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Rabies vaccination is a crucial part of rabies post-exposure prophylaxis (PEP), but it tends to consist of long and costly regimens of intramuscular (IM) injections. Most human rabies deaths are caused by delayed access, unaffordability or ineffective delivery of PEP. Reducing these barriers is crucial to ensure that this incurable yet preventable disease does not cost lives. In 2022, WHO published new guidance towards the introduction or expansion of rabies vaccination into national immunization programmes to systematically drive down human rabies deaths effectively and cost-efficiently. Such guidance grounds on the latest scientific recommendation provided by WHO’s Strategic Advisory Group of Experts in 2018. WHO recommends a shortened 1-week rabies vaccination schedule, with visits on days 0, 3 and 7. On each visit, a 2-site intradermal (ID) injection (using only 0.1 ml of vaccine in each site) is administered. ID administration allows for vials to be shared among several patients within a 6-8 hours timeline. Compared to IM administration, ID is cost- and dose-sparing, even in low-throughput clinics. Additionally, this regimen requires only 3 visits to the healthcare facility, improving patient compliance. However, the uptake of this shortened ID regimen remains limited. It should now be a matter of urgency for Health Ministries in rabies-endemic settings to adopt the WHO-recommended shortened ID vaccination schedule and ensure appropriate medical training to improve PEP delivery. This will enable countries to improve PEP delivery and allow underserved populations to access affordable, life-saving rabies vaccines. LESS      Full article

The epidemiologies of the ectoparasitoses tungiasis and scabies are unknown, and their distribution has not been described systematically in Brazil. We developed a rapid assessment method (RAM) based on an online questionnaire as a new tool to assess the prevalence of tungiasis and scabies and severe disease at the municipality level in the state of Ceará in northeast Brazil. As a first step, online records of tungiasis and scabies were collected from scientific publications, lay media, and the gray literature. Then, an image-based RAM with questions about the prevalence of these diseases, severe diseases, and animal reservoirs was developed as an online open questionnaire. Valid responses were obtained from 1265 respondents, primarily health professionals, from all 184 municipalities in the state. The literature review returned results for only two municipalities. The number of responses from the online questionnaires differed considerably between municipalities (one to 104 responses/municipality). Active contact with municipality health secretariats increased the number of respondents, especially community health agents. The RAM obtained consistent results regarding the prevalence and other epidemiological information. Our approach rapidly obtained primary data on the occurrence of these two important but neglected ectoparasitoses at the municipality level without considerable cost. This approach provides information for planning evidence-based control measures and identifying high-risk areas for focused studies. The RAM can easily be adapted and extended to other settings, countries, and diseases. LESS      Full article

Aim: We aimed to measure the degree to which onchocercal skin disease (OSD) impairs quality of life (QoL) in endemic resource-poor communities in the Ushongo, Kwande, and Katsina-ale local government areas of Benue State, Nigeria. Methods: We evaluated the skin characteristics and QoL of 307 children and adults with OSD using a modified dermatological life quality index (mDLQI). Assessment of OSD was conducted and scored using mDLQI from 0 (no effects) to 18 (large effects). Thereafter, structured questionnaires were applied to assess the knowledge, attitudes, and predictors of moderate and severe OSD patients. Results: In total, 235/307 (76.5%) participants presented onchocercal nodules; chronic papular dermatitis was found in 68 (22.1%). A total of 288 (93.8%) had two or more OSD-associated symptoms. The median mDLQI score was 0 [interquartile range (IQR): 0-0] in children and 5 in adults (IQR: 2-8). A higher mDLQI median score was observed in farmers. There was a statistically significant difference between children and adults (P < 0.001). The most frequently reported impairments were social exclusion, embarrassment/shame, and restriction from work/leisure activities. In logistic regression analysis, there was a significant association with increasing age (adjusted odds ratio (AOR) = 1.44; 95%CI: 1.21-1.71; P < 0.001) and visual impairment (AOR = 1.78; 95%CI: 1.02-3.10; P = 0.040) with severe mDLQI. Papular rash was an independent protective factor (AOR = 0.50; 95%CI: 0.27-0.93; P = 0.030).Conclusion: Onchocerciasis-related morbidity has a profound measurable impact on the individual QoL, affecting the overall socioeconomic well-being of the affected community, if left untreated. Therefore, strict supervision and follow-up of home-based mass treatment with ivermectin are vital for successful control of the disease and to reduce the burden on affected communities. LESS      Full article

Paragonimiasis, a foodborne trematodiasis is caused by various Paragonimus species endemic in Asia, Africa, and the Americas. Human infection occurs through consuming improperly cooked freshwater crustaceans, crabs or crayfish, eating raw meat of paratenic hosts or by ingesting metacercariae from contaminated hands and cooking utensils. More than 292 million persons worldwide are at risk. The morbidity associated with paragonimiasis includes acute febrile illness and chronic pleuro-pulmonary manifestations which may be confounded with tuberculosis or lung cancer. Ectopic manifestations mostly involve the central nervous system, heart, or subcutaneous tissues. Objectives: to evaluate the efficacy and safety of currently available drugs praziquantel (PZQ) and triclabendazole (TCZ). Methods: a PubMed and Google Scholar search and reference selection was performed according to the the Preferred Reporting Items for Systematic Reviews protocol using a combination of the terms “paragonimiasis” AND “treatment” OR “therap*” from 01/2000 to 02/2022. Results: no randomized controlled trials were identified. Five open trials on 487 patients treated with PZQ showed 81%-100% parasite clearance depending on dosage and duration. Three open trials on 226 patients with TCZ showed a 99.6% efficacy. A quantitative comparison was not applicable to retrospective analyses of hospital records, case series and case reports because of surgical interventions, various co-morbidities and -medications and definitions of cure. Some patients treated with PZQ required multiple courses or re-treatment with TCZ, whereas one patient treated with TCZ required re-treatment with PZQ. Conclusions: PZQ and TCZ are usually effective for treating paragonimiasis. Controlled randomized trials are required to compare the safety, efficacy and applicability of PZQ versus TCZ and to evaluate combined PZQ-TCZ therapy. LESS      Full article

Aim: Freshwater snails of the genus Bulinus act as essential intermediate hosts of Schistosoma haematobium, a trematode parasite that causes urogenital schistosomiasis. The snails are widely distributed throughout Nigerian waters. Since species identification of the Bulinus snails is important for appropriate control strategies of urogenital schistosomiasis, this study therefore aimed at identifying the Bulinus species responsible for transmission of the infection in four communities located in an endemic Local Government Area of Nigeria. It also aimed at using restriction fragment length polymorphism (RFLP) as a more affordable method than sequencing to characterize Bulinus snails from schistosomiasis endemic regions in Nigeria.Methods: In this study, 100 freshwater snails morphologically identified as Bulinus species were collected from four communities located in a previously reported schistosomiasis endemic Local Government Area (LGA), namely Olorunda LGA in Oshun State, Southwest Nigeria. All snails were screened for schistosome infection using polymerase chain reaction (PCR) targeting the DraI gene. Molecular identification of the snails was done by PCR amplification of their entire internal transcribed spacer region including the 5.8S ribosomal RNA gene and RFLP. Results: Five of the 100 snails were positive for schistosome infection. PCR-RFLP profiles showed bands of different sizes for 26 other snails including the schistosome-infected ones. RFLP analysis showed that 11 of the snails belonged to the freshwater snails of the genus Physa while 13 belonged to the freshwater snails of the genus Bulinus, including Bulinus globosus (8) and B. truncatus (5). The species of the remaining two snails could not be resolved using the reference profiles from our previous studies.Conclusion: This study confirmed previous observations that limited morphological uniqueness within the Bulinus groups hinders their identification, and RFLP is a cheaper alternative method to sequencing that can be used by laboratories with limited resources for Bulinus species identification. LESS      Full article

Aim: Although the COVID-19 vaccine in Malawi has been well taken up and encouraged by the current administration, many individuals either are hesitant to get vaccinated for COVID-19 or refuse to do so. Research has uncovered associated demographic and psychological reasons, but there is a lack of qualitative work involving individuals across Malawi to explore reasons for this hesitancy. We aimed to explore factors leading to hesitation and/or refusal to COVID-19 vaccination in Malawi. Methods: The study utilized an online survey to collect free-text responses to assess factors leading to hesitation or refusal of COVID-19 vaccination in Malawi. The respondents were part of an ongoing community project in Central Malawi. In total, 284 individuals took part (72 males, 212 females). The mean age was 47.94 (SD = 8.36). Sixty-nine respondents (24.3%) had been vaccinated and 215 (75.7%) had not. An inductive thematic analysis was conducted. Results: Four themes were yielded, describing; fear of vaccination, becoming vaccinated to protect others, perceived pressure to be vaccinated, and perceptions of the COVID-19 vaccine being ineffective and experimental.Conclusion: Measures to increase COVID-19 vaccine uptake and acceptance should target fear and misinformation as constraints. Interventions such as individual sensitization and motivational interviewing should be considered for guiding individuals towards considering COVID-19 vaccination. LESS      Full article

Paragonimiasis, a foodborne trematodiasis is caused by various Paragonimus species endemic in Asia, Africa, and the Americas. Human infection occurs through consuming improperly cooked freshwater crustaceans, crabs or crayfish, eating raw meat of paratenic hosts or by ingesting metacercariae from contaminated hands and cooking utensils. More than 292 million persons worldwide are at risk. The morbidity associated with paragonimiasis includes acute febrile illness and chronic pleuro-pulmonary manifestations which may be confounded with tuberculosis or lung cancer. Ectopic manifestations mostly involve the central nervous system, heart, or subcutaneous tissues. Objectives: to evaluate the efficacy and safety of currently available drugs praziquantel (PZQ) and triclabendazole (TCZ). Methods: a PubMed and Google Scholar search and reference selection was performed according to the the Preferred Reporting Items for Systematic Reviews protocol using a combination of the terms “paragonimiasis” AND “treatment” OR “therap*” from 01/2000 to 02/2022. Results: no randomized controlled trials were identified. Five open trials on 487 patients treated with PZQ showed 81%-100% parasite clearance depending on dosage and duration. Three open trials on 226 patients with TCZ showed a 99.6% efficacy. A quantitative comparison was not applicable to retrospective analyses of hospital records, case series and case reports because of surgical interventions, various co-morbidities and -medications and definitions of cure. Some patients treated with PZQ required multiple courses or re-treatment with TCZ, whereas one patient treated with TCZ required re-treatment with PZQ. Conclusions: PZQ and TCZ are usually effective for treating paragonimiasis. Controlled randomized trials are required to compare the safety, efficacy and applicability of PZQ versus TCZ and to evaluate combined PZQ-TCZ therapy. LESS      Full article

Aim: Although the COVID-19 vaccine in Malawi has been well taken up and encouraged by the current administration, many individuals either are hesitant to get vaccinated for COVID-19 or refuse to do so. Research has uncovered associated demographic and psychological reasons, but there is a lack of qualitative work involving individuals across Malawi to explore reasons for this hesitancy. We aimed to explore factors leading to hesitation and/or refusal to COVID-19 vaccination in Malawi. Methods: The study utilized an online survey to collect free-text responses to assess factors leading to hesitation or refusal of COVID-19 vaccination in Malawi. The respondents were part of an ongoing community project in Central Malawi. In total, 284 individuals took part (72 males, 212 females). The mean age was 47.94 (SD = 8.36). Sixty-nine respondents (24.3%) had been vaccinated and 215 (75.7%) had not. An inductive thematic analysis was conducted. Results: Four themes were yielded, describing; fear of vaccination, becoming vaccinated to protect others, perceived pressure to be vaccinated, and perceptions of the COVID-19 vaccine being ineffective and experimental.Conclusion: Measures to increase COVID-19 vaccine uptake and acceptance should target fear and misinformation as constraints. Interventions such as individual sensitization and motivational interviewing should be considered for guiding individuals towards considering COVID-19 vaccination. LESS      Full article