Publications by authors named "Baller April"

Objective: To describe the processes of reconciling overlapping guidance and prioritizing practice questions for a World Health Organization (WHO) guideline on Infection Prevention and Control (IPC) for Ebola and Marburg disease.

Methods: This work involved the reconciliation of guidance, the generation of potential practice questions and the prioritization of those questions. Contributors included the WHO secretariat, the WHO steering group, the guideline methodologists, and the guideline development group (GDG).

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Background: The declaration of mpox as a Public Health Emergency of International Concern highlights the need for interventions to interrupt virus transmission, including transmission via fabrics. Current World Health Organization guidance on clothes washing is based on a general consensus of virus inactivation; however, there is uncertainty about the efficacy of laundry detergents and disinfectants or the reduction of risk achieved by washing clothes for monkeypox virus (MPXV) specifically.

Methods: This study investigates the efficacy of manual washing for inactivating MPXV from clothes.

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During a health emergency, there is an urgent need to rapidly develop guidelines that meet minimum quality standards, as exemplified by the development of WHO guidelines on mask use in health care and community settings during the COVID-19 pandemic. Between January 2020 and October 2023, WHO developed 21 guideline updates on the use of masks as part of infection prevention and control (IPC) practices. Guideline developers had to deal with an ever-growing volume of evidence of variable quality.

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Disinfection efficacy tests were conducted on surface carriers inoculated with the monkeypox virus (MPXV) by applying six disinfectant solutions (and three controls) on six surfaces common in low-resource settings: four nonporous surfaces (stainless steel, glass, plastic, and latex) and two porous surfaces (ceramic and wood). Disinfectants were wiped on carriers in triplicate, with a 1 min contact time: 0.05 and 0.

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Objective: To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses.

Design: Integrative review.

Data Sources: PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature.

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Background: Strategy to mitigate various Ebola virus disease (EVD) outbreaks are focusing on Infection Prevention and Control (IPC) capacity building, supportive supervision and IPC supply donation. This study was conducted to assess the impact of a Pay for Performance Strategy (PPS) in improving IPC performance in healthcare facilities (HF) in context of the 2018-2019 Nord Kivu/ Democratic Republic of the Congo EVD outbreak.

Methods: A quasi-experimental study was conducted analysing the impact of a PPS on the IPC performance.

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Objectives: To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions.

Methods: Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF).

Results: Of 3481 cases of EVD, 579 (16.

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Background: The wearing of medical and non-medical masks by the general public in community settings is one intervention that is important for the reduction of SARS-CoV-2 transmission, and has been the subject of considerable research, policy, advocacy and debate. Several observational studies have used ecological (population-level) data to assess the effect of masks on transmission, hospitalization, and mortality at the region or community level.

Methods: We undertook this systematic review to summarize the study designs, outcomes, and key quality indicators of using ecological data to evaluate the association between mask wearing and COVID-19 outcomes.

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Article Synopsis
  • - Rubella, an RNA virus, is a significant cause of birth defects, but many African countries, including Liberia, do not include rubella vaccines in their immunization programs, prompting a need for research on its prevalence and affected populations.
  • - An analysis of suspected-measles cases from 2017-2018 revealed out of 1307 tested for rubella IgM, 36% were positive, with the majority of confirmed cases occurring in children under 15 years, particularly aged 5-9 years.
  • - The study found a majority of rubella cases were reported during Liberia's dry season (February to May), highlighting a concerning trend of infection not only in children but also in women of reproductive age and infants
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Article Synopsis
  • Early detection of meningococcal disease outbreaks is crucial, as seen in January 2018 when nine cases with four deaths emerged in Liberia's Lofa County, raising concerns about potential spread due to nearby borders.
  • A coordinated response was activated through a management system, with daily meetings and data collection to track cases, revealing a high attack rate and fatalities mostly among young males aged 3 to 14.
  • The findings highlighted a lack of recent vaccinations and stressed the importance of improving surveillance and preparedness for meningitis in areas not typically affected.
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Introduction: The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.

Methods: Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.

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Article Synopsis
  • In August 2014, WHO declared the Ebola outbreak in West Africa, including Liberia, a Public Health Emergency, emphasizing the importance of infection prevention and control (IPC) for healthcare workers to mitigate the crisis.
  • From April to October 2015, training and mentorship in IPC were conducted in Gbarpolu County, a hard-to-reach area of Liberia, using specific manuals and WHO guidelines, along with follow-up assessments.
  • As a result, all 180 healthcare workers trained showed significant improvements in IPC practices, with the minimum standard tool scores for safe care rising notably, demonstrating that capacity building was vital for both controlling the Ebola epidemic and ensuring ongoing quality care.
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Article Synopsis
  • The 2014-15 Ebola outbreak in West Africa was controlled, but subsequent infections occurred, including a significant 2015 cluster in Liberia linked to a 15-year-old boy.
  • Investigations revealed that the recent cases were related to a virus lineage from the earlier outbreak, indicating possible transmission from a survivor of the 2014 outbreak who experienced viral persistence.
  • The findings emphasize the risks of future Ebola outbreaks from previously infected individuals who can carry the virus long-term and potentially spread it to others.
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The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening.

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Problem: The lack of proper water and sanitation infrastructures and poor hygiene practices in health-care facilities reduces facilities' preparedness and response to disease outbreaks and decreases the communities' trust in the health services provided.

Approach: To improve water and sanitation infrastructures and hygiene practices, the Liberian health ministry held multistakeholder meetings to develop a national water, sanitation and hygiene and environmental health package. A national train-the-trainer course was held for county environmental health technicians, which included infection prevention and control focal persons; the focal persons acted as change agents.

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Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD.

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Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment.

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According to World Health Organization (WHO) data, the Ebola virus disease (Ebola) outbreak that began in West Africa in 2014 has resulted in 28,603 cases and 11,301 deaths (1). In March 2015, epidemiologic investigation and genetic sequencing in Liberia implicated sexual transmission from a male Ebola survivor, with Ebola virus detected by reverse transcription-polymerase chain reaction (RT-PCR) 199 days after symptom onset (2,3), far exceeding the 101 days reported from an earlier Ebola outbreak (4). In response, WHO released interim guidelines recommending that all male survivors, in addition to receiving condoms and sexual risk reduction counseling at discharge from an Ebola treatment unit (ETU), be offered semen testing for Ebola virus RNA by RT-PCR 3 months after disease onset, and every month thereafter until two consecutive semen specimens collected at least 1 week apart test negative for Ebola virus RNA (5).

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Background: Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus.

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The prevent mother-to-child transmission (PMTCT) "cascade" describes the programmatic steps for pregnant and breastfeeding women that influence HIV transmission rates. To this end, HIV-infected pregnant women and mothers need access to health services and adhere to antiretroviral (ARV) prophylaxis or lifetime treatment. Within the cascade, the concept of "retention-in-care" is commonly used as a proxy for adherence to ARV interventions and, even, viral suppression.

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Countries with high HIV prevalence face the challenge of achieving high coverage of antiretroviral drug regimens interventions including for the prevention of mother-to-child transmission of HIV (PMTCT). In 2011, the World Health Organization and the Department of Foreign Affairs, Trade and Development, Canada, launched a joint implementation research (IR) initiative to increase access to effective PMTCT interventions. Here, we describe the process used for prioritizing PMTCT IR questions in Malawi, Nigeria, and Zimbabwe.

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The government of Canada, through the Department of Foreign Affairs, Trade and Development (DFATD) has supported global efforts to reduce the impact of the HIV pandemic. In 2012, WHO and DFATD launched an implementation research initiative to increase access to interventions that were known to be effective in the prevention of mother-to-child transmission of HIV and to learn how these could be successfully integrated with other essential services for mothers and children. In addition to facilitating the implementation research projects, DFATD and WHO promoted four approaches: (1) Country-specific implementation research prioritization exercises, (2) Ministry of Health involvement, (3) Country-led, innovative, high-quality research, and (4) Leveraging regional networks and learning opportunities.

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