Reaching those at risk: Active case detection of leprosy and contact tracing at Kokosa, a hot spot district in Ethiopia.

INTRODUCTION: Leprosy is a chronic mycobacterial disease of public health importance. It is one of the leading causes of permanent physical disability. The prevalence of leprosy in Ethiopia has remained stagnant over the last decades. The aim of the study was to identify new leprosy cases and trace household contacts at risk of developing leprosy by active case detection. The study area was Kokosa district, West Arsi zone, Oromia region, Ethiopia. METHOD: A prospective longitudinal study was conducted from June 2016-September 2018 at Kokosa district. Ethical approvals were obtained from all relevant institutions. Health extension workers screened households by house-to-house visits. Blood samples were collected and the level of anti-PGL-I IgM measured at two-time points. RESULTS: More than 183,000 people living in Kokosa district were screened. Dermatologists and clinical nurses with special training on leprosy confirmed the new cases, and their household contacts were included in the study. Of the 91 new cases diagnosed and started treatment, 71 were recruited into our study. Sixty-two percent were males and 80.3% were multibacillary cases. A family history of leprosy was found in 29.6% of the patients with cohabitation ranging from 10 to 30 years. Eight new leprosy cases were diagnosed among the 308 household contacts and put on multi-drug therapy. The New Case Detection Rate increased from 28.3/100,000 to 48.3/100,000 between 2015/2016 and 2016/2017. Seventy one percent of leprosy patients and 81% of the household contacts' level of anti-PGL-I IgM decreased after treatment. In conclusion,the results of the study showed the importance of active case detection and household contact tracing. It enhances early case finding, and promotes early treatment, thereby interrupting transmission and preventing potential disability from leprosy.

Sero-prevalence of hepatitis B virus markers and associated factors among children in Hawassa City, southern Ethiopia.

BACKGROUND: Hepatitis B virus (HBV) infection is one of the major public health problems worldwide. Limited information exists about the epidemiology of HBV infection in Ethiopia. This study aimed to assess sero-prevalence of HBV markers and associated factors in children living in Hawassa City, southern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 471 children in Hawassa City, southern Ethiopia from May to September, 2018. A total of 471 children were included in the study using a multistage sampling technique. Data on demographic and risk factors were gathered using structured questionnaires. Blood samples were collected and sera were screened for hepatitis B surface antigen (HBsAg), antibody to core antigen (anti-HBc), and antibody against surface antigen (anti-HBs) using enzyme-linked immunosorbent assay. RESULTS: The sero-prevalence of HBsAg, anti-HBc, and anti-HBs markers among children were 4.4, 19.5 and 20.0%, respectively. Children at higher risk of having HBsAg marker were those who had a history of injectable medications (AOR 5.02, 95% CI: 1.14, 22.07), a family history of liver disease (AOR 6.37, 95% CI: 1.32, 30.74), a HBsAg seropositive mothers, (AOR 11.19, (95% CI: 3.15, 39.67), and had no vaccination history for HBV (AOR, 6.37, 95% CI: 1.32, 30.74). Children from families with low monthly income, who were home delivered, unvaccinated for HBV or with HBsAg seropositive mother had increased risk of having anti-HBc. CONCLUSIONS: The study findings showed an intermediate endemicity of HBV infection in the study setting. The observed rate of residual HBV infection with low rate of immunized children after HBV vaccination was high. Hence, introducing birth dose vaccine, safe injection practice and improving immunization coverage during pregnancy as part of the antenatal care package should be considered. Furthermore, governmental and non-governmental organizations should give attention on timely measures for the prevention of ongoing vertical transmission from mother to child as well as early horizontal transmission of HBV in Hawassa City, Ethiopia.

Vitamin D Deficiency is Associated with Increased Use of Antimicrobials among Preschool Girls in Ethiopia.

Preschool children in Addis Ababa, Ethiopia, are highly exposed to influenza viruses. Factors related to infections, nutrition, and environmental conditions that might explain the burden of influenza among these children were investigated. Ninety-five preschool children, 48 girls and 47 boys, were followed clinically for 12 months. Illness and immune responses to influenza; three other respiratory viruses; five airway pathogenic bacteria; and levels of vitamins D, A, and B12 were assessed. Most of the children had antibodies to numerous respiratory viral and bacterial agents at study start, and many were infected during follow-up. Twenty-five girls and 25 boys fell ill during the study, and were treated with one or more courses of systemic antimicrobials. Ninety percent of both girls and boys had 25-hydroxyvitamin D [25(OH)D] levels below the recommended levels. While there was no overall difference in the levels of vitamins D, A, and B12 between girls and boys, treated girls had significantly lower 25(OH)D levels than non-treated girls and treated boys. There was a considerable number of short for age children, but only the short treated girls had significantly lower 25(OH)D levels than the non-treated children. Preschool girls with low 25(OH)D levels were more vulnerable to pathogenic microbes than boys.

Seroprevalence of Hepatitis B virus surface antigen, anti-hepatitis C virus antibody and their associated factors among mothers living in Harar, Eastern Ethiopia

Background: Hepatitis B virus (HBV) and Hepatitis C Virus (HCV) infections are major causes of acute and chronic liver disease and infection by these viruses during pregnancy is associated with maternal, fetal and neonatal health complications. Understanding the epidemiology of these viruses could be valuable to take appropriate preventive measures. Objective: This study aims to determine the seroprevalence and associated factors of HBV and HCV infection among mothers living in Harar, Ethiopia. Materials and Methods: A cross-sectional study was conducted among 461 mothers living in Harar, Eastern Ethiopia from March 1 ­May 30, 2017. The systematic random sampling method was used to select the study participants. Sociodemographic information was collected through face-to-face interviews using pretested structured questionnaires. Five millilitres of venous blood was collected from each study subject and HBsAg and anti-HCV levels in sera were tested using a sandwich third generation Enzyme-Linked Immunosorbent Assay (ELISA). Data was analysed by using Statistical Package for Social Sciences (SPSS) version 20. Result: The seroprevalence rates for HBV and HCV infection were 5.9% and 1.1%, respectively. None of the mothers were co-infected with HBV and HCV. Among the potential risk factors, previous history of abortion (AOR =3.7 95%, CI 1.4-9.6) and multiple sexual exposures (AOR =10.6, 95% CI 4.0-27.9) were significant predictors of HBV infection. Conclusion: This study determined that the prevalence of HBV and HCV infection among mothers was 5.9% and 1.1% respectively. History of abortion and history of multiple sexual partners were significantly associated with HBV infection. Health education programs on the mode of HBV and HCV transmission, high-risk behaviours and methods of preventions are recommended to raise awareness and reduce the spread of infection

Serum level of anti-hepatitis B surface antigen and hbv associated factors among vaccinated and unvaccinated children in Harar, Eastern Ethiopia: a community - based study

Background: Hepatitis B virus infection is a major global health problem which is known to be the main cause of liver failure, cirrhosis, and hepatocellular carcinoma. Production of anti-HBs which is stimulated by HBV vaccine, provides protection against HBV infection. However, not all vaccinated children develop protective or durable levels of antibody against HBsAg. Therefore, testing for anti-HBs levels after HBV vaccination is important. Objective: The main objective of this study was to assess serum level of antibody against hepatitis B surface antigen among vaccinated and unvaccinated children in Harar, Eastern Ethiopia. Method: A community-based comparative cross-sectional study design was used. 540 children within the ages of 5-8 years (284 vaccinated and 256 unvaccinated) were enrolled in the study using simple random sampling in selected kebeles. Three to five milliliters of blood was collected from each study participant. Serum was separated and anti-HBsAg level was determined using ELISA. A pretested, structured questionnaire was used to collect socio-demographic and HBV associated factors exposure information of the study participants and their parents. Data entry and statistical analysis were done using SPSS statistical software version 21. Logistic regressions with 95% CI were used to identify independent predictors of anti-HBs. A p-value of less than 0.05 was considered statistically significant. Results: The overall seroprotection rate detected in this study was 95.4% among vaccinated children, whereas it was only 6.2% among unvaccinated children. 3.1% of unvaccinated children were positive for HBsAg, indicating chronic disease, whereas 1.1% of vaccinated children were HBsAg+. Anti-HBs levels declined from 414 U/ml at 5 years after vaccination to 105 U/ml after 8 years. Conclusion and Recommendation: Protective levels of anti-HBs were detected in 95.4% of vaccinated children suggesting that there is no need for a further booster dose for these children

Antibody response against Hepatitis B virus after vaccination and seroprevalence of HBV in children in Addis Ababa, Ethiopia

Background: Around two billion people have been infected with HBV worldwide, and more than 240 million are chronic carriers. Vaccine introduction for HBV in children was officially launched by the WHO in 1980. Since then the vaccine response level has been determined in different countries. Since the introduction of the vaccine in Ethiopia in 2007, few studies have been conducted to assess the antibody response against the HBV vaccine. Objectives: The aim of this study is to determine antibody response against HBV after hepatitis B vaccination and assess the seroprevalence of HBV in children in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted using a multistage probability sampling technique. Four hundred and fifty children between the ages of 5 and 8 living in Addis Ababa were enrolled. Socio-demographic characteristics were obtained through a structured questionnaire and three to four ml of blood was collected from each child. ELISA was performed to determine antibody levels against HBV. Results:The mean age was 7+1 (SD) years. Anti-HBs were detected in 54.3% (208/450) of children with a slightly higher proportion of protective level in females 98 (54.7%) than males 110 (53.9%). The overall vaccine coverage in our study was 85.1 %. The proportion of children with a protective level (>10 mIU/ml anti-HBs antibody) declined as the age of the child increased: 52.6%, 60%, 43.5% and 37.1% at the age of 5, 6, 7 and 8 years, respectively. Seroprevalence of HBsAg was 0.4%, whereas seroprevalence of anti-HBc was 5.6%. Age was negatively correlated with the response level (p=0.001), whereas sex and history of HBV infection had no significant association. Age was also significantly associated with seroprevalence of anti-HBc (p=0.003). Conclusion: The HBV vaccine coverage in children was high but antibody response against the vaccine appears low. Seroprevalence of the virus was also low. The low response level to the vaccine should be a concern and revaccination or booster doses should be considered for non-responding children. Further studies should also be undertaken

Ex-vivo characterization of regulatory T cells in pulmonary tuberculosis patients, latently infected persons, and healthy endemic controls.

BACKGROUND: Regulatory T cells (Treg) are an essential arm of adaptive immunity not only in tolerance and autoimmunity but also in infectious diseases. In Tuberculosis (TB), it has been suggested that the frequency of Tregs is higher in the blood of TB patients when compared to healthy controls with subsequent decline after treatment. However, with the discovery that FOXP3, the hallmark marker of Tregs, is not exclusive to Tregs and the lack of specific markers for Tregs, it has been a challenge to fully understand the role of Tregs in TB. METHOD: We isolated PBMC from smear positive TB patients (TB, N = 13) before and after treatment, latent TB infected participants (LTBI, N = 8), and healthy endemic controls (EC, N = 9) and evaluated the frequency of different populations of Tregs and expression of FOXP3 by flowcytometry using six markers. RESULTS: The findings in this study showed that the association of Treg frequency with TB disease depends on the phenotypic markers used. While the frequency of CD4(+)CD25(+/hi) T cells was higher in TB patients compared to LTBI individuals, there was no difference in the frequency of CD4(+)CD25(+)FOXP3(+)CD127(lo) Treg among TB, LTBI, or EC. However, delineation of Tregs into active and naïve subsets revealed a significant increase in FOXP3 expression in active primed Tregs (CD4(+)CD25(+)FOXP3(+)CD127(lo)CD45RO(+)Ki-67(+)) of TB patients compared to LTBI and EC; and a significantly higher frequency of resting primed (CD45RO(+)Ki-67(-)) Treg in QuantiFERON negative EC compared to TB patients. After treatment completion, there was a significant decline in the frequency of active primed Treg, median (IQR) from 12.4% (9.5-21.9) of Tregs to 9.3% (7.0-12.2); P = 0.003 Wilcoxon signed rank test. We conclude that Treg subsets may be differentially regulated and expressed in TB disease, cure, and infection.