Online Reports

Arboviruses represent a major cause of illness in Africa and have the potential to trigger widespread epidemics. We present data on arbovirus epidemics in Africa in 2023 and demonstrate the need for global public health authorities to intensify efforts in the surveillance and control of arbovirus diseases. Data were collected from the World Health Organization Weekly Bulletin on Outbreaks and Other Emergencies, Africa Centers for Disease Control and Prevention Weekly Event Based Surveillance Report, and other online sources. In 2023, a total of 7 arboviruses were responsible for 29 outbreaks across 25 countries in Africa, 22 of which occurred in West Africa; the outbreaks resulted in 19,569 confirmed cases and 820 deaths. Arbovirus epidemics in Africa pose a threat not only to public health within the continent but also globally, underscoring the urgent need for substantial investment in arbovirus surveillance, research, and preparedness capacities in Africa to prevent and respond to health crises effectively.

The current recommendation for treating Lassa fever with ribavirin is supported only by weak evidence. Given the persistent effects in areas with endemic transmission and epidemic potential, there is an urgent need to reassess ribavirin and investigate other potential therapeutic candidates; however, a robust clinical trial method adapted to Lassa fever epidemiology has not yet been established. We propose an adaptive phase II/III multicenter randomized controlled platform trial that uses a superiority framework with an equal allocation ratio and accounts for challenges selecting the primary end point and estimating the target sample size by using an interim analysis.

Hypervirulent Klebsiella pneumoniae (hvKp) can cause life-threatening infections in healthy community members. HvKp infections often involve multiple sites, some of which are unusual for classical K. pneumoniae (cKp) infections, such as the central nervous system, eyes, and fascia. The acquisition of antimicrobial resistance by hvKp has resulted in concerns of an emerging superbug. This concern is magnified by increasing geographic dissemination and healthcare associated infections. Currently, diagnostic testing to differentiate hvKp from cKp is lacking, causing challenges for clinical care, surveillance, and research. Although imperfect, the detection of all 5 of the biomarkers iucA, iroB, peg-344, rmpA, and rmpA2 is the most accurate and pragmatic means to identify hvKp. We propose a working definition for hvKp that will enhance accuracy for diagnosis and surveillance, which will aid in preventing the spread of hvKp.

Event management systems (EMS) are key tools for epidemic intelligence, integrating surveillance signals and incident response, although international standards to inform development are lacking. We describe the Nigeria Centre for Disease Control and Prevention (NCDC) SITAware, a software capable of operating with low internet bandwidth to generate notifications, reports, and spatiotemporal dashboards and provide event-level data for real-time accountability and postevent learning. SITAware was enabled by local institutional ownership, co-created at low cost, and integrated into existing workflows. In 2022, SITAware was used to manage ≈300 incidents, and NCDC implemented it subnationally. NCDC’s experience may inform EMS development and implementation in similar settings.

Since the severe acute respiratory syndrome outbreak in 2003, China has invested substantial efforts in promoting scientific and technological advances for medical countermeasures against high-threat pathogens. The examination of China’s landscape identifies progress and gaps in research and development (R&D) and also highlights management and regulatory issues that should be of concern to other countries. Our study examined the current state of R&D of medical countermeasures in China during 1990–2022. The findings showed a robust and diversified pipeline responding quickly to disease outbreaks and policy changes. However, proactive and highly innovative candidates are limited, and a large proportion of vaccines and drugs stagnate at the early development stage. A paradigm shift involving a preemptive R&D agenda and persistent investment, innovative technology development, and accelerated research translation is urgently needed to prepare for the next pandemic.