High Levels of Antibiotic Resistance Patterns in Two Referral Hospitals during the Post-Ebola Era in Free-Town, Sierra Leone: 2017-2019.

The Post-Ebola era (2017-2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients' laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.

Rebuilding transformation strategies in post-Ebola epidemics in Africa.

Rebuilding transformation strategies in post-Ebola epidemics in West Africa requires long-term surveillance and strengthening health system preparedness to disease outbreak. This paper assesses reconstruction efforts from socio-cultural, economic and ecological transformation response approaches and strategies in improving sustainable survivors and affected communities livelihood and wellbeing. A comprehensive approach is required in the recovery and rebuilding processes. Investing in rebuilding transformation requires fostering evidence-based and effective engaging new investors partnership strengthening, financing community-based programmes ownership, novel socio-economic innovations strategies and tools against the evolving and future Ebola epidemics. Thus, there should be improved community partnership, health and economic rebuilding programmes to address mistrust and care underutilization, poverty and care access inequity at all levels. Implementing effective post-Ebola national 'One Health' approach coupled with climate change mitigation and adaptations strategies is urgent public health needs aiming at improving the quality healthcare access, delivery trust and uptake in anticipation of EVD immunization program, productivity and emerging economy.

Fostering prevention and care delivery services capability on HIV pandemic and Ebola outbreak symbiosis in Africa.

Human immunodeficiency virus (HIV) and the re-emerging Ebola virus disease (EVD) are closely intertwined and remain a persistent public health threat and global challenge. Their origin and rapid transmission and spread have similar boundaries and share overlapping impact characteristics, including related symptoms and other interactions. The controversies and global threat of these viruses require rapid response policy and evidence-based implementation findings. The constraints and dual burden inflicted by Ebola and HIV infections are highly characterized by similar socio-demographics, socio-economic and political factors. EVD has similar effects and burdens to HIV infection. This study seeks to understand EVD in the context of HIV epidemic despite the challenges in developing an effective vaccine against HIV and EVD. Our findings show that early understanding, prevention and treatment of these diseases a global health threat mainly in Africa is important and valuable. The lessons learned so far from HIV and Ebola epidemics are crucial in health programming and execution of rapid response interventions and continued vigilance against EVD before it become another worldwide health menace. Therefore, the current regional West Africa EVD requires strengthening healthcare systems and building preparedness and response capacity. Importantly, appropriate community participation, health education and resilience coupled with deployment of effective novel diagnostic approaches in early warning and surveillance of threats and emerging diseases. Therefore, there is an urgent need to develop novel key strategies are crucial in curbing the constant viral resurgence, persistence transmission dynamics and spread, as well in accelerating Ebola vaccines regimen (immunization) development and national implementation plans in achieving sustained control, and eventual elimination.

Fostering Prevention and Care Delivery Services Capability on HIV Pandemic and Ebola Outbreak Symbiosis in Africa

Human immunodeficiency virus (HIV) and the re-emerging Ebola virus disease (EVD) are closely intertwined and remain a persistent public health threat and global challenge. Their origin and rapid transmission and spread have similar boundaries and share overlapping impact characteristics; including related symptoms and other interactions. The controversies and global threat of these viruses require rapid response policy and evidence-based implementation findings. The constraints and dual burden inflicted by Ebola and HIV infections are highly characterized by similar socio-demographics; socio-economic and political factors. EVD has similar effects and burdens to HIV infection. This study seeks to understand EVD in the context of HIV epidemic despite the challenges in developing an effective vaccine against HIV and EVD. Our findings show that early understanding; prevention and treatment of these diseases a global health threat mainly in Africa is important and valuable. The lessons learned so far from HIV and Ebola epidemics are crucial in health programming and execution of rapid response interventions and continued vigilance against EVD before it become another worldwide health menace. Therefore; the current regional West Africa EVD requires strengthening healthcare systems and building preparedness and response capacity. Importantly; appropriate community participation; health education and resilience coupled with deployment of effective novel diagnostic approaches in early warning and surveillance of threats and emerging diseases. Therefore; there is an urgent need to develop novel key strategies are crucial in curbing the constant viral resurgence; persistence transmission dynamics and spread; as well in accelerating Ebola vaccines regimen (immunization) development and national implementation plans in achieving sustained control; and eventual elimination

Phenotypic and genotypic characteristics of Vibrio cholerae O1 isolated from the Sierra Leone cholera outbreak in 2012.

BACKGROUND: This study describes phenotypic, genotypic and antibiotic susceptibility patterns of the strains isolated from the 2012 Sierra Leone cholera outbreak. Rectal swabs were collected from patients and cultured for Vibrio cholerae O1. METHODS: The isolates were subjected to multiplex PCR, mismatch amplification mutation assay (MAMA) PCR, pulsed field gel electrophoresis (PFGE), and antibiotic sensitivity tests using disk diffusion and minimum inhibitory concentration (MIC) E-test following standard procedures. RESULTS: Out of 17 rectal swabs tested, 15 yielded V. cholerae O1 biotype El Tor, serotype Ogawa. All the strains belonged to 'altered' variants as MAMA PCR result showed the presence of classical cholera toxin B. PFGE result revealed four pulse types. Using antibiotic disk diffusion, all the isolates were resistant to erythromycin, chloramphenicol, furazolidone, and trimethoprim/sulfamethoxazole (SXT) except SL1 which was sensitive to chloramphenicol and SXT. All the isolates were sensitive to nalidixic acid, tetracycline, doxycycline, azithromycin, and ciprofloxacin except SL2 which was resistant to nalidixic acid. However, variable sensitivity patterns were observed for kanamycin. The ranges of MIC were 0.125-0.50 mg/l, 0.003-0.023 mg/l and 0.38-0.75 mg/l for azithromycin, ciprofloxacin and tetracycline, respectively. CONCLUSIONS: This study demonstrates that altered variants of V. cholerae O1 of four clonal types were responsible for the 2012 outbreak of cholera in Sierra Leone.