2021 FETP INTERNATIONAL NIGHTS

Wednesday July 14–Thursday July 15, 2021

Sheraton Hotel || 165 Courtland St., NE || Atlanta || Georgia || USA

Cover photos credits

Top: Dr. Khyati Aroskar, India EIS. Joint operation with all stakeholders for the earliest international repatriation flight, airport
runway in India. The EIS Officer is evaluating the COVID-19 surveillance system established at this point of entry, March 2020.

Bottom left: Ernestina Agbemafle, Ghana FELTP. Resident of Ghana FELTP supervise vaccination team in round 2 of mOPV
vaccination campaign in Ellembelle District, Western Region, Ghana, October 2020.

Bottom right: Lilibeth Romero Mendoza, Colombia FETP. Field epidemiologist Lilibeth Romero (on the left) with the team from the
Leticia, Colombia health secretary, in the framework of the epidemiological survey on COVID-19 in a high-risk area.

Icons from https://thenounproject.com/; used with permission under the Creative Commons license.
 Table of Contents

FETP 40th Anniversary....................................................................................................................................................................... 2

Dr. Nancy Knight Welcome Letter.......................................................................................................................................... 4

Dr. Kip Baggett Welcome Letter.............................................................................................................................................. 5

Dr. Carl Reddy Welcome Letter................................................................................................................................................. 6

List of Poster Abstracts.................................................................................................................................................................... 7

Detailed Poster Abstracts............................................................................................................................................................10

List of Oral Abstracts........................................................................................................................................................................50

Detailed Oral Abstracts.................................................................................................................................................................51

Photo Contest Awards....................................................................................................................................................................57

Jeffrey P. Koplan Award for Excellence in Poster Scientific Presentation ���������������������������������������58

William H. Foege Award for Excellence in Oral Scientific Presentation ��������������������������������������������59

Sara Lowther FETP Memorial Award.................................................................................................................................61

Director’s Award for Excellence in Epidemiology and Public Health Response.......................62

Acknowledgments............................................................................................................................................................................63
FETP International Nights Committee.......................................................................................................................... ......63

1
 FETP 40th Anniversary
In 1980, the U.S. Centers for Disease Control and Prevention (CDC) helped establish the first Field
Epidemiology Training Program (FETP) outside of North America in Thailand (Canada’s FETP launched
independently in 1975). The year 2020 marked the 40th anniversary of the FETPs, which was modeled
after CDC's famed Epidemic Intelligence Service (EIS, launched in 1951). In fact, the program was
originally called Global EIS before taking on its current name of FETP.

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The COVID-19 pandemic led to the cancellation of the 2020 EIS Conference, the International Nights
event, and a formal celebration of the 40th anniversary. However, we would like to acknowledge this
milestone here, during the 2021 first virtual International Nights event.

The infographic below provides a visual timeline of FETPs worldwide over the past 40 years. To learn
more about how the FETPs have been expanding the footprint of disease detectives worldwide, visit
the CDC Global Health page at FETP 40th Anniversary webpage.

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 Dear colleagues:

It is with tremendous pleasure and excitement that I welcome you to the 2021
Field Epidemiology Training Program (FETP) International Nights. The event
provides an opportunity for public health professionals—epidemiologists,
physicians, academics, and others—to assemble for two sessions of oral and
poster presentations from FETP graduates and residents. The presentations
provide a remarkable insight into the vital public health work FETPs are doing in
their respective countries and around the globe.

This year is, by all measures, unique. Because of the COVID-19 pandemic, the
International Nights are, for the first time ever, taking place virtually and as a
stand-alone event. In addition, 2021 is a milestone year for FETP International Nights as we celebrate
the 20th anniversary of this exceptional forum.

Since 1980, the U.S. Centers for Disease Control and Prevention (CDC) has helped establish FETPs in
over 80 countries which have trained more than 18,000 disease detectives to collect, analyze, and
interpret disease information to save lives. Over the past four decades, FETP residents and graduates
have played integral roles in public health emergencies and responses, including preparedness and
response for COVID-19 within their countries; ebola in Central and West Africa; MERS-CoV transmission
in the Middle East, South Korea, and the Philippines; polio in Pakistan and Nigeria; and many others.
Without their expertise and direct involvement, these health crises would have undoubtedly had more
negative consequences.

While the Division of Global Health Protection's (DGHP) training programs have made significant
progress in increasing the number of global FETPs, we still have much work to do if we are to meet the
International Health Regulations surveillance goal of having one trained field epidemiologist per every
200,000 people. Meeting this goal is critical in increasing global health security, and these two days of
extraordinary presentations reaffirm just how important that goal is to the safety of our world.

As we gather to observe the accomplishments of FETPs globally, let us remember that two-thirds
of the world remains unprepared for a public health emergency. Multiple variants of severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, are appearing
worldwide. The COVID-19 pandemic reminds us that outbreaks can emerge anywhere without
warning and cause severe disruptions to public health systems, local and global economies, and
devastate the health and well-being of the world population. Given this stark reality, the value of FETPs
in global health security cannot be overstated.

I want to thank you for attending, but more importantly, I’d like to thank you for your contributions in
making the world a safer and healthier place for everyone.

RADM Nancy Knight, MD, USPHS

Director, Division of Global Health Protection
Center for Global Health
U.S. Centers for Disease Control and Prevention

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 Dear colleagues:

Welcome to the Field Epidemiology Training Program (FETP) International

Nights. This year is especially meaningful as we celebrate the 20th anniversary of
this event. Historically, FETP International Nights have been the highlight of the
Annual Epidemic Intelligence Service (EIS) conference, and with the conference
on hold, we are excited that, for the first time ever, this will be a standalone,
virtual event.

Throughout the past two decades, International Nights evolved to reflect the
increasing importance and value of the FETPs' contributions to global health.
Since 2016, the event has expanded from one to two nights—one night
dedicated to poster presentations and the other to oral presentations. These changes are a testament
to the incredible work of FETPs and the ever-increasing quality of the abstracts, making it difficult
to select the best to showcase. This year, we received 159 abstracts from 40 countries. The accepted
abstracts address a range of public health issues on infectious and non-infectious diseases.

The U.S. Centers for Disease Control and Prevention (CDC) remains committed to supporting FETPs,
a cornerstone of global public health workforce development. Today, more than ever, FETPs play a
crucial role in preventing, detecting, and responding to public health threats wherever they occur.
The past two years have been challenging and have been stark reminders of the ever-growing
threats we face around the globe. In 2020, the World Health Organization declared two public health
emergencies of international concern—the ebola virus disease outbreak in the Democratic Republic of
the Congo and the novel COVID-19 pandemic—only the 5th and 6th such declarations since 2009.

The year 2021 saw the continuation of the COVID-19 pandemic and two more ebola outbreaks.
Meanwhile, we continue to battle other threats such as polio, measles, malaria, and many other
diseases. FETP graduates and residents play critical roles in these and many other responses. In 2020,
FETP Advanced and Intermediate residents responded to 534 public health emergencies, including
COVID-19 (126), measles (14), and Crimean-Congo hemorrhagic fever virus (14), to name a few. They
also contributed to scientific research and understanding with the publication of 168 scientific papers
and over 50 surveillance reports.

I encourage you to attend this year's 20th International Nights and help us celebrate 41 years of work in
improving global health security for everyone everywhere.

Kip Baggett, MD, MPH

CAPT, US Public Health Service
Chief, Workforce and Institute Development Branch
Division of Global Health Protection
Center for Global Health
U.S. Centers for Disease Control and Prevention

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 Dear colleagues and friends:

On behalf of TEPHINET, the global network of Field Epidemiology Training

Programs (FETPs) strengthening public health systems and global health security
across more than 100 countries, I am pleased to welcome you to the 20th FETP
International Nights.

Prior to last year, we never imagined that we would be celebrating the twentieth
anniversary of this time-honored event virtually, and not here in Atlanta during
an EIS conference. However, I am deeply grateful to our partners at the U.S.
Centers for Disease Control and Prevention (CDC), our planning committee,
abstract reviewers, FETP authors and their supportive mentors for making this
year’s virtual event possible. FETP International Nights are an incredible forum for spotlighting FETP
residents who are rising leaders in public health. The work they will present over the next two days
demonstrates the value of these programs in developing the global health security workforce.

The COVID-19 pandemic has made clear the need for enhanced field epidemiology capacity in
all countries to enable earlier detection and coordinated response to public health threats. FETPs
strengthen public health systems by increasing the number and quality of field epidemiologists
in the public health workforce; developing global capacity for timely detection, investigation
of, and response to public health emergencies; improving capacity to collect public health data
through improved disease surveillance systems; and promoting the use of data and evidence-based
recommendations in public health policies and decision-making.

In total, residents and alumni of TEPHINET-member FETPs have evaluated, developed, or implemented
more than 5,000 disease surveillance systems and investigated more than 11,000 outbreaks or acute
health events. The 46 presenters from whom you will hear over the next two days represent just a few
of the 19,000 disease detectives who have trained through a TEPHINET-member FETP. As the last year
and a half has shown us, we still have much work to do, but without the commitment and expertise of
our FETP staff, residents, and alumni, we would undoubtedly be far worse off.

Thank you for attending this year’s FETP International Nights. I hope we can meet in person next year.

Carl Reddy, MBBCh, FCPHM, MSc (Epi)

Director, TEPHINET
The Task Force for Global Health

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 List of Poster Abstracts
Al-Jamrah, Khaled. Risk Factors for Multidrug-resistant Tuberculosis in Yemen, 2019: A Case-control
Study

Alma, Iyawa Clarisse. Evaluation of the Case-by-case Surveillance System for the Retention-in-care of
People Living with HIV in Two Urban Health Districts, Cameroon, 2019

AlMaibari, Hanan. Burden and Associated Risk Factors of Coronavirus Disease (COVID-19) in Al-
Buraimi Governorate, Oman

AlMutairi, Abdulaziz. Saudi CDC COVID-19 Rapid Response Teams—A 4-Month Report, April 2020–
July 2020

Banda, Dabwitso. Prevalence of SARS-CoV-2 Infection Among Outpatients During a Period of

Community Transmission—Zambia, July 2020

Bvochora, Talent. Evaluation of the COVID-19 Surveillance System in Harare City, Zimbabwe, 2020

Chipoya, Musole. Outbreak of Circulating Vaccine-derived Poliovirus Type-2, Chienge District, Luapula
Province, Zambia, September 2019

Demissie, Henok Solomon. Cervical Cancer Screening Service Uptake and Associated Factors Among
Women in Wolaita Zone, Southern Ethiopia, 2019

Elshishiney, Galal. Results of the Largest Nationwide Campaign Targeting 60 Million Egyptians Above
18 Years For Reducing Mortality From Noncommunicable Diseases, 2018–2019: A Focus on Diabetes
Mellitus

Emtom, Sepde. Epidemiological Profile and Risk Factors Associated with COVID-19 Deaths in Douala
City, Cameroon, 2020

Foday, Amara. Protective Behavioral Practices Toward Coronavirus Disease 2019 (COVID-19) Among
Health Care Workers in Sierra Leone, 2019

Fomba, Alfred. Investigation of Circulating Vaccine-derived Poliovirus (cVDPV) Type 2 Outbreak, Sierra
Leone, December 2020

Gauto, Micaela. COVID-19 in Chronic Dialysis Patients: One Year of Pandemic in Argentina

Getu, Amare. Incidence and Predictors of Tuberculosis Among HIV-infected Adults on Antiretroviral
Therapy after Universal Test and Treat Program in Selected Public Hospitals, Addis Ababa, Ethiopia,
2020

Gonahasa, Doreen. Evaluation of SARS-CoV-2 Transmission and Cross-border Transmission Risk

Factors Among Fishing Communities in Kyotera District, Uganda, May–June 2020

Haslett, Maria Isabella. Knowledge, Attitudes, and Practices During a Brazilian Spotted Fever
Outbreak in a Municipality in Southeastern Brazil, 2019

Hassan, Abdala. Factors Associated with Newly-diagnosed HIV Infections Among Young Adults Aged
15–24 Years Attending a Rural County Referral Hospital, Kenya, 2018

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Joseph, Gabriel. Guinea Worm Disease Case Search and Risk Assessment in Ohangwena and Omusati
Region, Namibia, February–March 2019

Kamboj, Arvind. Investigation of Newly-identified COVID-19 Clusters in Kalyanpuri, New Delhi, India,
June–July 2020

KC, Sachin. An Outbreak of Shigellosis Attributed to Consumption of Contaminated Well-water,

Kottamparamba, Calicut, Kerala, India, 2020

Keimbe, Charles. Factors Contributing to Delays in Accessing Maternal Delivery Services in Health
Facilities, Sierra Leone, 2018: A Community-based Cross-sectional Study

Kerr, Elenor. Monitoring Progress Towards Improvement in Human Immunodeficiency Virus Care for
Those Newly Diagnosed in Queensland, Australia, 2014–2018

Kgatla, Hellen. Epidemiology of COVID-19 in Tshwane District, South Africa, March–June 2020: A
Cross-sectional Study

Khan, Adnan. Risk Factors Analysis of an HIV Outbreak Among Children Under 15 Years, Sindh,
Pakistan, June 2019

Main, Stephanie. Investigation of an Early 2020 COVID-19 Outbreak in a Vulnerable Population at a

Psychiatric Health Facility in Victoria, Australia

Mengue Essindi, Annie Marielle. Impact of Pneumococcal Conjugate Vaccine 13 and Haemophilus
Influenzae Type b Vaccine: Database Analysis of the Sentinel Surveillance Site of the Pediatric Bacterial
Meningitis, Cameroon, 2003–2017

Menon, Nikhilesh. An Outbreak of Hepatitis A Due to Consumption of Wedding Party Food Prepared
from an Unchlorinated Well-water, Naripetta, Kozhikode district, Kerala, India, November 2019–January
2020

Mhiche, Ambakisye Kuyokwa. Mass Drug Administration Coverage and Determinants of Drug
Uptake for Elimination of Onchocerciasis in Ulanga District, 2019

Mhondoro, Marvellous. Risk Factors for Community-acquired Urinary Tract Infections by Extended
Spectrum Beta-lactamase Producing Bacteria, Harare, Zimbabwe, 2019

Mushangwe, Blessing. Predictors of Viral Load Suppression Among HIV Positive Female Sex Workers
on Antiretroviral Therapy in Harare, Zimbabwe, 2019

Mutebi, Ronald Reagan. Food Poisoning Outbreak Caused by Consumption of Humanitarian Relief
Food Contaminated with Jimsonweed (Datura stramonium), Napak and Amudat Districts, Uganda,
March 2019

Nabatanzi, Sandra. Uganda’s Preparedness and Prompt Control of Imported Ebola Virus Disease, June
2019

Ndlovu, Babongile. Skin Cancer Risk Factors Among Black South Africans—The Johannesburg Cancer
Study, 1995–2016

Njidda, Ahmad. Knowledge of Occupational Hazards and Prevalence of Injuries Among Construction
Workers Abuja, Nigeria, 2019

Rivera, Sandra. Impact of the SARS-CoV-2 Pandemic on Health Workers in Colombia, 2020

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Ruseesa, Edward. Tuberculosis Screening Among Contacts of Bacteriologically-confirmed TB Patients,
Rwanda, 7 June 2016–16 July 2019

Shao, Ge. Investigation of a Type 2 Vaccine-derived Poliovirus Event in Sichuan Province, China 2019

Syed, Muhammad Asif. Determinants of Primary Amoebic Meningoencephalitis Infection in Karachi,

Pakistan, 2019

Tigga, Ashish. Post-cyclone Rapid Needs Assessment, Puri Urban, Odisha, India, May 2019

Yang, Yi-Ting. Clostridium Perfringens Outbreak Associated with School Lunch, New Taipei City,
Taiwan, 2019

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 Detailed Poster Abstracts
Al-Jamrah, Khaled

Country: Yemen

Abstract title: Risk Factors for Multidrug-resistant Tuberculosis in Yemen, 2019: A

Case-control Study

Short biography: Khaled Al-Jamrah has a BSc and an MSc in Medical Microbiology from
Sana'a University. In 2020, he graduated from the Yemeni FETP. From May 2020 to the present, he has been
the IMCI Director on behalf of the Ministry of Health of Yemen. Khaled participated in activities aiming
to improve the quality of health services and served as a member of the national committee to develop,
formulate, and implement several guidelines, policies, strategies and mechanisms. He has published in
medical and epidemiological journals and has had three accepted abstracts at conferences over the past 2
years: the 2nd Arab Public Health Conference (Casablanca, Morocco), the 10th Southeast Asia and Western
Pacific Bi-regional TEPHINET Scientific Conference, and the 2021 FETP International Nights Conference.
Khaled is a member of the American Society for Microbiology.

ABSTRACT

Authors: Dr. Khaled Al-Jamrah, Dr. Esam Mahyoub, Dr. Abdulaziz Al aghbari, Dr. Labiba Anam

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a great challenge for TB

control program in Yemen where an estimated 2.3% of new TB cases and 18% of previously treated
cases had MDR-TB. This study aimed to determine the risk factors associated with MDR-TB in Yemen.

Methods: A case-control study was conducted at the four main TB-centers in Yemen during
November–December 2019. Patients diagnosed with MDR-TB were selected as cases, and controls
were selected from TB-patients who responded to first-line anti-TB drugs. Data were collected through
face-to-face interviews using a predesigned questionnaire. Bivariate and multivariable logistic
regression were used. The collected data were analyzed using Epi-Info 7.2.

Results: A total of 84 cases and 252 controls were selected. Among the cases, 64% were males
compared with 59% among the controls. The mean age of the cases was 34.8 ± 15 years compared to
35.2 ± 16 years for the controls. A history of previous TB treatment (aOR 11.8; 95% CI 6.0–22.9, p<0.001)
was strongly associated with MDR-TB. Those with a history of smoking (aOR 2.4; 95% CI 1.1–.0, p =
0.02), and a history of traditional therapy (aOR 4.0; 95% CI 1.5–11.1, p = 0.006) differed significantly
with MDR-TB. In addition, living in a rural residency (aOR 3.4; 95% CI 2.0–5.8, p<0.001), in a house with
a single room and with/without a single window (aOR 2.6; 95% CI 1.3–5.3, p = 0.008), (aOR 3.0; 95% CI
1 6–5.9, p<0.001) respectively, also were found to be independent factors associated with MDR-TB.

Conclusions: Previous TB-treatment, history of traditional therapy, history of smoking, living in a

rural residency, house with single room, and house with/without a single window were found to be
potential risk factors associated with MDR-TB. To reduce the burden of MDR-TB, enhancing directly
observed treatment, health education, and addressing identified factors are recommended.

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Alma, Iyawa Clarisse

Country: Cameroon

Abstract title: Evaluation of the Case-by-case Surveillance System for the Retention-
in-care of People Living with HIV in Two Urban Health Districts, Cameroon, 2019

Short biography: In 2015, Iyawa Clarisse Alma received a diploma in general medicine from
the Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon. For the next 3 years,
she was the chief doctor of a rural subdivisional medical center, implementing health programs such
as reproductive health, immunization, and HIV. In 2021, she graduated from the Cameroon FETP with a
Master in Field Epidemiology from the University of Buea. From 2018 to 2021, she conducted investigations
including a measles outbreak in a refugee’s camp and human monkey pox outbreak in the East region of
Cameroon. She was also involved in strengthening routine immunization and polio vaccination campaigns.
She was a member of the rapid response teams in the national incident management system for COVID-19.
Clarisse completed a 2-year internship at the national AIDS control committee, working on the tools of
psychosocial agents. She also evaluated the case-by-case surveillance system of retention-in-care of people
living with HIV on antiretroviral therapy in Cameroon. Since March 2021, Clarisse has been working at the
research unity of the national AIDS control committee.

ABSTRACT

Authors: Dr. Iyawa Clarisse Alma, Dr. Daniel Mabongo, Dr. Marinette Ngo Nemb, Dr. Serge Billong, Dr.
Rose-Carole Bohimbo, Dr. Armel Evouna, Dr. Georges Alain Etoundi Mballa

Background: In 2016, Cameroon recruited psychosocial agents (PSAs) to improve follow-up and
retention-in-care of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). PSAs perform
case-by-case surveillance of retention-in-care in addition to routine surveillance. The Center region
includes roughly 1/4 of Cameroon patients on ART. We evaluated the surveillance system of retention-
in-care of PLWHA in Biyem-assi and Cité verte Health Districts (HDs) in that region.

Methods: We conducted a cross-sectional study from 2017 to 2018. We realized a multistage sampling
by randomly selecting 2 of the 30 HDs and about half of health facilities (HFs) within each HD. We
also worked at the regional technical group of the national AIDS control committee (RTG/NACC).
Respondents were PSAs and all staff involved in surveillance. We assessed key system attributes with
the CDC 2001 updated guidelines for evaluation of public health surveillance systems. We collected
data from monthly reports of PSAs and routine surveillance through District Health Informations 2
Software (DHIS2). Analysis was done using Epi info 7.0.

Results: Overall, 140/194 (72%) people were surveyed in 17 HFs and the RTG/NACC. PSAs accounted
for 95% (133/140) of respondents and 62% (83/133) of them completed medical or psychosocial
training. Definition of retention-in-care and definition of at least three operational terms were known
by 74% (104/140) and 81% (113/140) of these same respective respondents. Surveillance reports at
RTG/NACC were only paper-based. Among respondents, 69% (97/140) knew when to start looking
for a patient who did not attend an appointment. The surveillance detected 52% (3,012/5,759) of
absentees reported in DHIS2 and 78% (105/135) of respondents stated that reports were available in
their HF.

Conclusions: The surveillance system of retention-in-care of PLWHA is simple. However, its utility,
reactivity, sensitivity, and stability can be improved. We recommend analyzing reports at the RTG/
NACC, recycling APS, and archiving reports after on-site validation.

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AlMaibari, Hanan

Country: Saudi Arabia

Abstract title: Burden and Associated Risk Factors of Coronavirus Disease (COVID-19) in
Al-Buraimi Governorate, Oman

Short biography: Hanan AlMarbouai is a medical officer in the Ministry of Health, Oman.
She is completing her second year of training in the Saudi FETP. She obtained her MD from Oman Medical
College in 2014. Prior to joining FETP, Hanan was a general physician in hospitals and health centers in
Oman for 4 years, then in administration as the medical officer in charge at an extended health center in
Oman for 1 year. Her interests include infectious and chronic diseases.

ABSTRACT

Authors: Dr. Hanan AlMaibari, Dr. Amal AlNafisi, Dr. Eman Saleh, Dr. Muhammad Muqeet Ullah, Dr.
Mostafa Elsayed ElNifily

Background: Oman reported its first case of COVID-19 on 24 February 2020, and has reported an
increasing number of cases recently. Understanding patient characteristics and demand on the
healthcare system is essential to ensure Oman can continue to provide high quality care. We describe
the burden of COVID-19 and risk factors for more severe disease in Al-Buraimi Governorate, Oman.

Methods: We retrieved demographic and clinical data from electronic medical records for all
COVID-19 laboratory-confirmed patients in Al-Buraimi Governorate from 1 February–31 August 2020.
We assessed risk factors for hospitalization and outcome using Chi-square test and multivariable
logistic regression model in Epi info 7 and SPSS software (p≤0.05 significance level).

Results: We identified 977 COVID-19 patients, with a prevalence rate of 8.4 per 1,000 in Al-Buraimi
Governorate, with rates of 9.5 per 1,000 among Omani, and 7.4 per 1,000 among non-Omanis. The
male:female ratio was 3.1:1. Of COVID-19 patients, 11.7% were hospitalized and 1.5% died. Diabetes
(12.2%) and hypertension (10.8%) were the most prevalent chronic conditions among COVID-19
patients. Older patients (>60 years old) and those with comorbidities (chronic kidney disease, diabetes,
heart disease, hypertension) were prone to hospitalization (p<0.001), intensive care (p<0.001), and
death (p<0.001). Multivariate logistic regression analysis found that these risk factors were significantly
associated with hospital admission (OR 5.905; 95% CI 3.923–8.889; p<0.001), ICU admission (OR 4.363;
95% CI 1.952–9.750; p<0.001), and death (OR 6.785; 95% CI 2.295–20.062; p<0.001).

Conclusions: We found more cases among men and Omanis. Public health messaging for COVID-19
prevention should be tailored to inform these groups to slow the spread. Our findings are consistent
with other studies, and local health care providers should be informed of the risk for severe disease
among older patients and those with comorbidities.

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AlMutairi, Abdulaziz

Country: Saudi Arabia

Abstract title: Saudi CDC COVID-19 Rapid Response Teams—A 4-Month Report,
April 2020–July 2020

Short biography: Abdulaziz Almutairi is a 2020 graduate of the Saudi FETP and currently
works there. He earned his Bachelor of Dental Surgery from Misr University for Science and Technology
in Egypt and his Diploma of Field Epidemiology from King Saud University. Prior to working for the FETP,
Abdulaziz was a dentist in the MOH primary health care centers for 3 years, then director of a dental center
in Hafar Albatin for a year. Prior to his FETP training, he worked in the Vision Realization Office in the MOH
for a year.

ABSTRACT

Authors: Dr. Abdulaziz AlMutairi, Dr. Sami AlMudarra

Background: Saudi Arabia reported its first COVID-19 cases on 2 March 2020. Cases continued to
spread in the Kingdom, and the existing public health infrastructure was unable to meet testing
demands. To meet this emerging public health need, the Saudi Center for Disease Control (CDC)
created rapid response teams (RRTs) to deploy quickly and for long periods of time to assist with
the response. The main objective of the COVID-19 RRTs is rapid testing of potential COVID-19 cases
and contacts. We describe the development and impact of the RRTs on testing and identification of
COVID-19 cases.

Methods: We collected data on team development and implementation. We reviewed data on sample
positivity and response time.

Results: The RRTs recruited and trained 20 members on infection prevention and control. Specific
member roles included swab collection, administration, and laboratory analyses. The COVID-19
RRTs were established in April 2020, and within 4 months, the RRTs had completed 99 missions and
conducted more than 2,300 tests. At least 352 (15.3%) swabs were positive; national positivity for
COVID-19 laboratory testing at that time was approximately 1%. The time from notification of a cluster
to swabbing was reduced from 24 hours to less than 8 hours.

Conclusions: The size and flexibility of the team allowed the Saudi government to quickly
and effectively identify cases of COVID-19, including those cases that are pre symptomatic or
asymptomatic, to prevent the transmission and spread of COVID-19. The high proportion of positive
swabs collected by the RRTs suggests they were effective at targeting groups at high suspicion
for COVID-19 infection and identifying cases before they could spread additional infection. While
establishing and operating the RRTs was challenging, the Saudi CDC gained invaluable experience in
public health emergency response.

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Banda, Dabwitso

Country: Zambia

Abstract title: Prevalence of SARS-CoV-2 Infection Among Outpatients During a Period

of Community Transmission, Zambia, July 2020

Short biography: Dabwitso Banda is recent FETP-Advanced graduate stationed at the

Zambia National Public Health Institute under the workforce development cluster. Currently he is a
coordinator for the FETP-Advanced, responsible for technical support to the residents, particularly on HIV-
related activities. He also oversees residents conducting field investigations of disease outbreaks. As an FETP
resident he conducted an anthrax outbreak investigation, a measles outbreak and a COVID-19 positivity
rate investigation among the case finding strategies in Zambia. He was also involved in the COVID-19
prevalence survey in Zambia, the first of its kind in sub-Saharan Africa. He also conducted a multidrug-
resistant TB surveillance system evaluation in the Copperbelt province. Prior to that, he was a medical
officer for 7 years, providing primary health care especially HIV care and maternal and child health.

ABSTRACT

Authors: Dr. Dabwitso Banda, Dr. Nyambe Sinyange

Background: Zambia recorded its first cases of SARS-CoV-2 infections in March 2020 and began
regularly testing persons at health facilities in April 2020. We assessed the prevalence of SARS-CoV-2
infection among outpatients during a period of community transmission to determine if health facility
testing was an effective case identification strategy.

Methods: We did a cross-sectional survey of outpatients in 20 health facilities in 6 districts in Zambia

during the first wave in July 2020. Participants were randomly selected regardless of symptoms, and
consenting participants completed a questionnaire. Nasopharyngeal swabs and blood specimens
were collected and tested for SARS-CoV-2 infection and antibodies using polymerase chain reaction
(PCR) and enzyme-linked immunosorbent assay (ELISA), respectively. SARS-CoV-2 prevalence was
calculated separately for PCR and ELISA as the number of positive individuals divided by the number
of individuals tested. Variance and 95% confidence intervals (CIs) were adjusted for clustering by
health facility. Additionally, outpatients’ SARS-CoV-2 PCR-positive prevalence was compared with the
community prevalence of 7.6% from a concurrent household survey in the same districts.

Results: Among the 1,975 persons approached, a total of 1,952 (98.8%) completed the questionnaire,
of whom 1,490 (76.3%) submitted nasopharyngeal specimens and 1,657 (84.3%) submitted blood
specimens. The median age was 32 years (interquartile range 24–43) and 60% were female. PCR-
positive prevalence was 13.4% (95% CI 8.3–18.5) and ELISA-positive prevalence was 8.2% (95% CI
5.1–11.4). Compared to persons in the community, outpatients had higher SARS-CoV-2 PCR-positive
prevalence (absolute difference: 5.7%; 95% CI 0.3–11.2).

Conclusions: During a period of community transmission, outpatients had a higher SARS-Cov-2

prevalence than the surrounding community. Health facility testing for SARS-Cov-2 infection during
periods of community transmission might be an effective case identification strategy. Based on these
findings, Zambia has targeted health facilities for SARS-CoV-2 surveillance.

14
Bvochora, Talent

Country: Zimbabwe

Abstract title: Evaluation of the COVID-19 Surveillance System in Harare City,

Zimbabwe, 2020

Short biography: Talent Bvochora is a medical epidemiologist and Zimbabwe FETP trainee.
She is currently attached to the city of Harare Health Department. As an FETP resident she evaluated the
COVID-19 surveillance system performance and provided appropriate recommendations for improvement
of the system to help curb the pandemic. Her work includes providing clinical leadership in strategic
approach to care and treatment of infectious diseases in the city, in line with the national guidelines.

ABSTRACT

Authors: Dr. Talent Bvochora, Dr. Hilda Bara, Dr. Prosper Chonzi, Ms. Tsitsi Juru, Dr. Emmanuel Govha,
Dr. Notion Gombe, Prof. Mufuta Tshimanga

Background: Surveillance is key for controlling the COVID-19 pandemic. Of the 90 confirmed cases
reported in Harare city between 1–4 December 2020, 80 (89%) had been detected in previous months.
Of these, only 10% were reported within 10 days of laboratory confirmation and could be contact-
traced. We assessed the performance of the laboratory-based COVID-19 surveillance system in Harare
city.

Methods: We conducted a descriptive cross-sectional study at Harare city COVID-19 facilities using
the updated CDC guidelines for evaluation of public health surveillance system. We reviewed the
line-list and 200 laboratory and case-investigation forms. We interviewed 56 health workers and 6
key informants to collect data on reasons for late reporting. We then evaluated the following system
attributes: representativeness, stability, data quality, and timeliness.

Results: Three of 43 public health facilities in the city and 3 private laboratories participated in
COVID-19 surveillance. The system was mainly paper-based. Of 200 case-investigation forms, 58%
did not have addresses, 16% no age, and 7% no sex documented. Late reporting of confirmed
cases resulted in 84%, 96%, and 80% of cases not being contact-traced in October, November, and
December, respectively. Reasons for late reporting were late turn around time of laboratory results
40/56 (71%) and poor knowledge of the reporting system 38/56 (68%). Of the three public health
facilities, none had communication and internet services, one had dedicated transport for COVID-19
activities, and two had case investigation forms.

Conclusions: The COVID-19 surveillance system in Harare city was not timely and data quality was
poor thereby affecting contact tracing. Decentralization of services is necessary to make the system
more representative of the city population. Continuous provision of resources such as transport and
means of communication is needed to ensure the system’s stability. Use of integrated electronic
systems may improve data quality and ultimately contact tracing.

15
Chipoya, Musole

Country: Zambia

Abstract title: Outbreak of Circulating Vaccine-derived Poliovirus Type-2, Chienge

District, Luapula Province, Zambia, September 2019

Short biography: Musole Chipoya is a graduate of the Zambia FETP, currently stationed in
the surveillance and disease intelligence cluster within the Zambia National Public Health Institute. She is
the focal point for surveillance of vaccine-preventable diseases with particular focus on polio and measles/
rubella. Her work includes routine review of vaccine-preventable disease surveillance data to ensure data
quality, completeness, and dissemination of findings to lower levels for prompt action. She has 5 years of
experience working as a general physician in Zambia. Musole attended medical school in China and has a
good command of Mandarin. In her role as FETP resident she investigated a typhoid and a polio outbreak
and participated in the vaccination response. Additionally, she lead an evaluation of the acute flaccid
paralysis surveillance system in Zambia and worked on an analysis of HIV among female sex workers in
Zambia.

ABSTRACT

Authors: Dr. Musole Chipoya, Dr. Nyambe Sinyange

Background: Africa has seen a significant rise in circulating vaccine-derived polioviruses type 2
(cVDPV2) outbreaks following the switch to bivalent oral polio vaccine (bOPV) in 2016. In September
2019, the World Health Organization (WHO) country office notified the Zambian Ministry of Health of a
case of VDPV-2 in Chienge district, Luapula province. This paper describes the investigation and public
health response.

Methods: An Investigation was conducted per WHO standard operating procedures, where cVDPV is
defined as VDPV demonstrating person-to-person transmission in the community or evidence from
human and/or environmental detections of related viruses. The patient’s grandmother and mother
were interviewed; blood samples were collected from the patient; and 36 stool samples were collected
from direct and community contacts aged <5 years from the two villages where the patient resided.
Genetic sequencing for intratypic differentiation was used to determine relatedness of poliovirus
samples.

Results: The patient was an unvaccinated 2-year-old boy from the Chienge district bordering the
Democratic Republic of the Congo (DRC). He had spent time in both countries, although his last
trip to DRC was >1 year prior to the illness. The patient developed sudden weakness in his lower
limbs following a fever of <24 hours in July. Sequencing results of the case showed VDPV2 with nine
nucleotide differentiation from Sabin-2. Of the 36 stool samples, 3 isolated polioviruses (one Sabin-
like-type 1 and two poliovirus-type 2[PV2]). Sequencing results of the two PV2 indicated genetic
linkage to the index case but not to any ongoing cVDPV2 outbreaks in the DRC.

Conclusions: The confirmed presence of cVDPV2 outbreak in Zambia represents another novel
emergence of cVDPV2 since switching to bOPV. Response included mass vaccination with monovalent
OPV2 in Luapula province and a countrywide catch-up vaccination with inactivated polio vaccine.
Future recommendations included strengthening AFP surveillance systems and improving vaccination
coverage.

16
Demissie, Henok Solomon

Country: Ethiopia

Abstract title: Cervical Cancer Screening Service Uptake and Associated Factors Among
Women in Wolaita Zone, Southern Ethiopia, 2019

Short biography: Henok Solomon Demissie is a senior public health specialist from Ethiopia.
He graduated from Addis Ababa University School of Medicine in 2014 and received a Master of Public
Health in Advanced Field Epidemiology in 2019 from St. Paul’s Hospital Millennium Medical College,
Ethiopia. Since March 2020, he has been a research fellow at the CDC Foundation Tobacco Control
Scholarship Program. Henok was awarded an NCD mini-grant project and successfully accomplished the
project during his field epidemiology residency. He has been presenting his project, including his outbreak
investigation, at TEPHINET’s 10th global scientific conference which was held in Atlanta. He worked as a
clinician at a general hospital in rural Ethiopia for almost 2 years, and after completing his post graduate
study he joined the Ethiopian Public Health Institute as a senior public health specialist and worked there
for a year. Currently he is a national officer at WHO, supporting the regional COVID-19 response.

ABSTRACT

Authors: Dr. Henok Solomon Demissie, Mrs. Fatimatu Fatimatu

Background: Cervical cancer is the fourth most frequent cancer representing 6.6% of all female
cancers and the majority occur in low and middle-income countries. Incidence and mortality from
cervical cancer can be prevented by precancerous screening. Screening service uptake in developing
countries is generally low. The aim of this study was to determine uptake of cervical cancer screening
service and associated factors among women in Wolaita Zone, southern Ethiopia.

Methods: The study was conducted in Wolaita Zone, southern Ethiopia, using a community-based
cross-sectional analytic study from July–August 2019, among women aged 30–49. A total of 401
women were sampled and multistage sampling technique was applied to select participants, with
cases receiving cervical cancer screening and controls remaining unscreened. Data were collected by
pretested and structured questionnaire. Data entry and analysis were done using SPSS. Bivariate and
multivariable logistic regression was performed to determine factors associated with service uptake.

Results: Among 387 study participants, only 39 (10.1%) were screened for cervical cancer. Age
between 35–39 (aOR 4.3; 95% CI 1.2–15) and 40–44 (aOR 6.1; 95% CI 1.3–26.8), history of multiple
sexual partners (aOR 4; 95% CI 1.4–11.2), good knowledge about cervical cancer (aOR 3.6; 95% CI
1.1–12.2), being sero-reactive for HIV (aOR 5.9; 95% CI 1.2–27.7), and ever recommended by health
professionals for screening (aOR 3.7; 95% CI 1.4–9.7) were significantly associated with screening
service uptake. Absence of symptoms and little understanding about cervical cancer and its screening
were major barriers for screening uptake.

Conclusions: The uptake of screening service is very low. Women aged 35–44, history of multiple
sexual partner, HIV infection, good knowledge about cervical cancer, and receiving a screening
recommendation were independent predicators of screening uptake. Awareness creation about
screening and cervical cancer, with special attention to women who are HIV-negative, have one
life time sexual partner, and are either below 35 years of age or above 45 years of age should be
strengthened.

17
Elshishiney, Galal

Country: Egypt

Abstract title: Results of the Largest Nationwide Campaign Targeting 60 Million

Egyptians Above 18 Years For Reducing Mortality From Noncommunicable Diseases,
2018–2019: A Focus on Diabetes Mellitus

Short biography: Galal Elshishiney is associate Egyptian Minister of Health for Public Health and Health
Policies, and Deputy Director for 100 million healthy lives initiatives. He also served as Director in charge
for noncommunicable diseases unit in the Egypt's Ministry of Health and Population. Currently he is a
committee member for command and control committee to fight and control coronavirus in Egypt. He
has a master’s degree in business administration and total quality management. He also achieved a field
epidemiology program in collaboration with CDC and EMPHNET, and a scientific clinical research training
program at Harvard Medical School of Medicine.

ABSTRACT

Authors: Dr. Galal Elshishiney, Dr. Sahar Samy, Dr. Hanaa Abuelsood, Dr. Salma Afifi, Mr. Aysam Salah,
Dr. Mohamed Hassany

Background: Egypt is facing a growing burden of noncommunicable diseases (NCDs) driven by

uncontrolled risk factors. Studies indicated that 15.1% of Egyptians aged 15–69 years are diabetics. A
total of 84% of all deaths and 67% of premature deaths are caused by NCDs. Taking advantage of the
HCV elimination mass campaign, Egypt implemented nationwide action to assess the burden and
reduce death toll from NCDs. Our aim is to describe the results of random blood glucose level (RBGL)
and Body Mass Index (BMI) for all Egyptians >18 years, 2018–2019.

Methods: Overall 5,656 healthcare facilities and 60,057 health care workers participated. Rapid
test was used to assess RBGL, hyperglycemia defined as ≥200 mg/dl, overweight defined as BMI
≥25, obesity as BMI ≥30, and morbid obesity as BMI ≥40. The national demographic database was
connected electronically to each subject interview and testing results. Media were used to motivate
community for participation. Hyperglycemic subjects were referred to the nearest hospital for
confirmation by HbA1c test, counselling, and treatment.

Results: Overall 49,931,468 Egyptians participated, representing 82.1% of the target population.
Their mean age was 42.5 ± 14.3 years, 48.4% were males. Hyperglycemia was identified in 2,596,436
(5.2%) of subjects, including 70.1% with no history of diabetes, half were 55–65 years of age and 45.8%
males. Rate of hyperglycemia differs by governorate (range: 6.4% in Gharbia–3.7% in Fayoum). Among
all hyperglycemic subjects, 502,896 (19.4%) visited governmental hospitals for confirmation and
treatment. Of them 72,133 (14.3%) subjects tested for HbA1c, including 61.7% confirmed as diabetics.
Of all subjects, 34.7% were overweight, 33.6% obese, and 6.3% morbidly obese. Obesity was higher in
females (64.2%).

Conclusions: Egypt has successfully implemented a large campaign for early detection of NCDs.
Results showed a high percentage of undetected diabetic patients and high rates of obesity.
Community health education is required to improve healthcare seeking behavior and lifestyle among
Egyptians.

18
Emtom, Sepde

Country: Cameroon

Abstract title: Epidemiological Profile and Risk Factors Associated with COVID-19
Deaths in Douala City, Cameroon, 2020

Short biography: Sepde Emtom received his MD from the Faculty of Medicine and
Biomedical Sciences of Yaounde in 2015. In 2021, he graduated from the Cameroon FETP with a master's
degree in epidemiology from the University of Buea. Prior to his training he was the surveillance point of
contact and the lead of the case-management unit for people living with HIV in the Deido health district,
Littoral region for 2 years. Now he is a support staff in the Department of Disease Control, Epidemics and
Pandemics of the MOH. During his internship in the neglected tropical diseases subdepartment, Sepde
evaluated the epidemiological surveillance system of burili ulcer in the northern part of his country and
participated in the elimination of human African trypanosomiasis as a public health problem in Cameroon.
From 2018 to 2021, Sepde responded to several outbreaks in Cameroon such as cholera in the north region,
yellow fever in the center region, malaria in a refugee camp, measles in the east region and COVID-19
across the country, especially in the littoral region where he did a planned study on people who died from
COVID-19.

ABSTRACT

Authors: Dr. Sepde Emtom, Dr. P.N. Atangia, Dr. Serge Billong, Mr. Alphonse Acho, Dr. Armel Evouna,
Dr. Priscilla Anya, Dr. Georges Alain Etoundi Mballa

Background: COVID-19 is an emerging, deadly viral zoonosis caused by SARS-CoV-2. In March 2020,
Cameroon was one of the most affected countries in Africa, with a case fatality rate of 2.2% (25/1,136),
and nearly half of the reported deaths were in Douala. We analyzed the risk factors for pandemic-
related deaths in this city in 2020.

Methods: We conducted a case-control study over a 2-month period in the health districts of Douala.
Risk factors were assessed by matching one case with two controls by age and sex. A case was any
suspected COVID-19 death in the community or in a hospital, confirmed by RT-PCR after postmortem
sampling, or any infected person who died of COVID-19. We collected sociodemographic data, clinical
characteristics, and risk factors like comorbidities using a questionnaire administered to the victims'
relatives. We used logistic regression to search for risk factors.

Results: A total of 1,493 COVID-19 cases were confirmed, of which 162 suspected deaths were
notified, 64 cases were confirmed by RT-PCR, and 56 were investigated. The remaining eight cases
did not obtain consent. The sex ratio M/F was 4.1, the mean age was 57.3 years (14–82). The most
represented group was 50–70 years. The attack rate was 4.62/10,000 (case fatality 4.3%). Risk factors
associated with death from COVID-19 were male (OR 2.64; 95% CI 1.23–5.66), age ≥60 years (OR 5.60;
95% CI 2.63–11.93), and hospital attendance >3 days after onset of symptoms (OR 2.88; 95% CI 2.49–
36.37). Comorbidities associated with death were hypertension (OR 51.2; 95% CI 11.5–228); diabetes
(OR 25.32; 95% CI 7.15–89.68); and asthma (OR 18.89; 95% CI 2.26–155.32). Self-medication with non-
steroidal anti-inflammatory drugs was associated with death (OR 6.83; 95% CI 1.36–71.12).

Conclusions: Fatality of COVID-19 in Douala remains high compared with that nationally. Risk factors
associated with deaths are related to age ≥60, hypertension, diabetes, and delayed management. The
response strategy should be primarily directed toward these vulnerable populations.

19
Foday, Amara

Country: Sierra Leone

Abstract title: Protective Behavioral Practices Toward Coronavirus Disease 2019

(COVID-19) Among Health Care Workers in Sierra Leone, 2019

Short biography: Francis Amara Foday is a district disease surveillance officer with 7 years’
experience in the health sector. He holds a Bachelor of Science in public health and is an Intermediate
and Frontline graduate of the Sierra Leone FETP. He is also a member of the Kailahun district public health
emergency management committee, charged with managing all emergency responses. He has been part
of the investigation of major outbreaks in Kailahun district, Sierra Leone, including the ebola outbreak in
2014. He is currently the case investigator for COVID-19 and lead investigator for the circulating vaccine-
derived poliovirus-type 2 outbreak in Kailahun district. Amara has evaluated different surveillance systems
and conducted several studies on emerging public health issues including the protective behavioral practice
against COVID-19 among health workers in Sierra Leone.

ABSTRACT

Authors: Mr. Amara Foday, Ms. Kadijatu Kamara, Mr. Abdul Sesay, Mr. Joseph Bangura, Mr. Patrick
Swaray, Mr. Jeffery Macavora, Ms. Mary Mansaray, Mrs. Musu Abu, Mr. David Moses, Mr. Umaru Sesay,
Mr. Idrissa Tarawalie, Mr. Salieu Jalloh, Mr. Sheku Samba, Mr. Alfred Fomba, Dr. Uzoma Ogbonna, Dr.
Leonard Hakizimana, Prof. Kofi Nyarko

Background: Coronavirus disease (COVID-19) is a global public health threat. Health care workers
(HCWs) are at high risk of infection because they treat COVID-19 patients. In Sierra Leone, HCWs were
affected disproportionately by COVID-19 at the beginning of the pandemic. HCWs’ practices towards
COVID-19 are crucial to prevent nosocomial COVID-19 transmission. We assessed protective practices
toward COVID-19 and associated factors among HCWs in Sierra Leone.

Methods: We conducted a cross-sectional study among 465 HCWs in hospitals and health centers.
We used multistage sampling to select participants and collected data on a pretested standardized
questionnaire. Eight behavioral practice-related variables were scored on a Likert scale from 1 to 5.
A participant’s total score could range from 8 to 40, and scores from 32 to 40 were classified as “good
practice.” Bivariate and multivariate logistic regression models were used to calculate adjusted odds
ratios (aOR) and 95% confidence intervals (CI) and used to identify risk factors.

Results: All 465 (100%) HCWs selected for this study responded. A total of 59% (95% CI 54–64%) HCWs
scored “good practice,” with 55% reporting they always washed their hands, and 57% reported wearing
a mask most of the time. Of the 265 (57%) who wore a mask most of the time, only 74 (28%) wore
the mask correctly, and 106 (40%) did not wear a mask during their interview. Factors significantly
associated with good COVID-19 preventive practice were working outside Freetown (aOR 3.7; 95% CI
2.2–6.2), having a colleague who had COVID-19 (aOR 1.6; 95% CI 1.0–2.6), having a high perception
that COVID-19 can be serious (aOR 3.7; 95% CI 1.9–7.5), and having a low perception that COVID-19 is a
problem in a health facility (aOR 2.1; 95% CI 1.1–4.4).

Conclusions: More HCWs must improve their practices of protective behaviors towards COVID-19 to
reduce transmission. We initiated continuing education and encouraged the enforcement of infection
prevention and control procedures among HCWs.

20
Fomba, Alfred

Country: Sierra Leone

Abstract title: Investigation of Circulating Vaccine-derived Poliovirus (cVDPV) Type 2

Outbreak, Sierra Leone, December 2020

Short biography: Alfred Fomba works in the Sierra Leone Ministry of Health and
Sanitation as a district disease surveillance officer in charge of Koinadugu District, northern
region. He is a clinician who studied community health and clinical sciences. He has a higher diploma and
Bachelor of Science in public health from Njala University. He is also a graduate of the Sierra Leone FETP
Intermediate and Frontline. Alfred participated in major responses including a cholera outbreak in 2012,
an ebola outbreak of 2014–2016 in the subregion, a mudslide in 2017, a measles outbreak in Koinadugu
district in 2017, and a vaccine-derived polio outbreak in 2021. Currently, he is the district case investigation
lead for Koinadugu COVID-19 response. This involves overall surveillance coordination including COVID-19
case investigation, training of case investigators, supervising contact tracers, providing supportive
supervision at all health facilities in the district, analyzing surveillance, preparing situational reports, and
reporting. He coordinates surveillance for all priority diseases at the district level.

ABSTRACT

Authors: Mr. Alfred Fomba, Mr. Joseph Bangura, Mr. Patrick Swaray, Mr. Idrissa Tarawalie, Mr.
Salieu Jalloh, Mr. Sheku Samba, Dr. Leonard Hakizimana, Dr. Uzoma Ogbonna, Dr. Eboh Victor, Mr.
Gebrekrstos Gebru, Prof. Kofi Nyarko, Dr. Alden Henderson, Dr. Tushar Singh

Background: Circulating vaccine-derived poliovirus (cVDPV), is a genetic mutation of the Sabin virus.
Sierra Leone reported its last case of wild poliovirus in 2010. In December 2020, the national disease
surveillance program was notified of three people with acute flaccid paralysis who had cVDPV2. We
investigated to identify the source, determine the magnitude of the outbreak, and the risk factors.

Methods: We assessed the clinical and vaccination status of the cases, searched for trivalent-Oral
Polio Vaccine (tOPV) and monovalent-OPV (mOPV2) in the health facilities serving the affected
communities. We searched for additional cases in affected communities and collected stool specimens
from contacts of case-patients. We assessed cold chain management and routine immunization
services. We conducted a vaccination coverage survey using WHO’s zero-dose case investigation form
in 128 randomly selected households in affected communities.

Results: Case-patients were a 26-month old male from Kambia, a 16-month old female from western
area rural, and a 15-month old female from Tonkolili district. All had fever and acute paralysis. No tOPV
or mOPV were found in the facilities. Poliovirus strains found in two case-patients were genetically
linked to cases in Guinea and Côte d’Ivoire. There was no history of travel within 21 days of symptom
onset for all cases. All received three doses of OPV, and two received one dose of inactivated polio
vaccine (IPV). Nine (47.4%) contacts tested positive for poliovirus type-2. Cold chain status at facilities
was poor. Only 47% (44/93) of children 0–59 months surveyed received three doses of OPV and 48%
(30/63) received one dose of IPV.

Conclusions: The cVDPV2 may have been imported from neighboring countries. OPV and IPV
coverage was low, and poor cold chain may have reduced the vaccine potency. We conducted
enhanced surveillance and prepared for nOPV2 vaccination. We recommend strengthening AFP
surveillance, routine immunization, and cold chain management.

21
Gauto, Micaela

Country: Argentina

Abstract title: COVID-19 in Chronic Dialysis Patients: One Year of Pandemic in Argentina

Short biography: Micaela Azucena Gauto is a biochemist who graduated from the
University of Buenos Aires. She is currently in the second year of residence in epidemiology,
under the National Ministry of Health’s Epidemiology Directorate. Prior to this, she completed a residency
in clinical biochemistry at the Dr. Juan P. Garrahan Nacional Pediatrics Hospital, where she also was chief
resident and a member of the board of directors of the national commission of biochemistry residents.
As an epidemiology resident during the COVID-19 pandemic, she has been working in the analysis of the
national COVID-19 cases surveillance, participating in monitoring and assistance activities in different
provinces of the country, participating in field research and in several studies on the impact of the
pandemic, and focusing in specific population groups (health care workers, chronic dialysis patients, close-
contacts).

ABSTRACT

Authors: Mrs. Micaela Gauto, Mrs. Andrea Baldani, Mr. Augusto Vallejos

Background: The characteristics of chronic dialysis (CD) patients may imply that the impact of SARS-
CoV-2 infection could be greater than in the general population. However, information related to this
topic in Latin America is limited. This study aimed to describe the COVID-19 pandemic in CD patients
in Argentina.

Methods: A cross-sectional study was performed on COVID-19 cases reported to the National
Health Surveillance System between March 2020–February 2021. A clinical, demographic, and
epidemiological description was made in CD patients compared with the general population.

Results: During the period under analysis, a total of 2,496 COVID-19 cases were diagnosed in CD
patients (2,107,676 nationwide) with a cumulative incidence almost 2-fold the national rate (83 cases
per 1,000 CD patients vs 46 cases per 1,000 population). The median age in CD patients was higher
than the general population’s (60 vs 37 years, p<0,05), while the median age of deceased cases
was lower (67 vs 73 years, p<0,05). The case fatality rate (CFR) in CD patients was 24%, 10-fold the
national value (2,4%). From the 20–29 years age group on, the CFR in CD patients was significantly
higher compared to the general population. A total of 87% of cases in CD patients had one or more
symptoms (53% in the general population). The temporal and geographical trends in both groups
were similar but the proportion of cases classified as close contact transmission was higher for CD
patients.

Conclusions: The incidence and CFR due to COVID-19 in CD patients was markedly higher than in
the general population. When analyzed by age, SARS-CoV-2 infections in CD patients had a higher
CFR in younger age groups. These findings evidence the particular vulnerability of CD patients in the
pandemic and the importance of developing control and prevention strategies for this population.

22
Getu, Amare

Country: Ethiopia

Abstract title: Incidence and Predictors of Tuberculosis Among HIV-infected Adults on

Antiretroviral Therapy After Universal Test and Treat Program in Selected Public Hospitals,
Addis Ababa, Ethiopia, 2020

Short biography: Amare Getu is a 2020 graduate of the Ethiopian FELTP at the University of Gondar.
Currently, he works for the Ethiopian Public Health Institute.

ABSTRACT

Authors: Mr. Amare Getu

Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living
with human immunodeficiency virus (HIV). Almost one-third of deaths among people living with HIV
are attributed to TB. This study aimed to assess the incidence and predictors of TB among patients
enrolled at public health hospitals in Addis Ababa, Ethiopia.

Methods: An institutional-based retrospective follow-up study was conducted at selected public

health hospitals in Addis Ababa from 1 January 2016–25 August 2020. Multistage random sampling
was employed to select 539 adults enrolled on antiretroviral therapy (ART). Data were collected by
record review, entered into Epi Data version 3.1, and exported to STATA version 14.1 for analysis. A
multivariable Cox-proportional hazard model was fit to identify predictors of TB among HIV patients
and Adjusted Hazard Ratio (AHR) with the corresponding 95% Confidence Interval (CI) was reported to
declare the significant predictors.

Results: A total of 529 records were included in the final analysis and produced 1,529 person-years
(PY) observation. The incidence rate of TB was 4.8 per 100 PY (95% CI 3.8–6.1). Baseline WHO stages
three or four (AHR 2.3; 95% CI 1.1–5.0), not taking isoniazid preventive therapy (IPT) (AHR 2.8; 95%
CI 1.1–7.3), CD4 count<200 (AHR 3.1; 95% CI 1.6–7.1), poor ART adherence (AHR 2.2; 95% CI 1.2–3.9),
underweight with body-mass index (BMI) <18.5) (AHR 2.4; 95% CI 1.30–4.51) and being bedridden
(AHR 3.1; 95% CI 1.5,–6.2) were independent predictors of TB.

Conclusions: TB incidence declined following initiation of the test and treat program in Ethiopia in
2017. Poor adherence, BMI <18.5kg/m, not taking IPT, baseline WHO stage 3 or 4, bedridden functional
status, and low CD4 count increased the hazard of TB. Hence, close follow-up, reminders, surveillance,
and tracing mechanisms targeting these high-risk groups would decrease TB among HIV patients.

23
Gonahasa, Doreen

Country: Uganda

Abstract title: Evaluation of SARS-CoV-2 Transmission and Cross-border Transmission

Risk Factors Among Fishing Communities in Kyotera District, Uganda, May–June 2020

Short biography: Doreen Nsiimire Gonahasa is a field epidemiologist with a master’s degree
in public health and background in food science and technology with particular interest in implementation
of the One Health approach to public health. Doreen has served in various capacities as a public health
specialist including response to disease outbreaks and health worker training and preparation of national
strategic documents in the health sector. Doreen, a recent graduate of the FETP-Advanced, is currently the
resident advisor for the FETP-Intermediate at the Uganda National Institute of Public Health.

ABSTRACT

Authors: Ms. Doreen Gonahasa, Dr. Alex Riolexus Ario, Dr. Ronald Reagan Mutebi, Mr. Daniel Kadobera,
Dr. Julie Harris

Background: Incoming travelers from neighboring countries were the primary source of early
COVID-19 cases in Uganda. Travelers crossed at multiple land and lake borders, including Kasensero
and Nangoma fishing communities on Lake Victoria. In April 2020, persons in these communities
migrated inland following flooding of Lake Victoria, leading to concern about introduction and spread
of COVID-19. We evaluated these communities for SARS-CoV-2 infection and border-community-
associated risk factors during May–June.

Methods: We conveniently sampled persons from Kasensero (population: 6,793) and Nangoma
(population: 2,949) regardless of symptoms. A confirmed case was positive SARS-CoV-2 RT-PCR from
a nasopharyngeal or oropharyngeal swab. Confirmed case-patients were isolated. We interviewed
confirmed case-patients to identify potential high-risk person-to-person exposures.

Results: A total of 4,602 individuals (3,344 [88%] from Kasensero and 441 [12%] from Nangoma) were
tested 19 May–27 June 2020. A total of 56% were males and 80% were aged 16–45 years. We identified
26 case-patients during 25 May–3 June, including 15 (0.5%) in Kasensero and 11 (2.5%) in Nangoma;
15 (58%) were asymptomatic. Reported interactions between female case-persons and foreigners
included sexual activity, bar service, or fish trading, while interactions between male case-persons and
foreigners comprised cross-border movements or fishing-related interactions. Six (23%) case-patients
had travelled to neighboring countries (road or lake travel) in the past 14 days. Among 228 contacts,
172 (75%) were locatable; 2 (1.2%) (symptomatic) tested positive. Contacts were monitored for face
mask use and social distancing. Testing of 1,454 additional community members from 4–28 June 2020,
yielded no cases.

Conclusions: We identified SARS-CoV-2 community transmission in Ugandan fishing communities

bordering Tanzania. Infections among women may have been acquired from sexual, social, or business
interactions with foreigners while those among men may have occurred during travel or fish-handling
activities. Similar border communities should be individually assessed early during outbreaks to
identify and intervene to reduce high-risk exposures.

24
Haslett, Maria Isabella

Country: Brazil

Abstract title: Knowledge, Attitudes, and Practices During a Brazilian Spotted Fever
Outbreak in a Municipality in Southeastern Brazil, 2019

Short biography: Maria Isabella Claudino Haslett is an occupational nursing specialist. She
has an MBA in Health Auditing. She graduated from the FETP-Brazil/EpiSUS in 2019, where she investigated
waterborne diseases, infectious diseases like chickenpox and leptospirosis, and developed a vaccine
coverage survey. Prior to that, she worked at the county and state levels, coordinating the surveillance
department and the immunization network. She was also a team coordinator in hospital assistance, in
the primary care network and in the family health strategy. She also implemented professional training
strategies. Maria Isabella is currently a technical consultant in the PAHO/WHO, working in the arbovirus
coordination at the Health Surveillance Department of the Brazil Ministry of Health. She helps implement
and strengthen strategies and actions for the surveillance of neuroinvasive diseases caused by arbovirus in
Brazil.

ABSTRACT

Authors: Ms. Maria Isabella Haslett, Ms. Camila Fernanda Santana, Ms. Lidsy Fonseca, Ms. Juliana
Fittipaldi, Ms. Junia Carrieri, Ms. Luciane Coutinho, Mr. Edmundo Flores, Ms. Isabela Veloso, Mr. José
Renato Costa, Ms. Cibelle Cabral

Background: Brazilian Spotted Fever (BSF) is a febrile hemorrhagic infectious disease caused by the
bacterium Rickettsia rickettsii, transmitted by the Amblyomma sculptum tick. Between May–June
2019, there was an outbreak of the disease in the municipality of Contagem, state of Minas Gerais,
Brazil, with five confirmed cases in the same family and four deaths (80% lethality). This study aimed to
evaluate the knowledge, attitudes, and practices (KAP) of the outbreak population in relation to BSF.

Methods: A cross-sectional KAP study was conducted through a semi-structured questionnaire

in June 2019. Individuals exposed to the probable site of infection during a BSF outbreak in the
municipality of Contagem were interviewed. Exclusion criteria comprised individuals under 18. It was
considered appropriate KAP to correctly answer ≥60% of the related questions for each attribute.
Prevalence ratios (PR) and confidence interval (CI 95%) were calculated.

Results: From 34 conducted interviews, 18 (53%) were female, 11 (32%) had incomplete elementary
school, and median age was 40 years. Knowledge: 32 (94,1%) knew how to get the disease, which
vector transmits it, and what environments were most exposed; 24 (70,6%) knew the symptoms of the
disease. Attitude: 29 (85,3%) would correctly prevent BSF infection, 11 (32,5%) would correctly remove
the vector from their bodies, and 31 (91,2%) would look for medical attention if they had fever after a
tick bite. Practice: of those with vegetation areas in their residence, 10 (29,4%) provide adequate care
in that place, and 22 (64,7%) protect themselves against the disease. There was a statistical association
between knowledge and attitude with PR = 0,9 (CI 95% 0,8–0,99).

Conclusions: The population demonstrated adequate knowledge and attitudes, but inadequate
practice in relation to BSF. The outbreak provided greater knowledge about the disease in this
population. Inadequate practice may be related to control interventions performed by the
municipality. We recommend intensifying educational actions aimed at the transmission mode,
disease control, and prevention.

25
Hassan, Abdala

Country: Kenya

Abstract title: Factors Associated with Newly-diagnosed HIV-infections Among Young

Adults Aged 15–24 Years Attending a Rural County Referral Hospital, Kenya, 2018

Short biography: Abdala Hassan is a medical epidemiologist from Mandera County,

northern Kenya. He is a graduate of the Kenya FELTP. As a resident he was attached to the National HIV
and STI Control Program, where he evaluated the progress towards elimination of mother to child HIV
transmission. He presented his work at the 9th TEPHINET global scientific conference in Chiang Mai, Thailand
in 2017. Abdala led investigations of Rift Valley fever outbreak in Kenya in 2018 and shared the findings with
participants at the 67th meeting of Annual Society of Tropical Medicine and Hygiene in New Orleans in 2018.
In 2018, he participated in protocol development for the Kenya population-based HIV impact assessment
survey as well as training and monitoring of the field teams. He is currently pursuing an anesthesiology
residency at Moi University, Kenya.

ABSTRACT

Authors: Dr. Abdala Hassan, Prof. Arthur Kwena, Dr. Joyce Wamicwe, Dr. Jane Githuku

Background: In 2017, about 2.7 million people aged 15–24 years were living with HIV globally,
430,000 of them being new infections. In Kenya, this age group accounted for 40% of all new HIV
infections nationally and 48% of new HIV infections in Siaya County in 2017. Drivers of these new
infections are not well known. We determined sociodemographic and behavioral factors associated
with new HIV infections among young adults to guide evidence-based interventions.

Methods: We conducted an unmatched case-control study at a ratio of 1:2 at Siaya county referral
hospital in August 2018. A case was an HIV-positive person aged 15–24 years diagnosed in May–
July 2018, a control was an HIV-negative youth tested in the same period. Sociodemographic and
behavioral information was obtained using a structured questionnaire. Univariate and multivariate
analyses were performed to identify factors associated with newly-diagnosed HIV infections. The
findings were shared with policy makers.

Results: We enrolled 59 cases and 118 controls; the mean age was 19.3 years (SD ± 3.0) among
cases and 20.6 years (SD ± 2.5) among controls. Cases' median age at sexual debut was 15 years
(interquartile range, IQR 11) and 18 years (IQR 17) among controls. There were 43 females (72.9%)
among cases and 63 (53.4%) among controls. Being female (aOR 2.72; 95% CI 1.09–6.74), belonging
to age-group 15–19 years (aOR 3.50; 95% CI 1.42–8.65), being an orphan (aOR 3.09; 95% CI 1.32–7.19),
early sexual debut (<15 years) (aOR 3.24; 95% CI 1.12–9.40) and being unaware of partners status (aOR
2.34; 95% CI 1.01–5.41) were independently associated with newly-diagnosed HIV infection. School
health talks to sensitize the school-going teens on HIV/AIDS were conducted.

Conclusions: Being orphaned, early sexual debut, and lack of knowledge of partners’ HIV status were
drivers of new infections. Targeted health promotion programming campaigns could help reduce HIV
incidence among young adults.

26
Joseph, Gabriel

Country: Namibia

Abstract title: Guinea Worm Disease Case Search and Risk Assessment in Ohangwena
and Omusati Region, Namibia, February–March 2019

Short biography: Gabriel Joseph is an environmentalist and public health expert. He has
a bachelor's degree in environmental health sciences from the Polytechnic of Namibia. He completed a
post graduate diploma in environmental management and a Master of Philosophy in environmental
management from the University of Stellenbosch in South Africa. Gabriel has a Master of Science in
Applied Epidemiology and Laboratory training program from the University of Namibia. He is currently
an epidemiologist at the Ministry of Health and Social Services, coordinating emergency preparedness
and response and International Health Regulations in the country. He is part of the rapid response team in
Namibia and Southern Africa.

ABSTRACT

Authors: Mr. Gabriel Joseph, Mrs. Emmy-Else Ndevaetela, Ms. Ndiitodino Kakehongo, Prof. Kofi
Mensah Nyarko, Mrs. Undjee Kaura, Mr. Stark Katokele, Mr. Festus Kuushomwa, Mrs. Emmerita Lipinge,
Mrs. Esther Haimbodi

Background: Dracunculiasis, commonly known as Guinea-worm disease (GWD), is a crippling parasitic

disease caused by Dracunculus medinensis, a long, thread-like worm. GWD is a neglected tropical
disease targeted for eradication. Namibia has never been known to be endemic of GWD and was
certified GWD free in February 2000. However, the recent confirmation of cases in Southern Angola,
which borders Namibia, calls for heightened disease surveillance. The Ministry of Health together with
WHO conducted active case search in the two regions bordering Angola. We investigated to assess risk
factors for GWD transmission, explore opportunities to strengthen GWD surveillance, and determine
whether there is GWD.

Methods: A descriptive study was conducted in 89 villages and 875 households bordering Angola
using convenience sampling. We conducted data review in health facilities, assessed knowledge
of GWD in the communities by showing GWD photo-cards, and administered questionnaires to
households. Data were analyzed using Excel.

Results: Out of 875 respondents, 5 (0.6%) recognized GWD on the photo-cards who claimed to have
seen it in Angola. A suspected-case investigated during the study was ruled out and determined to be
a body tissue. About 402 (45%) respondents had access to safe drinking water, 183 (21%) use unsafe
water-sources and 297 (34%) use both sources. About 59 (66%) villages are linked to cross-border
movement between Angola and Namibia.

Conclusions: No active GWD case was found. Cross-border movement from and to Angola, and lack of
safe-water sources in some villages were identified as risk factors for GWD. We oriented communities
and health workers on GWD. We recommended strengthening post-certification surveillance activities
per WHO’s global strategy of GWD eradication. The GWD to be included in the national IDSR reporting
system and advocacy for safe-water supply for all at-risk villages.

27
Kamboj, Arvind

Country: India

Abstract title: Investigation of Newly-identified COVID-19 Clusters in Kalyanpuri, New

Delhi, India, June–July 2020

Short biography: Arvind Kumar Kamboj is a trainee of India EIS at the National Centre for
Disease Control, New Delhi. In 2007 he received an MBBS from Lala Lajpat Rai Memorial Medical College,
District Meerut, Uttar Pradesh State. He then joined the health services in the Department of Medical
Health and Family Welfare of Uttar Pradesh State. Prior to that, he worked at a private Saraswathi Medical
College, District Hapur, Uttar Pradesh State, for one year. He was also associated with public health
activities at a community health centre in Meerut for the last 10 years as a senior medical officer. He
managed these activities working as medical officer, tuberculosis centre and a medical officer, nodal officer
for revised national tuberculosis control program, national pulse polio program, routine immunization
program, surveillance of acute flaccid paralysis and pertussis cases and also as nodal officer for active case
finding suspected for TB under monitoring of WHO. He was also responsible for monitoring the routine
immunization program, measle and rubella campaign, and other healthcare activities run in collaboration
with WHO and UNICEF. While working in the department of health services, he acquired training of non-
scalpel vasectomy, a new treatment strategic guidelines under RNTCP, HIV program training.

ABSTRACT

Authors: Dr. Arvind Kamboj, Dr. Nishant Nirwan, Dr. Kanica Kaushal, Dr. Sushma Choudhary, Dr. Tanzin
Dikid

Background: COVID-19 was declared a pandemic on 30 January 2020, as a Public Health Emergency
of International Concern. In the early part of the pandemic, the transmission dynamics of SARS CoV-2
were poorly understood and surveillance and containment strategies were evolving. We investigated
a new COVID-19 cluster to estimate fraction of asymptomatic, clinical course, positivity rate (PR), cycle
threshold (CT) values amongst household (HH), and immediate neighborhood (NGH) contacts of
confirmed cases in Delhi.

Methods: We enrolled a cohort of HH and NGH contacts at day 1 from two newly notified COVID-19
clusters; and collected sociodemographic, clinical information, and biological specimens for RT-PCR
and CT values. Follow-up field visits were made on day 13 and 28 for RT PCR and ELISA IgM antibody
testing. A daily symptom tracking of all contacts was done telephonically until day 28.

Results: In 27 enrolled contacts, 15 were positive for RT PCR (PR 56%) on day 1. Overall HH and NGH
PR for clusters were comparable (54% and 57%, respectively). All contacts (median age: 22 years;
range: 8–60 years; females: 74%) were asymptomatic throughout 28 days with no comorbidities.
Among 23 contacts, 4 and 12 were RT PCR-positive on day 13 and 28. Of the 4 RT PCR-positive on day
13, 3/4 were earlier positive on day 1; their corresponding CT values were lower (Orf1B gene; 25.6, 25.7,
32.3) than others (range 34.1–36.6). Of 27 contacts, 12 were positive for ELISA IgG antibody test.

Conclusions: All contacts were asymptomatic with no deaths throughout 28 days. Comparatively
lower CT values indicates high infectivity being positive from day 1–13. We recommended early
contact tracing and testing irrespective of symptoms to prevent further transmission and use of
non pharmacological interventions during home isolation. These guidelines were adopted in the
surveillance and containment strategy of government of India.

28
KC, Sachin

Country: India

Abstract title: An Outbreak of Shigellosis Attributed to Consumption of Contaminated

Well-water, Kottamparamba, Calicut, Kerala, India, 2020

Short biography: Sachin KC has a degree in modern medicine from Pushpagiri Medical
College, Tiruvalla. He works in the district medical office of Kannur district as an administrative medical
officer and is pursuing an Epidemic Intelligence Service course from the National Institute of Epidemiology,
Chennai

ABSTRACT

Authors: Dr. Sachin KC, Dr. Nikhilesh Menon, Dr. Polani Rubeshkumar, Dr. Bency Joseph, Dr.
Mohankumar Raju, Dr. Sarita RL, Dr. Jayasree V, Dr. Asha Devi

Background: In India, over 100,000 people die of waterborne diseases annually. On 11 December
2020, the district surveillance unit, Calicut, Kerala, notified a cluster of loose stools in Kottamparamba,
Calicut. We investigated the outbreak to identify potential exposures and propose recommendations.

Methods: We defined a case as loose stools (≥3 episodes) or vomiting in a resident of Kottamparamba,
December 2020. We actively searched and line-listed the cases. We described cases by time (epi-curve),
place (spot map), and person (attack rate by age and gender). We conducted the environmental
investigation, interviewed a key informant, and generated a hypothesis. We conducted a case-
control study to test the hypothesis. We defined the case as loose stools or vomiting in a resident of
Kottamparamba; and controls as a resident of Kottamparamba without symptoms. We computed
Odds Ratio (OR) and 95% confidence interval (CI) by comparing the attack rates between cases and
control. We sent 14 stool specimens and well water for laboratory investigation.

Results: We identified 53 (33%) cases and 1 death (case fatality rate = 0.02%) among 161 residents.
The attack rate was higher among <15 age group (64%, 25/39) and males (35%, 29/84). A spot
map showed clustering of cases around a well. We identified seepage of sewage water from the
subterranean pipeline into the well used for drinking and cooking purposes during the environmental
investigation. We recruited 53 cases and 108 controls to test the hypothesis that well-water could be
the potential exposure. Cases were more likely to have consumed contaminated water from the well
than controls (OR 11.2; 95% CI 3.5–35.7). The water analysis reports and stools samples showed the
presence of Shigella sonnei.

Conclusions: Contaminated well-water due to seepage of sewage led to an outbreak of shigellosis in

Kottamparamba. We recommended repairing the subterranean pipelines and regular chlorination of
well-water.

29
Keimbe, Charles

Country: Sierra Leone

Abstract title: Factors Contributing to Delays in Accessing Maternal Delivery Services in

Health Facilities, Sierra Leone, 2018: A Community-based Cross-sectional Study

Short biography: Charles Keimbe works in the Sierra Leone Ministry of Health and Sanitation
as a national surveillance officer in charge of the southern region. He is a graduate of the FETP Intermediate
and Frontline and a public health emergency management fellow from the US CDC in Atlanta. He
participated in major outbreak responses in Sierra Leone, including cholera in 2012, ebola in the subregion
of 2014–2016, and the mudslide of 2017. Currently, he is the national case investigation subpillar lead
for the COVID-19 response which involves training case investigation supervisors nationwide, supportive
supervision, data analysis, and reporting. He is also the lead for the national influenza sentinel surveillance
system, IDSR roll- out, and supporting the national routine surveillance system. He is also the national focal
point for auto visual AFP detection and reporting, an innovative strategy to enhance AFP case detection
and notification at the community level.

ABSTRACT

Authors: Mr. Charles Keimbe, Mr. Henry Bangura, Mrs. Doris Bah, Mrs. Isha Sesay, Ms. Fatmata Bangura,
Mr. Saffa Saffa, Mr. Amara Sheriff, Mr. Francis Tamba, Dr. Sahr Gborie, Mr. Andrew Bangalie, Mr.
Mohammed Jalloh, Mr. Gildo Okure, Mr. Gebrekrstos Gebru, Dr. Eric Ikoona, Prof. Kofi Nyarko, Dr. Tushar
Singh

Background: At 1,360 deaths per 100,000 live-births, Sierra Leone has the highest maternal mortality
ratio globally. National data indicate that over 98% of maternal deaths are related to delays in
accessing obstetric services, but no empirical study has been conducted to identify associated factors.
We identified factors contributing to delays in accessing maternal delivery services as perceived by
women in Sierra Leone.

Methods: We conducted a community-based survey among women who delivered from 1 May 2017–
30 June 2018, in 4 of 16 districts. We calculated a sample size of 605. Data on sociodemographics,
perceived delays in deciding to seek facility-based delivery services (delay-1), perceived delays in
reaching facility-based delivery services (delay-2), and data on the determinants of delays 1 and 2 were
collected. We calculated frequencies and proportions for factors contributing to the delays as well as
prevalence odds ratios (POR) and 95% Confidence Intervals (CI) to identify risk factors for the delays.

Results: Of the 614 mothers interviewed, the median age was 28 years (range: 14–52 years). The
prevalence of delay-1 was 23.3% (143/614), and delay-2 was 26.9% (165/614). The significant factors
contributing to delay-1 were low socioeconomic status, costly services, lack of essential medicines,
and limited knowledge of pregnancy-related complications. Factors contributing to delay-2 were
long distances and transport difficulties to health facilities. Bivariate analysis showed an association
between perceived delay-2 and previous pregnancy-related complications (POR 1.80; 95% CI 1.13–
2.83) and poor condition of roads (POR 2.34; 95% CI 1.15–4.77).

Conclusions: We found a high prevalence of perceived delays 1 and 2 for mothers to access obstetric
services. Delays were mainly related to transport difficulties, low knowledge of pregnancy-related
complications, and costly obstetric services. We recommended health education on pregnancy-related
complications; and a practical strategy for birth preparedness as well as improved transportation to
health facilities to reduce delays.

30
Kerr, Elenor

Country: Australia

Abstract title: Monitoring Progress Towards Improvement in Human Immunodeficiency

Virus Care for Those Newly Diagnosed in Queensland, Australia, 2014–2018

Short biography: Elenor Kerr has a Master of Applied Epidemiology from the Australian
National University. She completed the program at the Queensland Health Communicable Diseases Branch
in Brisbane, Australia; the Pasteur Institute, Cambodia; and the Doherty Institute in Melbourne, Australia;
as part of the ASEAN-Australia health security program. During this time, Elenor completed projects
related to HIV surveillance, influenza epidemiology, as well as malaria time to re-infection analysis and
investigation of a national salmonella outbreak. Prior to that, Elenor worked in sexual health and family
planning programs in the Asia-Pacific region. Her main areas of interest are in infectious disease outbreak
investigation, surveillance systems, and bloodborne virus and STI epidemiology.

ABSTRACT

Authors: Ms. Elenor Kerr, Dr. Jonathan Malo, Dr. Emma Field, Dr. Damin Si, Prof. Robert Ware, Dr. Sonya
Bennett, Prof. Stephen Lambert

Background: Shortening the time to viral suppression after HIV diagnosis reduces morbidity and
transmission. Current treatment indicators do not include the more relevant health outcome of
viral suppression. This study explored a recently proposed HIV care indicator, the percentage of
newly diagnosed individuals achieving early viral suppression, and investigated risk factors for non-
suppression in Queensland (population: 5.07 million), Australia.

Methods: We constructed a retrospective cohort of Queensland state-wide surveillance data for

newly diagnosed people with HIV, 2014–2018. Proportions achieving viral suppression, viral load <200
copies/mL, within 3 and 6 months of diagnosis were calculated overall and annually by demographic,
clinical, and risk groups. Risk factors associated with non-suppression were identified using univariable
logistic regression.

Results: Of 1,006 individuals diagnosed with HIV, 90% were male; 95% had at least one viral load
test at/following diagnosis. Individuals averaged 1.8 (range: 1–5) and 2.5 (1–8) tests within 3 and 6
months of diagnosis, respectively. The likelihood of achieving viral suppression increased year-on-
year (p<0.001); within 3 months from 19.6% in 2014 to 58.8% in 2018, and 6 months from 46.9% to
82.2%. Viral suppression was more common among older age-groups and individuals with lower
CD4 counts (<350 cell/µL) at diagnosis, and lower among injecting drug users (IDUs). Risk factors for
non-suppression included CD4 count ≥350 cells/µL (OR 3 months: 1.5; 95% CI 1.1–2.0; 6 months: 1.6,
1.2–2.4) and recent acquisition (OR 3 months: 1.3, 1.0–1.8; 6 months: 1.3, 1.0–1.7). STI infection pre/at
diagnosis was a risk factor at 6 months (OR 1.4, 1.1–1.9).

Conclusions: We found increasing viral suppression following HIV diagnosis between 2014–2018,
likely related to health service and monitoring improvements and changes to treatment guidelines.
These are important metrics for HIV control, improving our understanding of year-to-year progress for
population groups and enabling non-suppression risk factors to be understood and addressed.

31
Kgatla, Hellen

Country: South Africa

Abstract title: Epidemiology of COVID-19 in Tshwane District, South Africa, March–June

2020: A Cross-sectional Study

Short biography: Hellen Kgatla has a Bachelor of Nutrition from the University of Venda,
Limpopo Province, South Africa, and a postgraduate degree in HIV and AIDS management from the
University of Stellenbosch, Western Cape Province, South Africa. She recently graduated with Master of
Public Health in Field Epidemiology from University of Pretoria, Gauteng Province, South Africa. She began
her career as a nutritionist for the Department of Health in 2011. Her passion was improving the nutritional
status of communities through nutrition education, counselling, and management. In the Department of
Health, she was a nutrition coordinator aiming to improve the provision of nutrition services for people
living with HIV and AIDS. In 2019, she joined the South African FETP, where she was involved in COVID-19
response in Tshwane District, Gauteng Province. She currently is a field epidemiologist for the FETP.

ABSTRACT

Authors: Ms. Hellen Kgatla, Dr. Alex de Voux, Ms. Rebecca Mphaka, Dr. Alfred Musekiwa, Ms. Hetani
Mdose, Ms. Emelda Ramutshila, Dr. Mpho Moshime, Ms. Lekwetji Mamabolo, Dr. Lazarus Kuonza

Background: On 30 January 2020, the World Health Organization declared the coronavirus disease
2019 (COVID-19), a novel respiratory disease first identified in Wuhan China, a Public Health
Emergency of International Concern. South Africa (SA) reported its first COVID-19 case on 5 March
2020. Gauteng province, the economic hub of SA, soon became the COVID-19 epicenter and Tshwane
district among the areas with high transmission. We describe the epidemiology of COVID-19 cases in
Tshwane from March–June 2020, and determine factors associated with hospitalization and mortality.

Methods: COVID-19 cases confirmed at public and private public health laboratories in SA were
reported to the National Institute for Communicable Diseases (NICD). The NICD sent consolidated
surveillance reports to provincial health offices to disseminate to the districts. We analyzed
surveillance data of laboratory-confirmed COVID-19 cases reported during March–June 2020. Data
were analyzed using descriptive statistics and a multivariable logistic regression model was used to
determine factors associated with hospitalization and mortality.

Results: During March–June 2020, a total of 5,020 laboratory-confirmed COVID-19 cases were
reported in Tshwane. The mean age of cases was 39.7 years (standard deviation 16.1) and 56.7% were
female (n = 2,846/5,020). Hospitalization occurred in 4.9% (n = 246/5,020) of cases and 2% of cases
died (n = 103/5,020). Factors associated with hospitalization included age >60 years (adjusted odds
ratio [aOR] 18.70; 95% CI 11.83–29.55, p<0.001), male gender (aOR 1.38; CI 1.10–1.87, p = 0.035); and
having a pre-existing comorbidity (aOR 2.89; 95% CI 2.09–3.93, p<0.001). Risk factors for mortality
were age >60 years (aOR 47.13; 95% CI 8.33–121.20, p<0.001), male sex (aOR 1.72; 95% Cl 1.10–2.71, p
= 0.020), and having a pre-existing comorbidity (aOR 5.58; 95% CI 3.52–8.85, p<0.001).

Conclusions: COVID-19 affected people of all ages in Tshwane and was less severe among younger
cases. Age, gender, and pre-existing comorbidities were risk factors for both hospitalization and
mortality. Individuals with these characteristics should be prioritized for management of COVID-19
infections and vaccination.

32
Khan, Adnan

Country: Pakistan

Abstract title: Risk Factors Analysis of an HIV Outbreak Among Children Under 15 Years,
Sindh, Pakistan, June 2019

Short biography: Adnan Khan is the Deputy Director of Health Services at Karachi Pakistan.
He holds an MCPS in pediatrics from PNS Shifa Hospital Karachi, an MBBS from Liquat University of Medical
and Health Sciences Jamshoro, Sindh Pakistan, and is currently a fellow of the M.Phil in Epidemiology in the
FELTP in Islamabad. He is attached to the Regional Disease Surveillance and Response Unit in Karachi. Prior
to this, he worked at the Hepatitis Control Program Sindh in Karachi. As an FELTP fellow he investigated an
outbreak of dengue fever, Crimean-Congo hemorrhagic fever, and XDR typhoid fever. He also worked in the
largest outbreak of HIV outbreak among children under 15 years in Sindh.

ABSTRACT

Authors: Dr. Adnan Khan, Dr. Muhammad Asif Syed

Background: From April–June 2019, a total of 909 new HIV infections were identified in Larkana,
Pakistan; 86% were children age <15 years. To identify the possible transmission links in this outbreak,
a case-control study was conducted in June 2019.

Methods: An age, sex, and place matched case-control study was done with 100 cases and 200
control. For cases, we selected a stratified random sample of 100 HIV-positive children registered
in the treatment list. We chose two age and sex-matched controls from the neighborhood of each
HIV-positive case. All selected children were tested using WHO rapid diagnosis test. We interviewed
the parents of each selected child about previous exposures to parenteral treatment and compared
exposures of case and control children using conditional logistic regression.

Results: The ages of selected children ranged from 3 months to 10 years. A total of 83% of HIV-
positive children compared to 46% of HIV-negative children had received healthcare from one private
physician (aOR 29; 95% CI 10–79). Intravenous infusions during the last outpatient visit were more
likely in case-children than control-children (aOR 57; 95% CI 2.2 to >1,000). Among case-children,
94% had been given infusions through a drip set compared to 85% of control-children (aOR 7.7; 95%
CI 2.3–26). The drip set was a reused one for 70% of the case-children compared to 8% of control-
children (aOR 197; 95% CI 16–2400).

Conclusions: A high frequency of private physicians reusing intravenous drip sets to treat outpatients
seen in private practice was responsible for this HIV epidemic. Mapping and regulation of private
practitioners was suggested.

33
Main, Stephanie

Country: Australia

Abstract title: Investigation of an Early 2020 COVID-19 Outbreak in a Vulnerable

Population at a Psychiatric Health Facility in Victoria, Australia

Short biography: Stephanie Main is a field epidemiologist in training in Australia’s FETP

at the Australian National University. Prior to this, she was a research officer and investigator in the
international development discipline, at the Burnet Institute for Medical Research and Public Health. Her
primary focus is tuberculosis programs and operational, clinical and implementation research in Papua
New Guinea and Indonesia. Stephanie has a Bachelor of Science in research and a Master of Public Health.
Her recent work includes outbreak investigation and management for the Victorian COVID-19 response,
TB healthcare worker prevalence screenings in South-East Asia, sociobehavioral research in Indonesia, and
conceptualizing a latent TB surveillance system for LMICs.

ABSTRACT

Authors: Ms. Stephanie Main, Ms. Rebecca Schack, Dr. Ramona Muttucumaru, Ms. Lucinda Franklin, Dr.
Hazel Clothier, Dr. Tony Stewart, Ms. Sally Dougall, Dr. Kat Ryan, Dr. Tambri Housen, Ms. Amy Parry, Dr.
Jane Greig, Dr. Clare Looker, Dr. Charles Alpren

Background: On 1 April 2020, the Victorian authorities were notified of a confirmed COVID-19 case
linked to a psychiatric healthcare facility. We conducted an investigation to support the management
and control of this outbreak and to inform future practice.

Methods: Descriptive case series, laboratory investigation, and site review were done. We interviewed
laboratory-confirmed cases using a standardised questionnaire. Data collected included clinical data,
facility maps, rosters, and patients’ locations and activities. All staff and inpatients were tested on site
on 24 April 2020. Infection prevention control (IPC) and cleaning protocols were reviewed.

Results: To support the outbreak management, the facility was temporarily closed on 26 April, and
all inpatients transferred. We epidemiologically linked 18 cases to this outbreak: 5 staff, 8 inpatients,
and 5 household/family contacts. Median age of cases was 44 years (range 21–65), and 12 (67%) were
female. All identified cases reported symptoms, six cases were hospitalized, no associated deaths
were reported. A total of 15 cases were whole genomic sequenced, and 13 belonged to a genomic
cluster. Multiple waves of transmission occurred in the facility, localized to two of four wards, through
direct patient care or in group therapy sessions where patients and staff had daily contact for more
than 1 hour per session. The facility had established physical distancing measures, however we found
IPC practices, including personal protective equipment use and management of presumptive or
confirmed cases, were insufficient to meet needs, including significant diagnosis delays.

Conclusions: This was the first reported outbreak of COVID-19 in a psychiatric healthcare facility in
Australia. We found that established preventive measures were insufficient to manage this outbreak.
As such, improvements were made to IPC guidelines at the facility and across health facilities
in Victoria. Our investigation reinforces the importance of rapid case identification, diagnosis,
management and isolation, and robust and unique IPC protocols for sensitive healthcare settings.

34
Mengue Essindi, Annie Marielle

Country: Cameroon

Abstract title: Impact of Pneumococcal Conjugate Vaccine 13 and Haemophilus

Influenzae Type b Vaccine: Database analysis of the Sentinel Surveillance Site of the
Pediatric Bacterial Meningitis, Cameroon, 2003–2017

Short biography: Annie Marielle Mengue Essindi is a medical doctor and a Cameroon FETP graduate.
She is currently the chief of the vaccine-preventable disease and AEFI surveillance unit at the Expanded
Program on Immunization, Ministry of Public Health. She evaluated the surveillance system of adverse
event following immunization in Cité Verte health district, central region. She also worked on AEFI’s
measles and rubella national campaign in December 2019 and the polio campaign in response to cVDPV2
outbreak. Currently she is working on vaccination to response to COVID-19 pandemic in Cameroon. Her
work includes training health care providers on surveillance and vaccination, and participating in outbreak
investigations. In 2019, she received a TEPHINET mini grant to carry out a study on arterial hypertension.

ABSTRACT

Authors: Dr. Annie Marielle Mengue Essindi, Dr. Eric Mboke, Dr. Franky Baonga, Dr. Dorine Ngono
Noah, Dr. Armel Evouna, Dr. Georges Alain Etoundi Mballa

Background: Pediatric bacterial meningitis (PBM) is a preventable cause of childhood morbidity

and mortality. For Cameroon in 1999, the most common causes of PBM percentage-wise were
Streptococcus pneumoniae (S. pneumoniae), and Haemophilus influenzae type b (Hib). However,
data are limited on the change of PBM burden and causes since introduction in infant immunization
schedule of Hib vaccine in 2009 and pneumococcal conjugated vaccine 13 (PCV) in 2011. We
evaluated the impact of these vaccines on PBM in Yaounde.

Methods: We collected data of children aged 0–60 months before and after the introduction
of each vaccine for 2003–2017 in the Yaounde sentinel site for PBM surveillance. We analyzed
sociodemographic characteristics, prevalence, case fatality rate (CFR) for S. Pneumonia and Hib. The
Pasteur Center of Cameroon confirmed cases with positive cerebrospinal fluid culture. We used Fisher
exact test for comparison of data for pre-vaccine and post-vaccine periods.

Results: Overall, 374 PBM were confirmed out of 1,087 samples collected. S. Pneumonia accounted
for 19% (206) and Hib 9% (101) of PBM. Meningitis CFR was 9% (29/307). CFR among children of 0–11
months was 1% (1/101) for Hib and 14% (28/206) for S. Pneumonia. Hib PBM decreased from pre-
vaccine period (2003–2008) to post-vaccine period (2009–2017): 24% (83/351) vs 2% (18/736) (p =
0.043). S. Pneumonia PBM decreased from pre-vaccine (2003–2010) period to post-vaccine period
(2011–2017): 30% (137/455) vs 11% (69/632) (p = 0.005). Among post-vaccine positive cases, Hib was
found in 22% (18) and S. Pneumonia in 27% (69). Hib PBM serotype-2 was recovered in 86% (6/7) and
S. Pneumonia serotypes 15B, 5, 6A/B in 21% (3/14) were identified.

Conclusions: PBM attributable to S. pneumonia and Hib decreased after the introduction of
the respective vaccines. Correlating PBM incidence reduction with vaccination coverage data is
recommended and could further support continuous pediatric immunization to further decrease and
prevent future outbreaks.

35
Menon, Nikhilesh

Country: India

Abstract title: An Outbreak of Hepatitis A Due to Consumption of Wedding Party Food

Prepared from an Unchlorinated Well-water, Naripetta, Kozhikode district, Kerala, India,
November 2019–January 2020

Short biography: Nikhilesh Menon completed an MBBS from the MOSC Medical College, Kolenchery,
Kerala, India, and an MD in clinical microbiology from St John’s National Academy of Medical Sciences,
Bangalore, India. In 2017, he received a DTM&H from the London School of Hygiene and Tropical Medicine.
He as a post graduate diploma in Hospital and Health Management from Indira Gandhi National
Open University, India. He is currently an Epidemic Intelligence Officer at ICMR- National Institute of
Epidemiology, Chennai. He has been a district lab surveillance nodal officer for COVID-19, Ernakulam
district, Kerala, since January 2020, and has been instrumental in setting up a comprehensive COVID-19
testing laboratory in public sector in Ernakulam district, Kerala, which performs open RT-PCR, closed RT-
PCR, POC-RT PCR, RT-LAMP-based tests, and antigen test for COVID-19.

ABSTRACT

Authors: Dr. Nikhilesh Menon, Dr. Amjeeth Rajeevan, Dr. Sachin KC, Dr. Polani Rubeshkumar, Dr.
Mohankumar Raju, Dr. Manikandanesan Sakthivel, Dr. Parasuraman Ganeshkumar, Dr. Prabhdeep Kaur

Background: Hepatitis A (HAV) causes 5–15% of acute liver failure cases in India. On 4 December
2019, the district surveillance unit notified a cluster of HAV cases in Naripetta, Kozhikode, Kerala. We
investigated to identify potential exposures and propose recommendations.

Methods: We defined a case as fever/jaundice/dark urine in any resident of Naripetta, November

2019–January 2020. We conducted an active case search. We described the cases by date of symptoms
onset and plotted by their residence. We calculated the attack rate by age and gender. We conducted
a case-control study to test the generated hypothesis. We defined a case as HAV case; and control as
an individual without HAV in a resident of Naripetta, November 2019–January 2020. We calculated the
odds ratio (OR), adjusted OR (aOR), and 95% confidence interval (95% CI). We examined dose-response
and performed chi-square test for trend.

Results: The attack rate of HAV was 2 per 1,000 (60/24,833). The attack rate was higher among aged
15–29 years (5/1000) and males (3/1,000). Among the 60 cases, 52 (87%) had jaundice, and 33 (55%)
were hospitalized. All 60 cases attended a wedding party in November 2019. The epicurve suggested
a point-source outbreak, and cases reported following the wedding party. We generated a hypothesis
that water/food served during a wedding party could be the potential exposure. We recruited 60 cases
and 171 controls. Salad (aOR 3.0; 95% CI 1.02–8.8) and alcohol with water (aOR 2.4; 95% CI 1.1–5.5)
were significantly associated with HAV. Odds of HAV increased with an increase in exposures in salad
nor alcohol (OR 1[Ref.[), alcohol (OR 2.8), salad (OR 4.9), salad and alcohol (OR 11.4), Chi-square = 15.8,
p<0.001. We found that unchlorinated well-water was used to prepare salad and alcoholic drinks.

Conclusions: Consumption of salad and alcoholic drinks prepared from the unchlorinated well-water
caused an HAV outbreak in Naripetta. We recommended using chlorinated well-water.

36
Mhiche, Ambakisye Kuyokwa

Country: Tanzania

Abstract title: Mass Drug Administration Coverage and Determinants of Drug Uptake
for Elimination of Onchocerciasis in Ulanga District, 2019

Short biography: Ambakisye Kuyokwa Mhiche is a public health epidemiologist. He has

served as regional epidemiologist, regional health officer, and coordinator for Neglected Tropical Diseases
Control Program for Kigoma region, Tanzania. He has been a key person on the regional efforts to combat
disease outbreaks and public health emergencies, particularly COVID-19. He has been heading the regional
public health emergency Operation Center (EOC) and has helped establish a subnational EOC in Kigoma,
Dar es Salaam, and Kagera. He currently works with the Ministry of Health as coordinator for Trachoma
Elimination Program under the National Neglected Tropical Diseases Control Program. He is responsible for
coordinating, overseeing and executing the national strategy for trachoma elimination.

ABSTRACT

Authors: Mr. Ambakisye Kuyokwa Mhiche, Prof. Dinah Gasarasi, Dr. Ahmed Abade, Mr. Oscar Kaitaba,
Mr. Isaac Njau, Dr. Akili Kalinga

Background: Ulanga district has been implementing Mass Drug Administration (MDA) intervention
for the past 20 years. However, there has been limited evidence for transmission interruption while
prevalence of onchocerciasis in both human and vector species has remained persistently high. We
conducted a study to assess treatment coverage and explore determinants of drug uptake during
MDA program.

Methods: A cross-sectional community-based study using multistage cluster sampling method

was carried out in Ulanga district, Morogoro region from April–June 2019. Study participants were
randomly selected from households and interviewed using a structured questionnaire. Modified
Poisson regression was performed to determine independent factors associated with MDA uptake.

Results: A total of 502 participants were recruited during the study period with a response rate
of 96%. The mean age of the study participants was 37.8 ±15 years, the majority being in the age
range of 25–34 (25.5%) while females were 67%. MDA coverage was 68%, 83%, 84% and 79% for
Mawasiliano, Uponera, Isongo and Togo villages, respectively. These coverages were below the
optimal coverage recommended by WHO (85%) for successful transmission interruption. Having ≤24
years (adjusted prevalence ratio [APR] 3.9 [95% CI 1.9–8.3], p<0.05), living in the village for at least a
year (APR 3.4 [95% CI 2.4–4.8], p<0.05) and believing IVM prevent onchocerciasis (APR 13.4 [95% CI
2.9–60.9], p<0.05) were associated with increased chances of ivermectin uptake during MDA. Fear of
restriction from drinking alcohol after taking drugs was attributable to decreased drug uptake (APR
12[95% CI 2.4–60.9], p<0.05).

Conclusions: Low coverage of drug uptake indicates that the effectiveness of the MDA activities was
not up to the recommended level. These findings highlight the need to intensify the MDA awareness
campaign targeting less compliance group in the community to reinforce the benefits of ivermectin in
onchocerciasis control and address the community misconceptions about MDA.

37
Mhondoro, Marvellous

Country: Zimbabwe

Abstract title: Risk Factors for Community-acquired Urinary Tract Infections by Extended
Spectrum Beta-lactamase Producing Bacteria, Harare, Zimbabwe, 2019

Short biography: Marvellous Mhondoro is a senior laboratory scientist at Victoria Falls

Wildlife Trust, Diseases and Forensic laboratory. Previously, she worked at the Lancet clinical laboratory as
head scientist in the histopathology department. Marvellous is passionate about antimicrobial resistance
(AMR) research and control and has published on AMR trends in Harare. She is currently participating in
AMR surveillance training with the African Society for Laboratory Medicine. She has a Bachelor of Medical
Laboratory Sciences and a Master in Public Health, both from the University of Zimbabwe.

ABSTRACT

Authors: Ms. Marvellous Mhondoro, Mr. Nqobile Ndlovu, Mr. Simbarashe Chiwanda, Ms. Tsitsi Juru, Dr.
Gerald Shambira, Dr. Notion Gombe, Prof. Mufata Tshimanga

Background: Drug resistance is a major public health concern responsible for morbidity and mortality
globally. In Harare, third generation cephalosporins resistant E. coli in urines increased from 28%
to 38% between 2014 and 2017. These organisms known as extended spectrum beta-lactamase
producers (ESBL) are multidrug-resistant. The associated risk factors and treatment outcomes for ESBL
infections in Harare remain undefined. We determined factors associated with community-acquired
urinary tract infections (UTIs) by ESBL.

Methods: We conducted a 1:1 unmatched case-control study among patients attending two major
hospitals in Harare between April–August 2019. A case was a patient with community-acquired UTI
and a urine culture positive for ESBL-producing bacteria. We randomly selected participants from
laboratory registers and interviewed using structured questionnaires to collect data on demographic
characteristics, comorbidity factors, health related factors, and knowledge levels on UTI. Data were
analyzed to generate frequencies, means, proportions and odd ratios (ORs). We also conducted
bivariate and multi-variate analysis.

Results: A total of 81 cases-control pairs were recruited. UTI within the past 6 months (aOR 4.13; CI1
28–13.35), antibiotic use within the previous 12 months (aOR 2.93; CI 1.14–7.49) and in males, having
prostate enlargement (aOR 8.93; CI 1.88–42.47) were independent risk factors for community-acquired
UTI by ESBL-producing organisms. A total of 62% of isolates from cases (50/81) compared to 17%
(14/81) from controls were ciprofloxacin-resistant. A total of 32% (26/81) of isolates from the cases
compared to 11% (9/81) from controls were gentamicin-resistant. A total of 2% (4/162) of participants
had carbapenem-resistant infections. The cases were 70% less likely to fully recover within 7 days than
the controls.

Conclusions: Treatment of patients with recurrent UTI, previous antibiotic use, and men with prostate
diseases should be guided by laboratory results since they are at high risk of ESBL infection. We
recommend revision of treatment guidelines for UTI in patients with risk factors for ESBL-positive
infections.

38
Mushangwe, Blessing

Country: Zimbabwe

Abstract title: Predictors of Viral Load Suppression Among HIV Positive Female Sex
Workers on Antiretroviral Therapy in Harare, Zimbabwe 2019

Short biography: Blessing Mushangwe is a medical epidemiologist and a Zimbabwe FETP

graduate. She is currently working as a senior program manager at Zimbabwe Technical Assistance,
Training & Education Center for Health. As an FETP resident assigned to the Zimbabwe National AIDS
Council, she evaluated management of HIV comorbidities and provided appropriate and updated clinical
input in the development and adaptation of various HIV curricula and training material. Her work includes
providing clinical leadership in strategic approach to HIV treatment and care in line with the national HIV/
AIDS program.

ABSTRACT

Authors: Dr. Blessing Mushangwe, Mr. Raymond Yekeye, Dr. Cleophas Chimbetete, Dr. Sherpherd
Shamhu, Ms. Tsitsi Juru, Dr. Notion Gombe, Prof. Mufuta Tshimanga

Background: The estimated viral load suppression among female sex workers (FSWs) in Harare is
63% against 95% target for elimination of HIV. Virological non-suppression among FSWs living with
HIV increases the risk of HIV transmission to their clients. We determined predictors of viral load (VL)
suppression, to inform recommendations which may improve VL suppression among FSWs.

Methods: We conducted a 1:1 case-control study. A case was defined as a FSW aged ≥18 years on
antiretroviral therapy (ART) for at least 6 months with most recent viral load of ≥1,000 copies/ml. We
collected data on sociodemographic, behavioral, clinical, and psychological factors associated with VL
suppression using a questionnaire. We reviewed medical records of participants using a checklist to
determine clinical factors associated with VL suppression. We assessed adherence by conducting a pill
count of doses taken and depression by using a Shona symptom screening tool. Epi Info was used to
generate frequencies, means, proportions, and odds ratios at 95% confidence interval.

Results: We recruited 93 case-control pairs. FSWs who had been treated for a sexually transmitted
infection (STI) (aOR 2.0; 95% CI 1.1–4.4) and had below secondary level of education (aOR 2.4; 95% CI
1.2–4.7) were significantly more likely to be virally unsuppressed. Adherence to ART (aOR 0.2; 95% CI
0.1–0.5), consistent condom use (aOR 0.4; 95% CI 0.2–0.8) and being on ART for less than 5 years (aOR
0.4; 95% CI 0.2–0.7) reduced the likelihood of an unsuppressed viral load.

Conclusions: History of receiving STI treatment and having below secondary level of education
increased the odds of virological non-suppression. Good adherence, consistent condom use, and
being on ART for less than 5 years reduced the likelihood of an unsuppressed viral load. STI clinics
hold crucial opportunities for providing support and health education to FSWs who are at high risks of
virological non-suppression.

39
Mutebi, Ronald Reagan

Country: Uganda

Abstract title: Food Poisoning Outbreak Caused by Consumption of Humanitarian

Relief Food Contaminated with Jimsonweed (Datura stramonium), Napak and Amudat
Districts, Uganda, March 2019

Short biography: Ronald R. Mutebi holds a post graduate diploma in project planning and management
from UM, a Master of Public Health from Makerere University, School of Public Health, and a BMBS from
Mbarara University of Science and Technology. Before joining the advanced program, Ronald completed
the medium-term fellowship of both Quality Improvement and Leadership and Governance from
Makerere School of Public Health and gained experience in health systems leadership and public health
practices. As a regional epidemiologist of Uganda’s Masaka region, Ronald coordinated COVID-19 regional
epidemiologic response strategies during the first wave of the pandemic. Today, Ronald works with ICAP at
Columbia University, Mailman School of Public Health as a senior epidemiologist.

Authors: Dr. Ronald Reagan Mutebi, Dr. Alex Riolexus Ario, Ms. Maureen Nabatanzi, Dr. Irene
Kyamwine, Dr. Yvette Wibabara, Dr. Peter Muwereza, Mr. Daniel Eurien, Dr. Benon Kwesiga, Mr. Steven
Kabwama, Mr. Daniel Kadobera, Dr. Arthur Chang, Dr. Alden Henderson, Dr. John Callahan, Dr. Bao-
Ping Zhu

Background: Jimsonweed (Datura stramonium) grows in fields together with leguminous crops, such
as soybeans. It contains toxic alkaloids, and can cause gastrointestinal and central nervous system
symptoms when ingested. Due to persistent famine, the Karamoja region in Uganda, receives routine
humanitarian relief food, including corn-soy blend (CSB+). On 16 March 2019, the Uganda Ministry of
Health was alerted of a suspected foodborne outbreak in Karamoja. Patients reportedly developed
symptoms soon after eating CSB+. We investigated to determine the cause and scope of the outbreak,
and recommend control measures.

Methods: A suspected case was onset of confusion, dizziness, convulsions, hallucinations, diarrhea,
or vomiting in a resident of affected districts from 1 March–30 April 2019. We identified cases by
reviewing health facility records and active case-finding. We conducted a retrospective cohort
study with all 211 residents of villages receiving relief food, interviewed them about dietary history
during 11–15 March, and used Poisson regression to identify risk factors. Food samples underwent
microbiological (bacteria, mold, yeast), chemical (heavy metals), and DNA tests at three international
laboratories.

Results: We identified 293 suspected cases; 5 (1.7%) died. Symptoms included confusion (62%),
dizziness (38%), diarrhea (22%), nausea/vomiting (18%), convulsions (12%), and hallucinations (8%).
The outbreak started on 12 March, 2–12 hours after Batch X of CSB+ was distributed at health facilities.
A total of 89 (66%) of 134 persons who ate CSB+ developed illness compared to 2 (2.2%) of 75 who
did not (RR = 22; 95% CI 6.0–81). Samples of Batch X distributed 11–15 March, contained 14 tropane
alkaloids, including atropine (25–50 ppm) and scopolamine (1–10 ppm). Jimsonweed DNA was
identified from Batch X samples tested.

Conclusions: Consumption of food contaminated with toxic levels of tropane alkaloids caused this
outbreak. Implicated food was immediately recalled. Contamination may have occurred during mass
harvesting. Humanitarian food safety and quality checks should include tropane alkaloids.

40
Nabatanzi, Sandra

Country: Uganda

Abstract title: Uganda’s Preparedness and Prompt Control of Imported Ebola Virus
Disease, June 2019

Short biography: Sandra Nabatanzi is the outbreak coordinator for Makerere University
School of Public Health, Monitoring and Evaluation Technical Support program, CDC. She completed the
FETP with the Uganda Public Health FETP. She has vast experience in epidemiology and outbreak response
and management and has responded to COVID-19, ebola, yellow fever, cholera, measles, malaria, food
poisoning, and others. Sandra was nominated under the category of ebola prevention and management
at the heroes in health awards, 2020. Prior to her current role, she was a technical officer for public health
emergencies with the WHO and Ministry of Health. She is a member of the national task force for managing
outbreaks, east and southern Africa emergency forum, COVID-19 surveillance task force, and the National
Integrated Sentinel Surveillance technical working groups.

ABSTRACT

Authors: Ms. Sandra Nabatanzi, Dr. Alex Riolexus Ario, Dr. Allan Muruta, Dr. Issa Makumbi, Dr. Benon
Kwesiga, Mr. Atek Kagirita, Ms. Doreen Gonahasa, Mr. Paul Mbaka, Mr. Innocent Komakech, Dr. Felix
Ocom, Dr. Joseph Ojwang, Dr. Ida Marie Ameda, Mr. Simon Kyazze, Dr. Allan Mpairwe, Dr. Henry
Mwebesa, Dr. Miriam Nanyunja

Background: On 1 August 2018, the Democratic Republic of the Congo (DRC) declared an outbreak
of ebola virus disease (EVD) in North-Kivu province, 100 km from the Uganda border. The World Health
Organization (WHO) categorized the country as high-risk for importation, and Uganda immediately
commenced preparedness activities. On 11 June 2019, the Uganda Ministry of Health (MOH) recorded
the first case of EVD in Kasese District.

Methods: The Uganda MOH activated coordination mechanisms, conducted preparedness

assessments, and categorized districts of the country by risk. Preparedness interventions structured
around 11 EVD response pillars were heightened in 30 high-risk districts. A simulation exercise was
conducted in Kasese district to test the country’s readiness. EVD operational readiness was monitored
using key performance indicators. These preparations were tested when the first patient from DRC
entered Uganda.

Results: A 3-year-old with suspected EVD travelled from DRC through an undesignated border
crossing at Mpondwe, Kasese district, on 10 June 2019, after attending the burial of an EVD victim. He
had been accompanied by six relatives, two of whom later developed symptoms; all sought care at
Kagando hospital on 10 June 2019. Patients had bloody diarrhoea, muscle pain, headache, vomiting
blood, fatigue, and abdominal pain. Health workers at Kagando hospital suspected EVD and referred
the three patients to an ebola treatment unit at Bwera hospital, Kasese. All were confirmed positive
for EVD and died within 4 days of admission. In total, 114 contacts were identified, vaccinated, and
followed up for 21 days. None developed EVD symptoms. The MOH declared an end of the outbreak
42 days after the last contact with a confirmed case.

Conclusions: This EVD outbreak was contained at the source with no transmission in Uganda.
Heightened preparedness in a high-risk district enabled early detection, effective isolation, and
infection prevention and control.

41
Ndlovu, Babongile

Country: South Africa

Abstract title: Skin Cancer Risk Factors Among Black South Africans—The
Johannesburg Cancer Study, 1995–2016

Short biography: Babongile Ndlovu has a background in medical sciences (human

physiology) through training with the University of KwaZulu-Natal. She also has a Master in Field
Epidemiology through training with the University of the Witwatersrand and the South Africa FETP. She
is currently working for the National Institute for Communicable Diseases as a field epidemiologist and
supporting the COVID-19 response in the Western Cape province, South Africa.

ABSTRACT

Authors: Ms. Babongile Ndlovu, Mr. Wenlong Chen, Dr. Lazarus Kuonza, Dr. Mazvita Sengayi-
Muchengeti, Dr. Elvira Singh

Background: Persons with higher levels of melanin are assumed to have a lower risk of skin cancer
(SC). However, sunlight exposure is not the only SC risk factor and lesions can occur on covered body
sites. In South Africa (SA), SC incidence in blacks has increased from 1993–2014. This study aimed to
identify risk factors associated with SC and describe the histological and anatomical distribution of SC
subtypes among SA blacks.

Methods: We conducted a retrospective case-control study using data from the Johannesburg Cancer
Study (JCS). JCS recruited adult (≥18 years), SA blacks, newly diagnosed SC patients attending public
referral hospitals in Johannesburg from 1995–2016. Cases included SC subtypes; non-melanoma
(NMSC) and melanoma (MSC). Controls were those without a cancer diagnosis, sampled from the
same hospital. Information on sociodemographics (sex, age, province), smoking behavior, cooking or
warming fuel-type, and HIV status was collected. We evaluated risk factors associated with each SC
subtype using stepwise logistic regression.

Results: There were 160 NMSC and 101 MSC cases. NMSC lesions were mostly distributed on the skin
of head and neck in males (53.3%, 40/75) and on the trunk in females (43.5%, 37/85), while MSC lesions
were mostly distributed on lower limbs for males (67.5%, 27/40) and females (59.02%, 36/61). NMSC
cases had 2.56 times (confidence interval [CI] 1.60–4.10) and MSC cases had 1.99 times (CI 1.09–3.64)
the odds of being male compared to controls. NMSC cases had 10.48 (CI 2.05–53.70) times the odds of
using coal as a warming fuel compared to controls, after adjusting for age, province, cooking fuel-type,
smoking behavior and HIV status.

Conclusions: Differences in anatomical distribution of NMSC by sex suggest different SC risk factors
for males compared to females. Using coal as a warming fuel is a significant SC risk factor in this
population and warrants tailored interventions.

42
Njidda, Ahmad

Country: Nigeria

Abstract title: Knowledge of Occupational Hazards and Prevalence of Injuries Among

Construction Workers Abuja, Nigeria, 2019

Short biography: Ahmad M. Njidda is an MD and a graduate of the Nigeria FELTP. During
his residency in the FELTP, he was posted to the Nigeria Centre for Disease Control where he took part
in several disease outbreak responses. He supported various disease emergency operation centres,
after action reviews of public health emergencies and development of epidemic preparedness plan. He
authored a publication titled “the Nigeria Centre for Disease Control” and co-authored “Performance of
the Public Health System During a Full-Scale Yellow Fever Outbreak Simulation Exercise in Lagos State,
Nigeria, in 2018: How Prepared Are We for the Next Outbreak?” He has presented his work in scientific
conferences. Ahmad worked on the curriculum for the malaria short course delivered through the Africa
Field Epidemiology Network. At the beginning of the COVID-19 pandemic, he was part of the rapid response
team in Abuja. He is currently a senior medical officer in the case management branch of the Nigeria
National Malaria Elimination Program.

ABSTRACT

Authors: Dr. Ahmad Njidda, Dr. Auwal Abubakar, Dr. Jamilu Nikau, Dr. Muhammad Shakir Balogun, Dr.
Patrick Nguku, Dr. Adamu Shehu

Background: The health and safety profile of the construction industry in Nigeria is poor. The industry
alone accounted for 39.2% of injuries and 34.9% of deaths at the workplace in Nigeria between 2014
and 2016. We assessed the knowledge of occupational hazards, prevalence, and factors associated
with occupational injuries among construction workers in Abuja Municipal Area Council, Federal
Capital Territory.

Methods: We conducted a cross-sectional study among 223 construction workers selected using
the multistage sampling technique. We used a pre-tested structured interviewer-administered
questionnaire to elicit responses on knowledge of occupational hazards, injuries sustained, and factors
that determine injuries. We calculated means and proportions. We calculated adjusted odds ratios
(aOR) to determine the association between injury and independent variables using a multivariable
logistic regression at a 5% level of significance.

Results: A majority (220 [98.7%]) of the workers were males. Their mean age was 34.4 ± 7.3 years. A
total of 98 (43.9%) of them had been trained on occupational health. These workers were masons
(16.1%), carpenters (9%), scaffold builders (9%), and welders (9%). A total of 140 (62.8%) respondents
had adequate knowledge, and 185 (83%) had reported occupational injuries in the past 12 months.
A total of 99 (53.5%) of the injured sustained more than one injury. Predictors of injury were poor
knowledge (aOR 9.0; 95% CI 1.9-41.9), non-use of personal protective equipment (aOR 5.1; 95% CI
1.4–18.5), and working 40 hours or more per week (aOR 4.4; 95% CI 1.9–9.8).

Conclusions: The finding that a majority of workers had adequate knowledge was not reflected
in practice as shown by the high prevalence of injuries sustained in the past 12 months, which are
related to certain factors. We recommend that the FCT occupational health unit mandate construction
companies provide and enforce the use of PPE, establish a ceiling for working hours, and provide
regular training and supervision of workers.

43
Rivera, Sandra

Country: Colombia

Abstract title: Impact of the SARS-CoV-2 Pandemic on Health Workers in Colombia,

2020

Short biography: Sandra Milena Rivera Vargas is an epidemiologist from Rosario University,
candidate for a master's degree in epidemiology, el Bosque University, resident of the FETP. She has a
certification in prevention and control of healthcare-associated infections (HAIs) of the Juan Jara National
Institute of Health from Argentina and the Catholic University of Chile. She has more than 10 years of
experience in infection surveillance and control for HAIs. She is currently an epidemiologist for the HAI team
of the National Institute of Health, Colombia.

ABSTRACT

Authors: Ms. Sandra Rivera, Ms. Cindy Sánchez, Ms. Jessica Pedraza, Dr. Jose William Martínez, Dr.
Franklin Prieto

Background: In December 2019, the circulation of a new coronavirus (SARS-CoV-2) was identified as
the causative agent of a severe acute respiratory disease (COVID-19) in Wuhan, China, which spread
rapidly to the world. The World Health Organization declared a pandemic in March 2020. The first case
in Colombia was detected in March 2020. Transmission in health workers is frequent and is associated
with close and direct contact with patients. This study aims to characterize the behavior of SARS-
COV-2 in health workers in Colombia.

Methods: We conducted a retrospective, descriptive study of the surveillance of COVID-19 in health

workers between March–September 2020. A case definition was established as a health worker with
a positive PCR for SARS-CoV-2. Through a standardized field research form, demographic information,
signs, symptoms, contacts, and sources of infection were collected, classified into four categories:
associated with hospital, established by contact with a patient or work colleague with failures in the
use of measures of protection; indeterminate, where the contagion could not be determined; and
community or imported source. Clusters were established in hospitals from a case with a hospital
transmission source. A descriptive analysis was made.

Results: A total of 9,071 developed COVID-19, which represented 1.3% of the national total. A total of
97.7% presented mild symptoms and of these, 7.9% were asymptomatic. It was identified that 67.9%
associated went to the provision of the service, 17.0% undetermined source and 15.2% community.
Nursing technicians, physicians, and nurses were the most affected. The fatality was 0.7%. A total of
756 health institutions with hospital clusters and weaknesses in infection control were identified.

Conclusions: There is a high level of involvement of health personnel with a source associated with
the provision of the service, which shows the need to strengthen control measures.

44
Ruseesa, Edward

Country: Rwanda

Abstract title: Tuberculosis Screening Among Contacts of Bacteriologically-confirmed

TB Patients, Rwanda, June 2016–July 2019

Short biography: Edward Ruseesa received a bachelor’s degree in general medicine from
the National University of Rwanda in 2009. He recently completed his MSc in Field Epidemiology from the
University of Rwanda. From 2008 to 2011, he worked with American Refugee Committee International
(ARC)-Rwanda and Africa Humanitarian action (AHA)-Rwanda. He led, supervised, and oversaw the
implementation of health activities in refugee camps in Rwanda. In 2013, Edward joined the national TB
program as technical lead in charge of case finding in TB high-risk groups. His work contributes to early
detection of TB cases and early initiation of TB treatment, and to the reduction of morbidity and mortality
among TB patients. From February 2020 to date, Edward has been in the frontline for Rwanda’s COVID-19
response. His role includes supporting surveillance, evacuation and isolation of COVID-19 positive cases,
case management, and decentralization of response activities. He has worked in different capacities: as a
team lead of the national COVID-19 high-risk groups sample collection team and team lead of the team
tasked by Rwanda Ministry of Health to support COVID-19 response activities in the Southern province.

ABSTRACT

Authors: Dr. Edward Ruseesa, Prof. Joseph Ntaganira, Dr. Patrick Migambi, Mr. Samuel Rwunganira

Background: Although Rwanda has made substantial progress in tuberculosis (TB) control, it remains
a major public health challenge. From July 2016–June 2019, the TB surveillance system reported
17,535 all-forms TB cases with 13,132 (75%) bacteriologically confirmed. Since 2016, Rwanda has
conducted active case finding through symptoms’ screening among contacts of bacteriologically
confirmed TB patients at the beginning and at the end of TB treatment. We analyzed the data of TB
screening among contacts of bacteriologically confirmed TB patients to determine TB positivity trends
among the contacts.

Methods: A retrospective review of surveillance data from the Rwanda National TB Program from June
2016–July 2019, was conducted. Contact screening data are collected and reported electronically to
the HMIS by each health facility. We extracted the contact screening data from HMIS and analyzed the
aggregated data. Proportions of contacts of bacteriologically confirmed TB patients screened for TB
both at the beginning and at the end of TB treatment were calculated.

Results: From June 2016–July 2019, the proportion of contacts screened for TB at the beginning
and at the end of treatment was 96% (40,735/42,392), and 87% (38,973/44,606) respectively. The
presumptive TB-positivity rate at the beginning and at the end of treatment was 21% (8,650/40,735)
and 11% (4,342/38,973) respectively. Among presumptive TB cases, 4.4% (376/8,650) and 3.2%
(140/4,342) were confirmed TB respectively. TB-positivity yield among contacts at treatment initiation
were 0.7% (93/13,338), 1.0% (132/13,477) and 1.1% (151/13,920) in 2016–2017, 2017–2019 and 2018–
2019 respectively. Three districts (Kicukiro, Rwamagana, and Gasabo) out of 30 accounted for 44%
(228/516) of all TB cases reported from contact screening during a 3-year period.

Conclusions: Contact screening contributed to identifying a significant number of TB patients in

Rwanda, with an increasing yield from 2016 to 2019. However, contact screening at the end of TB
treatment should be reinforced.

45
Shao, Ge

Country: China

Abstract title: Investigation of a Type 2 Vaccine-derived Poliovirus Event in Sichuan

Province, China 2019

Short biography: Ge Shao is an attending doctor of disease control. She has been working
in immunization planning in municipal centers for disease control and prevention for 6 years, mainly
responsible for the monitoring of vaccination coverage rate, the management of the vaccination clinic,
and the investigation and control of the outbreak of vaccine-preventable infectious diseases. In 2019, she
joined the FETP in China. During the training, she investigated type 2 vaccine-derived polio in Sichuan, food
poisoning in schools, and the novel coronavirus outbreak in China. She graduated in 2020.

ABSTRACT

Authors: Ms. Ge Shao, Dr. Ning Wen, Dr. Lixin Hao, Dr. Chunxiang Fan, Dr. Chao Ma, Dr. Zhijie An, Dr.
Zundong Yin

Background: In 2016, type 2 poliovirus was withdrawn globally from trivalent live attenuated polio
vaccine (OPV) to stop generation of type 2 vaccine-derived polioviruses (VDPV2). China subsequently
changed routine immunization to one dose of inactivate polio vaccine (IPV) followed by three doses
of bivalent (I+III) OPV. In June 2019, a VDPV2 was detected from an acute flaccid paralysis (AFP) case in
Sichuan province. We investigated the VDPV2 event and monitored the response.

Methods: We reviewed AFP surveillance data and searched for additional AFP cases; collected stool
specimens from the case, contacts, and local communities; conducted environmental surveillance (ES)
in the county and high-risk prefectures; and conducted a coverage survey. The affected prefecture
conducted two non-selective Sabin-strain-IPV campaigns, and surrounding prefectures conducted
catch-up IPV campaigns.

Results: The VDPV2 had 28 mutations from the vaccine strain, and had 9 mutations in common with
a 13-mutation VDPV2 isolated in Xinjiang province ES in 2018. Three VDPV2s were detected in healthy
Sichuan children: two from contacts of the initial case and one from another local child. Prior to the
event, polio vaccine coverage was 65% among under-5-year-olds in surrounding townships based
on convenience sampling. The AFP case rate was above 1 per 100,000; none of these AFP cases were
polio. No type 2 polioviruses have been isolated through ES. All IPV campaign coverage rates were
above 98%.

Conclusions: This VDPV2 outbreak followed cessation of OPV2; no transmission source was identified.
The VDPV likely circulated for 3 years, enabled by weak routine immunization in the county. The IPV
campaigns appear to have prevented further VDPV2 spread, however, it is uncertain whether an IPV-
only strategy will completely stop transmission. We recommend enhancing AFP and environmental
surveillance and introducing a second IPV dose into routine immunization.

46
Syed, Muhammad Asif

Country: Pakistan

Abstract title: Determinants of Primary Amoebic Meningoencephalitis Infection in

Karachi, Pakistan, 2019

Short biography: Muhammad Asif Syed is an MD and graduate of the FELTP. He as a PhD in
Epidemiology and Public Health. He is working as a technical officer at the Regional Disease Surveillance
and Response Unit in Karachi under the Department of Health, Sindh. He has a wide range of expertise
in vectorborne, vaccine-preventable, and other communicable diseases, and investigation and response.
Being a mentor for FELTP resident, he provided technical support for more than 30 outbreak investigations.
In addition, he attended the one year fellowship related to biosafety and biosecurity from Germany and
One Health certificate course from the University of Florida. His area of interest are emerging and re-
emerging infections, public health surveillance, and outbreak investigation.

ABSTRACT

Authors: Dr. Muhammad Asif Syed, Dr. Ishfaq Memon

Background: Primary amebic meningoencephalitis (PAM) is an acute, fulminant, and fatal central
nervous system infection caused by an amoeba, Naegleria fowleri. It occurs naturally in warm,
freshwater bodies. Infection occurs only when contaminated water enters the nasal passages. Since
2014, PAM has been recognized as a continuing problem in Karachi. We did a case-control study to
identify risk factors for PAM in Karachi.

Methods: We defined cases as PCR-confirmed cases of PAM infection among the residents of Karachi,
during 2017–2019. Hospital records were reviewed. Using a standard questionnaire, we interviewed
family members about nasal irrigation and other nasal exposures to the water in 29 PAM cases.
For each case, three age-sex matched controls were recruited from the same neighborhoods and
interviewed with the same questionnaire. We measured the chlorination levels of the household
water of cases. We computed frequencies, attack rates (AR) and using conditional logistic regression,
adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: During 2017–2019, 29 PAM cases (AR 3/100,000 population) from 5–55 years old (median: 30)
with a male to female ratio of XX were reported. Cases experienced fever (100%), coma (100%), neck
stiffness (97%) and headache (52%). All died from 3–7 days after onset. Cases peaked in June (n = 7;
25%) and July (n = 8; 29%) when the mean ambient air temperatures reached 31.6C. Of cases, 76%
had performed nasal irrigation during ablution compared to 24% of controls (aOR 15; 95% CI 5.1–41).
Residual chlorine levels in the household water were found to be below 0.2 mg/l.

Conclusions: Performing nasal irrigation with inadequately chlorinated water during ablution was the
most probable cause of PAM in Karachi. Using boiled or chlorinated water for nasal irrigation during
ablution was recommended. A community awareness campaign which included infographics were
displayed in the mosques and health awareness was given to the general public.

47
Tigga, Ashish

Country: India

Abstract title: Post-cyclone Rapid Needs Assessment, Puri Urban, Odisha, India,
May 2019

Short biography: Ashish Nawal Tigga is a medical graduate and an Epidemic Intelligence
Service (EIS) officer trained under WHO-EIS. He completed his EIS training in 2019. He is presently working
as sub regional team leader for WHO-India and has experience of more than 10 years in public health.
As an EIS trainee he assessed the surveillance system of Kala-azar, investigated outbreaks of diarrhoea
and measles. He also was art of the in response team for cyclone ‘Fani’ in Odisha state. He was a medical
officer in the primary health centre for government and worked as trainer for adolescent reproductive and
sexual health for frontline workers. He has contributed in transition from trivalent to bivalent oral polio
vaccine national switch, maternal and neonatal tetanus elimination and launch of new vaccines in routine
immunization. He is also involved in the COVID-19 pandemic, conducting surveillance, contact tracing, and
monitoring of COVID-19 vaccination drive.

ABSTRACT

Authors: Dr. Ashish Tigga, Dr. Kevisetuo Dzeyie, Dr. Nihar Ranjan Ray, Dr. Sunil Dash, Dr. Rajesh Yadav,
Dr. Pankaj Bhatnagar, Dr. Pauline Harvey

Background: Extremely severe cyclonic storm Fani hit Odisha State on 3 May 2019, displacing 1.5
million and causing 64 deaths. We conducted a rapid needs assessment in highly affected Puri Urban
area in Odisha from 18–21 May 2019 to assess the health and safety needs of the affected community.

Methods: We adopted the Community Assessment for Public Health Emergency Response
methodology for selecting 210 households using 30 x 7 two-stage cluster sampling technique. We
interviewed households using a structured questionnaire. We calculated projected proportions with a
95% Confidence Interval (CI).

Results: Of the 210 households interviewed, an estimated 42% (CI 36–49) households reported a
member <5 years and 51% (CI 44–57) >65 years of age. An estimated 64% (CI 57–70) of households
reported significant damage, 47% (CI 40–54) evacuated and 17% (CI 12–22) reported injuries.
Households lacked working toilet (32%; CI 26–39), tap water (47%; CI 40–54), electricity (89%; CI 84–93)
and water purification method (70%; CI 63–76). Moreover, 50% (CI 43–56) households reported fever,
cough, diarrhoea, or rash; 33% (CI 27–40) experienced anxiety, depression, agitation or nightmares
since the cyclone, and 88% (CI 82–92) experienced an increased presence of mosquito. Of the 36% (CI
29–43) households with a member on prescription medicines for noncommunicable diseases, 36% (CI
25–47) did not have a week’s supply. Most urgent needs expressed by households were shelter (70%;
CI 64–76), electricity (50%; CI 44–58), drinking water (46%; CI 39–53) and food (32%; CI 26–38).

Conclusions: Cyclone Fani damaged nearly two-third and evacuated half of households, disrupted
basic necessities and caused psychological trauma. These findings guided authorities with the
response to basic needs, psychological support, and distribution of mosquito nets.

48
Yang, Yi-Ting

Country: Taiwan

Abstract title: Clostridium Perfringens Outbreak Associated with School Lunch, New
Taipei City, Taiwan, 2019

Short biography: Yi-Ting Yang is a trainee with the Taiwan FETP. She completed her Master
of Science in nursing from the Department of Nursing, College of Medicine, National Taiwan University.
She has been a nurse for 10 years at the medical center in Taiwan. She is currently a professional nurse at
the Taiwan Centers for Disease Control. Her work focuses on monitoring, investigating, and implementing
interventions for vectorborne diseases. She is interested in infectious disease epidemiology and advanced
statistics.

ABSTRACT

Authors: Ms. Yi-Ting Yang, Ms. Pei-Chen Chen, Dr. Jih-Hui Lin, Ms. Ching-Yi Wu, Ms. Yu-Ju Chen, Ms.
Hsueh-Hsuan Lin, Dr. Meng-Yu Chen

Background: Clostridum perfringens is a spore-forming bacterium commonly found on raw meat

and poultry, which may cause foodborne disease. In September 2019, an outbreak of gastroenteritis
occurred in three schools in New Taipei City, Taiwan. More than 200 students became ill after eating
school lunch provided by the same caterer on 3 September. We investigated the outbreak to identify
infection source and recommend preventive measures.

Methods: We conducted a case-control study in two affected schools. We defined case-patients as

students with onset of gastrointestinal symptoms occurring within 72 hours after eating school lunch
on 3 September 2019. We conducted bivariate analyses to identify foods associated with illness.
We tested stool samples of cases and leftover for common pathogens. We interviewed caterers and
reviewed food preparation and delivery process.

Results: We identified 199 cases and 387 controls. The median age of cases was 12 years (range
9–16 years). Main symptoms included diarrhea (n = 165, 83%) and abdominal pain (n = 134, 67%),
with median incubation period of 15 hours. Illness was associated with consuming braised chicken
(OR 2.62; 95% CI 1.66–4.17). Cpe-positive C. perfringens was detected in 10 of 16 stool samples.
Kitchen’s logbooks and caterer’s reports showed cooking without measuring internal temperature of
chicken, storing cooked foods at room temperature, and more than 4 hours from chicken cooking to
consumption.

Conclusions: Eating braised chicken was associated with the school outbreak of C. perfringens. We
recommend caterers should strengthen the risk monitoring during preparation, cooking, storage, and
transportation of food for school lunches, and schools should contract caterers complying with food
safety standards.

49
 List of Oral Abstracts
Hammer, Charlotte. Monitoring of COVID-19 Vaccine Acceptance and Reasons for Vaccine
Acceptance, Finland, April–December 2020

Mweso, Oliver. Prevalence of Suspected SARS-CoV-2 Reinfection Among the Zambian Population,
Zambia, 2020–2021

Nawaz, Nayyar. Risk Factors Associated with Frequent Outbreaks of Crimean Congo Hemorrhagic
Fever in Sindh Province, Pakistan: A Case-control Study

Relvas, Lais. Beriberi (Thiamine Hypovitaminosis) Outbreak Investigation Among Male Prisoners in a
State Public Jail, Brazil, 2020

Taubayeva, Ryszhan. Factors Associated with an Outbreak of COVID-19 in Oilfield Workers,

Kazakhstan, June–September 2020

Yousaf, Anna R. Household Transmission of SARS-CoV-2 from Children and Adolescents

50
 Detailed Oral Abstracts
Hammer, Charlotte

Country: Finland

Abstract title: Monitoring of COVID-19 Vaccine Acceptance and Reasons for Vaccine
Acceptance, Finland, April–December 2020

Short biography: Charlotte Hammer is a fellow of the European Program for Intervention Epidemiology
Training (EPIET). She is based at the Finnish Institute for Health and Welfare, in the Department of Health
Security, Helsinki. As part of her fellowship, she conducted outbreak investigations, performed surveillance
activities, and led operational research, and completed an international deployments for the ebola
response and one for the COVID-19 response. Prior to starting her field epidemiology training, she worked
in academia and humanitarian aid. In 2019, she completed her PhD; her thesis focused on outbreak risks
and rapid risk assessment in humanitarian emergencies. Charlotte will complete her EPIET fellowship in
September 2021 after which she will join the Disease Dynamics Unit at the University of Cambridge as
a research fellow with a focus on operational research on and response to outbreaks of emerging and
reemerging infectious diseases.

ABSTRACT

Authors: Dr. Charlotte Hammer, Dr. Veronica Cristea, Dr. Thimothee Dub, Dr. Jonas Sivelä

Background: Vaccination is a cornerstone in the fight against the COVID-19 pandemic. Finland started
vaccination against COVID-19 in December 2020. To better understand the impact of this control
measure in Finland, COVID-19 vaccination acceptance was monitored between April–December 2020.

Methods: We used the COSMO study protocol from WHO EURO, a tool for rapid, flexible and cost-
effective monitoring of public knowledge, risk perceptions, behaviors, and trust during the COVID-19
pandemic. Four rounds of online surveys with a representative sample of the adult Finnish population
of approximately 1,000 individuals each were conducted in April (x2), May, and November–December
2020. A question on willingness to accept COVID-19 vaccination was added. We performed a
descriptive analysis and linear regression of the likelihood of COVID-19 vaccine acceptance on a
7-point Likert scale and potential predictors.

Results: Vaccine acceptance declined from 70% (95% CI 67–73) in April to 64% (95% CI 61–67) in
December. Complacency among those aged below 50 years (estimate: -0.19; 95% CI -0.21 - -0.02)
and worry about side effects (-0.27; -0.35 - -0.19 below 50; -0.24, -0.30 - -0.18 above 50) were the
main reasons against vaccination. Concern about severe disease was a strong motive for vaccination
(0.11, 0.03–0.19 below 50; 0.08, 0.01–0.15 above 50). Convenience of vaccination (0.12, 0.05–0.19)
and recommendations by health care workers (HCWs) (0.22, 0.07–0.37) were identified as enablers for
vaccination among those aged under 50 years.

Conclusions: Vaccine acceptance slightly declined over time. Key communications will have to be
around the likelihood of side effects and vaccine safety and the need for younger people to get
vaccinated. Additionally, alternatives to increased convenience and recommendations by HCWs
need to be found for older group. The COSMO study design has been an effective mechanism for
monitoring behavioral insights rapidly and repeatedly during a pandemic and allows for cross-border
comparison.

51
Mweso, Oliver

Country: Zambia

Abstract title: Prevalence of Suspected SARS-CoV-2 Reinfection Among the Zambian

Population, Zambia, 2020–2021

Short biography: Oliver Mweso is a Zambia FETP resident, assigned to the Expanded
Program of Immunization site within the Zambia Ministry of Health. He is leading three COVID-19 related
research projects in Zambia: an investigation into the prevalence of suspected SARS-CoV-2 reinfection in
Zambia, a case control study evaluating COVID-19 vaccine effectiveness among health care workers in
Zambia, and predictors of clinical severe outcomes among persons admitted for COVID-19 in Zambia. Prior
to joining the FETP, Oliver was a general surgery registrar at the University Teaching Hospital in Lusaka
from 2017 to 2020. He graduated from the University of Zambia with a Bachelor of Medicine and Surgery
in 2013. He is a recipient of the Moses Sinkala Memorial Award for Research at the University of Zambia for
a study on the prevalence of deep vein thrombosis amongst adult patients with swollen lower limbs at the
university teaching hospital.

ABSTRACT

Authors: Dr. Oliver Mweso, Dr. Nyambe Sinyange

Background: The onset of the second COVID-19 wave in December 2020 in Zambia coincided with
detection of the B.1.351 SARS-CoV-2 variant as the predominant strain among sequenced specimens
in the country. This variant contains mutations that might lead to escape from pre-existing immunity
from natural infection or immunization. We sought to investigate the prevalence of suspected SARS-
CoV-2 reinfection among persons with confirmed COVID-19 in Zambia.

Methods: We did a retrospective data analysis of the database of positive SARS-CoV-2 test results (PCR
or RDT) in Zambia maintained by the Zambia National Public Health Institute from 18 March 2020
to 18 January 2021. We identified persons with more than one positive SARS-CoV-2 test and defined
a case of suspected reinfection as two positive SARS-CoV-2 test results separated by >3 months. We
analyzed demographic characteristics; clinical outcomes data were not available. We calculated the
suspected reinfection prevalence and 95% confidence intervals (CIs) in R.

Results: In total, 38,207 persons tested positive for SARS-CoV-2 in Zambia during 18 March 2020–18
January 2021. We identified 12 suspected reinfections for a prevalence of 0.03% (95% CI 0.02–0.06%).
The median age of persons with suspected SARS-CoV-2 reinfection was 28 years (interquartile range:
26–32) and six (50%) were female. Five (41.7%) of the 12 suspected reinfection cases occurred during
the second wave (mid-December 2020–January 2021) of the outbreak. All patients with SARS-CoV-2
reinfection were alive at the time of last contact.

Conclusions: Suspected SARS-CoV-2 reinfections were detected in Zambia, although the prevalence
was low and most occurred before the B.1.351 variant was detected in the country. None were
confirmed via genomic sequencing. Ensuring the ability to rapidly identify suspected reinfection and
confirm with SARS-CoV-2 genotyping will be critical to identify novel variants of interest and concern
in Zambia.

52
Nawaz, Nayyar

Country: Pakistan

Abstract title: Risk Factors Associated with Frequent Outbreaks of Crimean Congo
Hemorrhagic Fever in Sindh Province, Pakistan: A Case-control Study

Short biography: Nayyar Baloch Nawaz is an MD who graduated from DOW University of
Health Sciences in Karachi, Pakistan. She completed her MCPS fellowship in radiology from 2005–2007. She
also worked with WHO on polio eradication. She has participated in national and international workshops
and conferences for IDSR, outbreak investigation, and response. Currently she is working at the Regional
Disease Surveillance and Response Unit in Karachi under the Department of Health, Sindh. As an FELTP
fellow she is supporting the Pakistan government in the COVID-19 pandemic. She has investigated multiple
outbreaks of vaccine-preventable diseases, and vectorborne diseases like CCHF, dengue and chikungunya.
She is also providing technical support to the government of Sindh in developing humanitarian strategic
plans by conducting a vulnerability assessment in vulnerable areas and communities, which is a step
towards strengthening the country’s readiness for health-related emergencies and disasters management.

ABSTRACT

Authors: Dr. Nayyar Nawaz, Dr. Muhammad Asif Syed, Dr. Adnan Khan, Dr. Aamir Hussain, Dr. Arslan
Memon

Background: Congo Crimean hemorrhagic fever (CCHF) is a tick-borne zoonotic infection that is
enzootic in Sindh Province, Pakistan. Each year, it leads to many outbreaks and sporadic cases in
humans. Animal handlers and butchers are considered to be the high-risk groups. The main objective
of this study was to explore the risk factors for the CCHF infection and recommend control measures.

Methods: All 81 reported CCHF cases from 2016–2020 in Sindh Province were included in a case-
control study. A case was defined as any individual with CCHF viral nucleic acid in blood detected by
real-time reverse transcription-polymerase chain reaction (RT-PCR). Control were individuals selected
from neighborhoods of cases and who did not have a history of CCHF or acute febrile illness consistent
with CCHF. Information on exposures was collected using a structured questionnaire. A multivariate
logistic regression model was used to estimate adjusted odd ratios (aOR) with 95% confidence
intervals.

Results: Of the 81 cases, 69% were reported between July–October around the religious ceremony
of Eid-Al-Adha when livestock was customarily slaughtered. The highest attack rate, 6 per million
(26 cases) was in the 30–39 year age group. The case fatality rate was 35%. Animal handlers (aOR 4.8;
95% CI 2.5-6.9), butcher (aOR 5.7; 95% CI 2–14), history of a tick bite (aOR 3.7: 95% CI 1.0–12), and
cattle market visit (aOR 2.5; 95% CI 1.4–4.3) were significantly associated with contracting the CCHF
infection.

Conclusions: Animal handlers, butchers, tick bites, and cattle market visits were significantly
associated with CCHF. The preponderant cases were reported during Eid-al-Adha. Applying acaracides
to livestock 10–14 days prior to slaughter or export is recommended. The establishment of isolation
units with implementation of ICP measures, capacity building of HCW for surveillance, diagnosis, and
case management is highly recommended.

53
Relvas, Lais

Country: Brazil

Abstract title: Beriberi (Thiamine Hypovitaminosis) Outbreak Investigation Among

Male Prisoners in a State Public Jail, Brazil, 2020

Short biography: Laís Relvas has a degree in primary health care, a degree in problem-
based learning applied to the Brazilian Unified Health System, and a master's degree in public health
epidemiology. She is currently a fellow of the Brazil FETP/EpiSUS. Before that, she worked as a healthcare
manager at the municipality level, as a technical consultant in General Coordination of Information and
Epidemiological Analysis and in the General Coordination of Non-Communicable Diseases Surveillance,
both at Health Surveillance Secretariat of Ministry of Health. During FETP, she conducted an investigation
of diarrhea outbreak among indigenous populations, the implementation of national notification form for
multisystem inflammatory syndrome in children associated with COVID-19, the first evaluation of arboviral
neuroinvasive diseases surveillance system, and participated in a COVID-19 severity investigation caused by
infection of Gama SARS-CoV-2 variant of concern.

ABSTRACT

Authors: Ms. Lais Relvas, Ms. Magda Duarte, Ms. Danielle Castanha, Ms. Maria Amelia Costa, Ms. Naila
Juliana Araujo, Ms. Dihna Miranda, Mr. Marcio Henrique Garcia

Background: In early May 2020, an outbreak of unknown etiology was reported among male
prisoners in a public state jail in Brazil. Initial diagnostic hypotheses included leptospirosis, exogenous
intoxication, and water/foodborne diseases. Beriberi hypothesis (thiamine hypovitaminosis) was
considered during fieldwork. We investigated the outbreak to confirm the disease etiology, identify
risk factors associated to illness, and recommend control measures.

Methods: We conducted a descriptive followed by case-control study (1:1.5 ratio) based on medical
records, available laboratory results, and a standardized interview questionnaire. Thiamine dosage nor
therapeutic testing were possible. Cases were defined as inmates who met Beriberi suspected clinical
criteria between 1 January–15 June 2020. Control was any inmate who did not meet case definition.
We also described environments/routines related to etiological hypotheses, based on official jail’s
documents.

Results: Among 656 inmates, 262 cases of the unknown disease were identified, only 2% (1/66)
were confirmed for leptospirosis. The jail’s environments and routines description removed initial
hypotheses by plausibility and temporality criteria, while we identified a menu with characteristics
of food monotony, 15 hours intermittence between dinner and breakfast, a diet rich in simple
carbohydrates and interruption in food remittance by relatives due to the COVID-19 pandemic. A
total of 199 (76%) sick inmates met case definition of suspected Beriberi, of which 56 (28%) were
hospitalized and 6 (3%) died. Paresthesia (n = 120; 60%), edema (n = 113; 57%) and numbness (n = 98;
49%) were the most frequent signs and symptoms. Physical exercise (OR 0.3; 95% CI 0.1–0.9; p = 0.03)
and detention time longer than 6 months (OR 5.1; 95% CI 1.4–21.7; p = 0.02) were associated with
illnesses.

Conclusions: Hypovitaminosis was the outbreak’s probable etiology, especially by thiamine

deficiency. We recommended diversifying prisoners’ diet, including vitamins-rich foods; thiamine
administration for all prisoners; clinical monitoring to check prognostic improvement and final
classification of suspected beriberi cases; and offering rehabilitation when necessary.

54
Taubayeva, Ryszhan

Country: Kazakhstan

Abstract title: Factors Associated with an Outbreak of COVID-19 in Oilfield Workers,

Kazakhstan, June–September 2020

Short biography: Ryszhan Taubayeva is an epidemiologist specializing in prevention and

control of infectious and non-infectious diseases, and monitoring of air, soil, and water quality. Ryszhan
completed her undergraduate degree in public health in 2013 at the Asfendiyarov Kazakh National Medical
University. In 2018, she was accepted into the Central Asia FETP. She has worked at the Atyrau region branch
of the Kazakhstani Committee for Sanitary and Epidemiologic Control since 2013, and currently heads the
Department of Communal Facilities. She has implemented prevention and control measures for several
outbreaks of infectious diseases and poisonings, including tuberculosis, viral hepatitis, measles, food
poisonings, meningococcal disease, and SARS-Cov-2. During the COVID-19 pandemic, she was part of a
team tasked with implementing mitigation strategies in the region of Atyrau.

ABSTRACT

Authors: Dr. Ryszhan Taubayeva, Dr. Ainur Maratova, Dr. Sayagul Nassyrova

Background: Outbreaks of COVID-19 have been reported in many occupational settings. By June
2020, Kazakhstan suspended two-third of the oilfield workforce after 2,661 cases of COVID-19 were
reported despite implemented preventive measures. We assessed individual and environmental
factors associated with the COVID-19 transmission in the facility.

Methods: Cases were employees of selected shift camps with the highest incidence who tested
positive for SARS-CoV-2 during June–September 2020. We randomly selected controls from SARS-
CoV-2-negative employees who concurrently lived at the same shift camps. Sociodemographic data,
information on knowledge, attitude, practice towards COVID-19, working, and living environment
were collected. In addition to descriptive epidemiology, bivariate and multivariate logistic regression
analysis were performed with R software. Factors significant in the bivariate analysis (p<0.05) were
considered in the multivariate analysis.

Results: The study had 296 cases and 536 controls with 627 (75%) men and 527 (63%) participants
below 40 years of age. Of the 17 studied individual factors, rare antiseptic use (adjusted odds ratios
(aOR 4.1; 95% confidence intervals [CI] 1.8–10.1), non-use at the workplace (OR 2.96; 95% CI 1.24–7.62),
travel before shift work (aOR 2.8; 95% CI 1.0–7.9), and social interaction outside of work (aOR 1.8; 95%
CI 1.2–2.9) were associated with increased COVID-19 transmission. Belief that asymptomatic COVID-19
is contagious (aOR 0.5; 96% CI 0.3–0.8), belief that face masks protect in public places (aOR 0.4; 96%
CI 0.2–0.8), and use of fabric face masks (aOR 0.3; 96% CI 0.2–0.5) appeared to be protective against
COVID-19. Of the 19 environmental factors only air-conditioned premises (aOR 4.0; 95% CI 1.3–13.1)
was associated with COVID-19 transmission.

Conclusions: Individual factors were the main drivers of COVID-19 transmission; environmental
factors contributed little to the transmission. Communication messages should enhance workers’
individual responsibility and responsibility for the safety of others to reduce COVID-19 transmission.

55
Yousaf, Anna R.

Country: United States

Abstract Title: Household Transmission of SARS-CoV-2 from Children and Adolescents

Short biography: Anna Yousaf is an Epidemic Intelligence Service Fellow with the National
Center for Immunizations and Respiratory Diseases, Division of Bacterial Diseases, Respiratory
Diseases Branch at the U.S. Centers for Disease Control and Prevention. She received her medical degree
from the University of Kansas City School of Medicine, completed residencies in Internal Medicine and
Pediatrics at Tufts University/Baystate Medical Center, MA, and completed an adult infectious diseases
fellowship at Brown University/ Rhode Island Hospital, RI.

ABSTRACT

Authors: Mr. Eric Pevzner, Ms. Victoria T. Chu, Ms. Anna R. Yousaf, Ms. Karen Chang, Mr. Noah G.
Schwartz, Mr. Clinton J. McDaniel, Ms. Christine Szablewski, Ms. Marie Brown, Ms. Kathryn Winglee,
Mr. Scott H. Lee, Mr. Zhaohui Cui, Ms. Adebola Adebayo, Ms. Tiffany Aholou, Mr. Minal M. Amin, Mr.
Peter Aryee, Ms. Cindy Castaneda, Mr. Trudy Chambers, Ms. Amy C. Fleshman, Ms. Christin Goodman,
Mr. Tony Holmes, Mrs. Asha Ivey-Stephenson, Ms. Emiko Kamitani, Ms. Susan Katz, Ms. Jennifer Knapp,
Ms. Maureen Kolasa, Ms. Maranda Lumsden, Ms. Erin Mayweather, Mr. Asfia Mohammed, Ms. Anne
Moorman, Ms. Alpa Patel-Larson, Ms. Lara Perinet, Mr. Mark Pilgard, Mr. Deirdre D. Pratt, Ms. Shanica
Railey, Ms. Jaina Shah, Ms. Dawn Tuckey, Mr. Emilio Dirlikov, Mr. Dale Rose, Ms. Julia Villanueva, Ms.
Alicia M. Fry, Mr. Aaron J. Hall, Ms. Hannah L. Kirking, Ms. Jacqueline E. Tate, Ms. Cherie L. Drenzek, Ms.
Tatiana M. Lanzieri, Ms. Rebekah J. Stewart

Background: A better understanding of SARS-CoV-2 transmission from children and adolescents is

crucial for informing public health mitigation strategies.

Methods: We conducted a retrospective cohort study among household contacts of primary cases
(i.e., children and adolescents aged 7–19 years with laboratory evidence of SARS-CoV-2 infection
acquired during an overnight camp outbreak). Among household contacts, we defined secondary
cases using the Council of State and Territorial Epidemiologists definition. We described secondary
attack rates (SAR) and calculated odds ratios (OR) using generalized estimating equations to examine
characteristics of primary cases and contacts associated with transmission.

Results: Among 526 household contacts of 224 primary cases, 48 secondary cases were identified
(SAR 9%; 95% confidence interval [CI] 7%–12%). Age of the primary case was not associated with
transmission (aged 7–10 vs. 16–19 years: adjusted OR [aOR], 0.7; 95% CI 0.2–2.9). Among primary cases,
33% always wore masks around contacts and 65% isolated (remained ≥6 feet apart from contacts, with
a separate sleeping space and bathroom) during their infectious period; both behaviors increased with
age. Mask use by primary cases was associated with decreased transmission in the univariable (OR, 0.2;
95% CI 0.1–0.6) and multivariable (aOR 0.5; 95% CI 0.2–1.3) models, although not significantly in the
latter. Transmission decreased when primary cases isolated (aOR 0.4; 95% CI 0.1–0.9).

Conclusions: Children and adolescents can transmit SARS-CoV-2 in a household setting. Transmission
decreased when primary cases isolated. When feasible, children and adolescents with COVID-19
should isolate to mitigate SARS-CoV-2 transmission.

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 Photo Contest Awards
The FETP International Nights Photo Contest is an annual tradition. It gives FETP trainees and
graduates the opportunity to convey the impact of their work through compelling photographs
taken in the field. A panel of judges from TEPHINET and CDC reviews the submissions and selects the
first, second, and third place winners. A fourth place winner is determined via a popular vote on the
TEPHINET Facebook page.

Photo Contest Award Recipients

2020

1st place: Abdul Shakour Karimi (Afghanistan)

2nd place: Abdul Shakour Karimi (Afghanistan)
3rd place: Jessica Asante (Ghana)

2019

1st place: Tamuno-Wari Numbere (Nigeria)

2nd place: Kusnia Wati Rayahu (Indonesia)
3rd place: Sanam Hussain (Pakistan)
4th place (Facebook choice): Shimaa Abdallah Gebelly (Egypt)

2018

1st place: Fadhili Ngogo (Tanzania)

2nd place: Maureen Anyanwu (Nigeria)
3rd place: Kebkab Tilahun (Ethiopia)
4th place (Facebook choice): Mariz Zheila Blanco (Philippines)

2017

1st place: Tambri Housen (Australia)

2nd place: Nadougo Daniel Hanam (Chad)
3rd place: Meru Sheel (Australia)

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 Jeffrey P. Koplan Award for Excellence
in Poster Scientific Presentation
The Jeffrey P. Koplan Award for Excellence in Poster Scientific Presentation was established in 2014
in honor of Dr. Jeffrey P. Koplan, former director and 26-year veteran of the U.S. Centers for Disease
Control and Prevention (CDC), for his outstanding contributions to improving public health globally
and his commitment to excellence in scientific research, analysis, and presentation. The award is
presented to the winner of the scientific poster presentation that most effectively emphasizes the
results of an investigation and its impact on public health.

Dr. Koplan is a past-president of the International Association of National Public Health Institutes.
He currently serves as vice president for Global Health at Emory University and is the former director
of the Emory Global Health Institute, an organization created to advance Emory University’s efforts
to improve health around the world. Before assuming this position, Dr. Koplan was vice president,
Academic Health Affairs, for Emory University’s Woodruff Health Sciences Center, and director of CDC.

Dr. Koplan has served on many advisory groups and consultancies in the United States and
overseas and has written more than 200 scientific papers. He served as a trustee of Yale University
and is currently on the boards of the Marcus Family Foundation, Michael C. Carlos Museum, Kaiser
Foundation Health Plan of Georgia, Inc., and HealthMPowers.

Jeffrey P. Koplan Award Recipients

2019 PAKISTAN
Munaza F. Complications Associated with XDR Typhoid Fever Cases in Hospitalized Patients of District
Hyderabad, Pakistan, 2017–2018

2018 SOUTH AFRICA

Moema I. Outbreak of Culture-Confirmed Candida auris Bloodstream Infection in the Neonatal Unit of
a Public-sector Hospital, South Africa, July–September 2017

2017 ZIMBABWE
Mugari, H. Hospital-acquired Neonatal Sepsis Outbreak in an Intensive Care Unit, Parirenyatwa Group
of Hospitals, Zimbabwe, 2016

2016 UGANDA
Kihembo, C. Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, 2015

2015 CHINA
Xuehui L. Case-control Study of Risk Factors of Avian Influenza A (H7N9) Transmission in Live Poultry
Markets, Zhejiang Province, China, 2014

2014 ETHIOPIA
Kassa W. Dengue Fever Outbreak, Diredewa, Ethiopia, November 2013

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 William H. Foege Award for Excellence
in Oral Scientific Presentation
The William H. Foege Award for Excellence in Oral Scientific Presentation was established in honor
of Dr. William H. Foege, the renowned epidemiologist, Presidential Medal of Freedom recipient, and
former director of the U.S. Centers for Disease Control and Prevention (CDC) credited with devising the
global strategy that led to the eradication of smallpox in the late 1970s. The award is the highest FETP
International Nights honor presented for the best oral presentation.

Dr. Foege is an Emeritus Presidential Distinguished Professor of International Health at Emory

University and served as CDC director from 1977 to 1983. He founded The Task Force for Child Survival
(later renamed The Task Force for Global Health) and served as its executive director from 1984-2000.
Under Dr. Foege’s leadership, The Task Force for Global Health developed and applied a model of
collaboration that resulted in childhood immunization rates in the developing world increasing from
20 to 80 percent in just six years. He has also previously served as a senior fellow at the Bill and Melinda
Gates Foundation and director at The Carter Center.

William H. Foege Award Recipients

2019 TANZANIA
Kokuhabwa I. Linkage Into Care Among Newly-diagnosed HIV-infected Individuals in Njombe Region,
Tanzania, 2017–2018: A Prospective Cohort

2018 UGANDA
Alitubeera P. Food Poisoning Outbreak Caused by Poisonous Cassava Flour: Kasese District, Uganda,
2017

2017 INDIA
Sahu R. Outbreak Investigation of Acute Diarrheal Disease During a Religious Festival Associated with
Drinking Contaminated Pipeline Water in Radhakund, Uttar Pradesh, India, 2016

2016 INDIA
Nayak P. Outbreak Investigation of Cutaneous Anthrax in Koraput, Odisha, India, 2015

2015 CHINA
Lai X. Case-control Study of Risk Factors of Avian Influenza A (H7n9) Transmission in Live Poultry
Markets in Zhejiang Province, China, 2014

2014 ZIMBABWE
Bangure D. Effectiveness of Short Message Services Reminder on Childhood Immunization Program in
Kadoma, Zimbabwe: A Randomized Controlled Trial, 2013

2013 CHINA
Wang M. Mumps Attenuated Live Vaccine Effectiveness: 1:1 Matched Case-control Study in
Zhongshan, China, 2011–2012

2012 NIGERIA
Ibrahim L. Factors Associated with Interruption of Treatment Among Pulmonary Tuberculosis Patients
in Plateau State, Nigeria, 2011

59
2011 INDIA
Baral P. Hepatitis Outbreak Caused by Contaminated Tamarind Water Served in a Mobile Food Kiosk in
an Affluent Urban School of Mayurbhanj, Orissa, India, September 2010

2010 CHINA
Han K. Shigellosis Outbreak in an Elementary School in Sichuan Province, China, 7–16 June 2009

2009 AUSTRALIA
Jardine A. et al. The impact of Pneumococcal Conjugate Vaccination on Rates of Hospitalization for
Pneumonia, Australia,1998–2007

2008 CENTRAL ASIA

Sailybayeva G. et al. HIV Outbreak Investigation Among Hospitalized Children in Shymkent City,
Kazakhstan, June–November 2006

2007 CENTRAL ASIA

Dehkanova M. et al. Outbreak Investigation of Leptospirosis in Fayezabad District, Tajikistan, 14–22
April 2006

2006 ITALY
Sala M. et al. High-level Beta-hexachlorocyclohexane Contamination in Dairy Farms in the Sacco River
Valley, Latium, Italy, 2005

2005 CHINA
Zhang Y. et al. Large Outbreak of Waterborne Paratyphoid Fever Attributed to a Contaminated Well in a
Rural Junior High School in Guangxi Province, China, 2005

2004 BRAZIL
Daufembach L. et al. Barium Toxicity After Exposure to Contaminated Contrast Solution in Goiás State,
Brazil, 2003

2003 EPIET
Dürr U. et al. Outbreak of Aseptic Peritonitis Among Peritoneal Dialysis Patients Associated with the
Use of Icodestrin in Extremadura, Spain, January–April 2002

2002 BRAZIL
Lanzieri T. et al. Congenital Rubella Syndrome Following a Community-wide Rubella Outbreak in Rio
Branco, Acre, Brazil, 2000–2001

2001 CANADA
Galanis E. et al. Oculo-respiratory Symptoms Associated with Influenza Immunization, Canada, 2000

2000 SPAIN
Pelayo T. et al. Study of Two Outbreaks of Mumps in Children Vaccinated with the Rubini Strain, Spain,
1999

60
 Sara Lowther FETP Memorial Award
The Sara Lowther FETP Memorial Award provides support to a fellow or recent graduate of a Field
Epidemiology Training Program (FETP) to conduct a project that makes significant contributions to
infectious disease prevention and control in their country. The award honors the memory of Dr. Sara
Lowther, who made significant contributions to public health and passed away in May 2020. She
was the acting lead of the Epidemiology Technical Support Unit for FETP at CDC. She was passionate
about FETP as a means to develop and mentor young field epidemiologists around the world and
build global field epidemiology capacity. The award will be presented annually during the FETP
International Nights.

61
 Director’s Award for Excellence in
Epidemiology and Public Health Response
The Director’s Award for Excellence in Epidemiology and Public Health Response* is presented in
recognition of significant contributions toward successful responses to public health emergencies
(natural and man-made disasters, disease outbreaks, etc.). Nominees can include FETP or FELTP
resident advisors who have provided leadership working as part of a response and have been
successful in overcoming challenging circumstances.

The award also recognizes excellence in epidemiologic practice or research and contributions
that address a public health issue of major importance by applying epidemiologic principles and
methods. Nominations can recognize accomplishments that improved human health, made a
substantial reduction in burden of disease, or represented innovations to public health practice
based on epidemiologic foundations or implementation of epidemiologic approaches. Recognized
contributions should be practical, explicit, and applied rather than theoretical or implicit.

Director’s Award Recipients

2018 BRAZIL

2017 UGANDA

2016 PAKISTAN

2015 NIGERIA

* The Director’s Award is not necessarily given annually.

62
 Acknowledgments
The FETP International Nights committee would like to thank the oral and poster presenters and
photo contest participants for their scientific research and efforts to make this event a success. We also
thank the resident advisors, mentors, abstract reviewers, and volunteers for their time, expertise, and
commitment to supporting this event and FETPs around the world.

FETP International Nights Committee

Elena Atkinson, MSc Kip Baggett, MD, MPH Cindy W. Brown, MPA Amber Ellithorpe, CMP,
SGCMP

Robert Fontaine, MD, Angela Hilmers, MD, Pascale Krumm, PhD, Amber Lauff, MPH
MSc MS, MPH MA, MSTPC

Carl Reddy, MBBCh, Tina Rezvani, MA, MS Kelly Westermann Seymour Williams, MD,
FCPHM, MSc (Epi) MPH

63
The FETP International Nights are hosted by CDC’s Division of Global Health Protection and TEPHINET.
For more information about our programs, please contact:

Division of Global Health Protection TEPHINET Program

Centers for Disease Control and Prevention The Task Force for Global Health, Inc.
1600 Clifton Road, NE – Mailstop V-18-3 325 Swanton Way
Atlanta, GA 30329 Decatur, Georgia 30030, USA
www.cdc.gov/globalhealth/healthprotection Phone: (404) 687-5609
www.tephinet.org
For more information, contact CDC secretariat@tephinet.org
1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
www.cdc.gov