1.36-95.53), p = 0.03]. In relation to COVID-19 immunity, overall SARS-CoV-2 IgG seropositivity was 28.3% (17/60), whereas 0% (0/60) were seropositive to IgM; in particular, those with CD4 count nadir ≥ 350 cells/µl had higher odds of SARS-CoV-2 IgG seropositivity [OR =7.85 (2.03-30.28), p < 0.01]. No significant association was found between SARS-CoV-2 IgG seropositivity and HIV-RNA (non-viraemic, 33.3%; viraemic, 16.7%; p = 0.18). SARS-CoV-2 RNA prevalence was 4.5% (2/44). The two positive participants were with low-levels of viral load (Ct > 30) and seropositive to IgG. CONCLUSION: In the context of virological success, the majority of ALHIV harbour ADRMs, essentially driven by NNRTI mutations and low CD4 nadir. During the current pandemic, about one-third of ALHIV were previously exposed to SARS-CoV-2. However, some children might have been exposed and uninfected and others might have been infected but showed no serological response at sampling. These findings support the use of NNRTI-sparing regimens and the implementation of COVID-19 barrier measures targeting ALHIV during such a pandemic.

Coronaviruses Are Abundant and Genetically Diverse in West and Central African Bats, including Viruses Closely Related to Human Coronaviruses.

Bats are at the origin of human coronaviruses, either directly or via an intermediate host. We tested swabs from 4597 bats (897 from the Democratic Republic of Congo (DRC), 2191 from Cameroon and 1509 from Guinea) with a broadly reactive PCR in the RdRp region. Coronaviruses were detected in 903 (19.6%) bats and in all species, with more than 25 individuals tested. The highest prevalence was observed in Eidolon helvum (239/733; 39.9%) and Rhinolophus sp. (306/899; 34.1%), followed by Hipposideros sp. (61/291; 20.9%). Frugivorous bats were predominantly infected with beta coronaviruses from the Nobecovirus subgenus (93.8%), in which at least 6 species/genus-specific subclades were observed. In contrast, insectivorous bats were infected with beta-coronaviruses from different subgenera (Nobecovirus (8.5%), Hibecovirus (32.8%), Merbecovirus (0.5%) and Sarbecovirus (57.6%)) and with a high diversity of alpha-coronaviruses. Overall, our study shows a high prevalence and genetic diversity of coronaviruses in bats and illustrates that Rhinolophus bats in Africa are infected at high levels with the Sarbecovirus subgenus, to which SARS-CoV-2 belongs. It is important to characterize in more detail the different coronavirus lineages from bats for their potential to infect human cells, their evolution and to study frequency and modes of contact between humans and bats in Africa.

Face mask ownership/utilisation and COVID-19 vaccine hesitancy amongst patients recovering from COVID-19 in Cameroon: A cross-sectional study.

INTRODUCTION: This study aimed to establish pre-/post Coronavirus Disease 2019 (COVID-19) diagnosis/treatment symptoms, ownership/utilisation of face masks (FMs), as well as vaccine hesitancy (VH) amongst patients recovering from COVID-19. METHODS: A cross-sectional survey was conducted from April - October 2021. Data was collected with structured self-administered questionnaires. Multinomial regression was used to determine associations between ownership/utilisation of FMs with respondents' characteristics. RESULTS: Unproductive cough and fatigue were prevalent before and after treatment. Pre-/Post COVID-19 symptoms severity ranged from mild to moderate. There was a COVID-19 VH rate of 492 (74%). The prevalence of FM ownership and utilisation were, respectively, 613 (92.2%) and 271 (40.8%). One main factor was associated with FM ownership; respondent's sex (p; 5.5x10-2, OR; 0.5, 95%C.I; 0.3 - 1.0). The main reasons for irregular utilisation were; inability to be consistent, only used outdoors, and boredom. CONCLUSION: The treatment of COVID-19 does not mean immediate recovery as mild to moderate grade severity still persists. Face mask availability and ownership does not mean appreciable utilisation. This study advocates for an intensification of COVID-19 preventive practices, as well as elaborate education on the importance of vaccination.

Assessing core capacities for addressing public health emergencies of international concern at designated points of entry in cameroon during the COVID-19 Pandemic.

BACKGROUND: Points of Entry (POEs) are at the frontline for prevention, detection and response to international spread of diseases. The objective of this assessment was to ascertain the current level of existing International Health Regulations (IHR) core capacities of designated airports, ports and ground crossings in Cameroon and identify critical gaps for capacity building for prevention, early warning and response to public health threats including COVID-19. METHODS: Data were collected from April to May 2020 in 5 designated POEs: Yaounde Nsimalen International Airport (YIA), Douala international Airport (DIA), Douala Autonomous Port (DAP), Garoua-Boulai ground crossing, Kye-Ossi ground crossing which were all selected for their high volume of passenger and goods traffic. The World Health Organization (WHO) assessment tool for core capacity requirements at designated airports, ports and ground crossings was used to collect data on three technical capacities: (i) communication and coordination, (ii) Capacities at all times and (iii) capacities to respond to Public Health Emergencies of International Concern (PHEIC). RESULTS: All the investigated POEs scored below 50% of capacities in place. YIA recorded the highest percentage for all groups of capacities, coordination and communication and for core capacity at all times with a percentage of 42%, 58% and 32% respectively. For core capacity to respond to PHEIC, all the POEs recorded below 50%. The DAP and all ground crossings lacked trained personnel for inspection of conveyances. Only DIA had a public health emergency plan. There is no isolation/quarantine and transport capacity at the POEs. CONCLUSION: All POEs assessed did not meet IHR standards and need significant improvement to fulfill the IHR requirements. Unstructured communication channels between stakeholders make the implementation of IHR challenging. A coordination mechanism, with clear functions and structure, is necessary for well-coordinated response efforts to health emergencies at POEs. This assessment will serve as a baseline to inform planning and IHR implementation at designated POEs in Cameroon.

Diagnostic performance of molecular and serological tests of SARS-CoV-2 on well-characterised specimens from COVID-19 individuals: The EDCTP "PERFECT-study" protocol (RIA2020EF-3000).

BACKGROUND: The SARS-CoV-2 pandemic is a global threat affecting 210 countries, with 2,177,469 confirmed cases and 6.67% case fatality rate as of April 16, 2020. In Africa, 17,243 cases have been confirmed, but many remain undiagnosed due to limited laboratory-capacity, suboptimal performance of used molecular-assays (~30% false negative, Yu et al. and Zhao et al., 2020) and limited WHO-recommended rapid-tests. OBJECTIVES: We aim to implement measures to minimize risks for COVID-19 in Cameroon, putting together multidisciplinary highly-experienced virologists, immunologists, bioinformaticians and clinicians, to achieve the following objectives: (a) to integrate/improve available-infrastructure, methodologies, and expertise on COVID-19. For this purpose, we will create a platform enabling researchers/clinicians to better integrate and translate evidence into the COVID-19 clinical-practice; (b) to enhance capacities in Cameroon for screening/detecting individuals with high-risks of COVID-19, by setting-up effective core-facilities on-site; (c) to validate point-of-care SARS-CoV-2 molecular assays allowing same-day result delivery, thus permitting timely diagnosis, treatment, and retention in care of COVID-19 patients; (d) to implement SARS-CoV-2 diagnosis with innovative/highly sensitive ddPCR-based assays and viral genetic characterization; (e) to validate serological assays to identify COVID-19-exposed persons and follow-up of convalescents. METHODS: This is a prospective, observational study conducted among COVID-19 suspects/contacts during 24 months in Cameroon. Following consecutive sampling of 1,536 individuals, oro/nasopharyngeal swabs and sera will be collected. Well characterised biorepositories will be established locally; molecular testing will be performed on conventional real-time qPCR, point-of-care GeneXpert, antigen-tests and digital droplet PCR (ddPCR); SARS-CoV2 amplicons will be sequenced; serological testing will be performed using ELISA, and antibody-based kits. Sensitivity, specificity, positive- and negative-predictive values will be evaluated. EXPECTED OUTCOMES: These efforts will contribute in creating the technical and clinical environment to facilitate earlier detection of Sars-CoV-2 in Africa in general and in Cameroon in particular. Specifically, the goals will be: (a) to implement technology transfer for capacity-building on conventional and point-of-care molecular assays, achieving a desirable performance for clinical diagnosis of SARS-CoV2; (b) to integrate/improve the available infrastructure, methodologies, and expertise on Sars-CoV2 detection; (c) to improve the turn-around-time for diagnosing COVID-19 infection with obvious advantage for patients/clinical management thanks to low-cost assays, thus permitting timely treatment and retention in care; (d) to assess the epidemiology of COVID-19 and circulating-variants in Cameroon as compared to strains found in other countries.

Individual and healthcare supply-related HIV transmission factors in HIV-positive patients enrolled in the antiretroviral treatment access program in the Centre and Littoral regions in Cameroon (ANRS-12288 EVOLCam survey).

BACKGROUND: Despite great progress in antiretroviral treatment (ART) access in recent decades, HIV incidence remains high in sub-Saharan Africa. We investigated the role of individual and healthcare supply-related factors in HIV transmission risk in HIV-positive adults enrolled in 19 HIV services in the Centre and Littoral regions of Cameroon. METHODS: Factors associated with HIV transmission risk (defined as both unstable aviremia and inconsistent condom use with HIV-negative or unknown status partners) were identified using a multi-level logistic regression model. Besides socio-demographic and behavioral individual variables, the following four HIV-service profiles, identified using cluster analysis, were used in regression analyses as healthcare supply-related variables: 1) district services with large numbers of patients, almost all practicing task-shifting and not experiencing antiretroviral drugs (ARV) stock-outs (n = 4); 2) experienced and well-equipped national reference services, most practicing task-shifting and not experiencing ARV stock-outs (n = 5); 3) small district services with limited resources and activities, almost all experiencing ARV stock-outs (n = 6); 4) small district services with a wide range of activities and half not experiencing ARV stock-outs (n = 4). RESULTS: Of the 1372 patients (women 67%, median age [Interquartile]: 39 [33-44] years) reporting sexual activity in the previous 12 months, 39% [min-max across HIV services: 25%-63%] were at risk of transmitting HIV. The final model showed that being a woman (adjusted Odd Ratio [95% Confidence Interval], p-value: 2.13 [1.60-2.82], p<0.001), not having an economic activity (1.34 [1.05-1.72], p = 0.019), having at least two sexual partners (2.45 [1.83-3.29], p<0.001), reporting disease symptoms at HIV diagnosis (1.38 [1.08-1.75], p = 0.011), delayed ART initiation (1.32 [1.02-1.71], p = 0.034) and not being ART treated (2.28 [1.48-3.49], p<0.001) were all associated with HIV transmission risk. Conversely, longer time since HIV diagnosis was associated with a lower risk of transmitting HIV (0.96 [0.92-0.99] per one-year increase, p = 0.024). Patients followed in the third profile had a higher risk of transmitting HIV (1.71 [1.05-2.79], p = 0.031) than those in the first profile. CONCLUSIONS: Healthcare supply constraints, including limited resources and ARV supply chain deficiency may impact HIV transmission risk. To reduce HIV incidence, HIV services need adequate resources to relieve healthcare supply-related barriers and provide suitable support activities throughout the continuum of care.

COVID-19 vaccine acceptance and perceived risk among pregnant and non-pregnant adults in Cameroon, Africa.

BACKGROUND: The public health response to the global COVID-19 pandemic has varied widely by region. In Africa, uptake of effective COVID-19 vaccines has been limited by accessibility and vaccine hesitancy. The aim of this study was to compare perceptions of COVID-19 infection and vaccination between pregnant women and non-pregnant adults in four regions of Cameroon, located in Central Africa. METHODS: A cross-sectional survey study was conducted at urban and suburban hospital facilities in Cameroon. Participants were randomly selected from a convenience sample of adult pregnant and non-pregnant adults in outpatient clinical settings between June 1st and July 14th, 2021. A confidential survey was administered in person by trained research nurses after obtaining written informed consent. Participants were asked about self-reported sociodemographics, medical comorbidities, perceptions of COVID-19 infection, and vaccination. Descriptive statistics were used for survey responses and univariate and multivariable logistic regression models were created to explore factors associated with COVID-19 vaccine acceptability. RESULTS: Fewer than one-third of participants were interested in receiving the COVID-19 vaccine (31%, 257/835) and rates did not differ by pregnancy status. Overall, 43% of participants doubted vaccine efficacy, and 85% stated that the vaccine available in Africa was less effective than vaccine available in Europe. Factors independently associated with vaccine acceptability included having children (aOR = 1.5; p = 0.04) and higher education (aOR = 1.6 for secondary school vs primary/none; p = 0.03). Perceived risks of vaccination ranged from death (33%) to fetal harm (31%) to genetic changes (1%). Health care professionals were cited as the most trusted source for health information (82%, n = 681). CONCLUSION: COVID-19 vaccine hesitancy and misinformation in Cameroon was highly prevalent among pregnant and non-pregnant adults in 2021 while vaccine was available but not recommended for use in pregnancy. Based on study findings, consistent public health messaging from medical professionals about vaccine safety and efficacy and local production of vaccine are likely to improve acceptability.

Factors associated with routine vaccination card retention among children aged 0-59 months in Yaounde-Cameroon: A cross-sectional survey.

BACKGROUND: The routine vaccination card is an important health record for children, but recent findings suggest that vaccination card retention in Cameroon is low, varying from 29%-53%. The aim of this study was to assess factors associated with children's routine vaccination card retention in Cameroon. METHODS: This cross-sectional survey was conducted in Yaoundé in November 2021, targeting children aged 0-59 months. Participants were selected using a 2-stage systematic cluster sampling in which households were selected by a restricted sampling technique. Data were collected by interviewing the children's parents/guardians, and a vaccination card was said to be retained if it was presented to the interviewer by the interviewees. Data were analysed using multiple logistics regression with R version 4.1.0 (2021-05-18). FINDINGS: A total of 529 households were assessed with 361 children aged 0-59 months enrolled: 51% girls and 49% boys. Children aged 0-11 months represented 24.4% of all participants, and children aged 12-59 months were 74.6%. Vaccination card retention was 24% (87), and positive predictors of card retention included: girl child (adjusted Odds Ratio = 1.34, p-value = 0.0269), the respondent being one of the biological parents of the child: mother (adjusted Odds Ratio = 5.97, p-value = 0.0034) or father(adjusted Odds Ratio = 4.69, p-value = 0.0067), and living in a richer household (adjusted Odds Ratio = 1.56, p-value = 0.038). On the other hand, negative predictors of card retention were: child aged 12-23 months (adjusted Odds Ratio = 0.44, p-value = 0.0209) or aged 24-59months (adjusted Odds Ratio = 0.13, p-value = 0.0000), and having an employed mother (adjusted Odds Ratio = 0.34, p-value = 0.0066). CONCLUSION: Vaccination card retention in children aged 0-59 months in Yaoundé is low when compared with findings reported by studies from other locations in Cameroon. Besides, the poor and older children have lower odds of keeping routine vaccination cards. There is a need to design interventions to improve vaccination card retention, which considers household wealth and the age of the child.

Challenges, best practices, and lessons learned from oral cholera mass vaccination campaign in urban Cameroon during the COVID-19 era.

BACKGROUND: Since 1971, Cameroon has been facing an ever-growing series of cholera epidemics; despite all the efforts made by the government to address this substantial public health problem. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 5.3% following epidemics noted in the South, Littoral, and South-West regions which is far higher than the 1% World Health Organization acceptable rate. METHODOLOGY/PRINCIPAL FINDINGS: The Ministry of Public Health organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts. The first round was in August 2020 and the second in March 2021. We conducted a cross-sectional study and reviewed this vaccination campaign's challenges, best practices, and lessons. The vaccination coverage for the two doses of the oral cholera vaccine was 80.4%, with a refusal rate as high as 67%. People 20 years and above recorded the lowest vaccination coverage. The main challenge was misinformation about the cholera vaccine. The best practice was thorough population sensitization through community actors. CONCLUSION: Proper communication will always brave the odds of hesitancy and favor mass population vaccination to thwart hesitancy and consolidate herd immunity.

Rapid Increase of Community SARS-CoV-2 Seroprevalence during Second Wave of COVID-19, Yaoundé, Cameroon.

We conducted 2 independent population-based SARS-CoV-2 serosurveys in Yaoundé, Cameroon, during January 27-February 6 and April 24-May 19, 2021. Overall age-standardized SARS-CoV-2 IgG seroprevalence increased from 18.6% in the first survey to 51.3% in the second (p<0.001). This finding illustrates high community transmission during the second wave of COVID-19.

Reactive mass vaccination campaign against cholera in the COVID-19 context in Cameroon: challenges, best practices and lessons learned.

INTRODUCTION: since 1971, Cameroon is facing a growing series of cholera epidemics despite all the efforts made by the government to address this huge public health threat. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 4.3% following epidemics noted in the South, Littoral and South-West regions. The Cameroon Ministry of Public Health, has thus organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts of those regions. The objective of this study was to describe the challenges, best practices and lessons learned drawing from daily experiences from this reactive vaccination campaign against cholera. METHODS: we conducted a cross-sectional study drawn from the results of the campaign. We had a target population of 631,109 participants aged 1 year and above resident of the targeted health areas. RESULTS: the overall vaccination coverage was 64.4% with a refusal rate ranging from 0-10% according to health districts. Vaccination coverage was the lowest among people aged 20 years and above. The main challenge was difficulty maintaining physical distanciation, the main best practice was the screening of all actors taking part at the vaccination against COVID-19 and we found that emphasizing on thorough population sensitization through quarter heads and social mobilizers and adequately programming the campaign during a good climate season is crucial to achieving good vaccination coverage. CONCLUSION: lessons learned from this study could serve to inform various agencies in the event of planning rapid mass vaccination programs during pandemics.

COVID-19 perceptions and vaccine hesitancy: Acceptance, attitude, and barriers among Cameroonians.

BACKGROUND: Information about Cameroonians' views toward coronavirus disease 2019 (COVID-19) and amenability to receiving a vaccine is emerging. Learning more about Cameroonians' vaccine perspectives could guide prevention messaging and facilitate optimal communication modalities. OBJECTIVES: The primary objective of this study was to analyze the willingness to receive a COVID-19 vaccine among Cameroonians, pending availability. The secondary objectives were to assess perceptions of COVID-19's origin and to gauge views toward government-mandated vaccinations. METHODS: An 11-item questionnaire queried Cameroonians in-person and online, from March through May 2021, about their demographics and whether they believed that COVID-19 was man-made, whether COVID-19 vaccinations should be governmentally mandated, and whether they would receive a COVID-19 vaccine, if available. A free-text option inviting rationales for COVID-19 vaccine hesitancy was included. In-person participation took place on the grounds of St. Louis University in Douala, Cameroon, and was restricted to participants lacking Internet access or electronic mobile devices. Online participation included use of an electronic link that contained questionnaire content located within Google Forms. RESULTS: A total of 591 respondents participated by replying to at least 8 items on the questionnaire, 386 online and 205 in-person. Over 80% stated that they previously received a seasonal influenza vaccine. Roughly, 87% reported unwillingness to receive a COVID-19 vaccine, if available. Approximately 95% of respondents disagreed with governmental mandates on COVID-19 vaccinations. About 75% attributed COVID-19 to man-made as opposed to natural beginnings. Seven respondents' free-text comments cited lacking confidence in a COVID-19 vaccine, discriminatory COVID-19 vaccine distribution patterns in other parts of the world relative to Africa, and improper COVID-19 vaccine approval timeline. CONCLUSION: Raising awareness of COVID-19 misconceptions and barriers to vaccine acceptance is integral to accomplishing immunization goals. Cameroonians' pessimism in this study toward COVID-19 vaccination was multifaceted. Our findings signal a need for additional research that requests more qualitative insights, for example, interviews, focus groups, into vaccine aversion.