UNITY: A low-field magnetic resonance neuroimaging initiative to characterize neurodevelopment in low and middle-income settings.

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12-18 months of a child's life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.

Transatlantic spread of highly pathogenic avian influenza H5N1 by wild birds from Europe to North America in 2021.

Highly pathogenic avian influenza (HPAI) viruses of the A/Goose/Guangdong/1/1996 lineage (GsGd), which threaten the health of poultry, wildlife and humans, are spreading across Asia, Europe, Africa and North America but are currently absent from South America and Oceania. In December 2021, H5N1 HPAI viruses were detected in poultry and a free-living gull in St. John's, Newfoundland and Labrador, Canada. Our phylogenetic analysis showed that these viruses were most closely related to HPAI GsGd viruses circulating in northwestern Europe in spring 2021. Our analysis of wild bird migration suggested that these viruses may have been carried across the Atlantic via Iceland, Greenland/Arctic or pelagic routes. The here documented incursion of HPAI GsGd viruses into North America raises concern for further virus spread across the Americas by wild bird migration.

First molecular-based anti-TB drug resistance survey in Eritrea.

BACKGROUND: In the absence of reliable data on drug-resistant TB in Eritrea, a national survey was conducted in 2018 using molecular-based methods, bypassing the need for culture.METHODS: A cross-sectional study was conducted in all 77 TB microscopy centres in the country. All 629 newly registered sputum smear-positive pulmonary TB patients were enrolled over 12 months. Sputum samples were tested using the Xpert® MTB/RIF assay and targeted next-generation sequencing (Deeplex Myc-TB) to identify resistance and explore the phylogenetics of Mycobacterium tuberculosis complex strains.RESULTS: Drug resistance profiles were obtained for 555 patients (502 new, 53 previously treated). The prevalence of rifampicin-resistant TB (RR-TB) was respectively 2.0% and 7.6% among new and previously treated cases. All RR-TB isolates that were susceptible to isoniazid displayed a phylogenetic marker conferring capreomycin resistance, confirming circulation of a previously described resistant TB sub-lineage in the Horn of Africa. Only one case of fluoroquinolone resistance was detected.CONCLUSION: The prevalence of rifampicin resistance among TB patients is encouragingly low. The scarcity of fluoroquinolone resistance bodes well for the success of the recommended all-oral treatment regimen. Surveillance based on molecular approaches enables a reliable estimation of the burden of resistance and can be used to guide appropriate treatment and care.

Characterization of Colombian serotype 1 avian paramyxoviruses, 2008-2010.

Newcastle disease (ND) still remains one of the most important diseases affecting domestic poultry in Colombia. Here, for the first time, we report on the molecular characterization of 12 virulent and 12 avirulent or lentogenic avian paramyxovirus type 1 (APMV-1) strains that were isolated from commercial, backyard, and game poultry in Colombia from 2008 to 2010. The 12 virulent isolates had a fusion (F) protein cleavage site with basic amino acids at positions 113, 115, and 116 and a phenylalanine at position 117 (112RRQKR*F117), characteristic of virulent strains. The remaining 12 isolates had the F protein cleavage sites 112GKQGR*L117 or 112GRQGR*L117 typical of avirulent or lentogenic APMV-1 strains. Phylogenetic analysis of full-length F genes of all isolates was performed, and based on the recently proposed criteria for classification of APMV-1 strains, the 24 Colombian isolates were found to belong to class II viruses and clustered into four different genotypes. Ten virulent isolates clustered with genotype VII (sub-genotype VIId), seven lentogenic strains within genotype II, five lentogenic strains with genotype I (sub-genotype Ia), and two virulent isolates within genotype XII. Our data provide essential information on the genetic diversity of AMPV-1 isolates circulating in Colombia.

Reoccurrence of Suspected Human-to-Turkey Transmission of H1N1 Pandemic 2009 Virus in Turkey Breeder Flocks in Ontario and Manitoba, 2016.

Soon after the emergence of 2009 pandemic H1N1, the first outbreaks in breeder turkey operations were reported that implicated human-to-turkey transmission. In the spring of 2016, the reoccurrence of 2009 pandemic H1N1 lineage viruses infecting breeder turkey flocks in Ontario and Manitoba, Canada, also implicated human-to-turkey transmission. In addition to raising concerns over biosecurity and vaccine failures, these cases once again raise the issue of whether turkeys have the potential to act as a bridge species to generate novel influenza A virus reassortants with public health implications.

Investigation into the role of potentially contaminated feed as a source of the first-detected outbreaks of porcine epidemic diarrhea in Canada.

In January 2014, approximately 9 months following the initial detection of porcine epidemic diarrhea (PED) in the USA, the first case of PED was confirmed in a swine herd in south-western Ontario. A follow-up epidemiological investigation carried out on the initial and 10 subsequent Ontario PED cases pointed to feed as a common risk factor. As a result, several lots of feed and spray-dried porcine plasma (SDPP) used as a feed supplement were tested for the presence of PEDV genome by real-time RT-PCR assay. Several of these tested positive, supporting the notion that contaminated feed may have been responsible for the introduction of PEDV into Canada. These findings led us to conduct a bioassay experiment in which three PEDV-positive SDPP samples (from a single lot) and two PEDV-positive feed samples supplemented with this SDPP were used to orally inoculate 3-week-old piglets. Although the feed-inoculated piglets did not show any significant excretion of PEDV, the SDPP-inoculated piglets shed PEDV at a relatively high level for ≥9 days. Despite the fact that the tested PEDV genome positive feed did not result in obvious piglet infection in our bioassay experiment, contaminated feed cannot be ruled out as a likely source of this introduction in the field where many other variables may play a contributing role.

Characterization of a low pathogenic avian influenza H5N2 virus isolated from a turkey breeder flock in Manitoba, Canada.

In November 2010, an outbreak of avian influenza (AI) due to the H5N2 subtype virus occurred in a turkey breeder farm in northern Manitoba, Canada. The only clinical signs observed were depression, decrease in food consumption, and loss of egg production. The hemagglutinin (HA) cleavage (HA(0)) site of the isolated H5N2 virus was PQRETR/GLF, consistent with low pathogenic AI viruses. The intravenous pathogenicity index of this virus was zero. Whole-genome sequencing of two isolates that originated from two different barns was performed, and both isolates had 100% identical protein sequence in PB2, HA, NP, M1, M2, NS1, and NS2. The remaining gene segments (PB1, PA, and NA) had a single amino-acid difference when compared with each other. The nucleotide and protein sequences of eight gene segments from both isolates showed 99 or greater identity with other AI viruses that have been circulating in free-living aquatic birds in Canada and the United States within the last 10 yr. Phylogenetic analysis of the HA and neuraminidase (NA) gene segments showed that these viruses are closely related to other H5 strains that have been isolated from Manitoba and other parts of Canada. Serologic testing of archived serum samples collected from these turkeys a week before the outbreak showed no evidence of AI infection. In addition, other farms that were located within 3 km radius from the infected farm and farms that had epidemiologic connection with the farm also tested negative for the presence of H5N2 AI virus or antibody. This indicates that the virus might have been introduced to the farm from wild aquatic birds only a short time before detection. Results of this study highlight the importance of early detection and the significance of ongoing Canada-wide surveillance of AI in domestic poultry as well as in wild aquatic birds/ducks.

Seasonal and life-phase related differences in growth in Scarus ferrugineus on a southern Red Sea fringing reef.

Temporal trends in growth of the rusty parrotfish Scarus ferrugineus were studied on a southern Red Sea fringing reef that experiences seasonal changes in environmental conditions and benthic algal resources. Length increment data from tagging and recapture were compared among periods and sexes and modelled using GROTAG, a von Bertalanffy growth model. The growth pattern of S. ferrugineus was highly seasonal with a maximum occurring between April and June and a minimum between December and March. Body condition followed the seasonal variation in growth, increasing from April to June and decreasing from December to March. The season of maximum growth coincided with high irradiation, temperature increases and peak abundance of the primary food source, the epilithic algal community. There was a decline in growth rate during summer (July to October) associated with a combination of extreme temperatures and lowered food availability. There were strong sexual size dimorphism (SSD) and life-history traits. Terminal-phase (TP) males achieved larger asymptotic lengths than initial-phase individuals (IP) (L(∞) 34·55 v. 25·12 cm) with growth coefficients (K) of 0·26 and 0·38. The TPs were growing four times as fast as IPs of similar size. Three individuals changed from IP to TP while at liberty and grew eight times faster than IPs of similar size, suggesting that sex change in S. ferrugineus is accompanied by a surge in growth rate. The SSD in S. ferrugineus thus coincided with fast growth that started during sex change and continued into the TP. Faster growth during sex change suggests that the cost associated with sex change is limited.

Incidence of smear-positive tuberculosis in Dabat, northern Ethiopia.

OBJECTIVE: To determine the incidence of smear-positive tuberculosis (TB) in Dabat District, northern Ethiopia. METHODS: Using a population-based longitudinal design, a TB surveillance system was initiated among 46,165 residents at the Dabat Health and Demographic Surveillance System site. Trained field workers visited each household every third month and interviewed all individuals aged ≥14 years using a uniform questionnaire to detect suspected cases of TB (cough ≥15 days), at which time two sputum (spot-morning) samples were collected for smear microscopy. RESULTS: A total of 281,820 person-months were observed during the 1-year period, which generated 74 smear-positive TB cases. The incidence of smear-positive TB was calculated at 311 per 100,000 person-years (95%CI 240-382). Higher rates were observed among females (incidence rate ratio [IRR] 2.08, 95%CI 1.24-3.52), persons with no schooling (IRR 2.74, 95%CI 1.11-6.78) and urban residents (IRR 2.39, 95%CI 1.39-4.12). CONCLUSION: The incidence of smear-positive TB is high in Dabat District, suggesting a high risk of transmission in the communities. TB control programmes thus need to improve case-finding mechanisms at the community level in Ethiopia, with greater emphasis on risk groups.

Intestinal parasitic infection and nutritional status among school children in Angolela, Ethiopia.

INTRODUCTION: Gastrointestinal parasitic infections are most prevalent in populations with low household income, poor handling of personal and environmental sanitation, overcrowding, and limited access to clean water. We conducted this study to estimate the prevalence of parasitic infection and nutritional status, and to evaluate the extent to which the two are associated among schoolchildren in rural Ethiopia. METHODS: This is a cross sectional study of 664 students aged from 6 to 19 years old from Angolela, Ethiopia. Socio-demographic information was collected using a structured questionnaire. Anthropometric measurements were taken at the time of interview. Examinations of fecal samples for helminthic and protozoan parasitic infections were performed. Logistic regression procedures were employed to evaluate the association between stunting, underweightedness, and wasting with parasitic infections. RESULTS. One-third of the participants were found to have a protozoan infection, while 7.1% were found to have a helminthic infection. Approximately 11% of the students were stunted, 19.6% were wasted, and 20.8% were underweight. Severely underweight boys were 3.88-times as likely as boys of adequate weight (odds ratio OR = 3.88, 95% confidence interval CI: 1.12-13.52) to be diagnosed with protozoan infections. Among girls, those who were severely stunted were approximately 12 times (OR = 11.84, 95%CI: 1.72-81.62) as likely to be infected with a helminthic parasite, than those who were not. Overall, there was a deficit in normal growth patterns as indicated by lower than average anthropometric measures. DISCUSSION AND CONCLUSIONS. There is a high prevalence of intestinal parasitic infections. Stunting, wasting, and underweightedness were also prevalent, and showed patterns of associations with intestinal parasitic infections. Efforts should be made to strengthen and expand school and community-based programs that promote inexpensive, though effective, practices to prevent the spread of parasitic diseases. Initiatives aimed at improving the nutritional status of school children are also needed.

Laboratory reference values of complete blood count for apparently healthy adults in Ethiopia.

BACKGROUND: The objective of this study was to evaluate reference intervals for complete blood cell count parameters among apparently healthy 1,807 adults from Addis Ababa, Ethiopia. METHODS: Blood specimens were collected from each participant using standard procedures. The collected aliquots were processed according to standard operating procedures to determine participants' complete blood counts. Non-parametric methods were employed to calculate the reference intervals and 90% confidence intervals for complete blood counts. RESULTS: Overall the results show that reference ranges for women are lower than men. The white blood cell count, neutrophil, lymphocyte, monocyte, eosinophil, and basophil reference values appear to be lower than values reported elsewhere. CONCLUSIONS: Our study is the first comprehensive study on reference intervals of complete blood count among apparently healthy adults in Ethiopia. Future studies that assess other hematological parameters and studies that assess reference values for African pediatric populations are warranted.

Prevalence of Metabolic Syndrome among Working Adults in Ethiopia.

Objective. To evaluate the prevalence of metabolic syndrome (MetS) according to the International Diabetes Federation (IDF) and Adult Treatment Panel (ATP) III criteria among working East African adults. Design. This cross-sectional study of 1,935 individuals (1,171 men and 764 women) was conducted among working adults in Addis Ababa, Ethiopia. The study was conducted in accordance with the STEPwise approach of the World Health Organization. Results. According to ATP III and IDF definitions, the overall prevalence of MetS was 12.5% and 17.9%, respectively. Using ATP III criteria, the prevalence of MetS was 10.0% in men and 16.2% in women. Application of the IDF criteria resulted in a MetS prevalence of 14.0% in men and 24.0% in women. The most common MetS components among women were reduced high-density lipoprotein-cholesterol (HDL-C) (23.2%) and abdominal obesity (19.6%); whilst reduced HDL-C concentrations (23.4%) and high blood pressure (21.8%) were most common among men. Conclusion. MetS and its individual components are prevalent among an apparently healthy working population in Ethiopia. These findings indicate the need for evidence-based health promotion and disease prevention programs; and more robust efforts directed towards the screening, diagnosis and management of MetS and its components among Ethiopian adults.

Molecular and antigenic characterization of triple-reassortant H3N2 swine influenza viruses isolated from pigs, turkey and quail in Canada.

In 2005, triple-reassortant H3N2 (trH3N2) influenza A viruses were isolated from swine and turkeys in Canada. Subsequently, these viruses were isolated from humans and mink in 2006 and 2007, respectively. Following full genome sequencing, H3N2 viruses isolated from turkeys (2005), quail (2008) and swine (2009) in Canada, were characterized as trH3N2. The 2005 turkey isolate was found to be almost identical to other viruses isolated in that year, with quail and pig isolates related very closely to the 2005 trH3N2. Minimal antigenic evolution of the swine isolates relative to the reference 2005 virus was observed. These results suggest the establishment of a stable lineage of trH3N2 in Canadian pigs, with evidence for interspecies transmission to turkeys and quails.

Knowledge, attitudes and practices (KAP) of hygiene among school children in Angolela, Ethiopia.

INTRODUCTION: Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries. This study evaluated the KAP of hygiene among rural school children in Ethiopia and assessed the extent to which proper knowledge of hygiene was associated with personal hygiene characteristics. METHODS: This cross-sectional study was comprised of 669 students who were interviewed by trained staff Participants were in grades 1-6 at Angolela Primary School, located in rural Ethiopia. Data consisted of hygiene and hand washing practices, knowledge about sanitation, personal hygiene characteristics, and presence of gastrointestinal parasitic infection. Results. Approximately 52% of students were classified as having adequate knowledge of proper hygiene. Most students reported hand washing before meals (99.0%), but only 36.2% reported using soap. Although 76.7% of students reported that washing hands after defecation was important, only 14.8% reported actually following this practice. Students with adequate knowledge of proper hygiene were more likely to have clean clothes (AOR 1.62, CI 1.14-2.29) and to have a lower risk of parasitic infection (AOR 0.78, CI 0.56-1.09) although statistical significance was not achieved for the latter DISCUSSION AND CONCLUSION: Study findings underscore the need for more hand washing and hygiene education in schools; and provide objective evidence that may guide the development of comprehensive health and hygiene intervention programs in rural Ethiopian schools. Successful implementation of these programs is likely to substantially attenuate the transmissible disease burden borne by school children in rural settings.

Joint effect of maternal depression and intimate partner violence on increased risk of child death in rural Ethiopia.

OBJECTIVES: To assess independent and interaction effect of experience of intimate partner violence and depression on risk of child death. DESIGN: Community-based cohort design. SETTING: The study was conducted within the demographic surveillance site of Butajira Rural Health Program in south central Ethiopia. PARTICIPANTS: Women (n=561) who gave birth to a live child. MAIN OUTCOME MEASURES: Exposure status comprising physical, sexual and emotional violence by intimate partner was based on the WHO multi-country questionnaire on violence against women. Depression status was measured using the Composite International Diagnostic Interview. Risk of child death and its association with maternal exposure to violence and/or being depressed was analysed by incidence, rate ratios and interaction. RESULTS: The child death in the cohort was 42.1 (95% CI, 32.7 to 53.5) children per 1000 person years, and maternal depression is associated with child death. The risk of child death increases when maternal depression is combined with physical and emotional violence (RR=4.0; 95% CI, 1.6 to 10.1) and (RR=3.7; 95% CI, 1.3 to 10.4), showing a synergistic interaction. CONCLUSION: An awareness of the devastating consequences on child survival in low income setting of violence against women and depression is needed among public health workers as well as clinicians, for both community and clinical interventions.

Diagnostic test results and pathology associated with the 2007 Canadian H7N3 highly pathogenic avian influenza outbreak.

In September 2007, an H7N3 highly pathogenic avian influenza outbreak (HPAI) occurred on a multiple-age broiler breeder operation near Regina Beach, Saskatchewan, Canada. Mortality was initially observed in a barn that housed 24-wk-old roosters, with later involvement of 32-wk-old breeders. All birds on the affected premises were destroyed, and surveillance of surrounding farms demonstrated no further spread. The use of water from a dugout pond during periods of high demand, and the proximity of the farm to Last Mountain Lake, the northern end of which is a bird sanctuary, implicated wild aquatic birds as a possible source of the virus. Of particular note, the H7-specific real-time reverse transcription polymerase chain reaction assay that was in use at the time did not detect the virus associated with this outbreak. A Canadian national influenza A virus survey of wild aquatic birds detected no H7 subtype viruses in 2005 and 2006; however, H7 subtype viruses were detected in the fall of 2007. Phylogenetic analysis of a number of these H7 isolates demonstrated an evolutionary relationship with each other, as well as with the H7N3 HPAI virus that was isolated from the Saskatchewan broiler breeder farm.

Survey of influenza A viruses circulating in wild birds in Canada 2005 to 2007.

A multi-agency, Canada-wide survey of influenza A viruses circulating in wild birds, coordinated by the Canadian Cooperative Wildlife Health Centre, was begun in the summer of 2005. Cloacal swab specimens collected from young-of-year ducks were screened for the presence of influenza A nucleic acids by quantitative, real-time reverse transcription-polymerase chain reaction (RRT-PCR). Specimens that produced positive results underwent further testing for H5 and H7 gene sequences and virus isolation. In addition to live bird sampling, dead bird surveillance based on RRT-PCR was also carried out in 2006 and 2007. The prevalence of influenza A viruses varied depending on species, region of the country, and the year of sampling, but generally ranged from 20% to 50%. All HA subtypes, with the exception of H14 and H15, and all NA subtypes were identified. The three most common HA subtypes were H3, H4, and H5, while N2, N6, and N8 were the three most common NA subtypes. H4N6, H3N2, and H3N8 were the three most common HA-NA combinations. The prevalence of H5 and H7 subtype viruses appears to have a cyclical nature.

Studying possible cross-protection of Canada geese preexposed to North American low pathogenicity avian influenza virus strains (H3N8, H4N6, and H5N2) against an H5N1 highly pathogenic avian influenza challenge.

Highly pathogenic avian influenza (HPAI) H5N1 virus infections have caused unprecedented morbidity and mortality in different species of domestic and wild birds in Asia, Europe, and Africa. In our previous study, we demonstrated the susceptibility and potential epidemiologic importance of H5N1 HPAI virus infections in Canada geese. In this study, we investigated the potential of preexposure with North American lineage H3N8, H4N6, and H5N2 low pathogenicity avian influenza (LPAI) viruses to cross-protect Canada geese against a lethal H5N1 HPAI virus challenge. Based on our results, birds that were primed and boosted with an H5N2 LPAI virus survived a lethal H5N1 challenge. In contrast, only two of five birds from the H3N8 group and none of the birds preexposed to H4N6 survived a lethal H5N1 challenge. In vitro cell proliferation assays demonstrated that peripheral blood mononuclear cells collected from each group were no better stimulated by homologous vs. heterologous antigens.

Rho kinase activation and ROS production contributes to the cooling enhanced contraction in cutaneous equine digital veins.

A decrease in environmental temperature can directly affect the contractility of cutaneous vasculature, mediated in part by alpha(2)-adrenoceptors. Most of the cellular mechanisms underlying the cooling-enhanced contractility to alpha(2)-adrenoceptor agonists have been reported in cutaneous arteries but little information is available on cutaneous veins. To investigate the cellular mechanisms associated with the cooling-enhanced contraction to UK-14304 (alpha(2)-adrenoceptor agonist), isolated equine digital veins (EDVs) were studied at 30 degrees C and 22 degrees C. The effects of inhibitors were studied on the contractile response to UK-14304 (0.1 microM). The cooling-enhanced responses were inhibited by Rho kinase inhibitors [maximum response to UK-14304 95.2 +/- 8% of response to depolarizing Krebs solution (DKS) in control vessels cooled to 22 degrees C, compared with 31.4 +/- 6% in the presence of fasudil 1 microM and 75.8 +/- 6% with Y-27632 0.1 microM] and the effects of these inhibitors were considerably less at 30 degrees C (control response 56.4 +/- 5% of DKS; 34.9 +/- 6% with fasudil 1 microM and 50.6 +/- 9% with Y-27632 0.1 microM). Furthermore, Western blotting showed that one of the downstream targets for Rho kinase activity, ezrin/radixin/moesin, was phosphorylated after cooling and reduced by fasudil (1 microM) only at 22 degrees C. The activation of protein kinase C contributed to the contractile response, but predominantly at 30 degrees C (maximum response 82.3 +/- 9% of DKS for control; 57.7 +/- 10% in the presence of chelerythrine 10 microM) with no significant effect at 22 degrees C. The reduction of the response at 22 degrees C by antioxidants, rotenone (14% reduction), and tempol (21% reduction) suggested the contribution of reactive oxygen species (ROS). No evidence was obtained to support the participation of tyrosine kinase. These data demonstrate that Rho kinase activation and the production of ROS contributes to the cooling-enhanced contraction in these cutaneous digital veins.

Age at first dose of measles vaccination in Ethiopia.

BACKGROUND: Although measles vaccination is recommended to be given at nine months of age in Ethiopia and in most of sub-Saharan Africa, no information is available about the age at which children actually receive their first dose of measles vaccine. This has important implications in terms of preventing infection and averting epidemics of measles. OBJECTIVE: To determine the age at which Ethiopian children actually receive their first dose of measles vaccine. DESIGN: Cross sectional study. SETTING: All major vaccination facilities including private and non-governmental health facilities that were registered with the Addis Ababa city Administration Health Bureau. SUBJECTS: A total of 17,674 records of children who received measles vaccination in health facilities were reviewed and in rural areas 615 children were surveyed over one year period September 2004 to August 2005. RESULTS: In both the urban and the rural settings the median age of children at first dose of measles vaccination was nine months. In the rural areas only 19.8% of children had vaccination cards. Measles coverage by card and history in rural areas was 84.4%. Many children from the rural site received measles vaccination during supplemental immunisation activities (SIAs) rather than from routine vaccination programmes. Measles coverage significantly varies among sub-cities in Addis Ababa. CONCLUSION: Vaccination practices and measles coverage levels do not support delaying the first measles vaccine dose. Strengthening the routine vaccination programmes must receive priority before changing recommended age for the first dose of measles vaccine.