Insights and progress on epidemic characteristics, genotyping, and preventive measures of PEDV in China: A review.

Porcine Epidemic Diarrhoea (PED) is an acute, extremely infectious intestinal disease of pigs caused by the Porcine Epidemic Diarrhoea Virus (PEDV). The virus can affect pigs of all breeds and age groups and shows varying degrees of symptoms, with piglets, in particular, being infected with mortality rates of up to 100%. PEDV was first identified in China in the 1980s and in October 2010 a large-scale PED outbreak caused by a variant of PEDV occurred in China, resulting in huge economic losses. Initially, vaccination can effectively prevent the classical strain, but since December 2010, the PEDV variant has caused "persistent diarrhoea" with severe vomiting, watery diarrhoea, and high morbidity and mortality in newborn piglets as the dominant clinical features, with a significant increase in morbidity and mortality. This indicates that PEDV strains have mutated during evolution and that traditional vaccines no longer provide effective cross-immune protection, so it is necessary to optimize immunization programs and find effective treatments through epidemiological surveys of PEDV to reduce the economic losses caused by infections with mutated strains. This article reviews the progress of research on the aetiology, epidemiological characteristics, genotyping, pathogenesis, transmission routes, and comprehensive control of PEDV infection in China.

Prevalence of bovine coronavirus in cattle in China: A systematic review and meta-analysis.

Bovine coronavirus (BCoV) is one of the important pathogens that cause calf diarrhea (CD), winter dysentery (WD), and the bovine respiratory disease complex (BRDC), and spreads worldwide. An infection of BCoV in cattle can lead to death of young animals, stunted growth, reduced milk production, and milk quality, thus bringing serious economic losses to the bovine industry. Therefore, it is necessary to prevent and control the spread of BCoV. Here, a systematic review and meta-analysis was conducted to assess the prevalence of BCoV in cattle in China before 2022. A total of 57 articles regarding the prevalence of BCoV in cattle in China were collected from five databases (PubMed, ScienceDirect, CNKI, VIP, and Wan Fang). Based on the inclusion criteria, a total of 15,838 samples were included, and 6,136 were positive cases. The overall prevalence of BCoV was 30.8%, with the highest prevalence rate (60.5%) identified in South China and the lowest prevalence (15.6%) identified in Central China. We also analyzed other subgroup information, included sampling years, sample sources, detection methods, breeding methods, age, type of cattle, presence of diarrhea, and geographic and climatic factors. The results indicated that BCoV was widely prevalent in China. Among all subgroups, the sample sources, detection methods, breeding methods, and presence or absence of diarrheal might be potential risk factors responsible for BCoV prevalence. It is recommended to strengthen the detection of BCoV in cattle, in order to effectively control the spread of BCoV.

Identification and Characterization of Cell Lines HepG2, Hep3B217 and SNU387 as Models for Porcine Epidemic Diarrhea Coronavirus Infection.

Porcine epidemic diarrhea virus (PEDV), a member of the genera alphacoronavirus, causes acute watery diarrhea and dehydration in suckling piglets and results in enormous economic losses in the swine industry worldwide. Identification and characterization of different cell lines are not only invaluable for PEDV entry and replication studies but also important for the development of various types of biological pharmaceuticals against PEDV. In this study, we present an approach to identify suitable permissive cell lines for PEDV research. Human cell lines were screened for a high correlation coefficient with the established PEDV infection model Huh7 based on RNA-seq data from the Cancer Cell Line Encyclopedia (CCLE). Experimentally testing permissiveness towards PEDV infection, three highly permissive human cell lines, HepG2, Hep3B217, and SNU387 were identified. The replication kinetics of PEDV in HepG2, Hep3B217, and SNU387 cells were similar to that in Vero and Huh7 cells. Additionally, the transcriptomes analysis showed robust induction of transcripts associated with the innate immune in response to PEDV infection in all three cell lines, including hundreds of inflammatory cytokine and interferon genes. Moreover, the expression of inflammatory cytokines and interferons were confirmed by qPCR assay. Our findings indicate that HepG2, Hep3B217, and SNU387 are suitable cell lines for PEDV replication and innate immune response studies.

Effect of COVID-19 pandemic on essential health care services and mitigation strategies implemented in Benishangul gumuz: An emerging region of Ethiopia (preprint)

Health systems of low-to-middle-income countries may have fewer buffering resources and capacity against shocks from a pandemic. This study assessed the effects of COVID-19 on essential health care services and its mitigation strategies employed in Benishangul Gumuz Region in the Assosa district of western Ethiopia. Institutional based cross-sectional study design with multilevel triangulated mixed approach was used. Purposively selected health facilities and key informant or in-depth interviewee from different facilities were involved. Document review from health facilities reports and case registration logs were used to access the service utilizations per-and -post the pandemic. The study showed that there was a significant decrement in antenatal care (ANC) visits, family planning new acceptors, family planning repeated acceptors, skilled delivery, and in postnatal care within 7 days of delivery during the COVID-19 pandemic. There was an increase in home delivery, teenage pregnancy and still births. There was also a significant reduction in the vaccination coverage for almost all vaccines. During the pandemic, children treated for diarrheal disease and the number of people screened for human immunodeficiency virus (HIV), new HIV-positive individuals, and new HIV-positive individuals receiving antiretroviral therapy have decreased significantly. There has been a statistically significant increase in the number of people with elevated blood sugar during the pandemic. The COVID-19 pandemic has had a significant negative impact on essential health services, most notably in Benishangul Gumuz Region. Groups of individuals considered to be at higher risks of morbidity and mortality are the most significantly affected. Mitigation strategies have been implemented to address the indirect effects of the COVID-19 pandemic and improve health care delivery in the regions highly affected areas. Urgent and comprehensive action is needed to mitigate the future (long-term) impact of Covid-19 on the health of community in the region.

Analysis of the epidemiological characteristics between 2004 and 2017 and prediction of the changing pattern of other infectious diarrhea (OID) under COVID-19 in China.

The study describes epidemiological features and transmission of other infectious diarrhea (OID) before and during the epidemic of COVID-19 in China, which lays a foundation for OID prevention and control. Incidence rate and mortality data of OID containing detailed epidemiological information such as date, age and region from 2004 to 2017, and total OID case number from 2018 to 2020 were obtained from the Data Center of China's Public Health Science and the National Bureau of Statistics' statistical yearbook. The Joinpoint regression model and Z test was used to analyze, while R language and ArcGIS 10.5 for drawing. The autoregressive integrated moving average model was used to predict the influence of COVID-19 on OID. The OID incidence rate increased from 31.69/10 million in 2004 to 92.42/10 million in 2017, and the mortality rate decreased from 1.82/10,000 to 0.14/10,000. The male to female incidence ratio was 1.39:1 (P < .001). The patients' age showed a decreased trend with age (P < .001). The scattered children devoted the most OID incidence rate. The bimodal distribution of OID incidence was summer peak in northern China, 2 apparent peaks in central and eastern, and winter peak in southern. The autoregressive integrated moving average model predicted 1,406,557 in 2020, comparing the actual OID cases in 2020 to 1,062,277. Affected by the epidemic control measures of COVID-19, the number of OID cases declined by 32.4% (Absolute percentage error = 32.4%). The OID incidence rate in China continuously increased and showed a bimodal distribution in summer and winter with inconspicuous regional characteristics, gender and age susceptibility differences, and occupational differences. Meanwhile, COVID-19 significantly reduced OID incidence in 2020. The discoveries might bring a beneficial effect on OID prevention and control policies.

Prospective cohort study ofCryptosporidiuminfection and shedding in infants and their households (preprint)

ABSTRACT Background Cryptosporidium spp are responsible for significant diarrheal morbidity and mortality in under-five children. There is no vaccine, thus a focus on prevention is paramount. Prior studies suggest that person-to-person spread may be an important pathway for transmission to young children. Here we describe a longitudinal cohort study of 100 families with infants to determine rates of cryptosporidiosis within households during the COVID-19 pandemic. Methods Families living in Mirpur, Bangladesh with one infant age 6-8 months were enrolled and followed with weekly illness survey and stool testing for Cryptosporidium for 8 months. Results From December 2020 to August 2021, 100 families were enrolled. Forty-four percent of index children, and 35% of siblings had at least one Cryptosporidium infection. Shedding of Cryptosporidium occurred for a mean of 19 days (sd 8.3 days) in index infants, 16.1 days (sd 11.6) in children 1-5 years, and 16.2 days (sd 12.8) in adults. A longer duration of Cryptosporidium shedding was associated with growth faltering in infants. There was a spike in Cryptosporidium cases in May 2021, which coincided with a spike in SARS-CoV-2 cases in the region. Conclusion In this intensive, longitudinal study of Cryptosporidium infection in families we found high rates of cryptosporidiosis in infants and children, and prolonged parasite shedding, especially among malnourished children. These data support that transmission within the household is an important route of exposure for young infants, and that treatment of non-diarrheal infection to interrupt person-to-person transmission within the home may be essential for preventing cryptosporidiosis in infants. summary Cryptosporidiosis is a leading cause of morbidity and mortality among children. We followed 100 families with infants living in Bangladesh and studied the incidence of Cryptosporidium infection. We found prolonged Cryptosporidium shedding in stool was common among infants and adults.

[Epidemiological characteristics of notifiable infectious diseases in Beijing, 2021].

Objective: To understand the epidemiological characteristics of notifiable infectious diseases reported in Beijing in 2021 under the influence of the novel coronavirus pneumonia epidemic prevention and control policy, and provide reference evidence for the prevention and control of notifiable infectious diseases. Methods: Descriptive epidemiological methods were used to analyze the morbidity of notifiable infectious diseases reported in Beijing in 2021, with software R 4.1.2 for data process and ArcGIS 10.8 for visualization. Results: The morbidity of notifiable infectious diseases in Beijing in 2021 was 290.51/100 000, a decrease of 43.29% compared with 2020 and a decrease of 71.45% compared with the average during 2017-2019. The top 5 reported diseases with high morbidity were other infectious diarrhea, influenza, hand foot and mouth disease, pulmonary tuberculosis and syphilis. From the perspective of transmission route, intestinal infectious diseases were the main diseases, accounting for 50.15% (31 898/63 601) of the total cases. From the perspective of pathogens, viral infectious diseases were the main diseases, accounting for 59.63% (25 259/42 356) of the total cases. The laboratory diagnosis rate of notifiable infectious diseases reported in Beijing increased from the average of 16.47% (36 289/220 371) during 2017-2019 to 35.36% (22 490/63 601) in 2021. The laboratory diagnosis rate of parasitic infectious diseases was 83.33%. The districts with high incidence of intestinal infectious diseases were Pinggu, Miyun and Fengtai; Natural foci and insect borne infectious diseases were mainly reported in Yanqing, Mentougou, Fangshan and Daxing. Conclusion: The morbidity of notifiable infectious diseases in Beijing in 2021 showed a decrease trend. The laboratory confirmation rate of reported notifiable infectious disease cases increased, and there were great differences in the laboratory confirmation rate among different diseases. It is very necessary to improve the laboratory confirmation rate of the cases. The diseases with different transmission routes showed different geographical distributions. It is necessary to conduct the targeted prevention and control of infectious diseases in different areas.

A Two-Week Vacation in the Tropics and Psychological Well-Being-An Observational Follow-Up Study.

Despite the vast annual number of international visitors to the tropics, surprisingly little data are available on the psychological well-being associated with the travels or with travelers' diarrhoea (TD). We herein recruited participants of a vaccination trial, OEV-123, before their 12-day holiday in Benin, West Africa. We assessed the travelers' psychological distress with a general health questionnaire (GHQ-12) and retrieved data on TD from the trial database. The GHQ-12 was completed before (wave 0), at return (wave 1), and 1-month after (wave 2) the trip. Of the 174 participants, 73% were women, with a mean age 40 years. Moreover, 24% reported psychological distress before traveling, 10% immediately after, and 16% 1-month after the trip (GHQ-12, 3 or more; 0-12 scoring). The findings showed that psychological well-being increased after the tropical holiday. The GHQ-12 middle wave sum score differed from the wave 0 (p < 0.001) and wave 2 (p = 0.008) sum scores, with travelers reporting highest levels of well-being on their return, with evidence of a lasting improvement. TD was experienced by 71%, and it had a negative impact on psychological well-being only if experienced after travel.

Prevention and Control of Porcine Epidemic Diarrhea: The Development of Recombination-Resistant Live Attenuated Vaccines.

Porcine epidemic diarrhea (PED), causing up to 100% mortality in neonatal pigs, is a highly contagious enteric disease caused by PED virus (PEDV). The highly virulent genogroup 2 (G2) PEDV emerged in 2010 and has caused huge economic losses to the pork industry globally. It was first reported in the US in 2013, caused country-wide outbreaks, and posed tremendous hardship for many pork producers in 2013-2014. Vaccination of pregnant sows/gilts with live attenuated vaccines (LAVs) is the most effective strategy to induce lactogenic immunity in the sows/gilts and provide a passive protection via the colostrum and milk to suckling piglets against PED. However, there are still no safe and effective vaccines available after about one decade of endeavor. One of the biggest concerns is the potential reversion to virulence of an LAV in the field. In this review, we summarize the status and the major obstacles in PEDV LAV development. We also discuss the function of the transcriptional regulatory sequences in PEDV transcription, contributing to recombination, and possible strategies to prevent the reversion of LAVs. This article provides insights into the rational design of a promising LAV without safety issues.

Re-emergence of Severe Acute Diarrhea Syndrome Coronavirus (SADS-CoV) in Guangxi, China, 2021 (preprint)

Severe acute diarrhea syndrome coronavirus (SADS-CoV) has had a major impact on the swine industry in China, but has not been detected since 2019. Using real-time qPCR and metagenomic surveillance we identified SADS-CoV in a pig farm experiencing diarrheal disease. Genomic analysis supported the undetected circulation of SADS-CoV since 2019.

COVID-19 pandemic, challenges, and opportunities in Northern Uganda; Community overview and perspectives: A qualitative study using informant interviews. (preprint)

Background: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), a virus that causes COVID-19, has overwhelmingly interrupted human activities worldwide, especially in the low-to-middle income countries. Not much is reported about exclusive challenges and opportunities presented by the COVID-19 pandemic in some remote communities in Africa. Objective The objective of this study was to assess the community’s views and perspectives on the challenges and opportunities of the COVID-19 pandemic in Northern Uganda. Methods We interviewed 36 participants (age range, 28-63 years), including health workers, civil servants, members of civil society, security forces, politicians, and staff of local government administration who were members of COVID-19 district task forces in Northern Uganda using qualitative study methods between August and September 2021. The initial selection of participants was purposeful, but the snowballing technique was later used to select others. The interview questions were pre-tested among health workers and laypersons who were not part of the main study. Participants described how the COVID-19 pandemic presented challenges and opportunities, and the experience could be used to strengthen community resolves to control the pandemic and any other in the future. A local IRB approved this study. Data were analyzed using thematic analysis. Results The current study findings revealed challenges but many opportunities during the COVID-19 pandemic in this community, including loss of lives and livelihoods, increased poverty, lack of personal protection equipment, uncertainties, stress, and anxiety among health workers in the community. However, it also offered opportunities for quality family time, increased engagement, sensitization, and mobilization of communities for health, improved general security of persons and property, increased budgets and logistics for government departments, reduced incidences of diarrheal diseases and road traffic accidents, increased incomes for task force members, and more interactions among members during task force meetings. Conclusion Although the COVID-19 pandemic presented enormous challenges to low-to-middle-income countries, there are opportunities in some communities that are worth mentioning. Information obtained in this study has practical lessons that disease control experts could use to develop strategies to organize communities better and conduct disease surveillance activities for the COVID-19 pandemic and others.

Herbal Medicine used for the treatment of diarrhea and cough in Kampala city, Uganda (preprint)

Background: Globally, diarrheal and respiratory diseases are among the top ten causes of mortality, and are the major ailments for which humans seek treatment. Kampala, the capital city of Uganda is facing a proliferation of herbalists that sell herbal medicine (HM) used to manage ailments such as diarrhea and cough. The ethnopharmacological and economic aspects of HM sold in Uganda’s major cities such as Kampala are poorly understood, and this deters the HM sector from achieving its optimal capacity to adequately support health promotion and poverty reduction. The aim of this research was to: (i) profile the plant species used in the treatment of diarrhea and cough, and (ii) determine the basic economic aspects of HM trade in Kampala city. The purpose was to support the conservation of ethnopharmacological knowledge, and the design of strategic plans towards fostering optimal HM trade in urban settings. Methods: : A cross-sectional survey was conducted using a mixed methods approach. Sixty-five herbalists were selected in the five divisions of Kampala. The herbalists were interviewed using semi-structured questionnaires. Field observations were used to collect qualitative data. The data was analyzed using descriptive and inferential statistics with STATA version- 15.0. Results: : Eighty-four plant species from 41 families were documented: Fabaceae and Myricaceae with the highest number of species (9, 10.7% each). Citrus limon was the most commonly cited for cough, with a relative frequency of citation (RFC) of 1.00, and its relative medical importance was not significantly different from the other top 5 species except for Azadirachta indica (RFC=0.87), (χ 2 =8.923, p = 0.0028). Entada abyssinica (RFC=0.97) was most cited for diarrhea. Trees (34, 40.5%) were mostly used, and mainly harvested from wild habitats (55.2%), found in 20 districts across Uganda. These HM were mainly sold as powders and concoctions, in markets, shops, pharmacies, and roadside or mobile stalls. The highest prices were Uganda Shillings (UGX) 48,000 ($ 13.15)/Kg for Allium sativum , and UGX 16,000 ($ 4.38)/Kg for C. limon . All participants used HM trade as a sole source of basic needs; majority (60.0%) earned net monthly profit of UGX. 730,000 ($ 200) ≤ 1,460,000 ($ 400). The main hindrances to HM trade were the; disruptions caused by the COVID-19 pandemic (n=65, 100%), and the scarcity of medicinal plants (58, 89.2%). Conclusion: There is a rich diversity of medicinal plant species traded in Kampala to treat diarrhea and cough. The HM trade significantly contributes to the livelihoods of the traders in Kampala, as well as the different actors along the HM value chain throughout the country

Reducing Childhood Immunization to Scale Up COVID-19 Immunization in Low- and Lower Middle-Income Countries: Impact on Under-Five Mortality (preprint)

Background: Since the onset of COVID-19 pandemic, many of the routine childhood immunization campaigns have been postponed or cancelled in many low and lower-middle income countries (LLMICs). In this study, we evaluated the impact of reduction in routine childhood immunization coverage in 75 LLIMCs on the under-five mortality.Method: We estimated the impact on under-five mortality of a 10%-point reduction in the childhood immunization coverage. The analysis was done based on the reported child mortality due to diphtheria, tetanus, pertussis, Haemophilus influenzae type b, Streptococcus pneumoniae , rotavirus, measles and tuberculosis, the baseline coverage of each vaccine in each country and the efficacy of each vaccine.Findings: We estimated a total of 188 078 under-five deaths per 10%-point reduction in childhood immunization coverage in LLMICs. Approximately 61% of the deaths would occur in Sub-Saharan Africa. More than half of the deaths would be due to whooping cough and diarrheal diseases. Furthermore, 31 of 41 Sub-Saharan African countries would have more than 50 extra deaths per 100 000. The most affected countries would be Chad, Niger, and the Central African Republic with 150 or more extra deaths per 100 000. Among the Asian LLMICs, Myanmar and Tajikistan would have the highest number of deaths.Interpretation: Shifting resources from routine childhood immunization to COVID-19 vaccine programs would increase under-five mortality from vaccine preventable diseases. Therefore, maintaining childhood immunization coverage is crucial along with the measures to control COVID-19 pandemic.Funding: This study has been funded by NORAD and Trond Mohn Foundation.Declaration of Interest: None to declare.

Wastewater surveillance for infectious disease: a systematic review (preprint)

Wastewater surveillance of SARS-CoV-2 has shown to be a valuable source of information regarding SARS-CoV-2 transmission and COVID-19 cases. Though the method has been used for several decades to track other infectious diseases, there has not been a comprehensive review outlining all of the pathogens surveilled through wastewater. The aim of this study is to identify what infectious diseases have been previously studied via wastewater surveillance prior to the COVID-19 Pandemic and identify common characteristics between the studies, as well as identify current gaps in knowledge. Peer-reviewed articles published as of August 1, 2020 that examined wastewater for communicable and infectious human pathogens on 2 or more occasions were included in the study. Excluded from this list were all reviews and methods papers, single collection studies, and non-human pathogens. Infectious diseases and pathogens were identified in studies of wastewater surveillance, as well as themes of how wastewater surveillance and other measures of disease transmission were linked. This review did not include any numerical data from individual studies and thus no statistical analysis was done. 1005 articles were identified but only 100 were included in this review after applying the inclusion criteria. These studies came from 38 countries with concentration in certain countries including Italy, Israel, Brazil, Japan, and China. Twenty-five separate pathogen families were identified in the included studies, with the majority of studies examining pathogens from the family Picornaviridae, including polio and non-polio enteroviruses. Most studies of wastewater surveillance did not link what was found in the wastewater to other measures of disease transmission. Among those studies that did compare wastewater surveillance to other measures of disease transmission the value observed was dependent upon pathogen and varied by study. Wastewater surveillance has historically been used to assess water-borne and fecal-orally transmitted pathogens causing diarrheal disease. However, numerous other types of pathogens have been surveilled using wastewater and wastewater surveillance should be considered as a potential tool for many infectious diseases. Wastewater surveillance studies can be improved by incorporating other measures of disease transmission at the population-level including disease incidence and hospitalizations.

Genetic Evolution of Bovine Coronavirus Detected in the Republic of Korea (preprint)

Bovine coronavirus (BCoV) is associated with severe diarrhea in calves, winter dysentery in adult cattle, and respiratory diseases in cattle. However, there is limited information regarding its molecular characterization in the Republic of Korea (KOR). This study was conducted to investigate the prevalence of BCoV in diarrheic calves, perform global comparison of BCoV genome sequences, and suggest a new nomenclature. A total of 521 fecal samples were collected from diarrheic pre-weaned native Korean calves (age £60 days) from 100 herds in the KOR. The samples were divided into three groups based on age as follows: 1-21 days (n = 433), 21-40 days (n = 64), and 41-60 days (n = 24). The full-length Spike (S) gene was amplified and sequenced. The phylogenetic tree was constructed using the maximum-likelihood method and the evolutionary rates were estimated. BCoV infection was detected in 20 (3.8%) calves by real-time RT-PCR analysis, and nine full-length genome sequences were obtained from the 20 BCoV-positive samples. Genomic comparison analysis showed that these 2019-2020 variants exhibited the highest nucleotide sequence identity (98.6%-99.2%) with that of water deer (Hydropotes inermis) isolates. Phylogenetic analysis of the full genomes of the S gene revealed the following four BCoV groups: G1, classical BCoV strains; G2, 2002 Korean, Japan, Vietnam, Cuba, and USA strains/isolates; G3, European strains/isolates; and G4, Korean isolates (2004 and 2006 Korean isolates, 2010 BCoV-like, 2017 water deer, and 2019-2020 variants). The evolutionary rates accelerated from G1 to G4. This grouping was also closely related to the nucleotide substitution rate. Using molecular clock analysis of the S gene, the most recent common ancestor of each group was estimated to have originated in 1953, 1979, 1986, and 1993, respectively. Recently identified BCoV variants in the KOR are undergoing slow evolution. These findings provide useful information for understanding the molecular characterization of BCoVs. Further research is necessary to conduct recombination analysis to support BCoV evolution.

The Effectiveness of an Integrated Rural Health Care Intervention During the COVID-19 Pandemic Response in Siaya, Kenya: A Prospective Quasi-Experimental Study (preprint)

Background: Globally, the COVID-19 pandemic has had broad consequences on health outcomes with significant morbidity and mortality. Rural health systems face more challenges in the availability of a workforce, adequate infrastructure and equipment. We completed a baseline assessment of the health system in Siaya at the beginning stages of the COVID-19 pandemic and designed an integrated intervention to maximize the prevention of COVID-19 cases and optimize case management at community and health facility levels. Methods: In partnership with the Ministry of Health (MOH), we trained health care workers in COVID-19 infection prevention, control, and case management at community and health facility levels. We strengthened the diagnostic and monitoring capacity of healthcare workers with thermometers and pulse oximeters, and we trained clinicians in basic critical care. In addition, we addressed leadership skills and psychological first aid. Youth were included during implementation to promote the uptake of digital tools by health care workers. Primary outcome measures were the total number of confirmed COVID-19 cases and the total number of COVID-19 related deaths in Siaya. Secondary outcome measures were related to hand hygiene practices and use of essential health services; specifically, the incidence of diarrheal diseases and respiratory infections not related to COVID-19, and the number of facility based deliveries. Findings: The incidence of confirmed COVID-19 cases was low compared to neighboring counties (with risk reduction ratios up to 7.8, CI 6.85-8.89). The total number of COVID-19 cases was 266 and the total number of COVID-19 related deaths was 7 at the time of the analysis in November 2020. The incidences of diarrheal diseases and respiratory infections (URTIs) not related to COVID-19 were lower in 2020 compared to 2019 and use of essential maternal health services was maintained during the COVID-19 response: specifically, the mean number of diarrheal cases was 3’033 in 2020 and 4’795 in 2019 (p=0.001); the mean number of URTIs not related to COVID-19 was 19’683 in 2020 and 27’567 in 2019 (p=0.015); and the mean number of facility based deliveries was 2’402 in 2020 and 2’322 in 2019 (p=0.2). Interpretation: An integrated and comprehensive intervention with capacity building at community and health facility levels results in the reduction of COVID-19 infections, and the reduction in the number of diarrheal and non COVID-19 related respiratory infections. Furthermore, the intervention resulted in the maintained use of maternal health services during the COVID-19 response.Trial Registration: Clinicaltrials.gov NCT04501458Funding Statement: Wellcome TrustDeclaration of Interests: None to declare.Ethics Approval Statement: Ethical review approvals received from the University of Nairobi Ethics Review Committee and Jaramogi Oginga Odinga Teaching and Referral Hospital Ethics Review Committee (approval number IERC/JOOTR/219/20)

Dysentery as the only presentation of COVID-19 in a child: a case report.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused irreparable damage to society, and the damage continues. Pediatricians are confronted with COVID-19 in a variety of presentations, which may lead to delayed diagnosis and treatment. Early diagnosis of the disease plays an important role in preventing transmission of the virus in the community. CASE PRESENTATION: Here we report a 27-month-old previously healthy Iranian female child who presented with fever and bloody diarrhea, diagnosed with COVID-19 based on contact history, exclusion of enteric bacterial pathogens and parasites, and positive stool and nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction (RT-PCR) tests. The patient had viral shedding for more than a month. CONCLUSIONS: The pediatric population usually does not present with typical clinical features of COVID-19, which are respiratory involvement. Dysentery may be the only presentation of this disease, and long-term isolation should be considered, as the viral shedding may last for more than a month.

Knowledge, attitude and practice toward COVID-19 among healthcare workers in public health facilities, Eastern Ethiopia (preprint)

On 13 March 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already fragile health-care delivery system and reduce the availability of services for endemic health concerns such as malaria and diarrheal diseases. Cross sectional study was conducted on heath care workers in three public health facilities in Somali region to assess knowledge, attitude and practice towards COVID-19. T-test and ANOVA were used to analyze the relationship between the dependent, and independent variables. Spearman’s correlation was used to assess the relationship between mean knowledge and attitude scores. A vast majority of the participants were male (n = 293, 67.5%), with a mean age of 27.6 (SD: 5.3) years. The mean knowledge score was 13.7 (SD: 2.6) and the mean attitude score 10.5 (SD: 4.1). Only 45.2 % (n = 196) of the participants had a good attitude toward COVID-19. There was a negative correlation between knowledge scores, attitude scores (r=-0.295, P<0.001) and practice (r=-0.298, P<0.001). The overall level of knowledge was good. However, the attitude and practice were relatively low. We recommend strategies for enhancing the capacity of healthcare workers to develop positive attitude and practice.

Probiotics: Versatile Bioactive Components in Promoting Human Health.

The positive impact of probiotic strains on human health has become more evident than ever before. Often delivered through food, dietary products, supplements, and drugs, different legislations for safety and efficacy issues have been prepared. Furthermore, regulatory agencies have addressed various approaches toward these products, whether they authorize claims mentioning a disease's diagnosis, prevention, or treatment. Due to the diversity of bacteria and yeast strains, strict approaches have been designed to assess for side effects and post-market surveillance. One of the most essential delivery systems of probiotics is within food, due to the great beneficial health effects of this system compared to pharmaceutical products and also due to the increasing importance of food and nutrition. Modern lifestyle or various diseases lead to an imbalance of the intestinal flora. Nonetheless, as the amount of probiotic use needs accurate calculations, different factors should also be taken into consideration. One of the novelties of this review is the presentation of the beneficial effects of the administration of probiotics as a potential adjuvant therapy in COVID-19. Thus, this paper provides an integrative overview of different aspects of probiotics, from human health care applications to safety, quality, and control.