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Background The resurgence of poliovirus infection in previously polio free regions and countries calls for renewed commitment to the global polio eradication efforts including strengthening of Acute Flaccid Paralysis (AFP) surveillance systems. Zambia is one of the countries substantially at risk for the importation of poliovirus infection from neighbouring countries including Malawi, Mozambique, and Democratic Republic of the Congo (DRC). This study describes a seven-year AFP surveillance, assesses the surveillance indicators, and highlights areas for improvement. Methods We conducted retrospective analysis of the routinely collected AFP surveillance data from January 2015 to December 2022. The AFP surveillance indicators performance was assessed using the World Health Organisation’s recommended minimum AFP surveillance indicators performance. Results Cumulatively, a total of 1715 AFP cases were reported over the study period. More than half, 891 (52%) of reported cases were aged < 5 years with 917 (53.5%) of males. More than half, 1186 (69.2%) had fever at onset, 718 (41.9%) had asymmetric paralysis and 1164 (67.9%) had their paralysis progressed within 3 days of onset. The non-polio AFP rate ranges from 3.4 to 6.4 per 100,000 children < 15 years old and stool adequacy ranging from 70.9% to 90.2% indicating sensitive surveillance with late detection of cases. The percentage of cases with early stool collection, timely transportation was above the World Health Organisation (WHO) minimum of 80% but with declining proportion of stools arriving in the laboratory in optimal condition. Completeness of 60-days follow-up evaluation was suboptimal ranging from 0.9% to 28.2%. Conclusion The AFP surveillance system in Zambia is doing well. However, additional efforts are needed to improve early detection of cases; stool sample collection, transportation and monitoring to ensure arrival in good condition in the laboratory; and improve 60-days follow-up evaluation for evidenced-based classification of inadequate AFP cases and proper care.

Background Mpox, a viral infection caused by an Orthopoxvirus, has reemerged outside its historically endemic regions in Central and West Africa. This geographical expansion introduces a potential risk of transmission in Zambia, where geographic proximity and active trade routes increase vulnerability. We report the first confirmed case of Mpox in Zambia, involving a 32-year-old Tanzanian cross-border truck driver who presented to Mukando Health Post in Central Province, on 4 October 2024. Case presentation We present a 32-year-old male patient of African descent whose symptoms included a history of 3-day fever, itchy rash, joint pains, fatigue, and sore throat. Physical examination revealed a papular rash over the face, trunk, and extremities with extension to the palms but spared the soles of the feet. No lesions were noted in either the mucosal or genital areas. However, enlarged lymph nodes were palpable in the cervical region. Biological specimens were collected and submitted to Zambia National Public Health Reference Laboratory. Samples collected, including oral swabs in transport media, whole blood, skin scrapping from lesions, swabs from lesions, and urine samples. Analytics conducted on the samples included testing for polymerase chain reaction for Mpox, human immunodeficiency virus, rapid plasma reagin for syphilis, and hepatitis B and C. Contact tracing identified both primary and secondary contacts. Polymerase chain reaction confirmed Mpox DNA in initial whole blood, with persistent detection in skin lesions and throat swabs. The patient was commenced on symptomatic treatment with benzyl benzoate, paracetamol, ibuprofen, chlorpheniramine, and phenoxymethylpenicillin and continued the same treatment after the confirmation of Mpox diagnosis. He was advised to continue good hygiene practice and remain in isolation to prevent transmission to others. None of the 22 traced contacts reported any symptoms nor tested positive. Conclusion Our report emphasizes the transmission risk for Mpox in traditionally nonendemic areas resulting from cross-border movement. This highlights the need for countries to strengthen surveillance systems resulting in increased sensitivity, specificity, and timeliness required for early detection and response to Mpox. A multifaceted collaborative approach is required between countries to ensure formalized cross-border collaboration, strengthening health-seeking behavior through deployment of mobile clinics, and utilization of digital platforms risk communication and community engagement. Improved supply chain management for laboratory reagents, sample collection, and personal protective equipment coupled with training of health workers is crucial for adequate preparedness and successful containment of outbreaks. These initiatives, collectively undertaken, will result in a robust response system safeguarding public health and preventing emerging threats such as Mpox from becoming endemic.

Background The COVID-19 pandemic had a devastating impact on childhood routine immunization programs, resulting in increased measles mortalities and complications. In Zambia, the likelihood of measles-related deaths and complications in children was possibly increased because of high rates of unvaccinated children, late diagnosis, and poor case management, which could have been a consequence of exclusive focus on COVID-19 interventions. This study aimed at examining the effect of the COVID-19 pandemic on measles mortality and its predictors among patients seen at health facilities in Zambia. Methods We used longitudinal data (January 2020 to August 2023) from outbreak investigations and time series data from 2017 to 2023 to understand the impact of COVID-19 on measles immunization and know the predictors of measles mortalities. The period running from January 2017 to February 2020, just before the first reported COVID-19 case, was defined as pre-COVID-19, and March 2020 to December 2023 as post-COVID-19. Multivariable logistic regression analysis was used to determine predictors of mortality. A segmented Poisson regression model was used to determine the correlation between the underlying patterns of measles mortality and the commencement of the COVID-19 pandemic. Results A total of 3429 measles cases were reported during the study period. Of these, 1261 had complete metadata and were included in the analysis. The median age was 3 years (IQR, 1–7). Out of the 1261 enrolled, 54 (4.3%) were reported died. A total of 205 (21.0%) were IgM positive, and 207 (16.9%) were vaccinated. Monthly measles mortality increased by 220%, from 0.06 per 100,000 before COVID-19 to 0.23 during the pandemic. Predictors of mortality were younger age category (0–4) (AOR = 2.78; 95% CI 1.16–7.14), testing positive for measles IgM (AOR = 2.17; 95% CI 1.07–4.39), rush (AOR = 3.66; 95% CI 1.31, 6.21), and female sex (AOR = 1.90; 95% CI 1.04–3.50), which increased the odds of dying. However, being vaccinated (AOR = 0.06; 95% CI 0.01–0.42) reduced the odds of dying. Evidence for the COVID-19 effect was strongly associated with increased measles mortality (RR, 1.02; 95% CI 1.00, 1.04; 0.017) with a trend step change of 81% (RR, 1.81; 95% CI 1.14–2.87). There was also an increased trend of measles cases (RR, 1.04; 95% CI 1.01–1.06) during the pandemic. Measles dose 2 vaccination trends increased by about 0.3% during the COVID-19 pandemic due to the Supplementary Immunization Activity (SIA) (RR, 1.003; 95% CI 1.000–1.010). However, there was a dramatic drop of about 42% (RR = 0.58, 95% CI 0.46–0.72). Conclusions Measles caused a significant increase in child mortality during the pandemic period. A mix of systemic, clinical, and individual factors affected measles mortality. Prioritizing vaccine coverage, especially for younger children and marginalized populations; enhancing diagnostic and treatment capacities; and addressing gender and healthcare access disparities are all essential components of interventions aimed at lowering mortality. The findings suggest that public health interventions focusing on measles vaccination, rapid detection, and appropriate case management are crucial to reducing mortality and preventing further transmission. To achieve population immunity, sustained efforts are required to maintain high coverage rates.

Enteric infections due to viral pathogens are a major public health concern. Detecting the risk areas requires a strong surveillance system for pathogenic viruses in sources such as wastewater. Towards building an environmental surveillance system in Zambia, we aimed to identify group A rotavirus (RVA) and human adenovirus (HAdV) in wastewater. Convenient sampling was conducted at four study sites every Tuesday for five consecutive weeks. The research team focused on three different methods of viral concentration to determine the suitability in terms of cost and applicability for a regular surveillance system: the bag-mediated filtration system (BMFS), polyethylene glycol-based (PEG) precipitation, and skimmed milk (SM) flocculation. We screened 20 wastewater samples for HAdV and RVA using quantitative polymerase chain reaction (qPCR) and conventional polymerase chain reaction (cPCR). Of the 20 samples tested using qPCR, 18/20 (90%) tested positive for HAdV and 14/20 (70%) tested positive for RVA. For the genetic sequencing, qPCR positives were subjected to cPCR, of which 12 positives were successfully amplified. The human adenovirus was identified with a nucleotide identity range of 98.48% to 99.53% compared with the reference genome from GenBank. The BMFS and SM flocculation were the most consistent viral concentration methods for HAdV and RVA, respectively. A statistical analysis of the positives showed that viral positivity differed by site (p < 0.001). SM and PEG may be the most appropriate options in resource-limited settings such as Zambia due to the lower costs associated with these concentration methods. The demonstration of HAdV and RVA detection in wastewater suggests the presence of the pathogens in the communities under study and the need to establish a routine wastewater surveillance system for the identification of pathogens.