Early Release

Synopses

• Enhancing Respiratory Disease Surveillance to Detect COVID-19 in Shelters for Displaced Persons, Thailand–Myanmar Border, 2020–2021
  B. Knust et al. View Abstract

  We developed surveillance guidance for COVID-19 in 9 temporary camps for displaced persons along the Thailand–Myanmar border. Arrangements were made for testing of persons presenting with acute respiratory infection, influenza-like illness, or who met the Thailand national COVID-19 Person Under Investigation case definition. In addition, testing was performed for persons who had traveled outside of the camps in outbreak-affected areas or who departed Thailand as resettling refugees. During the first 18 months of surveillance, May 2020–October 2021, a total of 6,190 specimens were tested, and 15 outbreaks (i.e., >1 confirmed COVID-19 cases) were detected in 7 camps. Of those, 5 outbreaks were limited to a single case. Outbreaks during the Delta variant surge were particularly challenging to control. Adapting and implementing COVID-19 surveillance measures in the camp setting were successful in detecting COVID-19 outbreaks and preventing widespread disease during the initial phase of the pandemic in Thailand.

• CDC’s COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions
  H. M. Soeters et al. View Abstract

  The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE’s 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC’s work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.

• Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic
  P. Marcenac et al. View Abstract

  A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.

• Lessons Learned from CDC’s Global COVID-19 Early Warning and Response Surveillance System
  P. M. Ricks et al. View Abstract

  Early warning and response surveillance (EWARS) systems were widely used during the early COVID-19 response. Evaluating the effectiveness of EWARS systems is critical to ensuring global health security. We describe the Centers for Disease Control and Prevention (CDC) global COVID-19 EWARS (CDC EWARS) system and the resources CDC used to gather, manage, and analyze publicly available data during the prepandemic period. We evaluated data quality and validity by measuring reporting completeness and compared these with data from Johns Hopkins University, the European Centre for Disease Prevention and Control, and indicator-based data from the World Health Organization. CDC EWARS was integral in guiding CDC’s early COVID-19 response but was labor-intensive and became less informative as case-level data decreased and the pandemic evolved. However, CDC EWARS data were similar to those reported by other organizations, confirming the validity of each system and suggesting collaboration could improve EWARS systems during future pandemics.

• Faith Community Engagement to Mitigate COVID-19 Transmission Associated with Mass Gathering, Uman, Ukraine, September 2021
  L. Erickson-Mamane et al. View Abstract

  Annually, ≈30,000 Hasidic and Orthodox Jews travel to Uman, Ukraine, during the Jewish New Year to pray at the burial place of the founder of the Breslov Hasidic movement. Many pilgrims come from the northeastern United States. The global health implications of this event were seen in 2019 when measles outbreaks in the United States and Israel were linked to the pilgrimage. The 2020 pilgrimage was cancelled as part of the COVID-19 travel restrictions imposed by the government of Ukraine. To prepare for the 2021 event, the National Public Health Institute, the Public Health Center of Ukraine, organized mitigation measures for pilgrims arriving in Uman, and the CDC COVID-19 International Task Force assisted with mitigation measures for pilgrims coming from the United States. We describe efforts to support COVID-19 mitigation measures before, during, and after this mass gathering and lessons learned for future mass gatherings during pandemics.

• Adopting World Health Organization Multimodal Infection Prevention and Control Strategies to Respond to COVID-19, Kenya
  D. Kimani et al. View Abstract

  The World Health Organization advocates a multimodal approach to improving infection prevention and control (IPC) measures, which Kenya adopted in response to the COVID-19 pandemic. The Kenya Ministry of Health formed a national IPC committee for policy and technical leadership, coordination, communication, and training. During March–November 2020, a total of 69,892 of 121,500 (57.5%) healthcare workers were trained on IPC. Facility readiness assessments were conducted in 777 health facilities using a standard tool assessing 16 domains. A mean score was calculated for each domain across all facilities. Only 3 domains met the minimum threshold of 80%. The Ministry of Health maintained a national list of all laboratory-confirmed SARS-CoV-2 infections. By December 2020, a total of 3,039 healthcare workers were confirmed to be SARS-CoV-2–positive, an infection rate (56/100,000 workers) 12 times higher than in the general population. Facility assessments and healthcare workers' infection data provided information to guide IPC improvements.

• Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020
  M. E. Peck et al. View Abstract

  Beginning in March 2020, to reduce COVID-19 transmission, the US President’s Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.

• Clinical and Economic Impact of COVID-19 on Agricultural Workers, Guatemala
  D. Olson et al. View Abstract

  We evaluated clinical and socioeconomic burdens of respiratory disease in banana farm workers in Guatemala. We offered all eligible workers enrollment during June 15–December 30, 2020, and annually, then tracked them for influenza-like illnesses (ILI) through self-reporting to study nurses, sentinel surveillance at health posts, and absenteeism. Workers who had ILI submitted nasopharyngeal swab specimens for testing for influenza virus, respiratory syncytial virus, and SARS-CoV-2, then completed surveys at days 0, 7, and 28. Through October 10, 2021, a total of 1,833 workers reported 169 ILIs (12.0 cases/100 person-years), and 43 (25.4%) were laboratory-confirmed infections with SARS-CoV-2 (3.1 cases/100 person-years). Workers who had SARS-CoV-2‒positive ILIs reported more frequent anosmia, dysgeusia, difficulty concentrating, and irritability and worse clinical and well-being severity scores than workers who had test result‒negative ILIs. Workers who had positive results also had greater absenteeism and lost income. These results support prioritization of farm workers in Guatemala for COVID-19 vaccination.

• Use of Epidemiology Surge Support to Enhance Robustness and Expand Capacity of SARS-CoV-2 Pandemic Response, South Africa
  R. Taback-Esra et al. View Abstract

  As COVID-19 cases increased during the first weeks of the pandemic in South Africa, the National Institute of Communicable Diseases requested assistance with epidemiologic and surveillance expertise from the US Centers for Disease Control and Prevention South Africa. By leveraging its existing relationship with the National Institute of Communicable Diseases for >2 months, the US Centers for Disease Control and Prevention South Africa supported data capture and file organization, data quality reviews, data analytics, laboratory strengthening, and the development and review of COVID-19 guidance This case study provides an account of the resources and the technical, logistical, and organizational capacity leveraged to support a rapid response to the COVID-19 pandemic in South Africa.

• SARS-CoV-2 Prevalence in Malawi Based on Data from Survey of Communities and Health Workers in 5 High-Burden Districts, October 2020
  J. Theu et al. View Abstract

  To determine early COVID-19 burden in Malawi, we conducted a multistage cluster survey in 5 districts. During October–December 2020, we recruited 5,010 community members (median age 32 years, interquartile range 21–43 years) and 1,021 health facility staff (HFS) (median age 35 years, interquartile range 28–43 years). Real-time PCR–confirmed SARS-CoV-2 infection prevalence was 0.3% (95% CI 0.2%–0.5%) among community and 0.5% (95% CI 0.1%–1.2%) among HFS participants; seroprevalence was 7.8% (95% CI 6.3%–9.6%) among community and 9.7% (95% CI 6.4%–14.5%) among HFS participants. Most seropositive community (84.7%) and HFS (76.0%) participants were asymptomatic. Seroprevalence was higher among urban community (12.6% vs. 3.1%) and HFS (14.5% vs. 7.4%) than among rural community participants. Cumulative infection findings 113-fold higher from this survey than national statistics (486,771 vs. 4,319) and predominantly asymptomatic infections highlight a need to identify alternative surveillance approaches and predictors of severe disease to inform national response.

• Outcomes after Acute Malnutrition Program Adaptations to COVID-19, Uganda, Ethiopia, and Somalia
  T. Shragai et al. View Abstract

  At the onset of the COVID-19 pandemic, protocols for community-based management of acute malnutrition (CMAM) were implemented to support continuity of essential feeding services while mitigating COVID-19 transmission. To assess correlations between adaptation timing and CMAM program indicators, we evaluated routine program data in Uganda, Ethiopia, and Somalia for children 6–59 months of age. We specifically analyzed facility-level changes in total admissions, average length of stay (ALOS), total children screened for admission, and recovery rates before and after adaptations. We found no statistically significant changes in program indicators after adaptations. For Somalia, we also analyzed child-level changes in ALOS and in weight and mid–upper arm circumference at admission and discharge. ALOS significantly increased immediately after adaptations and then decreased to preadaptation levels. We found no meaningful changes in either weight or mid–upper arm circumference at admission or discharge. These findings indicate that adapted CMAM programs can remain effective.

• Effect of Nigeria Presidential Task Force on COVID-19 Pandemic, Nigeria
  O. Bolu et al. View Abstract

  Nigeria had a confirmed case of COVID-19 on February 28, 2020. On March 17, 2020, the Nigerian Government inaugurated the Presidential Task Force (PTF) on COVID-19 to coordinate the country’s multisectoral intergovernmental response. The PTF developed the National COVID-19 Multisectoral Pandemic Response Plan as the blueprint for implementing the response plans. The PTF provided funding, coordination, and governance for the public health response and executed resource mobilization and social welfare support, establishing the framework for containment measures and economic reopening. Despite the challenges of a weak healthcare infrastructure, staff shortages, logistic issues, commodity shortages, currency devaluation, and varying state government cooperation, high-level multisectoral PTF coordination contributed to minimizing the effects of the pandemic through early implementation of mitigation efforts, supported by a strong collaborative partnership with bilateral, multilateral, and private-sector organizations. We describe the lessons learned from the PTF COVID-19 for future multisectoral public health response.

• Comparison of COVID-19 Pandemic Waves in 10 Countries in Southern Africa, 2020–2021
  J. Smith-Sreen et al. View Abstract

  We used publicly available data to describe epidemiology, genomic surveillance, and public health and social measures from the first 3 COVID-19 pandemic waves in southern Africa during April 6, 2020–September 19, 2021. South Africa detected regional waves on average 7.2 weeks before other countries. Average testing volume 244 tests/million/day) increased across waves and was highest in upper-middle-income countries. Across the 3 waves, average reported regional incidence increased (17.4, 51.9, 123.3 cases/1 million population/day), as did positivity of diagnostic tests (8.8%, 12.2%, 14.5%); mortality (0.3, 1.5, 2.7 deaths/1 million populaiton/day); and case-fatality ratios (1.9%, 2.1%, 2.5%). Beta variant (B.1.351) drove the second wave and Delta (B.1.617.2) the third. Stringent implementation of safety measures declined across waves. As of September 19, 2021, completed vaccination coverage remained low (8.1% of total population). Our findings highlight opportunities for strengthening surveillance, health systems, and access to realistically available therapeutics, and scaling up risk-based vaccination.

• India Field Epidemiology Training Program Response to COVID-19 Pandemic, 2020–2021
  S. Singh et al. View Abstract

  The India Field Epidemiology Training Program (FETP) has played a critical role in India’s response to the ongoing COVID-19 pandemic. During March 2020–June 2021, a total of 123 FETP officers from across 3 training hubs were deployed in support of India’s efforts to combat COVID-19. FETP officers have successfully mitigated the effect of COVID-19 on persons in India by conducting cluster outbreak investigations, performing surveillance system evaluations, and developing infection prevention and control tools and guidelines. This report discusses the successes of select COVID-19 pandemic response activities undertaken by current India FETP officers and proposes a pathway to augmenting India’s pandemic preparedness and response efforts through expansion of this network and a strengthened frontline public health workforce.

• Effects of Decreased Immunization Coverage for Hepatitis B Virus Caused by COVID-19 in World Health Organization Western Pacific and African Regions, 2020
  H. J. Kabore et al. View Abstract

  The World Health Organization–designated Western Pacific Region (WPR) and African Region (AFR) have the highest number of chronic hepatitis B virus (HBV) infections worldwide. The COVID-19 pandemic has disrupted childhood immunization, threatening progress toward elimination of hepatitis B by 2030. We used a published mathematical model to estimate the number of expected and excess HBV infections and related deaths after 10% and 20% decreases in hepatitis B birth dose or third-dose hepatitis B vaccination coverage of children born in 2020 compared with prepandemic 2019 levels. Decreased vaccination coverage resulted in additional chronic HBV infections that were 36,342–395,594 in the WPR and 9,793–502,047 in the AFR; excess HBV-related deaths were 7,150–80,302 in the WPR and 1,177–67,727 in the AFR. These findings support the urgent need to sustain immunization services, implement catch-up vaccinations, and mitigate disruptions in hepatitis B vaccinations in future birth cohorts.

• Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems, Belize, Kenya, Ethiopia, Peru, and Liberia, 2020–2021
  D. C. Shih et al. View Abstract

  Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2, which causes COVID-19. The US Centers for Disease Control and Prevention collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Staff at sentinel sites collected epidemiologic data from persons meeting AFI criteria and specimens for SARS-CoV-2 testing. A total of 5,501 patients with AFI were enrolled during March 2020–October 2021; >69% underwent SARS-CoV-2 testing. Percentage positivity for SARS-CoV-2 ranged from 4% (87/2,151, Kenya) to 19% (22/115, Ethiopia). We show SARS-CoV-2 testing was successfully integrated into AFI surveillance in 5 low- to middle-income countries to detect COVID-19 within AFI care-seeking populations. AFI surveillance systems can be used to build capacity to detect and respond to both emerging and endemic infectious disease threats.

• Gaps in Publicly Shared SARS-CoV-2 Genomic Surveillance Data: An Analysis of Global Submissions
  E. C. Ohlsen et al.
• Past as Prologue: Rubella Vaccination Program Lessons May Inform COVID-19 Vaccination
  M. G. Dixon et al.
• The Future of Infodemic Surveillance as Public Health Surveillance
  H. Chiou et al. View Abstract

  Public health systems need to be able to detect and respond to infodemics (outbreaks of misinformation, disinformation, information overload, or information voids). Drawing from our experience at the US Centers for Disease Control and Prevention, the COVID-19 State of Vaccine Confidence Insight Reporting System has been created as one of the first public health infodemic surveillance systems. Key functions of infodemic surveillance systems include monitoring the information environment by person, place, and time; identifying infodemic events with digital analytics; conducting offline community-based assessments; and generating timely routine reports. Although specific considerations of several system attributes of infodemic surveillance system must be considered, infodemic surveillance systems share several similarities with traditional public health surveillance systems. Because both information and pathogens are spread more readily in an increasingly hyperconnected world, sustainable and routine systems must be created to ensure that timely interventions can be deployed for both epidemic and infodemic response.

• Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa
  D. J. Gomes et al. View Abstract

  The coronavirus disease pandemic has highlighted the need to establish and maintain strong infection prevention and control (IPC) practices, not only to prevent healthcare-associated transmission of SARS-CoV-2 to healthcare workers and patients but also to prevent disruptions of essential healthcare services. In East Africa, where basic IPC capacity in healthcare facilities is limited, the US Centers for Disease Control and Prevention (CDC) supported rapid IPC capacity building in healthcare facilities in 4 target countries: Tanzania, Ethiopia, Kenya, and Uganda. CDC supported IPC capacity-building initiatives at the healthcare facility and national levels according to each country’s specific needs, priorities, available resources, and existing IPC capacity and systems. In addition, CDC established a multicountry learning network to strengthen hospital level IPC, with an emphasis on peer-to-peer learning. We present an overview of the key strategies used to strengthen IPC in these countries and lessons learned from implementation.

• Effectiveness of Whole-Virus COVID-19 Vaccine among Healthcare Personnel, Lima, Peru
  C. S. Arriola et al. View Abstract

  In February 2021, Peru launched a COVID-19 vaccination campaign among healthcare personnel using an inactivated whole-virus vaccine. The manufacturer recommended 2 vaccine doses 21 days apart. We evaluated vaccine effectiveness among an existing multiyear influenza vaccine cohort at 2 hospitals in Lima. We analyzed data on 290 participants followed during February–May 2021. Participants completed a baseline questionnaire and provided weekly self-collected nasal swab samples for 16 weeks; samples were tested by real-time reverse transcription PCR. Median participant follow-up was 2 (range 1–11) weeks. We performed multivariable logistic regression and adjusted for preselected characteristics. During the study, 25 (9%) participants tested SARS-CoV-2–positive. We estimated adjusted vaccine effectiveness at 95% (95% CI 70%–99%) among fully vaccinated participants and 100% (95% CI 88%–100%) among partially vaccinated participants. These data can inform the use and acceptance of inactivated whole-virus vaccine and support vaccination efforts in the region.

• Effects of COVID-19 on Vaccine-Preventable Disease Surveillance Systems in the World Health Organization African Region, 2020
  J. Bigouette et al. View Abstract

  Global emergence of the COVID-19 pandemic in 2020 curtailed vaccine-preventable disease (VPD) surveillance activities, but little is known about which surveillance components were most affected. In May 2021, we surveyed 214 STOP (originally Stop Transmission of Polio) Program consultants to determine how VPD surveillance activities were affected by the COVID-19 pandemic throughout 2020, primarily in low- and middle-income countries, where program consultants are deployed. Our report highlights the responses from 154 (96%) of the 160 consultants deployed to the World Health Organization African Region, which comprises 75% (160/214) of all STOP Program consultants deployed globally in early 2021. Most survey respondents observed that VPD surveillance activities were somewhat or severely affected by the COVID-19 pandemic in 2020. Reprioritization of surveillance staff and changes in health-seeking behaviors were factors commonly perceived to decrease VPD surveillance activities. Our findings suggest the need for strategies to restore VPD surveillance to prepandemic levels.

• Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response, Haiti
  M. Mirza et al.
• Building on Capacity Established through US Centers for Disease Control and Prevention Global Health Programs to Respond to COVID-19, Cameroon
  E. K. Dokubo et al.
• Leveraging Lessons Learned from Yellow Fever and Polio Immunization Campaigns during COVID-19 Pandemic, Ghana, 2021
  K. Amponsa-Achiano et al.
• Lessons from Nigeria’s Adaptation of Global Health Initiatives during the COVID-19 Pandemic
  C. Ihekweazu
• Sexual Violence Trends before and after the COVID-19 Pandemic, Kenya
  W. Ochieng et al. View Abstract

  COVID-19 mitigation measures such as curfews, lockdowns, and movement restrictions are effective in reducing the transmission of SARS-CoV-2; however, these measures can enable sexual violence. We used data from the Kenya Health Information System and different time-series approaches to model the unintended consequences of COVID-19 mitigation measures on sexual violence trends in Kenya. We found a model-dependent 73%–122% increase in reported sexual violence cases, mostly among persons 10–17 years of age, translating to 35,688 excess sexual violence cases above what would have been expected in the absence of COVID-19–related restrictions. In addition, during lockdown, the percentage of reported rape survivors receiving recommended HIV PEP decreased from 61% to 51% and STI treatment from 72% to 61%. Sexual violence mitigation measures might include establishing comprehensive national sexual violence surveillance systems, enhancing prevention efforts during school closures, and maintaining access to essential comprehensive services for all ages and sexes.

• Contribution of PEPFAR-Supported HIV and TB Molecular Diagnostic Networks to COVID-19 Testing Preparedness in 16 Countries
  E. Romano et al. View Abstract

  The US President’s Emergency Plan for AIDS Relief (PEPFAR) supports molecular HIV and tuberculosis diagnostic networks and information management systems in low- and middle-income countries. We describe how national programs leveraged these PEPFAR-supported laboratory resources for SARS-CoV-2 testing during the COVID-19 pandemic. We sent a spreadsheet template consisting of 46 indicators for assessing the use of PEPFAR-supported diagnostic networks for COVID-19 pandemic response activities during April 1, 2020, to March 31, 2021, to 27 PEPFAR-supported countries or regions. A total of 109 PEPFAR-supported centralized HIV viral load and early infant diagnosis laboratories and 138 decentralized sites reported performing SARS-CoV-2 testing in 16 countries. Together, these sites contributed to >3.4 million SARS-CoV-2 tests during the 1-year period. Our findings illustrate that PEPFAR-supported diagnostic networks provided a wide range of resources to respond to emergency COVID-19 diagnostic testing in 16 low- and middle-income countries.

• Use of Project ECHO in Response to COVID-19 in Countries Supported by US President’s Emergency Plan for AIDS Relief
  J. Wright et al. View Abstract

  The US Centers for Disease Control and Prevention, with funding from the US President’s Plan for Emergency Relief, implements a virtual model for clinical mentorship, Project Extension for Community Healthcare Outcomes (ECHO), worldwide to connect multidisciplinary teams of healthcare workers (HCWs) with specialists to build capacity to respond to the HIV epidemic. The emergence of and quick evolution of the COVID-19 pandemic created the need and opportunity for the use of the Project ECHO model to help address the knowledge requirements of HCW responding to COVID-19 while maintaining HCW safety through social distancing. We describe the implementation experiences of Project ECHO in 5 Centers for Disease Control and Prevention programs as part of their COVID-19 response, in which existing platforms were used to rapidly disseminate relevant, up-to-date COVID-19–related clinical information to a large, multidisciplinary audience of stakeholders within their healthcare systems.

• Extending and Strengthening Routine DHIS2 Surveillance Systems for COVID-19 Responses in Sierra Leone, Sri Lanka, and Uganda
  C. Kinkade et al. View Abstract

  The COVID-19 pandemic challenged countries to protect their populations from this emerging disease. One aspect of that challenge was to rapidly modify national surveillance systems or create new systems that would effectively detect new cases of COVID-19. Fifty-five countries leveraged past investments in District Health Information Software version 2 (DHIS2) to quickly adapt their national public health surveillance systems for COVID-19 case reporting and response activities. We provide background on DHIS2 and describe case studies from Sierra Leone, Sri Lanka, and Uganda to illustrate how the DHIS2 platform, its community of practice, long-term capacity building, and local autonomy enabled countries to establish an effective COVID-19 response. With these case studies, we provide valuable insights and recommendations for strategies that can be used for national electronic disease surveillance platforms to detect new and emerging pathogens and respond to public health emergencies.

• Literature Review of the Role of National Public Health Institutes in COVID-19 Response
  A. Zuber et al.
• COVID-19 Response Roles among International Public Health Emergency Management Fellowship Graduates
  S. Krishnan et al.
• Continuing Contributions of Field Epidemiology Training Programs to Global COVID-19 Response
  E. Bell et al.
• Using Population Mobility Patterns to Adapt COVID-19 Response Strategies in 3 East Africa Countries
  R. D. Merrill et al. View Abstract

  The COVID-19 pandemic spread between neighboring countries through land, water, and air travel. Since May 2020, ministries of health for the Democratic Republic of the Congo, Tanzania, and Uganda have sought to clarify population movement patterns to improve their disease surveillance and pandemic response efforts. Ministry of Health–led teams completed focus group discussions with participatory mapping using country-adapted Population Connectivity Across Borders toolkits. They analyzed the qualitative and spatial data to prioritize locations for enhanced COVID-19 surveillance, community outreach, and cross-border collaboration. Each country employed varying toolkit strategies, but all countries applied the results to adapt their national and binational communicable disease response strategies during the pandemic, although the Democratic Republic of the Congo used only the raw data rather than generating datasets and digitized products. This 3-country comparison highlights how governments create preparedness and response strategies adapted to their unique sociocultural and cross-border dynamics to strengthen global health security.

• Adapting Longstanding Public Health Collaborations between Government of Kenya and CDC Kenya in Response to the COVID-19 Pandemic, 2020–2021
  A. Herman-Roloff et al. View Abstract

  Kenya’s Ministry of Health (MoH) and the US Centers for Disease Control and Prevention in Kenya (CDC Kenya) have maintained a 40-year partnership during which measures were implemented to prevent, detect, and respond to disease threats. During the COVID-19 pandemic, the MoH and CDC Kenya rapidly responded to mitigate disease impact on Kenya’s 52 million residents. We describe activities undertaken jointly by the MoH and CDC Kenya that lessened the effects of COVID-19 during 5 epidemic waves from March through December 2021. Activities included establishing national and county-level emergency operations centers and implementing workforce development and deployment, infection prevention and control training, laboratory diagnostic advancement, enhanced surveillance, and information management. The COVID-19 pandemic provided fresh impetus for the government of Kenya to establish a national public health institute, launched in January 2022, to consolidate its public health activities and counter COVID-19 and future infectious, vaccine-preventable, and emerging zoonotic diseases.

• Community-Based Surveillance and Geographic Information System‒Linked Contact Tracing in COVID-19 Case Identification, Ghana, March‒June 2020
  E. Kenu et al.
• Leveraging HIV Program and Civil Society to Accelerate COVID-19 Vaccine Uptake, Zambia
  P. Bobo et al. View Abstract

  To accelerate COVID-19 vaccination delivery, Zambia integrated COVID-19 vaccination into HIV treatment centers and used World AIDS Day 2021 to launch a national vaccination campaign. This campaign was associated with significantly increased vaccinations, demonstrating that HIV programs can be leveraged to increase COVID-19 vaccine uptake.

• Global Responses to the COVID-19 Pandemic
  C. H. Cassell et al.

Research

• A Nationally Representative Survey of COVID-19 in Pakistan, 2021–2022
  S. Aheron et al. View Abstract

  We conducted 4,863 mobile phone and 1,715 face-to-face interviews of adults >18 years residing in Pakistan during June 2021–January 2022 that focused on opinions and practices related to COVID-19. Of those surveyed, 26.3% thought COVID-19 was inevitable, and 16.8% had tested for COVID-19. Survey participants who considered COVID-19 an inevitability shared such traits as urban residency, concerns about COVID-19, and belief that the virus is a serious medical threat. Survey respondents who had undergone COVID-19 testing shared similarities regarding employment status, education, mental health screening, and the consideration of COVID-19 as an inevitable disease. From this survey, we modeled suspected and confirmed COVID-19 cases and found nearly 3 times as many suspected and confirmed COVID-19 cases than had been reported. Our research also suggested undertesting for COVID-19 even in the presence of COVID-19 symptoms. Further research might help uncover the reasons behind undertesting and underreporting of COVID-19 in Pakistan.

Commentary

• Partnerships, Collaborations, and Investments Integral to CDC’s International Response to COVID-19
  R. P. Walensky

Synopses

• Comprehensive Review of Emergence and Virology of Tickborne Bourbon Virus in the United States
  M. K. Roe et al.
• Multicenter Case-Control Study of COVID-19–Associated Mucormycosis Outbreak, India
  V. Muthu et al.
• Role of Seaports and Imported Rats in Seoul Hantavirus Transmission, Africa
  G. Castel et al.

Research

• Genomic Epidemiology Linking Nonendemic Coccidioidomycosis to Travel
  J. Monroy-Nieto et al.
• Akkermansia muciniphila Associated with Improved Linear Growth among Young Children, Democratic Republic of the Congo
  C. George et al. View Abstract

  To investigate the association between enteric infections, fecal microbes, and child growth, we conducted a prospective cohort study of 236 children <5 years of age in rural eastern Democratic Republic of the Congo. We analyzed baseline fecal specimens by quantitative PCR and measured child height and weight at baseline and growth at a 6-month follow-up. At baseline, 66% (156/236) of children had >3 pathogens in their feces. We observed larger increases in height-for-age-z-scores from baseline to the 6-month follow-up among children with Akkermansia muciniphila in their feces (coefficient 0.02 [95% CI 0.0001–0.04]; p = 0.04). Children with Cryptosporidium in their feces had larger declines in weight-for-height/length z-scores from baseline to the 6-month follow-up (coefficient –0.03 [95% CI –0.05 to –0.005]; p = 0.02). Our study showed high prevalence of enteric infections among this pediatric cohort but suggests A. muciniphila can potentially serve as a probiotic to improve child growth.

• Seroepidemiology and Carriage of Diphtheria in Epidemic-Prone Area and Implications for Vaccination Policy, Vietnam
  N. Kitamura et al.
• Risk for Severe Illness and Death among Pediatric Patients with Down syndrome Hospitalized for COVID-19, Brazil
  C. Leung et al.
• COVID-19 Booster Dose Vaccination Coverage and Factors associated with Booster Vaccination among Adults, United States, March 2022
  P. Lu et al.
• Risk for Severe COVID-19 Outcomes among Persons with Intellectual Disabilities, the Netherlands
  M. Koks-Leensen et al.
• Molecular Tools for Early Detection of Invasive Malaria Vector Anopheles stephensi Mosquito
  O. P. Singh et al.
• Genomic Confirmation of Borrelia garinii, United States
  N. Rudenko et al.
• High SARS-CoV-2 Seroprevalence after Second Wave (October 2020–April 2021), Democratic Republic of the Congo
  Y. Munyeku-Bazitama et al.
• Widespread Exposure to Mosquitoborne California Serogroup Viruses in Caribou, Arctic Fox, Red Fox, and Polar Bears, Canada
  K. J. Buhler et al.
• Human Immunity and Susceptibility to Influenza A(H3) Viruses of Avian, Equine, and Swine Origin
  E. Vandoorn et al.
• Integration of Citizen Scientist Data into the Surveillance System for Avian Influenza Virus, Taiwan
  H. Wu et al.

Dispatches

• Photobacterium damselae subsp. damselae Pneumonia in Dead, Stranded Bottlenose Dolphin, Eastern Mediterranean Sea
  D. Morick et al.
• Clinical Forms of Japanese Spotted Fever from Case-Series Study, Zigui County, Hubei Province, China, 2021
  Z. Teng et al.
• Pathologic and Immunohistochemical Evidence of Possible Francisellaceae among Aborted Ovine Fetuses, Uruguay
  F. Giannitti et al.
• Efficient Inactivation of Monkeypox Virus by World Health Organization‒Recommended Hand Rub Formulations and Alcohols
  T. L. Meister et al. View Abstract

  Increasing nonzoonotic human monkeypox virus (MPXV) infections urge reevaluation of inactivation strategies. We demonstrate efficient inactivation of MPXV by 2 World Health Organization‒recommended alcohol-based hand rub solutions. When compared with other (re)emerging enveloped viruses, MPXV displayed the greatest stability. Our results support rigorous adherence to use of alcohol-based disinfectants.

• Detection of Monkeypox Virus DNA in Airport Wastewater, Rome, Italy
  G. La Rosa et al.
• Using Serum Specimens for Real-Time PCR-Based Diagnosis of Human Granulocytic Anaplasmosis, Canada
  C. Boodman et al.
• Survey of West Nile and Banzi Viruses in Mosquitoes, South Africa, 2011–2018
  C. MacIntyre et al.
• Burden of Postinfectious Symptoms after Acute Dengue, Vietnam
  D. H. Tam et al.
• Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions in Malaria-Hyperendemic Region, South Sudan
  I. Molina de la Fuente et al.
• Early Warning Surveillance for SARS-CoV-2 Omicron Variants, United Kingdom, November 2021–September 2022
  S. Foulkes et al. View Abstract

  Since June 2020, the SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) study has conducted routine PCR testing in UK healthcare workers and sequenced PCR-positive samples. SIREN detected increases in infections and reinfections during Omicron subvariant waves contemporaneous with national surveillance. SIREN’s sentinel surveillance methods can be used for variant surveillance.

• Detection of Clade 2.3.4.4b Avian Influenza A(H5N8) Virus in Cambodia, 2021
  K. M. Edwards et al.
• Successful Treatment of Balamuthia mandrillaris Granulomatous Amebic Encephalitis with Nitroxoline
  N. Spottiswoode et al.

Research Letters

• Catheter-Related Bloodstream Infection Caused by Mycolicibacterium iranicum
  E. L. Ranson et al.
• SARS-CoV-2 Omicron (BA.5) Infections in Vaccinated Persons, Rural Uganda
  J. Mugisha et al.
• Increased Seroprevalence of Typhus Group Rickettsiosis, Galveston County, Texas, USA
  L. S. Blanton et al.
• Monkeypox Virus Infection in 18-Year-Old Woman after Sexual Intercourse, France, September 2022
  A. Vallée et al. View Abstract

  A monkeypox virus outbreak has spread worldwide since April 2022. We report a young woman in France positive for monkeypox virus transmitted through oral and vaginal sex. Ulceronecrotic lesions developed intravaginally and around her vulva. Health professionals should become familiar with all aspects of infection from this virus, including possible vertical transmission.

• Monkeypox Virus Infection in 22-Year-Old Woman after Sexual Intercourse, New York, USA
  N. Zayat et al. View Abstract

  We report a case of a 22-year-old woman in New York, USA, who had painful vulvar and intravaginal lesions after sexual intercourse and tested positive for monkeypox virus. Literature documenting the clinical manifestations of monkeypox in female genitalia remains insufficient.

• Rapid Seroprevalence Survey of SARS-CoV-2 in Central and Western Divisions of Fiji, 2021
  S. J. Curtis et al.

Letter

• Hepatitis E Vaccine and Genotype
  A. S. Azman et al.

Online Report

• Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of Congo, 2018–2020
  D. Mukadi-Bamuleka et al.

Synopsis

• Infant Botulism, Israel, 2007–2021
  B. Goldberg et al.

Research

• Incidence and Transmission Dynamics of Bordetella pertussis Infection in Rural and Urban Communities, South Africa, 2016‒2018
  F. Moosa et al.
• Influence of Regional Terrain on Lassa Fever Virus Exposure, Republic of Guinea
  S. Longet et al.

Dispatches

• Longitudinal Prepost Analysis of Electronic Health Information to Identify Possible COVID-19 Sequelae
  E. S. Click et al.
• Estimated Cases Averted by COVID-19 Electronic Exposure Notification, Pennsylvania, USA, November 8, 2020–January 2, 2021
  S. Jeon et al.

Research Letters

• Occupational Monkeypox Virus Transmission to Healthcare Worker, California, USA, 2022
  J. Alarcón et al. View Abstract

  Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non–needle stick MPXV transmission to an HCW in the United States.

• Familial Mpox Virus Infection Involving 2 Young Children
  P. Del Giudice et al.
• Detection of Dirofilaria immitis in a Dog Imported to Chile
  C. A. Alvarez Rojas et al.