International Health – Volume 7 Issue 1 January 2015

International Health
Volume 7 Issue 1 January 2015

Chikungunya: here today, where tomorrow?
Stephen Higgs and Dana L. Vanlandingham
Until 2005, chikungunya virus (CHIKV) was a relatively little-studied pathogen restricted to parts of Africa and Asia. Epidemics were sporadic and separated by years of quiescence. In late 2004, the East Central South African genotype of CHIKV moved from Kenya onto the Indian Ocean island of Comoros. The global onslaught of CHIKV had begun. In November of 2005, viral isolates were identified with, what might normally be regarded as an insignificant, single alanine to valine mutation at position 226 of the envelope E1 gene.1 This simple mutation had a remarkable effect; making the virus approximately 100 times more infectious to the Asian tiger mosquito, Aedes albopictus, and it was this species that was transmitting the virus rather than the usual vector, Aedes aegypti.2 Subsequent ‘second-step’ mutations further enhanced the ability of the virus to infect and/or disseminate from the midgut to the salivary glands in Ae. albopictus.3 However, these viruses can still be transmitted by Ae. aegypti. Within a year of the Indian Ocean lineage emerging, over 250 000 people had been infected. An epidemic in Asia began within months and has infected several million people in India and other Asian countries. Chikungunya infections occurred in many countries as a result of people travelling from areas with active transmission. The presence of tiger mosquito vector has been critical to enable localized CHIKV outbreaks in Italy and France. This species continues to invade new territory…

Human rabies deaths in Africa: breaking the cycle of indifference
Betty Dodeta,*, Mathurin C. Tejiokemb, Abdou-Rahman Aguemonc and Hervé Bourhyd
Author Affiliations
aAfroREB coordinator, Dodet Bioscience, 6B rue de Verdun, 69300 Caluire et Cuire, France
bEpidemiology and Public Health Service, Centre Pasteur du Cameroun, Yaoundé, Cameroon
cFaculté des Sciences de la Santé, 01 BP 188, Cotonou, Bénin
dInstitut Pasteur, Unité Dynamique des lyssavirus et adaptation à l’hôte, WHO Collaborating Centre for Reference and Research on Rabies, Paris, France
Received July 22, 2014.
Revision received September 3, 2014.
Accepted September 3, 2014.
The current outbreak of Ebola virus disease has mobilized the international community against this deadly disease. However, rabies, another deadly disease, is greatly affecting the African continent, with an estimated 25 000 deaths every year. And yet, the disease can be prevented by a vaccine, if necessary with immunoglobulin, even when administered after exposure to the rabies virus. Rabies victims die because of neglect and ignorance, because they are not aware of these life-saving biologicals, or because they cannot access them or do not have the money to pay for them. Breaking the cycle of indifference of rabies deaths in humans in Africa should be a priority of governments, international organizations and all stakeholders involved.

High coverage of vitamin A supplementation and measles vaccination during an integrated Maternal and Child Health Week in Sierra Leone
Fatmata F. Sesaya,*, Mary H. Hodgesa, Habib I. Kamaraa, Mohamed Turaya, Adam Wolfeb, Thomas T. Sambac, Aminata S. Koromad, Wogba Kamarae, Amadou Fallf, Pamela Mitulaf, Ishata Contehf, Nuhu Makshag and Amara Jambaih
Author Affiliations
aHelen Keller International, PO Box 369, Freetown, Sierra Leone
bColumbia University, Mailman School of Public Health, New York, NY USA
cChild Health and Expanded Program on Immunization, Ministry of Health and Sanitation, Freetown, Sierra Leone
dNutrition Program, Ministry of Health and Sanitation Sierra Leone, Youyi Building Brookfields, Freetown Sierra Leone
eNational HIV/AIDS Secretariat, Ministry of Health and Sanitation, Kingharman Road Freetown, Sierra Leone
fWorld Health Organization, Country Office, Sierra Leone and Inter Country Support Team for West Africa (IST-WA)
gUnited Nations Children’s Fund, Country Office, Sierra Leone
hDirectorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
In May 2012, the twice-yearly Maternal and Child Health Week (MCHW) integrated vitamin A supplementation (VAS) and supplementary measles vaccination to reach all children 6–59 months in Sierra Leone. Following the MCHW, a post event coverage survey was conducted to validate VAS coverage and assess adverse events following immunization.
Using the WHO Expanded Program on Immunization sampling methodology, 30 clusters were randomly selected using population proportionate to size sampling. Fourteen caregivers of children 6–59 months were interviewed per cluster for precision of ±5%. Responses were collected via mobile phones using EpiSurveyor.
Overall VAS and measles coverage was 91.9% and 91.6%, respectively, with no significant differences by age group, sex, religion or occupation. Major reasons given for not receiving VAS and measles vaccination were not knowing about the MCHW or being out of the area. Significantly more mild adverse events (fever, pain at injection site) were reported via the post event coverage survey (29.1%) than MCHW (0.01%) (p<0.0001).
The MCHW reached >90% of children in Sierra Leone with equitable coverage. Increased reporting of mild adverse events during the survey may be attributed to delayed onset after measles vaccination and/or direct inquiry from enumerators. Even mild adverse events following immunization requires strengthened reporting during and after vaccination campaigns.