Title Participants "Pathogen reduction of blood components during outbreaks of infectious diseases in the European Union : an expert opinion from the European Centre for Disease Prevention and Control consultation meeting" "D Domanovic, I Ushiro-Lumb, Veerle Compernolle, S Brusin, M Funk, P Gallian, J Georgsen, M Janssen, T Jimenez-Marco, F Knutson, GM Liumbruno, P Mali, G Marano, Y Maryuningsih, C Niederhauser, C Politis, S Pupella, G Rautmann, K Saadat, I Sandid, AP Sousa, S Vaglio, C Velati, N Verdun, M Vesga, P Rebulla" "Efficient management of transportation logistics related to animal disease outbreaks" "Hilde Vernieuwe, Els Ducheyne, Guy Hendrickx, Bernard De Baets" "Factors influencing the occurrence of infectious disease outbreaks in Lebanon since the Syrian crisis" "Mariana Helou, Gerlant van Berlaer, Kaissar Yammine" "Since the beginning of the Syrian crisis in 2011, the region has witnessed a major population displacement. Lebanon, a country with a population of 4.2 million, has welcomed around one million refugees. A rise in the incidence of Measles, Hepatitis A and Leishmaniosis was noted. This paper aims to document the incidence of outbreaks along with the factors that contributed to their emergence in Lebanon. A comprehensive literature review was conducted using electronic databases and (non) governmental reports, including studies reporting the state of Syrian refugees in Lebanon and those reporting on infectious outbreaks in Lebanon and Syria. Primary outcomes were defined as incidence or prevalence of Measles, Hepatitis A, and Leishmaniosis in both populations. Secondary outcomes were set to be the risk factors for the outbreaks. As of February 2016, Lebanon registered a total of 1.067.785 refugees. Infectious outbreaks were reported in Lebanon just after initiation of Syrian migration, with 1760 new measles cases, 1551 hepatitis A cases, and 1033 Leishmania cases in 2013. Local factors probably contributing to the emergence and dissemination of the outbreaks include living conditions, water and sanitation, nutritional state, and immunization. The outbreaks were not only reported in regions with higher refugee concentration, but also within other Lebanese regions. This was attributed to deficiencies in immunization of measles, low socioeconomic status and poor living conditions. The Syrian crisis has led to considerable impact on the demographic, economic, and political systems in Lebanon, next to an important burden on the healthcare system." "Implementation and evaluation of new tools for Ebola virus disease response during outbreaks in eastern Democratic Republic of the Congo: from rapid diagnostic tests to genomic sequencing." "Daniel Mukadi" "The Democratic Republic of the Congo has faced fifteen Ebola virus disease (EVD) outbreaks, among which the 2018-2020 was the most widespread and deadliest so far. During that outbreak associated with chronic insecurity, community mistrust and resistance, thirteen field laboratories were deployed to support the EVD diagnosis with the GeneXpert. As this latter cannot be used everywhere in remote areas due to its additional requirements, rapid diagnostic tests (RDTs) were proposed as an alternative tool to support quick decision-making at the point-of-care. However, questions regarding RDTs diagnostic performance and usability were raised due to their disparate performances. In the first part of this PhD thesis, we showed how decentralized and strategically positioned diagnostic laboratories quickly helped to mitigate the risk of Ebola virus spread through rapid, efficient, accurate and well-structured response. Quick hand over of competences and capacities to local teams led to successful management of further health emergencies (EVD flare-ups and Covid-19 pandemic), as those laboratories had dedicated equipment and well-trained local personnel. Sequencing data guided public health decision-making, helped understanding the outbreak dynamics, at risk populations and exposed health zones. In the second part of this PhD, QuickNaviTM RDT had high specificity and quite good sensitivity than OraQuick and Coris tests in outbreaks conditions. QuickNavi-EbolaTM was less impressive compared to previous studies; OraQuick test was almost in line with previous findings, although it performed better for the middle and lower Ct-values in laboratory conditions. None of the four Ebola RDTs evaluated throughout our studies, achieved the desired (sensitivity >98%, specificity >99%) or acceptable (sensitivity >95%, specificity >99%) levels of performance as stated by the WHO Target Product Profile for EBOV tests. However, respective specificities of the QuickNaviTM (>99%) and OraQuick Ebola (98%) in most our studies were close to the acceptable level of performance (>99%). Based on overall performances, QuickNaviTM and Oraquick Ebola RDTs were proposed as a screening panel at the point-of-care to triage and isolate suspect-cases waiting for the RT-qPCR results. RDTs results expectancy will be done separately i.e. individuals with at least one positive RDT isolated in the high-risk area and those with negative RDTs results in low-risk area. For postmortem surveillance, OraQuick RDT effectively complemented the response efforts, improved the community engagement, and decreased the number of systematic safe and dignified burials (SDBs) in corpses with non-reactive test. Trust towards postmortem testing led families to voluntarily request for SDBs despite OraQuick non-reactive results." "Head-to-head comparison of diagnostic accuracy of four Ebola virus disease rapid diagnostic tests versus GeneXpert (R) in eastern Democratic Republic of the Congo outbreaks" "Daniel Mukadi-Bamuleka, Junior Bulabula-Penge, Bart K.M. Jacobs, Anja De Weggheleire, Francois Edidi-Atani, Fabrice Mambu-Mbika, Anais Legand, John D. Klena, Peter N. Fonjungo, Placide Mbala-Kingebeni, Sheila Makiala-Mandanda, Masahiro Kajihara, Ayato Takada, Joel M. Montgomery, Pierre Formenty, Jean-Jacques Muyembe-Tamfum, Kevin Ariën, Johan van Griensven, Steve Ahuka-Mundeke" "Background Ebola virus disease (EVD) outbreaks have emerged in Central and West Africa. EVD diagnosis relies principally on RT-PCR testing with GeneXpert (R), which has logistical and cost restrictions at the peripheral level of the health system. Rapid diagnostic tests (RDTs) would offer a valuable alternative at the point-of-care to reduce the turn-around time, if they show good performance characteristics. We evaluated the performance of four EVD RDTs against the reference standard GeneXpert (R) on stored EVD positive and negative blood samples collected between 2018 and 2021 from outbreaks in eastern Democratic Republic of the Congo (DRC).Methods We conducted a prospective and observational study in the laboratory on QuickNavi-EbolaTM, OraQuick (R) Ebola Rapid Antigen, Coris (R) EBOLA Ag K-SeT, and Standard (R) Q Ebola Zaire Ag RDTs using left-over archived frozen EDTA whole blood samples. We randomly selected 450 positive and 450 negative samples from the EVD biorepositories in DRC, across a range of GeneXpert (R) cycle threshold values (Ct-values). RDT results were read by three persons and we considered an RDT result as ""positive"", when it was flagged as positive by at least two out of the three readers. We estimated the sensitivity and specificity through two independent generalized (logistic) linear mixed models (GLMM).Findings 476 (53%) of 900 samples had a positive GeneXpert Ebola result when retested. The QuickNavi-EbolaTM showed a sensitivity of 56.8% (95% CI 53.6-60.0) anda specificity of 97.5% (95% CI 96.2-98.4), the OraQuick (R) Ebola Rapid Antigen test displayed 61.6% (95% CI 57.0-65.9) sensitivity and 98.1% (95% CI 96.2-99.1) specificity, the Coris (R) EBOLA Ag K-SeT showed 25.0% (95% CI 22.3-27.9) sensitivity and 95.9% (95% CI 94.2-97.1) specificity, and the Standard (R) Q Ebola Zaire Ag displayed 21.6% (95% CI 18.1-25.7) sensitivity and 99.1% (95% CI 97.4-99.7) specificity.Interpretation None of the RDTs evaluated approached the ""desired or acceptable levels"" for sensitivity set out in the WHO target product profile, while all of the tests met the ""desired level"" for specificity. Nevertheless, the QuickNavi-EbolaTM and OraQuick (R) Ebola Rapid Antigen Test demonstrated the most favorable profiles, and may be used as frontline tests for triage of suspected-cases while waiting for RT-qPCR confirmatory testing. Copyright (c) 2023 Published by Elsevier B.V. This" "Managing input C/N ratio to reduce the risk of Acute Hepatopancreatic Necrosis Disease (AHPND) outbreaks in biofloc systems : a laboratory study" "Barbara Hostins, Wilson Wasielesky, Olivier Decamp, Peter Bossier, Peter De Schryver" "Temporal and Spatial Patterns and a Space-Time Cluster Analysis of Foot-and-Mouth Disease Outbreaks in Ethiopia from 2010 to 2019" "Fanos Woldemariyam, Jan Paeshuyse" "Foot-and-mouth disease (FMD) is an endemic disease in Ethiopia, although space-time cluster and monthly variation studies have never been assessed at national level. The current study aimed to identify the spatial and temporal distribution of FMD outbreaks in Ethiopia from national outbreak reports over a period of ten years from 1 January 2010 to 31 December 2019. To this end, a total of 376,762 cases and 1302 outbreaks from 704 districts were obtained from the Minister of Agriculture for analyses. In general, the dry periods, i.e., October to March, of the year were recorded as the peak outbreak periods, with the highest prevalence in March 2012. The monthly average and the outbreak trends over ten years show a decrease of outbreaks from 2010 to 2019. Decomposing the FMD outbreak data time series showed that once an outbreak erupted, it continued for up to five years. Only 12% of the reported outbreaks were assigned to a specific serotype. Within these outbreaks, the serotypes O, A, SAT-2, and SAT-1 were identified in decreasing order of prevalence, respectively. When a window of 50% for the maximum temporal/space cluster size was set, a total of seven FMD clusters were identified in space and time. The primary cluster with a radius of 380.95 km was identified in the southern part of Ethiopia, with a likelihood ratio of 7.67 (observed/expected cases). The third cluster, with a radius of 144.14 km, was identified in the northeastern part of the country, and had a likelihood ratio of 5.66. Clusters 1 and 3 occurred from January 2017 to December 2019. The second cluster that occurred had a radius of 294.82 km, a likelihood ratio of 6.20, and was located in the central and western parts of Ethiopia. The sixth cluster, with a radius of 36.04 km and a likelihood ratio of 20.60, was set in southern Tigray, bordering Afar. Clusters 2 and 6 occurred in the same period, from January 2014 to December 2016. The fourth cluster in northern Tigray had a calculated radius of 95.50 km and a likelihood ratio of 1.17. The seventh cluster occurred in the north-central Amhara region, with a radius of 97 km and a likelihood ratio of 1.16. Clusters 4 and 7 occurred between January 2010 and December 2013. The spatiotemporal and cluster analysis of the FMD outbreaks identified in the context of the current study are crucial in implementing control, prevention, and a prophylactic vaccination schedule. This study pointed out October to March as well as the main time of the year during which FMD outbreaks occur. The area that extends from the south to north, following the central highlands, is the main FMD outbreak area in Ethiopia." "Costing infectious disease outbreaks for economic evaluation: a review for hepatitis A" "Jeroen Luyten, Philippe Beutels" "With the aim to understand and estimate the economic impact of outbreaks of community-acquired infections, we performed a review focusing on hepatitis A outbreaks, and retained 13 papers, which had collected relevant cost information during such outbreaks. All costs in this article are expressed in $US, year 2007 values. The costs of hepatitis A outbreaks ranged from $US140 000 to $US36 million, and the costs per case in an outbreak situation ranged from $US3824 to $US200 480. These costs were typically found to be substantially higher than estimates from cost-of-illness studies and estimates used in cost-effectiveness analyses, mostly because of costly outbreak-control measures. Post-exposure prophylaxis is a major cost factor, especially for food-borne outbreaks. As a result of the increasing proportion of those susceptible to hepatitis A in low-incidence countries, future outbreaks could, on average, increase in size. The increasing occurrence of hepatitis A cases in outbreak situations and the associated control costs should appropriately be accounted for in economic evaluations of vaccination programmes in low-incidence countries. In order to do this, more studies documenting such outbreak-control strategies in terms of costs and resource use are needed." "Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): A rapid systematic review" "Niels De Brier, Stijn Stroobants, Philippe Vandekerckhove, Emmy De Buck" "INTRODUCTION: The novel Coronavirus Disease (COVID-19) outbreak currently puts health care workers at high risk of both physical and mental health problems. This study aimed to identify the risk and protective factors for mental health outcomes in health care workers during coronavirus epidemics. METHODS: A rapid systematic review was performed in three databases (March 24, 2020) and a current COVID-19 resource (May 28, 2020). Following study selection, study characteristics and effect measures were tabulated, and data were synthesized by using vote counting. Meta-analysis was not possible because of high variation in risk factors, outcomes and effect measures. Risk of bias of each study was assessed and the certainty of evidence was appraised according to the GRADE methodology. RESULTS: Out of 2605 references, 33 observational studies were selected and the identified risk and protective factors were categorized in ten thematic categories. Most of these studies (n = 23) were performed during the SARS outbreak, seven during the current COVID-19 pandemic and three during the MERS outbreak. The level of disease exposure and health fear were significantly associated with worse mental health outcomes. There was evidence that clear communication and support from the organization, social support and personal sense of control are protective factors. The evidence was of very low certainty, because of risk of bias and imprecision. CONCLUSION: Safeguarding mental health of health care workers during infectious disease outbreaks should not be treated as a separate mental health intervention strategy, but could benefit from a protective approach. This study suggests that embedding mental health support in a safe and efficient working environment which promotes collegial social support and personal sense of control could help to maximize resilience of health care workers. Low quality cross-sectional studies currently provide the best possible evidence, and further research is warranted to confirm causality." "Enterotoxigenic Escherichia coli strains are highly prevalent in Ugandan piggeries but disease outbreaks are masked by antibiotic prophylaxis" "Emmanuel Okello, Kristof Moonens, Joseph Erume, Henri De Greve" "Post-weaning diarrhea (PWD) caused by enterotoxigenic Escherichia coli (ETEC) is an important disease of newly weaned piglets. ETEC strains commonly express F4 and/or F18 fimbriae that attach to carbohydrate receptors present on the intestinal epithelium during colonization. The disease status in the Ugandan piggeries had previously not been studied. In this cross-sectional sero-survey and clinical outbreak monitoring, we found very high sero-prevalence levels of both anti-F4 (70.5 %) and anti-F18 (73.7 %) antibodies, despite limited cases of clinical outbreaks. Strains isolated from these cases were typically F18+ ETEC. High antibiotic resistance and multi-drug resistance were characteristics of the isolates, with highest resistance level of over 95% to commonly used antibiotics such as penicillin and tetracycline. We conclude that ETEC infections are widely spread on farms in Central Uganda but clinical disease outbreaks were masked by the management practices on these farms, like the use of extensive antibiotic prophylaxis."