Abstracts of Poster Presentations Tuesday, 17th of September

© The Author(s) 2019. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

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Trans R Soc Trop Med Hyg 2019; 113: S99–S140doi:10.1093/trstmh/trz090 Advance Access publication 16 September 2019

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Abstracts of Poster PresentationsTuesday, 17th of September 2019

P002

EPIDEMIOLOGY OF MALARIA IN KEMBATA-TEMBARO ZONE,SOUTHERN ETHIOPIA: A FIVE YEAR DATA ANALYSIS FROM2011-2015

Addissie A., Lire A.School of Public Health, Addis Ababa University, Addis Ababa,Ethiopia

Background: Between 2000 and 2015, the number of malaria casesdeclined by 42% while the malaria death rate declined by 66% in theAfrican Region. However, Malaria is a major public health challenge inEthiopia, contributing 4% of all cases in Africa. It makes approximately68% of the population the country at risk. Therefore, this surveillance dataanalysis was needed to analyze magnitude, trends, and geographicaldistribution of the disease in Kembata-Tembaro Zone from 2011 to 2015.Aim: To assess the pattern of malaria, incidence and prevalence in thestudy area for the purpose of informing public health action.Methods: A descriptive study was employed for analysis of dataon malaria indicators from the Integrated Disease Surveillance andResponse System database for the years 2011-2015. The surveillancedata were analyzed to show incidence, trends and variation in risk byreporting woredas (districts) by using charts, graphs and tables.Result: In the Zone, the average estimated annual incidence of reportedtotal malaria in the overall population was 69 per 1000 persons andconfirmed malaria were 54 per 1,000 per year over the five years (2011 to2015). As of the calendar years 2011-2015, the annual incidence of totalmalaria report dropped from 119/1000 to 9/1000 and reported malariain-patient admissions and deaths dropped from 1.7/1000 to 0.9 per1,000 per year and 1.3/100,000 to 0.4/100,000 respectively. In addition,laboratory test increases from 60% in 2011 to 90.2% in 2015.Conclusion: We conclude that the magnitude of Malaria in Kembata Tem-baro Zone declined (dropped significantly from 119/1000 to 9/1000) from2011-2015. From all woredas, kedida woreda is most frequently affectedworeda in the Zone. Even though different malaria control strategies weredesigned to roll back to its minimum level in Kembata Tembaro Zone,still malaria cases were not decreased as expected. Therefore, the zonalhealth department should maintain such reduction in both morbidity andmortality due to malaria.

P003RELAPSING FEVER CASES SURVEILLANCE DATA ANALYSISFROM 2012-2016 IN ADDIS KETEMA SUB-CITY, ADDIS ABABA,ETHIOPIANesga D., Addissie A.School of Public Health, Addis Ababa University, Addis Ababa,Ethiopia

Background: Relapsing fever is a recurrent febrile infection caused byvarious Borrelia spirochetes transmitted either by lice (epidemic relapsingfever) or by ticks (endemic relapsing fever). In both forms, the interval

between fevers ranges from 4 to 14 days. This surveillance data anal-ysis study will help to identify the trends of Relapsing fever in AddisKetema Sub City with in the past five years and compare it with thecurrent status of disease which may give information on the trends ofRelapsing fever.Aim: To analyse the surveillance data of Relapsing Fever in Addis Ketemasub city from 2012-2016 by describing its magnitude and distributionamong woredas.Methodology: We conducted retrospective surveillance data analysis inAddis Ketema sub-city by using secondary data that was recorded insub-city from 2012-2016 and analysis was done within one month (Jan16/2017- Feb 15/2017).Results: There were around 381 Relapsing Fever cases reported in thepast five years (2012-2016) among which about 69% was reported in2016 and among the total cases reported in 2016, again 52% of themwas from woreda 07. In addition to that, in 2017 during five weeks ofreporting period there were around 30 cases reported from three Woredas(Woreda 7, Woreda 1, Woreda 4). Depending on the number of cases theyreported within the past five years Woredas are arranged according tohigh risk area in descending order as Woreda 7, woreda 8, woreda 1,Woreda 9, Woreda 4, woreda 2, woreda 5, Woreda 6, and Woreda 3/10.The overall Cumulative Incidence rate of relapsing fever in Addis Ketemasub city in the past five years (2012-2016) were ranges from 6/100,000to 85/100,000.Conclusion: Within the last five years the trend of RF was increasing andthere were Outbreaks in Addis Ketema Sub-city starting from March 2016till now. Therefore, it is recommended to follow the trend of RF in sub-city closely and give appropriate interventions giving special attention forWoredas those identified as high risk areas.

P004ASSESSMENT OF KNOWLEDGE AND BEHAVIOUR OF CARDIO-VASCULAR RISK FACTORS AMONG ADULTS IN COMMUNITIESOF NORTH TAJIKISTANAfandiyeva G.1, Karimova G.1, Mengliboyeva Z.1, Arigoni M.1,Matthys B.2,3, Prytherch H.2,3

1Representative Office of the Swiss Tropical and Public HealthInstitute in Republic of Tajikistan, Dushanbe, Tajikistan;2Swiss Centre for International Health, Swiss Tropical and PublicHealth Institute;3University of Basel, Basel, Switzerland

Introduction: Health literacy (HL) is a person‘s ability to find, read, under-stand and act on health information effectively to make decisions aboutthe own health1. Low HL has been linked to a poorer health status.Aim: We have assessed the knowledge, beliefs and behaviour relating tocardiovascular diseases, risk factors and related diseases (diabetes andobesity) among the adult population in a district in North Tajikistan in2018.Methods: A mixed-method longitudinal cross-sectional study was usedto measure the key indicators. The questionnaire had been elaborated

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Poster Presentations

and validated by a national team of experts. The sample size was calcu-lated following the WHO STEPS surveillance manual2.Results: Overall, 217 adults were interviewed in 11 communities for thebaseline. Every fifth respondent (19%) had a good and half of them(50%) a fair overall knowledge on cardiovascular diseases and relatedrisk factors. ‘Stress’ was most often mentioned (59%), followed by ‘highblood pressure’ (45%), ‘poor diet’ (38%), ‘obesity’ (24%), and ‘diabetes’(20%). Gender differences were observed for ‘smoking or tobacco use’,whereby men 2.5 times more often cited this risk factor compared towomen (28% vs. 11%, respectively). Men of the older generation muchmore often mentioned the risk factors diabetes – (28%) compared toolder women (9%), and high blood pressure (53% vs. 26%, respectively).A majority of the interviewees (83%) believed that their own healthstatus is self-paced, but almost half of the respondents (45%) havenever tried to change their lifestyle. Significant gender-related differenceswere observed for eating less fat (men: 9%, women: 20%), eating morefruits and vegetables (men: 40%, women: 1%), and controlling the ownglucose level (men: 4%, women: 14%). Many respondents estimatedhaving opportunities, time and financial resources to change their ownlifestyle. Significant generational differences were found for having finan-cial resources with 80% of the younger interviewees declaring havingenough money to change their lifestyle compared 66% of their oldercounterparts.Conclusion: Applying the concept of health literacy in this way supportsmore comprehensive options for health improvement, disease preventionand a more successful disease self-management among individuals withchronic diseases.

References:1. World Health Organization. Track 2: Health literacy and health behavior.7th Global Conference on Health Promotion [cited 02.12.2014]; Availablefrom: http://www.who.int/healthpromotion/conferences/7gchp/track2/en/2. The WHO STEPwise approach to Surveillance of noncommunicablediseases ( STEPS) Noncommunicable Diseases and Mental HealthWorldHealth Organization, 2003. Switzerland : [email protected]

P008

THE VECTOR BIOLOGY OF ECTOPARASITES ON RODENT FROMTHE ASIR REGION OF SAUDI ARABIA

Alghamdi S.Q.1,2, Alagaili A.N.3, Stekolnikov A.A.4, McGarryJ.W.5, Darby A.C.6, Makepeace B.L.11Institute of Infection & Global Health, University of Liverpool,Liverpool, UK;2Dept. of Biology, College of Sciences, AL-Baha University;3Dept. of Zoology, King Saud University, Riyadh, Saudi Arabia;4Zoological Institute RAS, St Petersburg, Russia;5Institute of Veterinary Science, University of Liverpool;6Institute of Integrative Biology, University of Liverpool, Liverpool,UK

Background: Rodents have become increasingly recognised as hostsof ectoparasites and reservoirs of numerous human diseases includingscrub typhus, bartonellosis, Lyme disease, and plague. Vector-borne bac-terial zoonoses associated with rodents are a particularly large groupof diseases that are emerging/re-emerging worldwide (Mathison & Pritt,2014).Objectives: This study aimed to define the taxonomic diversity andbacterial microbiome of ectoparasites collected from wild rodents in the‘Asir Region of southwestern Saudi Arabia, with a main focus on chiggermites (family Trombiculidae), the vectors of scrub typhus.

Methods: Wild rodents were trapped in scrubland across one site on theslopes of the Asir Mountains in 2016 (Al Ous’) and four sites in 2017(Al Ous’, Al Jarf, Alogl and Wosanib). Following DNA extraction, the v4region of bacterial 16S rRNA was amplified by PCR, and amplicons weresequenced on an Illumina MiSeq.Results: A total of 7,802 ectoparasites were obtained from 74 rodentspecimens, including chigger mites, fleas (Parapulex chephrenis),ticks (Haemaphysalis erinacei and Rhipicephalus spp.), lice (Polyplaxbrachyrrhyncha and Polyplax oxyrrhyncha), and gamasid mites(Laelapslamborni, Ornithonyssus bacoti). Based on the morphology of thescutum, chiggers were assigned to subgenera into 17 species, includ-ing four putative new species:Neotrombicula sp.n.,Microtrombiculaaff.machadoi,Schoutedenichia.aff.thracica and Schoutedenichia sp. n.(Nadchatram, et al. 1974; Stekolnikov., 2013). Ectoparasite-associatedbacteria were investigated using a 16S rRNA amplicon sequencingapproach. Potentially pathogenic bacteria included Borrelia spp. inchiggers, Bartonella spp. in fleas, and Coxiella spp., Francisella spp. andAnaplasma bovis in ticks. Symbiotic bacteria with putative mutualisticwere present in fleas (Wolbachia and Spiroplasma spp.) and lice(Candidatus Legionella).Conclusion: This is the first survey of rodent ectoparasite diversity andzoonotic bacterial pathogens performed in the ‘Asir Region of SaudiArabia. The chigger diversity in the region is especially high, and thepresence of Borrelia spp. in these mites should be investigated furtherto determine if they might be vectors of Lyme borreliosis or relapsingfever.

References:1. Nadchatram, M. & Dohany, A.L., (1974). A pictorial key to the subfam-ilies, genera and subgenera of Southeast Asian chiggers (Acari, Prostig-mata, Trombiculidae), Kuala Lumpur: Institute for Medical Research.2. Stekolnikov, A.A., (2013). Leptotrombidium (Acari: Trombiculidae) of theWorld. Zootaxa, 3728(1). zootaxa.3728.1.1.3. Mathison, B. A., & Pritt, S. (2014). Laboratory Identification of ArthropodEctoparasites, 27(1), 48–67. http://doi.org/10.1128/CMR.00008-13

P009

VARIATIONS IN PRE-VACCINATION PLATELET COUNTS: DATAFROM THE EBOVAC-SALONE STUDY IN RURAL NORTHERNSIERRA LEONE

Baiden F.1,2, Ishola D.1,2, Kowuor D.1,2, Afolabi M.1,2, Owusu-KyeiK.1,2, Lowe B.2, Kohn B.1,2, Otieno T.1,2, Manno D.2, Samai M.1,3,Leigh B.1,3, Greenwood B.2, Watson-Jones D.2,4

1EBOVAC-Salone Project. Kambia, Kambia District, Sierra Leone;2London School of Hygiene and Tropical Medicine, London UK;3College of Medicine and Allied Health Sciences, Freetown, SierraLeone;4Mwanza Intervention Trials Unit, Mwanza, Tanzania

Introduction: Platelet counts are important during vaccine trials becauseof potential vaccine-associated thrombocytopenia (VAT). The EBOVAC-Salone trial in northern Sierra Leone is a phase 2/3 safety and immuno-genicity trial of the Ad26.ZEBOV, MVA-BN-Filo 2 dose Ebola vaccine regi-men developed by Janssen. In this trial, platelet counts were assessed atleast twice during pre-vaccination using the same laboratory proceduresand equipment.Aim: To describe variations in platelet counts and identify determiningfactors.Methods: We compared platelets counts at two pre-vaccination timepoints, at least 1 day apart and categorised the variations into those thatvaried within 25%, and those that varied by > 25%. We used logistic

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regression to explore how variations were related to gender, age, areaof residence and days between tests.Results: At least two pre-vaccination platelet counts were available for1090 (34% females) participants. They included 194 (18%) participants1-3 years, 198 (18%) 4-11 years, 205 (19%) 12-17 years and 493 (45%)>17 years. The median number of days between tests was 8 (interquartilerange 1-14). Mean platelet count was 252 x 109/L (standard deviation- 93 x 109/L). In both 1st and 2nd tests, counts were higher in females(270 and 275 respectively) than in males (243 and 241) (p-value<0.01).In 248 (23%) of tests, variances between tests were >25%. In 78 indi-viduals (7%) variance was >50%. Variations of >25% were associatedwith being female (OR=1.37, 95% confidence interval, C.I. 1.06-1.84,P=0.03). Children aged 1-3yrs were more likely to have variations of>25% than adults (OR=5.04, 95% CI 3.45-7.35, P<0.01). Intervals of >28days and 14-28 days between tests were associated with variations of>25% (OR=1.6, 95% CI 0.64-4.41, P=0.287 and OR=2.05, 95%CI 1.51-2.79, P<0.01) respectively. The was no significant variation by place ofresidence; rural or sub-urban (OR=1.22, 95% CI 0.89- 1.67, P=0.27). Theindependent predictors of >25% variation were age (1-3yrs) and numberof days (>28days) between tests, (P<0.01).Conclusions: In rural northern Sierra Leone, significant variations inplatelet counts can occur at short intervals. Caution is needed whenassessing VAT in children and when the interval between tests is >14days.

P010

WHO FAILED TO MEET TO ELIGIBILITY CRITERIA IN A VACCINETRIAL IN NORTHERN SIERRA LEONE, AND WHY? ANALYSIS OFDATA FROM THE EBOVAC-SALONE STUDY

Baiden F.1,2, Ishola D.1,2, Kowuor D.1,2, Afolabi M.1,2, Owusu-KyeiK.1,2, Lowe B.2, Kohn B.1,2, Otieno T.1,2, Manno D.2, Samai M.1,3,Leigh B.1,3, Greenwood B.2, Watson-Jones D.2,4

1EBOVAC-Salone Project. Kambia, Kambia District, Sierra Leone;2London School of Hygiene and Tropical Medicine, London, UK;3College of Medicine and Allied Health Sciences, Freetown, SierraLeone;4Mwanza Intervention Trials Unit, Mwanza, Tanzania

Introduction: The EBOVAC-Salone trial in Kambia, district northern SierraLeone is a phase 2/3 safety and immunogenicity trial of theAd26.ZEBOV, MVA-BN-Filo 2 dose Ebola vaccine regimen developed byJanssen. Strict eligibility criteria were applied to screen and enroll adultsand children > 1 yr. We applied adapted laboratory normal ranges anddetermined malnutrition using WHO/CDC growth charts.Aim: To describe the characteristics of participants who did not meeteligibility criteria and the reasons why.Methods: A participant who underwent screening but was not enrolledwas considered to have failed screening (screen-failures). We extracteddata on screen-failures at all three clinics (two sub-urban and onerural) and performed analysis to describe their sociodemographiccharacteristics. We ran frequencies to detail reasons for failures andperformed statistical analysis to explore the effect of sex, age and cliniclocation.Results: A total of 556 (33%) out of 1,630 (65% males) potentialparticipants aged >1-year failed screening. The majority, 344 (63%)were males. The major causes were out-of-range (abnormal) laboratoryparameter(s) (mostly haemoglobin <8gm/dl) (49%), study design-specific requirements (mostly apprehensions about blood draw) (29%),acute illness (mostly malaria) (8%), clinically-assessed anemia (7%)and malnutrition (6%). There were no significant gender differencesin the causes of failures (P-value=0.08). There were differences byage groups (P<0.01). While abnormal laboratory parameters were

mainly in adults (56% of cases), all cases of malnutrition were amongchildren aged <12yrs.There were differences by clinic location (P<0.01).Whereas there were more acute illnesses (9% vs. 6%) and study design-specific ineligibilities (32% vs.16%) in the sub-urban clinics, clinically-assessed anemia (13%-6%), abnormal laboratory parameters (52%vs. 49%) and malnutrition (12%-5%) were more in the rural clinic(P<0.01).Conclusions: Laboratory parameters and study design-specific require-ments accounted for a high proportion of screen failures in this studyin rural northern Sierra Leone. A high index of clinical suspicion, useof locally-determined normal laboratory ranges and use of short pre-screening questionnaires may help to conserve resources in future trials.Malnutrition among children in this population needs to be addressed.

P011

MODELLING THE IMPACT OF DENGUE CONTROL INTERVENTIONADDRESSING HOTSPOT TRANSMISSION SANTIAGO DE CUBA,CUBA, 2010-2018

Baldoquín Rodríguez W.1, Gomez Padron T.2, Fonseca V.21Epidemiology Dept., Tropical Medicine Institute "Pedro Kourí",Havana;2Epidemiology Dept., Provincial Center of Hygiene, Epidemiologyand Microbiology, Santiago de Cuba, Cuba

Introduction: Current dengue control strategies mainly comprise dis-persed and irregular control actions that are reactive to detected clinicalcases and/or massive insecticide application to mitigate outbreaks. InSantiago de Cuba we implement control strategies based on risk strati-fication at city level in order to concentrate pro-active, sustained effortsin high transmission risk areas.Aims: To describe dengue outbreak occurred between 2010 and 2018 inSantiago de Cuba and the changes on epidemiological pattern associatedto interventions addressing hotspot.Methodology: We use SIR; Richards model for modeling dengue trans-mission. We introduce mobility of humans between neighboring areasinto a mathematical model.Results: The series of weekly reported cases show that instead of asingle wave associated with the rainy season, on average, a long waveof cases starting in statistical week 33 (summer) last to week 10 ofthe next year. Despite the persistence of seasonal patterns, our analysisalso shows that the areas where the new strategy was implemented,outbreaks parameters (basic reproduction number, outbreak size andpeak epidemic size) decrease faster than in the areas with the standardcontrol measures.Conclusion: Targeting control strategies in areas at high risk for denguetransmission could change the epidemiological pattern of dengue trans-mission and reduce the outbreak impact.

P014

A HANG-UP AND BEHAVIOUR CHANGE COMMUNICATION CAM-PAIGN TO IMPROVE BED NET USE: A PILOT STUDY FROM THELOCALITY OF BARÉ - BAKEM IN CAMEROONBekolo C.E., D’Arcy T.University of Dschang, Dschang, Cameroon

Background: In Cameroon, two mass distribution campaigns of long-lasting insecticide-treated nets (LLINs) between 2011 and 2016 havetaken the country to a near universal coverage. However, there exists awide gap between bed net ownership and use especially in the rural andpoorest households. We aim to report how a door-to-door hang-up and

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behaviour change communication (BCC) campaign could improve bed netuse in a rural population of Baré in Cameroon.Methods: We conducted a four-day campaign comprised of a door-to-door hang up of unhung LLINs and a BCC on bed net use in April 2017in the Peace Corps Volunteer Community of Baré. Sleeping under a bednet the previous night was used as the indicator for bed net use. A two-sample proportional test was used to determine the difference in bed nethang-up and use before and after the campaign.Results: A total of 6879 persons from 1414 households in all the 13neighbourhoods and villages were reached by 26 volunteers. The numberof LLINs still remaining one year after the distribution of 4255 LLINs was2959 (70%) of which 1032 (35%) were still unhung. During the campaign,a total of 435 additional LLINs were hung up at a cost estimated at lessthan US$1 per LLIN. The overall bed net hang-up rate rose from 65%(95%CI: 57% - 74%) before the campaign to 80% (95%CI: 71% - 89%)after the campaign (p = 0.02). Bed net use increased from 75% (95%CI:65% - 86%) before the campaign to 92% (95%CI: 86% - 99%) after thecampaign (p = 0.009).Conclusion: This small-scale dual intervention of LLIN hang up and BCCcould be a useful tool to improve bed net use by scaling up bed nethang up. We recommend a more robust methodology applied on a largerpopulation size to determine the effectiveness of this campaign.

P015

THE TICK CELL BIOBANK: TICK AND OTHER ARTHROPOD CELLLINES FOR TROPICAL MEDICINE RESEARCH

Bell-Sakyi L.1, Al-Khafaji A.1, Hartley C.1, Darby A.2, Baylis M.3,4,Makepeace B.L.11Dept. of Infection Biology, Institute of Infection and GlobalHealth, University of Liverpool;2Institute of Integrative Biology, University of Liverpool;3Dept. of Epidemiology and Population Health, Institute of Infec-tion and Global Health, University of Liverpool;4NIHR Health Protection Research Institute in Emerging andZoonotic Infections, Institute of Infection and Global Health,University of Liverpool, Liverpool, UK

Continuous cell lines derived from ticks and other arthropods are essen-tial tools for laboratory-based research on medically-important, vector-borne viruses, bacteria, protozoa and helminths. The Tick Cell Biobank(TCB) at the University of Liverpool, the world’s only dedicated repositoryfor tick and other arthropod cell lines, underpins this research throughprovision of existing cell lines and training in their maintenance to scien-tists worldwide, and generation and characterisation of novel cell lines.As well as housing the world’s largest collection of tick cell lines, theTCB is working to generate new cell lines from biting midges, sand flies,tsetse flies, mosquitoes and mites. The burden of vector-borne diseasefalls disproportionately on lower- and middle-income countries (LMIC)in the Tropics, and the TCB’s emphasis on tropical arthropod vectorsreflects this; to facilitate dissemination and uptake of arthropod cellline technologies by LMIC scientists, the TCB is establishing Outposts inMalaysia, Kenya and Brazil. Recent applications of tick cell lines in tropicalmedicine research include development of the first in vitro culture systemfor propagation of Mycobacterium leprae, and advances in understandingof tick-human transmission of Crimean-Congo hemorrhagic fever virus,tick-borne flaviviruses and spotted fever group Rickettsia species.

P016

LEPROSY AFTER THE ELIMINATION: NEPAL EXPERIENCE FROMTHE UNIVERSITY TEACHING HOSPITALS

Bhattarai S.1, Rijal A.2, Marahatta S.2, Khadka A.11Dept. of Dermatology and Venreology, Kathmandu Medical Col-lege, Kathmandu;2Dept. of Dermatology and Venreology, B.P.Koirala Institute ofHealth Sciences, Dharan, Nepal

Introduction: Leprosy is a chronic granulomatous immune response toinfection of the skin and the nerves with mycobacterium leprae. Though,Leprosy has been eliminated from developed countries, it is still consid-ered to be a major public health problem in developing countries of Africa,Asia and Latin America. Declaration of elimination of leprosy as a publichealth problem in Nepal was done on the 19th of January 2010 but thedisease prevalence is still high in endemic regions.Aim: To estimate the number of cases visiting a tertiary care centre inEastern and Central Nepal after the declaration of the elimination.Methods: All clinically diagnosed and newly registered cases of leprosyattending Dermatology Department of BPKIHS and KMCTH were prospec-tively included in the study (2010-2018). A detailed history, cutaneousand nerve examination were performed and recorded in a pre set pro-forma.Results: A total of 544 new cases where seen in the dermatology OPDwith a male preponderance of 363/544 (66.7%). The patients weremore in the 20-29 years age group. 495/544(90.9%) patients presentedwith skin lesions while 410/544(75.36%) of the patients had only nerveinvolvement.Reactions were seen in 379/544(69.6%) patients and disabilities wereseen in 251/544(46.1%) patients. Multibacillary treatment was startedin 392/544 (72.0%) patients and Paucibaciallary in 152/544(27.9%)patients after the clinical, bacteriological and histological co-relation.Conclusion: The current reality is that there is a need to sustain andprovide quality leprosy services to all persons through general healthsystem, including a good referral system. Efforts need to be made toreduce deformity through early detection, self care, physiotherapy andreconstructive surgery and developing sound surveillance systems. Con-stant evaluation, monitoring and case detection should be still pursuedactively in endemic districts. Health Education activities and involvementof teaching hospitals and trained health specialist at the tertiary generalhealth care delivery system would further help in sustaining the nationalgoal of elimination.

P017

REDUCED PLASMA CONCENTRATIONS OF VITAMIN B6 ANDINCREASED PLASMA CONCENTRATIONS OF THE NEUROTOXIN3-HYDROXYKYNURENINE ARE ASSOCIATED WITH NODDINGSYNDROME: A CASE CONTROL STUDY IN GULU AND AMURUDISTRICTS, NORTHERN UGANDA

Obol J.H.1, Arony D.A.2, Wanyama R.3, Luryama Moi K.2, BodoB.4, Odong P.O.5, Odida M.61Dept. of Public Health, Gulu University;2Dept. Microbiology and Immunology, Gulu University;3Medical Biochemistry, Gulu University;4Paediatrics and Child Health, Gulu University;5District Health Office, Amuru District Local Government, Amuru,Uganda;6Dept. of Pathology, Makerere University, Kampala, Uganda

Introduction: Nodding syndrome is a rare disease whose onset of symp-toms in affected children is marked by the development of nodding headmovements, which are reported to be provoked either by the sight of foodor exposure to cold weather. The nodding head movements have beendocumented to correspond with the onset of subclinical brain seizure

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activity on electroencephalography. The disease has been demonstratedto progress cognitive impairment, stunting, lip changes and other physicaldeformities, mental retardation, behavioural disabilities and malnutrition.Nodding syndrome was first reported in Uganda in 2003 among internallydisplaced populations. The risk factors for nodding syndrome in Ugandalargely remains unknown.Aims: The aim of the study was to explore and determine the associationof vitamin B6 deficiency and the resulting high 3-hydroxykynurenine (3-HK) levels and nodding syndrome as well as other risk factors amongchildren with nodding syndrome in Northern Uganda.Methods: Case-control study conducted in Gulu and Amuru districts.Cases were children/young adults with nodding syndrome. Healthy chil-dren/young adults were recruited as controls from same community ascases. Data on socio-demographic and other risk factors was collectedusing questionnaires. Whole blood was collected in EDTA tubes for assayof 3-HK and vitamin B6 using sandwich ELISA. Conditional logistic regres-sion model was used to assess associations.Results: 66 cases and 73 controls were studied. Factors associated withnodding syndrome were being positive for 3-HK (AOR=4.50, p=0.013),vitamin B6 concentration below mean (AOR=7.22, P=0.001), child beingtaken care of by mother only (AOR=5.43, p=0.011), child being taken careof by guardian (AOR=5.90, p=0.019) and child consuming relief food atweaning (AOR=4.05, p=0.021).Conclusion: Having low vitamin B6 concentration which leads to a buildp of 3-hydroxykynurenine concentration in cases as a main risk factor.Therefore, cases should be treated with vitamin B6 and community mem-bers should be sensitise to ensure adequate dietary intake of vitaminB6 so that the risk of nodding syndrome among children is averted.We encourage future prospective intervention study to be conductedto assess the effect of low vitamin B6 on the development of noddingsyndrome via raised 3-HK concentration.

P020

HOTEL SECTOR ENGAGEMENT FOR LARVAE AND MOSQUITOSURVEILLANCE IN ALGARVE REGION, PORTUGAL: THE MOSK.O.INTERVENTION PROTOCOL

Cancela M.1, Bodião J.1, Guerreiro N.2, Guerreiro A.C.21Public Health Unit, Primary Health Care Unit Grouping Algarve I -Central;2Dept. of Public Health and Planning, Algarve Regional HealthAdministration, Faro, Portugal

Introduction: Aedes albopictus mosquito, also known as Asian tigermosquito, is one of the most invasive species in the world and a vec-tor of several diseases like dengue, chikungunya and others. Albopictusis a container-inhabiting specie that can be found in urban or ruralenvironments, both public and private areas with vegetation, occupiedby humans or animals. Cities and large towns are good environmentsfor sustainable mosquito larval control since mosquito breeding sitesare well-defined and easily located. The most effective way to preventAlbopitus dissemination is reducing breeding sites. This specie was firstintroduced in mainland Portugal in Penafiel and Algarve region in 2017.In the summer of 2018, it has been detected again in a peri-urban areaand in an hotel both in Algarve Region. None of the captured mosquitoeswere infected.Aim: This project aims to reduce breeding sites and the early detection ofmosquitoes.Methods: We identified around seventy-two hotels in Loulé county withsimilar microclimates which are favorable for Aedes Albopictus prolifera-tion. One garden maintenance worker in each hotel who will serve as focalpoint will be nominated and will receive theoretical and practical train-ing lead by a Public Health medical resident and Environmental Health

experts/techniques about: (i) identification, managing and reduction oflarvae breeding sites, (ii) early detection of larvae and mosquitoes and(iii) vector control measures. A communication channel will be createdto exchange information between the hotel entities and the local publichealth authorities.Results: We expect to nominate and train at least one focal point at eachhotel identified. With this intervention, we expect to reduce breeding sitesat hotels and the risk of mosquitoes’ proliferation.Conclusion: We expect that promoting partnerships and intersectoralcollaborations between hotel sector and local health services couldstrengthen the surveillance of these species.

P021

KNOWLEDGE AND PREVENTIVE ATTITUDES ON VISCERALLEISHMANIASIS AMONG BRAZILIAN DOG OWNERS: REPORTFROM A HOUSEHOLD SURVEY

Carvalho A.G.1,2, Luz J.G.G.1,2, Rodrigues L.D.2, Dias J.V.L.3,Fontes C.J.F.11Post-Graduation Program in Health Sciences, Federal University ofMato Grosso, Cuiabáil;2School of Medicine, Federal University of Mato Grosso, Ron-donópolis;3School of Medicine, Federal University of Jequitinhonha andMucuri Valleys, Teófilo Otoni, Brazil

Introduction: In Brazil, visceral leishmaniasis (VL) represents a zoonosiscaused by the protozoan Leishmania (Leishmania) infantum. Dogs are themain domestic animal reservoir. At present, VL is expanding geographi-cally through the Brazilian territory, and 3,500 new cases on average areannually reported. The adopted control measures are proving to be inef-ficient, despite of the high costs involved. Thus, it is important to assessthe popular knowledge, attitudes, and practices on VL to identify thegaps that should be targeted to drive appropriate, lasting, and effectiveinterventions.Aim: To describe the knowledge and preventive attitudes concerningvisceral leishmaniasis (VL) among dog owners from a Brazilian hyperen-demic area (Rondonópolis, Mato Grosso State).Methods: Data were collected between October 2016 and February 2017during a household survey. A total of 405 dog owners were interviewedbased on a semi-structured questionnaire.Results: Most of the interviewees (95.6%) had previously heard aboutVL. However, only 27% were aware of the clinical manifestations ofthe human disease. Fever, skin lesions, and abdominal distention werepredominantly cited. In contrast, 65.4% were aware of the signs ofcanine VL (CVL), especially onychogryphosis, skin lesions, and alopecia.Although 59.3% considered VL to be a vector-borne disease, the major-ity did not know the vector’s name (94.6%) and could not identify it(93.1%). Household spraying of insecticides on their own account orby public health agencies was reported by 65.4% and 17.8% of therespondents, respectively. The use of topical repellents (17.5%) and useof bed net/window screen (1.75%) were considered as unusual practices.Previous ownership and treatment of a dog with CVL was reported by23.5% and 13.6% of the respondents, respectively. The reasons behindeuthanasia recommendations for infected dogs were unknown by 34.8%of the participants, and 69.7% reported that they would consent foreuthanasia if their dog was infected. A small proportion of dogs werepreviously tested for CVL (13.3%), vaccinated against CVL (1.5%), andwore insecticide-impregnated collars (13.8%).Conclusion: The lack of awareness and misconceptions about VL andits prevention was observed, which emphasizes the need for healtheducation.

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P022PREVALENCE AND ASSOCIATED FACTORS OF SOIL-TRANSMITTED HELMINTH AND FOOD-BORNE TREMATODEINFECTIONS IN RURAL THAILAND: MULTILEVEL ANALYSISUSING BAYESIAN HIERARCHICAL REGRESSION MODELING

Charoensakulchai S.1, Suwannahitatorn P.21Fifth year medical student, Phramongkutklao College of Medicine;2Dept. of Parasitology, Phramongkutklao College of Medicine,Bangkok, Thailand

Introduction: Cultures and ways of life bring rural Thai populationsinto close contact with soil-transmitted helminth (STH) and food-bornetrematode (FBT) infections. Associated factors and estimation of at-riskareas of infections are not widely studied in Thailand.Aims: Identify associated factors and estimate at-risk areas for interven-tion.Methods: Cross-sectional study was conducted in 2017 using stool exam-ination and questionnaires in 6 villages of Phra-ploeng District, Sa-KaeoProvince, eastern Thailand. Stool specimen were prepared with simplesmear, Kato-Katz and formalin-ethyl concentration technique. Village-level and individual risk for acquiring the infection was evaluated usingBayesian hierarchical regression modeling with posterior estimation fromMCMC sampling. Village-level risk was determined as probability of havingOR > 1 in each village.Results: From 1267 enrolled participants, highest prevalence of STH andFBT infection was Strongyloides stercoralis (SS) and Opisthorchis viverrini(OV): 3.8 % and 8.4%, respectively. For SS infection, male gender andhookworm coinfection increased risk of infection. Prevalence of hook-worm infection was 1.3% and increased risk of SS infection with OR =11.3 (2.4-30.6, 95% credible interval). For OV infection, male gender andconsumption of Koi pla (local instantly prepared freshwater fish menu)increased risk of infection. Increasing age increased risk of infection forboth SS and OV. For village-level risk, probability of having higher risk forSS infection ranged 22.3 – 73.0% and for OV infection ranged 42.4-58.2%,in 6 villages.Conclusion: Male gender and increasing age increase risk of infectionfor SS and OV. Therefore, hygiene and consumption behaviors should beconsidered for these high-risk population. Hookworm shares the samemode of infection with SS through direct contact with soil. Koi pla is adirect cause of OV infection through food consumption. The control strat-egy can be modified accordingly, based on high-risk behaviors. Bayesianhierarchical regression modeling is useful for area-level risk estimationto aid decision making on providing intervention. Risk for STH infectionis wide in range for SS infection while risk for OV infection is morehomogenous in 6 villages. This data could help in prioritizing strategy.

P023EFFECT OF INSECTICIDE-TREATED BED NETS ON VISCERALLEISHMANIASIS INCIDENCE IN BANGLADESH. A RETROSPEC-TIVE COHORT ANALYSIS

Chowdhury R.1,2, Chowdhury V.3, Faria S.4, Akter S.2, Dash A.P.5,Bhattacharya S.K.6, Bern C.7, Akhter S.2, Boelaert M.8, Banu Q.91Nutrition and Clinical Services Division, International Center forDiarrhoea Disease Research, Bangladesh (icddr,b), Mohakhali;2Dept. of Medical Entomology, National Institute of Preventive andSocial Medicine, Mohakhali;3Dept. of Statistics, Dhaka College;4Communicable Disease Control Dept., Directorate General ofHealth Services (DGHS), Mohakhali, Dhaka, Bangladesh;5Central University of Tamil Nadu, Thiruvarur;

6Kothari Medical Centre, Kolkata-700027, West Bengal, India;7Dept. of Epidemiology, UCSF School of Medicine, San Francisco,USA;8Dept. of Public Health, Institute of Tropical Medicine, Antwerp,Belgium;9Dept. of Biology, Asian University for Women, Chittatong,Bangladesh

Background: Visceral leishmaniasis (VL) is a parasitic disease, transmit-ted by the sand fly species Phlebotomus argentipes in the Indian sub-continent. We evaluated the effect of long-lasting insecticide treatedbed-nets (LLIN) and bed-nets impregnated with slow-release insecticidetablet K-OTAB 1-2-3 (jointly insecticide-treated nets or ITN) on VL inci-dence in a highly endemic sub-district (upazila) in Bangladesh.Aim: We aimed to assess the effect of LLIN/ITN on VL incidence in theendemic communities.Methods: Several distributions of LLIN or K-OTAB 1-2-3 for self-impregnation of bed-nets at home took place in Fulbaria upazila,Mymensigh district from 2004-2008 under three research projects. Weincluded all households (n=8142) in the 20 villages that had benefitedin the past from one of these interventions in the “exposed cohort”. Werecruited a “non-exposed cohort” in villages with contemporaneouslysimilar incidence rates who had not received such vector controlinterventions (7729 HHs from nine villages). In both cohorts, we visitedall families house-to-house and ascertained any VL cases for the 3-yearperiod before and after the intervention. We evaluated the incidence rate(IR) of VL in both cohorts as primary endpoint, applying the difference-in-differences method. We also interviewed households about theacceptability and durability of the ITN intervention.Results: The study identified 1011 VL cases (IR 140.47/10,000 per year[py]) before the intervention, of which 534 and 477 cases in the inter-vention and control areas respectively. The IR was 144.13/10,000 pyand 136.59/10,000 py in the intervention and control areas respectively,with no significant difference before the intervention. After the inter-vention, 555 cases (IR 77.11/10,000 py) were identified of which 178(IR 48.04/10,000 py) in the intervention and 377 (107.95/10,000 py) inthe control area. The intervention area had a significant lower IR thanthe control area during follow up, rate difference = –59.91, p<0.0001.The IR during follow up was significantly reduced by 96.09/10,000 py inthe intervention area (p<0.0001) and 28.63/10,000 py in control area(p<0.0001) compared to baseline. There was a strong and significantoverall effect of the ITN intervention, δ = –67.45, p <0.0001.Conclusion: ITNs should be considered for integrated vector control dur-ing the maintenance phase of the VL elimination programme.

P024

ASSESSMENT OF KNOWLEDGE, ATTITUDES AND PRACTICESTOWARDS KALA-AZAR IN AN ENDEMIC DISTRICT INBANGLADESH - A CROSS SECTIONAL SURVEY

Faria S.1, Chowdhury R.2,3, Islam M.S.2, Akter S.3, Islam M.M.4,Akhter S.3, Chowdhury V.51Communicable Disease Control Dept., Directorate General ofHealth Services (DGHS), Mohakhali;2International Centre for Diarrhoea Disease Research, Bangladesh(icddr,b);3National Institute of Preventive and Social Medicine (NIPSOM),Mohakhali, Dhaka;4IWorld Health Organization – Country Office Bangladesh, Gulshan;Institute of science trade and technology (ISTT), Mirpur;5Dept. of Statistics, Dhaka College, Dhaka, Bangladesh

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Background: Visceral Leishmaniasis (VL), is a deadly disease, transmittedby the sand fly, Phlebotomus argentipes in the Indian sub-continent.In 2005, the governments of Bangladesh, India and Nepal signed aMemorandum of Understanding to eliminate the disease by 2015, adeadline which was later extended to 2017. Bangladesh achieved thetarget in 2017, but in order to get the elimination certificate from theWorld Health Organization, this target needs to be sustained for at leastthree consecutive years. Active community participation will be essentialif this success is to be maintained for a longer period of time.Aim: We aimed to assess the current knowledge, attitudes and practiceson kala-azar.Methods: A community-based cross-sectional study was conducted intwo endemic upazilas (sub-districts), Fulbaria and Trishal. Based on theUpazila Health Complex (UHC) surveillance data, one endemic village wasrandomly selected from each of these upazilas. Total 511 households(HHs) [261 in Fulbaria and 250 in Trishal] were included in the study. Anadult household was interviewed using a structured questionnaire.Results: We found 53% respondents were illiterate and 78.86% houseswere made of tin. 36.79% HHs had cattle sheds and 75.00% werewithin 20 feet distance from the living area. All participants had heardabout kala-azar. 30.14% of HHs or neighboring HHs have/had kala-azarpatients during past years. About 69% respondents knew that kala-azaris transmitted through sick persons. More than 39% participants said thatmosquitoes transmitted kala-azar, but about 91% informed that theyhad heard of sand flies. About 47% participants were aware that thisvector laid their eggs in the water. Less than 60% of respondents had afairly good knowledge on kala-azar. 88.14% people prefers to visit UHC fortreatment. We found 65.95% participants have good attitudes. More than62% of people used bed nets for preventing sand fly bites and 96.48%families had mosquito nets. More than 50% participants showed goodpractices on kala-azar.Conclusion: Overall the community is well aware of kala-azar but nationalprogramme should not stop their current community sensitization activ-ities, since a halt in the efforts might undo all the progress made so far.

P025

INVESTIGATING THE RELATIONSHIP BETWEEN INSECTICIDERESISTANCE, UNDERLYING MOLECULAR MECHANISMS ANDMALARIA PREVALENCE IN ANOPHELES GAMBIAE S.L FROMGUINEA

Collins E.L.1, Vaselli N.M.1, Sylla M.2, Beavogui A.H., Osborne J.1,Lawrence G.3, Irish S.3,4, Walker T.1, Messenger L.A.3, 5

1Dept. of Disease Control, Faculty of Infectious Tropical Diseases,London School of Hygiene and Tropical Medicine, London, UK;2Centre National de Formation et de Recherche en Santé Rurale deMaferinyah, Maferinyah, Guinea;3Entomology Branch, Division of Parasitic Diseases and Malaria,Center for Global Health, Centers for Disease Control and Preven-tion, Atlanta;4President’s Malaria Initiative, Bureau for Global Health, Office ofInfectious Disease, United States Agency for International Devel-opment, Washington DC;5American Society for Microbiology, Washington DC, USA

The threat of insecticide resistance across sub-Saharan Africa isanticipated to severely impact the continued effectiveness of malariavector control. We investigated the effect of carbamate and pyrethroidresistance on Anopheles gambiae s.l age, Plasmodium falciparuminfection and characterized molecular resistance mechanisms inGuinea. Pyrethroid resistance was intense, with survivors of ten timesthe insecticidal concentration required to kill susceptible individuals.

The L1014F kdr allele was significantly associated with mosquitosurvival following deltamethrin or permethrin treatment (p=0.003 andp=0.04, respectively). N1575Y and I1527T mutations were identifiedin 13% and 10% of individuals, respectively, but neither conferredincreased pyrethroid tolerance. Partial restoration of pyrethroid sus-ceptibility following synergist pre-exposure suggest a role for mixed-function oxidases. Carbamate resistance was lower and significantlyassociated with the G119S Ace-1 mutation (p=0.001). Oocyst rateswere 6.8% and 4.2% among resistant and susceptible mosquitoes,respectively; survivors of bendiocarb exposure were significantly morelikely to be infected (p=0.03). Resistant mosquitoes had significantlylower parity rates; however, a subset of intensely pyrethroid-resistantvectors were more likely to be parous (p=0.042 and p=0.045, forsurvivors of five and ten times the diagnostic dose of insecticides,respectively). Our findings emphasize the need for additional studiesdirectly assessing the influence of insecticide resistance on mosquitofitness.

P026

SEROPREVALENCE OF VACCINE-PREVENTABLE DISEASES INYOUNG AFRICAN MIGRANTS RECENTLY ARRIVED TO MADRID,SPAIN

Comeche B., Chamorro-Tojeiro S., Pérez-Molina J.A., Norman F.,Monge-Maillo B., López-Vélez R.National Referral Unit for Tropical Diseases, Infectious DiseasesDept.,Ramón y Cajal University Hospital, Madrid, Spain

Introduction: The vaccination coverage in the migrants is poorer incomparison with the native population. Seroprevalence studies of vaccinepreventable-diseases in newly arrived immigrants would be essentialbefore designing a specific vaccination program in this collective.Aim: Check the vaccination coverage of the newly arrived African immi-grants.Methods: Retrospective study of seroprevalence in young Africanmigrants, new arrivals (>16 years old), who attended in a referral centrein Madrid, Spain, from November 2017 to November 2018. The followingserological determinations were performed: HBV, HAV, measles, rubella,mumps and varicella. Migrants susceptible to any of these diseases weresubsequently referred for immunization.Results: 79 migrants from 14 different African countries were included.Most of them were from West Africa: 25 (31%) from Republic of Guinea,14 (18%) from Cameroon and 9 (11%) from Ivory Coast. Mean age was26 years (SD 7.9) and 73 (92%) were males. Immunity for rubella wasdetected in 75 (95%), for HAV in 75 (95%), for measles in 72 (91%), forvaricella in 70 (89%), for mumps in 65 (82%), and for HBV in 42 (53%).Guineans were the best immunized although no significant differenceswere found among countries. Of mention is that only 50% of women (allof them in childbearing age) had rubella immunity.Conclusion: 1. In our study, vaccine-preventable diseases coverage issimilar to those officially reported from these countries to the WHOreflecting accuracy in reporting data. 2. Although the measles immunityrate is high, it does not reach the 95% established by the EuropeanVaccine Action Plan for measles elimination. 3. The low proportion ofimmune women of childbearing age against rubella makes necessary thescreening of this disease and the implementation of active measures fortheir immunization.

P028

SUSTAINABLE CONTAINMENT OF DENGUE OUTBREAKSTHROUGH COMPREHENSIVE INTEGRATED APPROACH

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Dheerasinghe D.S.A.F.1, Samaraweera P.C.1, Cader M.2,Rajapakshe O.B.W.1, Abeysekara I.1, Weerasinghe W.M.I.P.1,Rathnayake R.M.T.D.1, Kodithuwakku K.A.L.C.1, PannilaHetti N.1, Tissera H.A.1,3

1National Dengue Control Unit of the Ministry of Health;2National Programme for Tuberculosis Control and Chest Diseasesof Ministry of Health;3Epidemiology Unit of the Ministry of Health, Sri Lanka

Introduction: Dengue is a major public health problem in Sri Lankawhere the entire country and all ages are affected due to high diseasetransmission.Aim: The aim of the programme is to carry out proactive integrated vectormanagement led by source-reduction campaigns based on real-timeweb-based epidemiological and entomological surveillance data, alongwith the participation of all stakeholders.Methods: There has been great progress in disease and entomologicalsurveillance, clinical management, and active engagement of variousministries through the Presidential Task Force (PTF) on Dengue Prevention.Accordingly, guidelines for Aedes vector surveillance and control wasdeveloped by the National Dengue Control Unit to streamline the inte-grated vector management strategies throughout the country.Regional Epidemiologists, Medical Officers of Health, Entomologists andHealth Entomological Officers, and Public Health Inspectors were trainedon vector surveillance and vector control at National level in 2017.Special Mosquito Control Campaigns (SMCCs) for source reduction, withthe participation of stakeholders especially Tri-Forces, were conducted in2017 and 2018 covering 2.7 million and 1.4million premises respectively.To improve the clinical management of Dengue, in-service training pro-grammes were conducted (35 and 14 programmes in 2017 and 2018respectively) for consultants, medical officers, nursing officers in high-riskdistricts by the local experts. Further, capacities of high dependency unitswere strengthened.The PTF was reactivated in 2017 with the participation of relevant stake-holders, to obtain maximum support. Up to now, 24 PTF meetings havebeen conducted to assess the progress of Dengue prevention and controlactivities and containment of outbreaks.Results: During SMCCs conducted in 2017 and 2018, Health care workersalong with the Tri-Forces found 20% and 21% potential breeding placesand 1.98% and 2.29% positive breeding places in the respective years.With all these efforts, there is a reduction of annual incidence of Denguefrom 865.9 to 239.8 per 100,000 population (in 2017 and 2018 respec-tively) and case fatality rates have been halved from 0.24% in 2017 to0.11% in 2018.Conclusion: It is found that an integrated approach is an effectivemethod in sustaining low endemicity and curtailing outbreaks inresource-poor settings.

P030

IMMUNIZATION APPROACH "REACH EVERY DISTRICT" WHENGAVI FUNDING STOPS IN TANDJOARE, TOGO

Djanda L.1, Kassankogno Y.2, Boko A.K.1, Lacle A.1, ThonneauP.31Dept. of Immunization, Lomé, Togo;2Faculties of Health Sciences, University of Lomé, Togo;3Senghor University in Alexandria, Egypt

Introduction: The objective of "Reach Every District" (RED) approachwas to ensure sustainable and equitable vaccination coverage for everywoman and child in every community. According to the World HealthOrganization, RED has proven its impact on improving vaccinal coveragein developed countries between the years 2000 and 2011. The health

district of Tandjoaré recorded low vaccination coverage following the endof GAVI fund.Aim: The aim of our study was to describe the indicators for implementingthe RED approach.Methods: A cross-sectional study was done based on interviews with 18managers of the Expanded Program on Immunization (EPI) of health-care facilities (HCFs) and 70 community leaders. All healthcare facilitiesoffering vaccination services in the district were included in our study.The analysis of the results was based on the WHO indicators of the REDapproach.Results: Among healthcare facilities, 17% had microplanning documentsfor immunization activities for the current year. Less than a quarter ofhealthcare facilities were on schedule for routine immunization sessions.Only one healthcare facility had properly completed and updated vaccineand consumable stock management sheets. None of the healthcarefacilities have received external funding for the implementation of theRED approach. Among HCFs surveyed, less than half carried out advancedstrategies and 11% vaccinated at least once a week. Community partic-ipation in the microplanning process was 44% according to EPI officersand 26% according to community leaders. No supportive supervisionvisits were received by the HCFs surveyed. Among HCFs, less than aquarter had up-to-dated, plotted self-monitoring diagrams. None of theEPI managers were able to provide accurate information on the 5 com-ponents of the RED approach.Conclusion: Our study shows that the RED approach is not sufficientlyimplemented in the Tandjoaré district,Togo when GAVI funding stops. Anappropriation by the HCFs of this approach constitutes a way of improvingvaccination coverage.

P031

PERMETHRIN RESISTANT BED BUGS (CIMEX LECTULARIUS) CANBE KILLED BY A COMBINATION OF H2O2 FLUID AND PERME-THRIN – A SYNERGISTIC EFFECT AS A LIGHT AT THE END OFTHE TUNNEL

Duscher G.G.1, Hodzic A.1, Battisti E.2, Boigenzahn S.3, SchwanT.3, Jaeger P.3, Ljuhar D.31Institute of Parasitology, University of Veterinary Medicine,Vienna, Austria;2Università degli Studi di Torino, Turin, Italy;3Braincon Technologies, Vienna, Austria

Introduction: Due to traveling habits of the people as well as the trans-portation of goods bed bugs emerged all over the world and became anincreasing pest all over the world. Those bugs can be found in hotels,hostels and cabins and is not limited to poverty. Bed bugs feed onhumans at night and may cause wheals, redness and pruritus and asconsequence of the nightly visits insomnia and anxiety state. Until nowthere is no confirmed vector role for the bed bugs, but experimentally thecan transmit some pathogens e.g. Trypanosoma cruzi.Aim: Countermeasures in the past led to selection for resistant bugs,including resistant against pyrethroids. Therefor we tested permethrinresistant and non-resistant bed bugs with a special combination of H2O2and permethrin.Methods: Bed bugs were exposed to a mixture of permethrin andH2O2, permethrin alone and H2O2 alone by the use of a modifiedfogger (droplet size ∼ 1 μm). On the molecular level we investigatedthe expression of mRNA of several detoxification enzymes from thegroups cytochrome P450 monooxygenases, glutathione-S-transferasesand carboxylesterases by the use of RT-qPCR.Results: The mixture (permethrin and H2O2) performed best during theviability study as well as during the detoxification studies. This mightbe due to a synergetic effect of the compounds. After exposure with

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permethrin the oxidative stress increases and additionally O2 radicals areapplied.Conclusion: This are first promising results, but other strains of bed bugshave to be tested to confirm the success of this treatment.

P034

VIDEO-ENHANCED WHO CONE TESTS: DETAILED INSIGHTSFROM A 3-MINUTE TEST

Emery M., Matope A., Gleave K., Hughes A., Steen K., Foster G.,Jones J., McCall P.J.Dept. of Vector Biology, Liverpool School of Tropical Medicine,Liverpool, UK

WHO-cone bioassay tests are used to evaluate the toxicity of insecticide-treated bednets and other impregnated textiles against malariamosquitoes. They are a standard component in the screening pipelinefor evaluating novel insecticidal treatments for use on bednets, asearch that has become a global priority with the urgent need fornew insecticides that do not share resistance mechanisms withpyrethroids.A simple three-minute procedure, the cone bioassay, provides data onknockdown and mortality at various times post-exposure but has twoimportant limitations. First, the actual time a mosquito spends in contactwith the test netting may be significantly less than the 3 minutes of‘exposure’ time, particularly if the net treatment has repellent properties;this could significantly underestimate a net’s lethality. Secondly, in theabsence of an attractive host on the other side, a treated net’s repellentproperties might be relatively high, further increasing the underestima-tion of its actual impact.To permit more accurate measurement of the effects of insecticidalnetting, and also in an attempt to reveal additional information onbehavioural effects (e.g. contact-irritancy vs. spatial repellency) we useda basic smartphone camera to record mosquito activity during the conebioassay for subsequent analysis.The WHO standard cones and the net substrate being tested are mountedon a custom fabricated acrylic bioassay rig. Five anopheline femalemosquitoes are tested for three minutes, with or without a humanattractant (no blood feeding). Videos are analysed by scan sampling atfive second intervals to quantify numbers of mosquitoes in contact withthe net, the cone or in free flight. We developed custom software toanalyse video frames every 0.1s to detect moving mosquitoes withinthe cone. Thus, mosquito movement is recorded and categorised intofour cone regions. Individual video frames are aggregated sequentially togenerate a composite image of the total collective behavioural response.Using data from a range of current and next generation bednets, we willreport on the video cone test’s performance compared with other testmethods, and its potential to complement the WHO cone bioassay atminimal cost.

P036

IMPROVING DETECTION OF RECENT SUBCLINICAL LEPTOSPI-RAL INFECTIONS IN HIGH PREVALENCE COMMUNITIES: MOD-ELLING THE MICROSCOPIC AGGLUTINATION TEST (MAT) TITREDECAY

Eyre M.1, Giorgi E.1, Costa F.2,3, Ko A.3,4, Diggle P.J.11CHICAS, Faculty of Health and Medicine, Lancaster University,Lancaster, UK;2Instituto de Saúde Coletiva, Universidade Federal da Bahia, Sal-vador, Brazil;

3Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz,Ministério da Saúde, Salvador, Brazil;4Dept. of Epidemiology of Microbial Diseases, School of PublicHealth, Yale University, New Haven, USA

Introduction: Leptospirosis is a zoonotic disease which causes over amillion human cases annually. Exposure to Leptospira bacteria is highin urban slum conditions with a significant proportion testing positivefor leptospiral antibodies, making it difficult to identify recent subclinicalinfections in these populations. The gold standard diagnostic for detect-ing leptospiral infection is the microscopic agglutination test (MAT). Rein-fection is usually defined serologically by a defined threshold (antibodytitre ≥ 800) or an increase in titre relative to a previous measure (normallya four-fold increase in titre). However, these definitions do not take intoaccount the immune response of an individual over time, which can bemodelled as an initial titre rise on infection and subsequent decay overthe following years. This can result in reinfections between follow-ups notbeing detected.Aim: To characterise agglutinating antibody titre rise and decay inhuman leptospirosis cases and evaluate its use in the detection ofreinfections.Methods: To estimate the minimum follow-up time required to be ableto detect reinfections, antibody response data was simulated for a rangeof titre rise and decay parameter values with infection events modelledas a Poisson process. A statistical model was then fitted to data fromlongitudinal serological cohort surveys to estimate these parameters.Data sources for this analysis were an ongoing longitudinal serologicalcohort study in Salvador, Brazil and three historical studies from Barba-dos, Italy and São Paolo, Brazil. This final model was then applied to along-term biannual serological cohort study in Salvador (2013-2019) todetect reinfections.Results: This is an ongoing study which will report on the relationshipbetween follow-up time and titre rise and decay parameters, and willestimate these parameters, accounting for differences in age, sex andpopulation leptospirosis prevalence. It will compare the number of rein-fections detected by the model with current definitions.Conclusion: This study will provide important information about theimmune response to leptospiral infection in humans and a new toolfor identifying reinfection from longitudinal serological survey data. Thiswill be valuable for epidemiological research, in particular identifying keyroutes of transmission and vulnerable subpopulations.

P037

DIFFERENTIAL BEHAVIOR IN TRANSCRIPTOMIC AND PRO-TEOMIC PROFILES OF Leishmania mexicana ISOLATES:TARGETS FOR DIAGNOSIS?

Fernández-Figueroa E.A.1, Muñoz-Montero S.A.1, Imaz-Rosshandler I.2, Becker-Fauser I.3, Miranda-Ortíz H.4,Cervantes-Sarabia R.3, Alanis-Funes G.5, Rangel-Escareño C.11Computational Genomics Dept. National Institute of GenomicMedicine, Mexico City, Mexico;2DAMTP, Centre for Mathematical Sciences, University of Cam-bridge, Cambridge, UK;3Unidad de Investigación en Medicina Experimental, Centro deMedicina Tropical, Facultad de Medicina, Universidad NacionalAutónoma de México, Mexico City;4Sequencing Unit, National Institute of Genomic Medicine, MéxicoCity;5School of Engineering and Sciences, Tecnológico de Monterrey,Mexico City, Mexico

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Introduction: Leishmania mexicana can cause two forms of clinical dis-eases: a benign localized cutaneous leishmaniasis (LCL) characterizedby ulcers at sites of parasite inoculation, and the highly destructive andinvasive form, diffuse cutaneous leishmaniasis (DCL) characterized byintensely parasitized macrophages within nodules that spread uncon-trolledly throughout the skin, and also invades the oropharyngeal andnasal mucosae of patients in an advanced stage of the disease. Thecause of disease progression in these patients remains unknown, earlyimmune events during disease development may establish conditionsthat determine the outcome of the infection. Therefore, some of thecritical early protective molecules, receptors and mechanisms neededfor protection against Leishmania seem to be shut down, leaving DCLpatients unprotected against parasite replication.Aim: Analyse the differences in transcriptomic and proteomic profilebetween Leishmania mexicana isolated from lesions of patients withdiffuse and localized cutaneous leishmaniasis.Methods: Follow-up research was done by using RNA-seq and LC-MS/MSfocused on the infective parasites. Thus, the transcriptome and proteomeof Leishmania mexicana isolates from LCL and DCL lesions were analysed.Results: Preliminary results in DCL parasite samples showed over-expression in genes involved in dynein complex, phosphatidylserinebiosynthetic process and microtubule motor activity, in DCL isolates.Affecting cellular components, biological processes and molecularfunctions simultaneously. Additionally, 57 statistically significant proteinsbetween DCL vs LCL isolates were observed. The enrichment analysis(Gene Ontology) were represented by aminoacylase, hydrolase andchaperonin activity. Also, there was a differential expression in PP2C(over-expressed) and GP63 (down-expressed) proteins between DCL vsLCL isolates. The cause of the differential gene and protein expression inDCL patients remains under study. However, it is tempting to speculatethat DNA methylation or epigenetic modulation may play a role. It hasbeen shown that the response of immune cells to invading pathogenscan lead to genomic instability and DNA damage and that intracellularpathogens can alter the epigenome integrity of the host. Future work willaddress whether these alterations happen through DNA methylation orby microRNA regulation in host phagocytic cells.

Acknowledgements:The work was funded by INMEGEN 144-2013-06-26, INMEGEN 33-2008-06-01, PAPIIT IN217515, CONACyT 221405 and FINNOVA CONACyT242368.

P040

DOES MALARIA IN PREGNANCY AFFECT NEURODEVELOPMEN-TAL OUTCOMES?

Gnaneswaran B.1,2, Conroy A.3,4, Madanitsa M.5, Gichuru P.2,Kain K.3,4, Gladstone M.J.11Alder Hey Children’s hospital, NHS Foundation Trust, Liverpool, UK;2University of Liverpool, Liverpool, UK;3Tropical Disease Unit, Sandra Rotman Centre for Global Health,Toronto;4UHN-Toronto General Hospital, University of Toronto, Canada;5College of Medicine, University of Malawi, Blantyre, Malawi

Introduction: Approximately 125 million pregnant women are at riskof placental malaria (PM) and ∼25% of all pregnancies in sub-SaharanAfrica is complicated by placental malaria at delivery. Research hasshown that malaria exposure in utero leads to permanent neurocognitiveimpairments in offspring in an experimental model of PM. This potentiallyshifts the focus from measuring neonatal mortality and low birth weightin children born to malaria infected mothers to measuring long-termneurodevelopment.

Methods: A randomised control trial conducted in Malawi comparingintermittent preventive treatment (IPTp) in pregnancy versus intermittentscreening and treatment (ISTp) in pregnancy for malaria was usedas the “parent study” to evaluate the association between malariain pregnancy and developmental outcomes such as MDAT, A not B,McArthur Bates Communication Development Inventory (CDI) anddelayed inhibition. Infants of women recruited in antenatal clinic(HIV negative) from two rural sites in Malawi were followed up at12, 18 and 24 moths. Statistical analyses were performed to look atdevelopmental outcomes in each of the two groups of children (IPTp) vs(ISTp)as well as between early antenatal and postnatal factors and laterdevelopment.Results: In total, 431 children were included in the study. Our preliminaryresults have shown no significant difference in A not B at 18 and 24months (p = 0.37; 0.30), language acquisition at 18 and 24 monthson CDI (p =0.11; 0.11) and no difference in FCI between the groups(p = 0.69; 0.73). However, low birth weight, gestational age, maternaleducation, socioeconomic status demonstrated a significant relationshipwith developmental outcomes.Conclusions: It is clear from this study that ISTp is not necessarily tobe recommended as a new policy for prevention and management ofmalaria in pregnancy. We have shown, however, that there needs to bemore emphasis on interventions to prevent low birth weight, pretermbirth and improving early child development for those that are most atrisk.

References:1. Boivin M et al. (2011). Trop Med Int Health 16, 263-271.2. Conroy A et al. (2013). Cell Host & Microbe, Feb 20133. Gladstone M et al. (2011). PLoS Med 8, e1001121.

P041

LOW IMMUNIZATION COVERAGE IN GEDEO ZONE, SOUTHETHIOPIA – A COMMUNITY BASED CROSS SECTIONAL STUDY

Hailu S.1,2,3, Astatkie A.2, Johansson K.A.3, Lindtjørn B.31Dept. of Public Health, Dilla University, Dilla;2Dept. of Public Health, Hawassa University, Hawassa, Ethiopia;3Centre for International Health and Medical Dept., University ofBergen, Norway

Introduction: Immunization is a cost–effective intervention which hasprevented more than 5 million deaths around the world (2010-2015).The same progress in vaccination coverage has been made over thepast four decades in many African countries, including Ethiopia. How-ever, universal immunization coverage has not yet been reached. Only39% of children in aged 12-23 months old received all basic vaccina-tion in Ethiopia according to the 2016 Ethiopian Demographic HealthSurvey.Aim: The aim of this study was to evaluate immunization coverage, andassess both individual and community-level factors that may explainincomplete vaccination coverage among children age group 6-36 monthsof age in Wonago district, in South Ethiopia.Methods: A community based cross-sectional study was conducted inthree randomly selected kebeles in Wonago district. A sample of 1,116children aged 6-36 months (923 child-mother pairs) participated in thestudy. Multilevel regression analysis was used to conduct the analysisusing STATA software. Children and mothers (level-1) were nested withinthe kebeles (level-2).Results: Eighty-five percent of children took at least a single dose ofvaccine. The complete immunization coverage of children age group 12-36 months was 52.4%. Five predictor variables were associated withcomplete immunization, which remain significant after controlling for

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several individual and community level variables; children whose mothershad more than four antenatal care visits [AOR=6.69; 95% CI (1.71, 27.68)], had one or more tetanus-toxoid vaccinations during their pregnancy[AOR=2.61; 95% CI (1.41, 4.81)], and knew at what age the vaccinationis complete [AOR=1.97; 95% CI (1.22, 3.16)], being a boy [AOR = 0.63;95% CI (0.42, 0.94)] and children who got Vitamin A supplementation inthe last 6 month [AOR 2.84; 95% CI (1.61, 4.99)]. There was clusteringeffect at the individual and community level with intra cluster correlationcoefficient of 48.1%.Conclusion: The immunization coverage was low in Wonago district,South Ethiopia. There were significant differences in immunizationcoverage across communities. Promoting maternal health care uti-lization and community service could enhance future immunizationcoverage.

P042

SPATIO-TEMPORAL MALARIA CASE DISTRIBUTION IN THEPRESENCE OF INDOOR RESIDUAL SPRAYING (IRS) AT APLANTATION IN SOUTHERN MALAWI

Hoek Spaans R.1, Stanton M.C.2, Jones C.M.1,3

1Liverpool School of Tropical Medicine, Liverpool;2Lancaster Medical School, Lancaster University, Lancaster, UK;3Malawi-Liverpool-Wellcome Trust Clinical Research Programme,Blantyre, Malawi

Introduction: With the global push towards malaria elimination, addi-tional measures besides treatment and mass distribution of long lastinginsecticidal nets (LLIN’s) are needed. The past years, as a consequenceof increased costs associated with switching insecticides because of theemerging resistance against pyrethroids, the national malaria controlprogramme (NMCP) in Malawi has not made use of indoor residual spray-ing (IRS). Meanwhile, Illovo Sugar has continued to conduct private IRSprogrammes on their plantations in the Chikwawa and Nkhotakota dis-tricts. Their routine data collections have provided a unique opportunityto gain more insight into the role of environmental and climatological fac-tors on spatio-temporal malaria case distribution within an agriculturalsetting. The efficacy of IRS programmes can vary greatly depending onlocal malaria transmission patterns. With more than 70% of Malawiansemployed within the agricultural sector, this study has relevance to theMalawian NMCP.Aim: To identify drivers of the spatio-temporal distribution of malariacases in agricultural setting where IRS is implemented.Methods: Malaria case data, diagnosed by rapid diagnostic tests (RDT),were collated from seven occupational health clinics located in IllovoNchalo. Bi-annual IRS spraying of approximately 3000 householdswith pyrethroids was performed until 2014 before a switch to annualspraying with the long-lasting organophosphate, Actellic. Environmentaldata were extracted from remotely sensed images of the plantation.Meteorological data from the Illovo weather station were accessedonline. Data from the past five years were analyzed to identifyspatio-temporal patterns in malaria case data using a geostatisticalframework.Results: A decline in clinical malaria cases over a period of five yearsis observed and described in the context of current malaria prevalenceelsewhere in southern Malawi. The distribution pattern of malaria casesiss described and the impact of environmental (spatial) and meteoro-logical (temporal) drivers are quantified. The role of the IRS programmeand its coverage on the spatio-temporal distribution of malaria cases isevaluated.Conclusion: We present a case-study of measuring the impact of IRSwithin a low-lying area of southern Malawi, a region historically possess-ing high malaria transmission.

P043CAN INDONESIA ACHIEVE MALARIA ELIMINATION? RESEARCH,MAPPING AND SURVEILLANCE LABORATORY DATA NEEDS THEFEASIBILITY OF MALARIA ELIMINATIONHutagalung J.1, Kusnanto H.2, Supargiyono1, Sadewa A.H.3,Novijanti R.4, Garjito T.A.51Centre for Research and Development of Biomedical and BasicHealth Technology, Ministry of Health Republic of Indonesia;2Field Epidemiology Training Program (FETP), Faculty of Medicine,Universitas Gadjah Mada, Yogyakarta, Indonesia;3Dept. of Biochemistry Universitas Gadjah Mada, Yogyakarta;4Eijkman Institute for Molecular Biology, Jakarta;5Institute for Vector & Reservoir Control Research & Development(IVRCR&D), National Institute of Health Research and Develop-ment, MoH, Indonesia, Salatiga, Cental Java, Indonesia

Background: Currently MoH Indonesia announced to have reached thepre-elimination stage by 2020 and to be free of malaria transmissionby 2030. Unfortunately, lacking real surveillance data real prevalenceand API from different assignment of malaria and detailed maps of theepidemiological distribution are needed. The research required to supportthese objectives is critically evaluated here.Methods: A survey of 555 people enrolled in this study who were sys-tematically selected from healthy population from five districts in East-ern Indonesia. Data was collected by standard questionnaire, physicalexamination and laboratory tests. All protocols of assignment followedmanufactures manual. Confirmed cases of malaria are positive by n-PCRand microscopic test. Univariate and bivariate statistical analysis (OddsRatios, α= 0.05 with 95% CI) were performed with the SPSS 16.0 softwarepackage.Results: Among the 555 samples, there were only 1.6% samples (9/555)by microscopic and 32.6% (181/555) by n-PCR positive for malaria respec-tively. Plasmodium vivax was the dominating species. Not using bednets was the most significant risk factors with malaria prevalence (OR=2.34 with 95% CI= 1.98-4.83). Surveillance mapping spatial analysis(GIS) indicated three distinguish significant clusters (13 cases/7.2%, 54cases/29.9% and 87 cases/48.1%). All malaria clusters were found in lowcases incidence (LCI) malaria as per the standard classification.Conclusion: Malaria elimination in eastern Indonesia can proceed strate-gically using new evidence based practices that provide more reliableresults. Routine treatment to stop silent transmission, outbreak controlefforts and improved laboratory surveillance are needed to effectivelymeet the goals of malaria elimination in Indonesia.

P044EPIDEMIOLOGY OF VISCERAL LEISHMANIASIS AMONG CHIL-DREN IN GADARIF HOSPITAL, EASTERN SUDAN

Ahmed M.A.A.1, Idris S.M.O.1, Adam G.K.2, Ali A.A.A.31Dept. of medicine, Gadarif University, Gadarif;2Dept. of obstetric and Gynecology, Gadarif University, Gadarif;3Dept. of obstetric and Gynecology, Kssala University, Kassla,Sudan

Introduction: Since 1900s, visceral leishmaniasis (VL) has been amongthe most important health problems in Sudan, particularly in the endemicareas such as eastern and central regions.Aim: To investigate the epidemiological factors of VL in Gadarif hospital,eastern Sudan.Methods: This was a cross sectional, hospital-based study conductedfrom 1st January 2017 to 31st December 2017 in Gadarif hospital,eastern Sudan.

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Results: During the study period there were 47 identified children withVL among 145 suspected cases. The most common clinical presenta-tions were fever (47, 100%), pallor (47, 100%), weight loss (40, 85.1%),splenomegaly (37, 78.7%), lymphadenopathy (33, 70.2%), vomiting (32,68%) cough (28, 59%), loss of appetite (22, 46.8%),diarrhoea (17, 36.1%)and jaundice (5, 10.6%).With regard to the outcome after short term follow up 37 patients(78.8%) improved without complications, while 3 (6.4%, 2 (4.3%), 2(4.3%), 1 (2.1%), 1 (2.1%) and 1 (2.1%) developed pneumonia, otitismedia, septicaemia, urinary tract infection, parasitic infestation and PKDLrespectively. Lower mean of haemoglobin level was observed amongthe VL cases in comparison with the suspected cases (in whom VL wasexcluded) haemoglobin level {8.9 (3.1) Vs 11 (6.3), P = 0.021}. Againmore proportion of anaemic (47 (100%) Vs 14 (14.2%), P = 0.000) andseverely anaemic (23 (48.9%) Vs 2 (2%), P = 0.006) patients was detectedamong the infected children. Using logistic regression analyses there wassignificant association between rural residence (CI = 1.5–24, OR = 19.1, P= 0.023), male gender (CI = 6.6–18.7, OR = 6.4, P = 0.001) and VL amongchildren.Conclusion: While there is an advance in prevention and management ofvisceral leishmaniasis our results indicate that VL is still a public healthproblem with its severe complications among children in eastern Sudan.

P046

WHAT IS THE STATUS OF LASSA FEVER VACCINE DEVELOP-MENT? A LITERATURE REVIEW AND REFLECTION FROM A TROP-ICAL PUBLIC HEALTH PERSPECTIVE

Ishola D.A.1,2

1Faculty of Infectious and Tropical Diseases, London School ofHygiene & Tropical Medicine, London, UK;2Kambia Field Site, Kambia, Sierra Leone

Introduction: Lassa fever (LF) is a rodent-borne zoonotic viral haem-orrhagic illness (VHI) known since 1969; causing regular epidemics inWest Africa with significant mortality and morbidity; including an ongoingoutbreak in Nigeria. Similar to Ebola, no human vaccine is available for thisoutbreak-prone VHI.Aim: This review was conducted to understand the current state of LFvaccine development research in the published literature.Methods: A systematic literature search was conducted, and lastupdated in October 2018, to identify human clinical trials of any stage;or experimental animal studies evaluating candidate vaccine efficacyagainst mortality from lethal Lassa virus exposure. Pubmed search termsincluded lassa[All Fields] AND ("vaccines"[MeSH Terms] OR "vaccine∗"[AllFields]) and (((vaccin∗) OR immunisation)) AND lassa. Major registrieswere searched for registered trials.Results: From an initial 233 potential papers, thirteen non-human studiesmet inclusion criteria (six studies in non-human primate (NHP) models;and seven guinea-pig studies). Twelve studies reported at least partialprotection of study animals from lethal Lassa exposure. In four studies,complete protection of NHP was reported. The vaccine platforms in thesestudies were a recombinant vaccinia virus (n=1, published in 1989); arecombinant vesicular stomatitis virus platform (n=2, 2005 and 2015);and a reassortant Mopeia/Lassa virus (2008). The search of major clinicaltrial registries did not reveal any human studies.Conclusion and reflection: Although studies are few, efficacy in NHP withvaccines on three different vaccine platforms indicates some promise.On reflection, it is demoralising to realise that three of the potentiallypromising studies were published between 10 and 29 years ago, raisinga concern about the prospects for movement towards clinical trials. It isnotable that whilst LF is historically and currently focused in West Africa,the vector is present more widely across Africa, and socio-environmental

conditions for LF transmission are also widely prevalent. Vaccine can-didates that fully protect non-human primates urgently need furtherexperimental validation and advancement towards early-stage humanstudies. Ongoing LF transmission strongly suggests that vaccine efficacystudies are likely to be feasible. The recent advent of the CEPI initiativeis heartening and would hopefully help accelerate progress towards aneffective human vaccine.

P047USING A GEOGRAPHICAL INFORMATION SYSTEM TO MONITORINSECTICIDE RESISTANCE STATUS OF MALARIA VECTORS INPAKISTAN

Jabeen A., Ansari J.A., Ikram A., Khan M.A.Field Epidemiology & Disease Surveillance Division, National Insti-tute of Health, Islamabad, Pakistan

Introduction: Geographic Information System (GIS) has emerged as apowerful evidence based practice technology for early detection andtimely, response to disease outbreak. A study on susceptibility status ofAnopheles species of mosquitoes was conducted in three provinces andAzad Jamu Kashmir, Pakistan. Six Anopheles species were tested againstsix different insecticides.Aim: To develop a geographical information system based map for dis-tribution of both primary and secondary malaria vectors and insecticideresistance in malaria vectors.Methods: WHO test kits and procedures were used to test the suscepti-bility status of blood fed wild caught Anopheles species in field conditionand F1 generation of survived species in laboratory condition.Results: In all district An. stephensi, An. subpictus, An. culicifacies, An.maculatus, An. annularis showed high resistance against DDT. Throughstatistical analysis,it was found that in district Faisalabad An. stephensi (p= 0.015); district Layyah An. stephensi (p = 0.001) and An. subpictus (p =0.01); district Rawalpindi An. stephensi (p = 0.02), An. culicifaces (p = 0.02)and An. maculatus (p = 0.02); district Zhob An. stephensi (p = 0.01), An.culicifacies (p = 0.03) and An. subpictus (p = 0.03) and district Mirpur An.culicifacies (p = 0.04) significantly resistant to DDT. Only in Faisalabad An.stephensi (p = 0.03) showed significant resistant against Deltamethrin.In district Faisalabad An. stephensi (p = 0.01) and An. culicifacies (p =0.03) were significantly resistant to Lambdacyhalothrin. An. culicifacies(p = 0.01) showed significant resistance against Malathion in districtFaisalabad. No resistance for Bendiocarb was observed.Conclusion: Map showing risk area may be helpful for assessing potentiallocations for the implementation of resistance management and inte-grated vector control strategies. Such strategies could be direct the actionplans to reduce or replace insecticides used in Integrated Vector Manage-ment (IVM) activities. A unique baseline data on insecticide resistance isnow available in Pakistan, which enables to follow trends in the resistancestatus in Pakistan and which will serve as basis for further resistancemanagement.

P048

MOSQUITO ALERT PAKISTAN - A TOOL FOR SURVEILLANCE ANDMONITORING OF MALARIA, DENGUE, CHIKUNGUNYA ZIKA ANDWEST NILE DISEASE VECTORS

Jabeen A., Ikram A., Ansari J.A., Khan M.A.Field Epidemiology & Disease Surveillance Division, National Insti-tute of Health, Islamabad, Pakistan

Introduction: The National Institute of Health (NIH) has launched its first-ever android based application named “Mosquito Alert Pakistan (MAP)” in

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Pakistan. Aedes aeypti and albopictus are the primary vectors for chikun-gunya, dengue, yellow fever and zika; Anopheles for malaria and Culexspread West Nile fever, lymphatic filariasis and Japanese encephalitis.Mosquito surveillance provides an early warning system for the risk oftransmission of mosquito borne diseases in an area.Aim: The main purpose of this App is to collect information on diseasevector (Aedes, Anopheles and Culex) mosquitoes to assist surveillanceresearch and control of vector borne diseases.Methods: Android based MAP had been developed with the help of Infor-mation Technology department, National Institute of Health, Pakistan.Through this MAP, general public sent photo of mosquitoes and theirbreeding places form different cities of Pakistan. Medical Entomologistidentified all photos received from January through May 2019.Results: Out of the total 154 photos received so far, 69 pictures werereceived from Punjab, 28 from Sindh, 18 from Islamabad, 17 from KPK and12 from Baluchistan. Aedes mosquitoes were detected from two localitiesof Islamabad while 1 picture of Anopheles species was received fromLoralai, Balochistan. Culex species were reported from Karachi, Jamshoro,Miani, Hasilpur, Kalu Khan, Taunsa, Aminpur Bangla, Sargodha, Jampur,Bahawalnagar, Chiniot, DG Khan, Islamabad, Hyderabad, Bannu, Sam-brial, Qila Mala Singh, Loralai, Lahore, Peshawar, Kamalia and Rawalpindi.Eight pictures were not clear, whereas 10 pictures did not have anymosquito.Conclusion: The present study provides information regarding geograph-ical distribution of mosquitoes in Pakistan. MAP would play a significantrole in surveillance and monitoring of mosquitoes. This will help in formu-lating better vector control strategies in Pakistan.

P049

LASSA-SEROPREVALENCE AND ITS PREDICTORS IN FARANAHPREFECTURE, GUINEA: A CROSS-SECTIONAL SURVEY

Jankhöfer C.H.1, Marí Sáez A.1,2, Magassouba N.3, Soropogui B.3,Camara A.3, Günther S.4, Gabriel M.4, Fichet-Calvet E.4, BorchertM.1,2

1Institute of Tropical Medicine and International Health, Charité -Universitätsmedizin Berlin, Berlin;2Centre for International Health Protection, Robert Koch Institute,Berlin, Germany;3Projet des Fièvres Hémorragiques en Guinée, Laboratoire deVirologie, Conakry, Guinea;4Dept. of Virology, Bernhard Nocht Institute for Tropical Medicine,Hamburg, Germany

Introduction: Lassa Fever is a haemorrhagic fever endemic in West Africa.Transmission of Lassa virus (LASV) mostly occurs through contact withthe Natal multimammate mouse, Mastomys natalensis, and its faecesor body fluids. In many endemic areas consumption of M. natalensis iscommon; hunting, preparing, cooking and eating have been suspectedto be risk factors for infection with the Lassa virus.Aim: To determine the seroprevalence in Faranah prefecture in Guineaand to identify predictors for Lassa seropositivity.Methods: Six villages in Faranah prefecture were selected based on theirsize (∼1,000 inhabitants), their remoteness (i.e. distance from pavedroads) and the presence of LASV in rodents. Households, houses and indi-viduals were recruited by stratified cluster sampling. Data were collectedthrough questionnaires and blood samples, and tested for Lassa virusIgG antibodies using ELISA. Descriptive, bi- and multivariable analysis wasconducted to establish a predictive model.Results: Of 1374 recruited participants, 1302 were tested by ELISA. Thetotal seroprevalence reached 84.0% (95% CI: 81.9 – 85.9). Men andwomen were equally affected and seropositivity increased with age.

Already the youngest participants (6 years old) had a seroprevalenceof 62%. Most of the people (93.3%; 91.4–94.8) reported their housesto be infested by rodents. Rodent hunting (52.9%; CI 50.1–55.7) andconsumption (68.7%; 63.9–73.1) were common practices pursued in thefields. Only 6 of more than 100 independent variables were found to besignificantly predictive for Lassa infection, among them farming variouscrops (rice: aOR 1.75, 95%CI 1.20-2.55; peanuts 2.09, 1.45-3.02), burrowsin a house (aOR 2 burrows 2.03, 1.34-3.06) and fever with hearing loss(1.85, 1.04–3.31).Conclusion: An unprecedented high seroprevalence was measured inUpper Guinea. The study found fewer variables related to rodent con-tacts or housing quality to be associated with Lassa-seropositivity thanexpected. This implies that seroprevalence as outcome, as opposed toseroconversion, may be of limited value for identifying predictors. Thehigh prevalence in 6 years old children suggests that children are animportant target group for prevention, and that future research on Lassadisease burden and transmission may need to include younger children.

P050

EVALUATION OF ROTAVIRUS VACCINE EFFECTIVENESSAGAINST G1 AND G2 STRAINS POSSESSING A DS-1-LIKEGENETIC BACKBONE IN MALAWIAN INFANTS

Jere K.C.1,2, Bar-Zeev N.1,2, Bennett A.1,2, Pollock L.1,2,Sanchez-Lopez P.F.3, Nakagomi O.1,4, Tate J.E.5, Parashar U.D.5,Heyderman R.S.2,6, French N.1,2, Iturriza-Gomara M.1,2,7,Cunliffe N.A.1,2

1Centre for Global Vaccine Research, Institute of Infection & GlobalHealth, University of Liverpool, Liverpool, UK;2Malawi-Liverpool-Wellcome Trust Clinical Research Program-me/Dept. of Medical Laboratory Sciences, College of Medicine,University of Malawi, Blantyre, Malawi;3Dept. of Genetics and Microbiology, Faculty of Medicine, Universityof Murcia, Murcia, Spain;4Graduate School of Biomedical Sciences, Nagasaki University,Nagasaki, Japan;5Epidemiology Branch, Division of Viral Diseases, National Centerfor Immunization and Respiratory Diseases, Centers for DiseaseControl and Prevention, Atlanta, USA;6Division of Infection and Immunity, University College London,London, UK;7NIHR Health Protection Research Unit in Gastrointestinal Infec-tions, University of Liverpool, Liverpool, UK

Introduction: Despite introduction of rotavirus vaccines in many coun-tries, rotavirus remains the major cause of severe gastroenteritis in chil-dren. Malawi introduced a Wa-like G1P[8] Rotarix human rotavirus vaccine(HRV) into its childhood immunisation schedule in 2012, reaching 95%coverage by 2015. Hospital-based surveillance demonstrated the emer-gence of atypical DS-1-like G1P[8] rotaviruses in 2013; similar to whathas also been reported from some countries. There are, however, no datademonstrating how effective rotavirus vaccines are against them.Aim: To examine whether the emergence of DS-1-like G1P[8] strainscould be due to reduced protection afforded by the Wa-like G1P[8] HRVand also estimate its effectiveness (VE) against DS-1-like G1P[8] strains,and against concurrently circulating G2 strains with a DS-1-like geneticbackbone.Methods: Whole genome sequences (WGS) were generated using Illu-mina technology from G1 and G2 rotavirus strains that were randomlyselected each month in children under 5 years who were hospitalisedwith diarrhoea in Blantyre, Malawi between January 2013 and December

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2015. Logistic regression was used to calculate VE by comparing the oddsof rotavirus vaccination among rotavirus EIA-positive cases and rotavirustest-negative controls.Results: Of 216 rotavirus strains sequenced, 53% (114/216) had a Wa-like, 44% (88/216) had a DS-1-like and 3% (14/216) had mosaic geno-type constellations. Among those with Wa-like constellation, 72% wereG1, 25% were G12 and <1% were G2 strains. Of the DS-1-like strains,69% were G2 and 31% were G1 rotaviruses. Of the 110 G1 strainsanalysed by WGS, 75% and 25% were Wa-like and DS-1-like, respec-tively. Atypical G1 rotaviruses with DS-1-like genotype constellation weredetected for the first time in Malawi in 2013; their circulation peakedin 2014 and subsequently decreased in 2015 (<1%, n=1/72). Vaccineeffectiveness among infants hospitalised with acute DS-1-like G1P[8]rotavirus gastroenteritis was 85.6% (95% CI: 34.4%, 96.8%), P=0.01,and was 62.8% (95% CI: -75.8%, 92.1%), P=0.212 against DS-1-like G2rotaviruses.Conclusions: High vaccine effectiveness against atypical G1P[8] strains,combined with their subsequent decline, suggests that their emergencewas unrelated to vaccine introduction. These data support national rec-ommendations for rotavirus vaccine use, particularly for low incomecountries with high burden of diarrhoeal disease.Disclaimer:This study was supported by GlaxoSmithKline who were provided theopportunity to review a preliminary version of this abstract for factualaccuracy, but the authors are solely responsible for final content andinterpretation.

P052HOW TO PROVIDE ANTIMALARIALS TO VULNERABLE CHIL-DREN? A COST-EFFECTIVENESS ANALYSIS OF DELIVERY MODESFOR POST-DISCHARGE MALARIA CHEMOPREVENTION INSOUTHERN MALAWI

Kühl M.J.1, ter Kuile F.2, Phiri K.3, Robberstad B.4, on behalf ofthe PMC Consortium1,4Center for International Health, Dept. of Public Health, Universityof Bergen, Bergen, Norway;2Dept. of Clinical Sciences, Liverpool School of Tropical Medicine,Liverpool, UK;3College of Medicine, University of Malawi, Blantyre, Malawi

Introduction: Children treated for severe anaemia in Malawi are at highrisk of dying or being re-admitted due to malaria infections during the firstmonths following their hospitalization. Post-Discharge Malaria Chemo-prevention (PMC) showed a 31%-protective effect compared to standardtreatment for the first six months. We conducted two randomized con-trolled trials (RCTs) using dihydroartemisinin-piperaquine (DP) to confirmthe efficacy of PMC (Kenya and Uganda) and to determine parents’adherence behaviour to different delivery modes of PMC (Malawi). Basedon these trials, this study provides the economic evaluation of PMC forMalawi under implementation conditions. The results will contribute toWHO implementation guidelines for PMC in East Africa. Moreover, theintegration of adherence data into an economic evaluation of preventivetreatment offers a new angle to the implementation research in thisregion.Aim: Determine the cost-effectiveness of different delivery modes of PMCto under-5-year-old children in Malawi.Method: This cost-effectiveness analysis (CEA) compares two PMC deliv-ery modes: (1) providing the full treatment course of DP to parents athospital discharge and (2) monthly dispensing of monthly DP doses atthe hospital. CEA is done for the provider and the societal perspectives.Participant cost and adherence data stem from our implementation trial(RCT) with 375 participants in Zomba District, Malawi. Provider cost were

determined based on surveys and expert interviews at Zomba CentralHospital and literature review. Probabilities of transitions between healthstates and efficacy data for DP vs. placebo stem from our confirmatorymulti-centre RCT with 1049 participants in Kenya and Uganda. Healtheffects are summarized as disability adjusted life years (DALYs). Cost-effectiveness is estimated using probabilistic Markov models analysedin ‘treeage 2019’-software. Results are reported as incremental cost-effectiveness ratios (ICER) for each perspective. National willingness topay is determined according to WHO-recommendations.Results: The final CEA cannot be conducted before one RCT databasebecomes accessible in early 2019. Initial CEA of the delivery modessuggests important results for both cost perspectives: (1) providing thefull course of DP upon hospital discharge appears to strongly dominate(2) monthly dispensing of DP at the hospital.Conclusion: The conclusion follows upon final analysis.

P053COST-EFFECTIVENESS ANALYSIS OF POST-DISCHARGEMALARIA CHEMOPREVENTION FOR SEVERELY ANAEMIC CHIL-DREN IN KENYA AND UGANDAKühl M.J.1, ter Kuile F.2,4, Phiri K.3, Kwambai T.2,4, Dhabangi A.5,Robberstad B.1, on behalf of the PMC Consortium1Center for International Health, Dept. of Public Health, Universityof Bergen, Bergen, Norway;2Dept. of Clinical Sciences, Liverpool School of Tropical Medicine,Liverpool, UK;3College of Medicine, University of Malawi, Blantyre, Malawi;4Kenya Medical Research Institute (KEMRI), Centre for GlobalHealth Research, Nairobi, Kenya;5Makerere University College of Health Sciences, Kampala, Uganda

Introduction: Children who were treated for severe anaemia in Kenyaand Uganda are at high risk of dying or being re-admitted to hospitalwithin six months due to malaria infections. In Malawi, Post-dischargeMalaria Chemoprevention (PMC) showed a 31%-protective effect in chil-dren under 5 years old compared to standard treatment for the firstsix months. We conducted a confirmatory randomized controlled trialof PMC using dihydroartemisinic-piperaquine (DP) to confirm the efficacyin Kenya and Uganda. Combining these results with a cost-effectivenessmodel of PMC in Malawi, this study provides the economic evaluation ofPMC for Kenya and Uganda. The results may inform the upcoming WHOguidelines for PMC in East Africa.Aim: Determine the cost-effectiveness of PMC delivered to under-5-year-old children who were treated for severe anaemia in Kenya andUganda.Method: This cost-effectiveness analysis (CEA) compares the PMC inter-vention arm with the placebo arm. CEA is done for the provider andthe societal perspectives. Participant cost, probabilities of transitionsbetween health states, and efficacy data for DP vs. placebo stem fromthe confirmatory multi-centre RCT with 1049 participants. Additionaladherence scenarios will be developed based on adherence informationfrom an implementation trial in Malawi. Health effects are summarizedas disability adjusted life years (DALYs). Cost-effectiveness is estimatedusing probabilistic Markov models analysed in ‘treeage 2019’-software.Results are reported as incremental cost-effectiveness ratios (ICER) foreach perspective. National willingness to pay is determined according toWHO-recommendations.Results: The final CEA will be conducted in April 2019, depending on thetrial data. Initial CEA suggests that the intervention strongly dominatesthe placebo treatment. Therefore, context-specific CEA for decision mak-ers in East African countries may soon be needed to inform policy andimplementation design.

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Conclusion: The conclusion follows upon final analysis.

P054

A FOUNDATION DOCTOR’S EXPERIENCE OF DEVELOPINGEDUCATIONAL RESOURCES TO DISSEMINATE INFORMATIONABOUT CHOLERA AND POLIO IN CONFLICT SETTINGS WITHINTHE EASTERN MEDITERRANEAN REGION (EMR)

Kurian M.1, Bayad N.21NHS, Nottingham;2Public Health England, Plymouth, UK

Introduction: The Eastern Mediterranean Region (EMR) as outlined bythe World Health Organization (WHO) is all too familiar with conflict.Propagated by various socioeconomic and political factors, Pakistan andYemen have had an exponential increase in the cases of poliomyelitis andcholera respectively.Aims: This poster will focus on the development of medical resources forchildren regarding poliomyelitis. These resources will be used to educatethe wider population on issues regarding transmission, management andprevention of these communicable diseases.Methods: In producing medical resources, it is important to consider theeducational needs of vulnerable populations such as those in conflictzones and children. A literature review was necessary in order to developresources suitable for Pakistan. I used the key terms such as ‘Pakistan,’‘EMR’, ‘polio’, ‘conflict’ and ‘education’. Terms such as ‘AND/OR’ helped torefine the searches. I developed Hussain’s Guide to Poliomyelitis aimedat providing information regarding poliomyelitis to children and youngpeople in a way that is funny, relatable and concise. The resources aredesigned based on research into learning theories, popular children’s fic-tion and school science curricula. Additionally, I worked with a specialistgroup to produce educational resources for all ages on the pathogenesis,transmission, management and prevention of cholera.Conclusion: Developing educational resources for conflict settings hasseveral challenges. It is essential to ensure that public health campaignsenable individuals to empower themselves in the most adverse circum-stances.

References:1. The World Health Organization, 2008. The social determinantsof health in countries in conflict: a perspective from the EasternMediterranean Region. Available at: http://apps.who.int/iris/bitstream/handle/10665/119883/dsa955.pdf?sequence=1&isAllowed=y [Accessedon 10th March 2019]2. The Lancet Gatroenterology and Hepatology, 2017. Health Catastro-phe the toll of cholera in Yemen. Available at: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30224-8/fulltext [Accessedon 10th March 2019]3. Balakrishnan, V. Cholera in Yemen. The Lancet Infectious Diseases, 2017Vol 17: Issue 7. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30352-3/fulltext [Accessed on 10th March2019]

P055

REVIEW OF PROGRESS ON COUNTRY’S ACTION PLAN ONANTIMICROBIAL RESISTANCE IN WHO AFRICAN REGION

Kuti O.O.1, Alori S.21UNICEF Ghana, Accra, Ghana;2Lagos Laboratory Services., Pathology Section, General Hospital,Lagos, Nigeria

Introduction: World Health Organization (WHO) identified AntimicrobialResistance (AMR) as a top ten priority global health threat for 2019. In2011 when AMR was declared as the theme for the WHO Health Dayand the 6-point AMR policy package was launch, all member stateswere expected to prepare a national plan for tackling AMR by 2017in alignment with the Global Action Plan on AMR (GAP) developedin 2015.Methods: A review of the progress in country action planning for address-ing AMR in the forty-seven (47) countries in the WHO AFRO region usingavailable country responses from the global AMR monitoring database.The global AMR monitoring database is an open access global AMR moni-toring database of country responses from a self-administered question-naire established by the tripartite UN agencies consisting of WHO, FAOand OIE.Results: 43% (20) of the countries reported having a comprehensivenational plan to fight resistance to antibiotics and other antimicrobialmedicines. Majority, 93.6% (44), of the WHO AFRO countries report-ing having an essential medicine lists and 91.5% (43) have nationalmedicines policies and treatment guidelines for rational drug use. How-ever only 21 % (10) have overarching national infection prevention andcontrol (IPC) policies. Antibiotics and other antimicrobial medicines areavailable without a prescription in 9 of the countries.The survey results show that the number of countries with functioningmultisectoral coordination working groups was only 11 based on reportedregular focused meetings.Conclusion: Ensuring antimicrobial effectiveness is now seen as a globalpublic good that must be protected by all national governments andpublic authorities. Understanding individual country responses in tacklingAMR in Africa is challenged by a lack of continent-wide surveillance data.The self-reported country assessments revealed that by February 2019,close to half of the countries in the WHO AFRO region reporting having aplan at various stages of implementation with the remaining half of thecountries having a plan under development.Monitoring progress on implementation of the national plans is crucial tocontrolling antibiotic resistance, however in of the many countries, poorlaboratory infrastructure and manpower with weak data managementhampers effective surveillance and response as intended in national AMRplans.

P059

INVERTEBRATE HOSTS AND EPIDEMIOLOGICAL PREDICTORSOF AMERICAN TEGUMENTARY LEISHMANIASIS IN BRAZIL: ASYSTEMATIC-REVIEW

Borilli Pereira M., Lera-Nonose D.S.S.L., Fermiano T.H., GanazaK.L.T., Sartori K.P., Sydor B.G., Aristides S.M.A., Silveira T.G.V.,Teixeira J.J.V., Lonardoni M.V.C., Demarchi I.G.Dept. of Clinical Analysis and Biomedicine, Health Sciences Center,Universidade Estadual de Maringá, Maringá, Brazil

Introduction: American tegumentary leishmaniasis (ATL) in Brazilinvolves a great diversity of vectors, parasite species and reservoirs.Aim: In this systematic review, we investigated studies on invertebratehosts and the predictive factors involved in the transmission of thedisease.Methods: The review followed the PRISMA method, searching for articlesin the databases Pubmed, Web of Science, Scopus and LILACS, usingterms/descriptors. Original studies published between 2008 and 2018were included.Results: A total of 16 articles were included, most of them from theNorth of Brazil, and the state with most studies was Minas Gerais. For-est and rural areas were the sites with highest vector collection. Also,urban and peri-urban areas were significantly prevalent. Seventeen insect

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http://apps.who.int/iris/bitstream/handle/10665/119883/dsa955.pdf?sequence=1&isAllowed=y

http://apps.who.int/iris/bitstream/handle/10665/119883/dsa955.pdf?sequence=1&isAllowed=y

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30224-8/fulltext

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30224-8/fulltext

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30352-3/fulltext

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30352-3/fulltext


genus were identified, being Lutzomyia the most frequent. Interesting,other insects with unclear vectorial properties were found to be natu-rally infected, such as Trichophoromyia auraensis, Evandromyia sp. andPressatia sp, suggesting further investigations. Vector collections weremainly made in the Northeast, followed by North, Southeast, and South ofBrazil. Most of the studies used polymerase chain reaction (PCR) to detectLeishmania natural infection in DNA samples obtained from sand flies.The RFLP-PCR technique for Leishmania minicircle kinetoplast DNA wascommonly used. On average, the natural infection rate of sand flies was1.50%. The subgenus Viannia, especially L. (V.) braziliensis, was the mostreported.Conclusion: This review highlights the great diversity of ATL vectors inBrazil widely distributed with a remarkable prevalence of Leishmania(Viannia) sp. infection in Lutzomia dwelling on forests or remaining ones.Unquestionably, the surveillance of sand flies and natural infection byLeishmania are fundamental to evaluate the role of each vector speciesin the maintenance of the ATL endemicity, proposing more effectivemeasures of prevention and control.

P060FACTORS ASSOCIATED WITH HUMAN VISCERAL LEISHMANI-ASIS OCCURRENCE: A CASE-CONTROL STUDY IN CENTRAL-WESTERN BRAZIL

Luz J.G.G.1,2, Carvalho A.G.1,2, Morais M.L.3, Naves D.B.2, DiasJ.V.L.3, Fontes C.J.F.11Post-Graduation Program in Health Sciences, Federal University ofMato Grosso, Cuiabá;2School of Medicine, Federal University of Mato Grosso, Ron-donópolis;3School of Medicine, Federal University of Jequitinhonha andMucuri Valleys, Teófilo Otoni, Brazil

Introduction: Visceral leishmaniasis (VL) is a life threatening neglectedtropical disease. In Brazil, VL is geographically expanding nationwide as azoonotic disease, and the factors associated with its occurrence are stillpoorly understood.Aim: To identify the factors associated with VL occurrence in the munici-pality of Rondonópolis (Mato Grosso State, Central-Western Brazil), whichrecently emerged as an endemic area with intense transmission of thehuman disease.Methods: This research was conducted as a case-control study. It wasincluded all the VL cases confirmed and reported in the municipalitybetween 2011 and 2016 who consented participation. Those who diedwere excluded. For each case, two controls were included, matched byage group and geographical location. The controls lacked a clinical historyof the disease and had a negative VL immunochromatographic test.Data was collected from March to October 2017 by interviews usinga structured questionnaire that considered retrospective socioeconomiccharacteristics, environmental aspects of the intra and peri-domiciliary,presence of animals, and individual habits. Univariate analysis followedby forward multivariate conditional logistic regression were used to iden-tify the factors associated with VL.Results: During the evaluated period, Rondonópolis reported 81 VL cases,of which 37 (45.7%) were included in the present study. Of these, 51.4%were males with a median age of 26.2 years. The control group wascomposed by 70 individuals with a predominance of males (52.8%)and a median age of 28.1 years. The following variables were associ-ated with human VL: bathroom and/or kitchen existence outside of thehome [OR = 7.8; 95% CI = (2.1 – 29.5)], presence of a vegetable garden[OR = 5.3; 95% CI = (1.3 – 21.2)], and presence of decaying fruits withinthe yard [OR = 10. 7; 95% CI = (2.0 – 52.1)].The final model was also adjusted according to family income.

Conclusion: The identified factors strongly suggest the importance ofhousehold environmental characteristics in the occurrence of human VL.This may be useful in guiding control actions and preventive measures forthe disease.

P061

EPIDEMIOLOGY OF MALARIA AND ANAEMIA AMONG SCHOOLAGED CHILDREN IN TANZANIA

Makenga G.1,2, Baraka V.1, Minja D.T.1, Nakato S.2, Francis F.1,Madebe R.1, Lusingu J.P.1, Van geertruyden J.P.21National Institute for Medical Research, Tanga Centre, Tanga,Tanzania;2Global Health Institute, University of Antwerp, Antwerp, Belgium

Introduction: Approximately 85 million school aged children of subSaharan Africa are affected by malaria related anaemia. In thesesettings, malaria accounts for about 13-50% of all school absenteeism,causes anaemia that also impairs the cognitive development. Further,due to changing malaria epidemiology, school aged children areincreasingly more vulnerable due to delayed acquisition of protectiveimmunity. Co-morbidities with soil-transmitted helminths (STH), schis-tosomiasis and malnutrition complicates the problem further as theyas well contribute to anaemia, nutritional deficiencies and cognitiveimpairment.Aim: The study aims to determine social economic and demographicfactors related to malaria transmission, and anaemia in school agedchildren living in high endemic areas. Also the impact of co infection withmalaria and STH on haemoglobin level will be explored.Methods: The study will utilise baseline data from a clinical trial(NCT03640403) that is being conducted in Muheza, Tanzania, todetermine effectiveness and safety of two antimalarial drugsDihydroartemisinin-piperaquine (DP) and Artesunate-amodiaquine(ASAQ) in preventing malaria related morbidity in school aged chil-dren living in high endemic areas. In this trial 1602 school childrenwill be recruited and randomised to receive either DP, or ASAQ orcontrol (no drug), to be given as intermittent preventive treatment(IPTsc) every 4 months for a year. At baseline, a cross sectionalsurvey will be conducted, consented parents will be visited at theirhouseholds where social economic and demographic information willbe obtained. Also information on bed net ownership and use amongchildren (5–15 years old) will be collected. Geo-reference data for keyparameters will be mapped at the household level by means of ageographic information system (GIS). At schools, the children will beclinically examined for fever and malnutrition. They will be tested formalaria parasiatemia, and haemoglobin level. In addition, stool andurine samples will be collected for testing STH and schistosomiasisinfections.Conclusion: To be discussed on the conference.

P062

PREVALENCE OF MALARIA PARASITAEMIA IN PREGNANTWOMEN AND SCHOOL AGED CHILDREN LIVING IN SIMILARENDEMIC SETTING OF SUB SAHARAN AFRICA: A SYSTEMATICREVIEW AND META-ANALYSIS

Makenga G.1,2, Menon S.2, Baraka V.1, Minja D.T.1, Nakato S.2,Francis F.1, Lusingu J.P.1, Van geertruyden J.P.21National Institute for Medical Research, Tanga Centre, Tanga,Tanzania;2Global Health Institute, University of Antwerp, Antwerp, Belgium

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Introduction: There is a strong correlation between the prevalence ofmalaria in children underfive and pregnant women, with the averageprevalence in underfive higher than that in pregnant women. However,school aged children (5-15 years) have a higher malaria parasitaemiaprevalence than their under-five counterparts. In high-transmission set-tings, up to 70% of school-aged children harbor malaria parasites which ismostly asymptomatic. Thus, epidemiologically, school aged children con-tribute significantly as reservoir for malaria transmission and thereforeundermining the effectiveness of control programmes. Intermittent pre-ventive treatment (IPT) of pregnant women as well as seasonal malariachemoprevention in children underfive have been implemented in severalsub-Saharan countries and have proven to be highly effective. However,none of the IPT strategies is targeting school children.Aim: The study aimed to understand malaria prevalence distribution inthe communities of sub-Saharan Africa to inform on strategies to improvetargeted malaria control, mainly extending IPT to school children (IPTsc).Methods: In a systematic review, we obtained data on malaria preva-lence in pregnant women and school aged children living in the sameendemic setting from the Malaria in Pregnancy Library, PubMed, Cochranelibrary and Web of Science in December 2018. Publications reportingmalaria prevalence for both pregnant women and school aged childrenwere selected. We used fixed effects meta-analysis to obtain a pooledrisk ratio (RR) of malaria in school aged children versus pregnant women.We used meta-regression to assess factors affecting the risk ratio.Results: Data from 6 studies were used, these included 11 datapoints. There was a strong linear relation between the prevalence ofmalaria infection in pregnant women and school aged children (r=0·90,p<0·00018). Risk was higher in school aged children compared topregnant women (RR=2.0, 95% CI 1·73–2.30, p<0.01). Children in highendemic area had higher risk.Conclusion: School aged children are folds higher at risk of malariaparasitaemia compared to pregnant women in similar settings. ExtendingIPT to IPTsc would likely reduce transmission and burden of malaria in theentire communities, and would be pragmatically feasible and acceptable.

P063

HOST TARGETS OF THE ANTHELMINTIC DRUG PRAZIQUANTEL

Park S.-K., McCorvy J.D., Marchant J.S.Dept. of Cell Biology, Neurobiology & Anatomy, Medical College ofWisconsin, Milwaukee, USA

Introduction: Schistosomiasis is a neglected tropical disease causedby infection with parasitic blood flukes. Infections are treated with theantiparasitic drug praziquantel (PZQ), used clinically for several decades.While the target(s) of PZQ remained undefined in the parasite, targetshave been recently identified in the human host, encompassing bind-ing sites for R-PZQ on the human 5-hydroxy-tryptamine-2B receptor1

(5HT2BR) and S-PZQ on the human transient receptor potential melastatin8 (TRPM8) ion channel2,3. Studying these interactions is important for tworeasons. First, engagement of these targets potentially contributes to thetherapeutic efficacy of PZQ. Second, defining these interactions will likelyprovide important information as to the binding poise and selectivity ofPZQ for parasitic target(s).Aim: To identify the binding site of R-PZQ at human 5HT2BR.Methods: 5-HT2BR function was screened using a Ca2+ flux assay. HEK293Cells expressing 5-HT2BR, or 5-HT2BR mutants, were plated into 384-well,tissue culture plates one day before the assay at a density of ∼15,000cells/well in DMEM containing 1% dialyzed fetal bovine serum. Next day,media was decanted and 20μL of Fluo-4 Direct dye (Invitrogen) wasadded per well and incubated for 1hr at 37◦C. Cells were stimulated withligands (5-HT, PZQ) diluted in drug buffer (HBSS, 20 mM HEPES, 0.1%BSA, 0.01% ascorbic acid, pH 7.4) and calcium flux measured using a

FLIPR-Tetra (Molecular Devices). Data were performed in triplicate andanalyzed using the dose-response function in GraphPad Prism 5.0.Results: In Ca2+ imaging assays, 5-HT triggered Ca2+ mobilization in5HT2BR-expressing HEK cells. R-PZQ acted as a partial agonist (EC50 =6.8±1.9μM). Various point mutations were made around the orthostericand extended binding pockets of the human 5-HT2BR, and analyses ofpositive and negative data used to refine a docking model for R-PZQ.Notably, mutation of residues in the extracellular loop 2 (EL2) previouslyimplicated in stereoselective binding of R-PZQ by modeling analyses,inhibited R-PZQ evoked Ca2+ release.Conclusion: These mutagenesis data are suggestive of the basis forstereoselective binding and selectivity of R-PZQ at 5-HT2BR over otherhuman G protein-coupled receptors.

References:1. Chan JD et al. Nat Communications [2017]; 8(1):1910.2. Babes RM et al. Toxicol Appl Pharmacol. [2017]; 336:55-65.3. Gunaratne G et al. PLoS NTD [2018]; 12(4):e0006420

P064

POTENTIAL BENEFITS OF COMBINING TRANSFLUTHRIN-TREATED SISAL PRODUCTS AND LONG-LASTING INSECTICIDALNETS FOR CONTROLLING INDOOR-BITING MALARIA VECTORS

Masalu J.P.1, Okumu F.O.1,2,3, Mmbando A.S.1, Sikulu-Lord M.T.4,

Ogoma S.B.1,5

1Environmental Health and Ecological Sciences Dept., IfakaraHealth Institute, Morogoro, Tanzania;2School of Public Health, University of the Witwatersrand, Johan-nesburg, South Africa;3Institute of Biodiversity, Animal Health and Comparative Medicine,University of Glasgow, Glasgow, UK;4Queensland Alliance of Agriculture and Food Innovation, TheUniversity of Queensland, Brisbane, Australia;5US National Research Council, National Academies of Sciences,Engineering, and Medicine, USA

Background: Transfluthrin vapour prevents mosquito bites by disruptingtheir host-seeking behaviors.Aim: We measured the additional benefits of combining transfluthrin-treated sisal decorations and long lasting insecticidal nets (LLINs) with anaim of extending protection against early evening, indoor-biting malariavectors when LLINs are ineffective.Methods: We investigated the indoor protective efficacy of locally madesisal decorative baskets (0.28 m2), treated with 2.5 ml and 5.0 ml trans-fluthrin in terms of mosquito density, exposure to bites and 24 hourmortality. Experiments were conducted in experimental huts, located inLupiro village, Ulanga district, south-eastern Tanzania. Human landingcatches (HLC) were used to measure exposure to bites between 1900-2300 hrs. Each morning, at 0600 hrs, mosquitoes were collected insidehuts and in exit traps and monitored for 24 hours mortality.Results: Sisal decorative baskets (0.28 m2) treated with 2.5 ml and5.0 ml transfluthrin, deterred three-quarters of Anopheles arabiensismosquitoes from entering huts (relative rate, RR = 0.26, 95% confidenceinterval, CI: 0.20-0.34, p< 0.001 and RR= 0.29, 95% CI: 0.22-0.37, p<

0.001 respectively). Both treatments induced a 10 fold increase in 24hour mortality of An. arabiensis mosquitoes (odds ratio, OR= 12.26, 95%CI: 7.70-19.51, p< 0.001 and OR = 18.42, 95% CI: 11.36-29.90, p< 0.001respectively).Conclusion: Sisal decorative items, treated with spatial repellents,provide additional household and personal protection against indoorbiting malaria and nuisance mosquitoes in the early evening, when

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conventional indoor vector control tools such as, LLINs are not in use.We recommend that future studies to investigate the epidemiologicalrelevance of combining LLINs and transfluthrin decorated baskets interms of their effect on reduction in malaria prevalence.

P065

BITING RISK AND INSECTICIDE RESISTANCE IN CULEX PIPIENSCOMPLEX IN RURAL SOUTH-EASTERN TANZANIA

Matowo N.S.1,2,3,4, Abbasi S.1, Munhenga G.5,6, Tanner M.2,3,Mapua S.A.1, Oullo D.7, Koekemoer L.L.5,6, Kaindoa E.1,7, NgowoH.S.1, Coetzee M.5,6, Utzinger J.2,3,, Okumu F.O.1,8

1Environmental Health and Ecological Sciences Dept., IfakaraHealth Institute, Ifakara, Tanzania;2University of Basel, Basel, Switzerland;3Swiss Tropical and Public Health Institute, Basel, Switzerland;4Dept. of Disease Control, London School of Hygiene and TropicalMedicine, London, UK;5Wits Research Institute for Malaria, MRC Collaborating Centrefor Multi-Disciplinary Research on Malaria, School of Pathology,Faculty of Health Sciences, University of the Witwatersrand, Johan-nesburg, South Africa;6Centre for Emerging Zoonotic & Parasitic Diseases, National Insti-tute for Communicable Diseases, Johannesburg, South Africa;7US Army Medical Research Directorate-Africa, Kisumu, Kenya;8School of Public Health, Faculty of Health Sciences, University ofthe Witwatersrand, Johannesburg, South Africa

Introduction: Culex mosquitoes cause significant biting nuisance andsporadic transmission of arboviral and filarial diseases in tropical coun-tries such as Tanzania. However, there is a knowledge gaps on the biol-ogy of Culex mosquitoes and their resistance to common public healthinsecticides.Aim: The main aim of this study was to assess the fine-scale spatialand temporal variations in insecticide resistance in the Culex species,and estimate human biting risk associated with Culex species relative tomosquito species in the study area.Methods: Using standard WHO procedures, we investigated resistanceprofiles and underlying mechanisms in Culex pipiens emergent from field-collected larvae in three neighbouring administrative wards (Minepa,Lupiro and Mavimba) in south-eastern Tanzania during dry and wetseasons in 2015 and 2016. Synergist tests with piperonyl butoxide (PBO),diethyl maleate (DEM), and triphenyl phosphate (TPP), were used toinvestigate insecticide resistance mechanisms of the observed resistancephenotype. Proportional biting densities of Culex species, relative to othertaxa, were determined from indoor surveillance data from 2012, 2013and 2015.Results: Resistance varied significantly between wards and seasons.For example, in Minepa, females were susceptible to bendiocarb andfenitrothion in wet season yet resistant in dry season, while in neigh-bouring Lupiro ward, they were fully susceptible to this pesticide in bothseasons. Synergist assays revealed possible involvement of monooxy-genases, esterases and glutathione -S- transferase in pyrethroid andDDT resistance. Morphology-based identification and molecular assays ofadult Culex revealed that 94% were Cx. pipiens complex, of which 81%were Cx. quinquefasciatus, 2 % Cx. pipiens pipiens and 3% were hybrids.About 14% of the specimens could not be positively identified. Separately,adults collected indoors were 100% Cx. pipiens complex, and constituted61% of overall indoor biting risk.Conclusion: We conclude that Cx. pipiens complex, constitute the great-est biting nuisance inside people’s houses, and exhibit resistance to mostinsecticides with resistance levels varying between neighbouring wards

and seasons. Elevated metabolic enzymes could underlie the mechanismof resistance phenotypes. Mosquito control programs should considerthese findings when deploying pesticide-based interventions, as the highdensities and resistance could negatively influence overall impact andacceptability of the operations.

P067HIGH RESOLUTION INSIGHT INTO HEPATITIS B VIRUS EPI-DEMIOLOGY IN AFRICA TO INFORM ON INTERVENTIONSTRATEGIES

McNaughton A.L.1, Lourenço José2, Bester P.A.3, Mokaya J.1,Goedhals D.3, Gupta S.2, Seeley J.4,5, Newton R.4,6, Ocama P.7,Matthews P.C.1,8

1Nuffield Dept. of Medicine, University of Oxford, Oxford;2Dept. of Zoology, University of Oxford, Oxford, UK;3Division of Virology, University of the Free State and NationalHealth Laboratory Service, Bloemfontein, South Africa;4Medical Research Council/Uganda Virus Research Institute andLondon School of Hygiene and Tropical Medicine Uganda ResearchUnit, Entebbe, Uganda;5Faculty of Global Health and Development, London School ofHygiene and Tropical Medicine, London, UK;6Dept. of Health Sciences, University of York, York, UK;7Makerere University College of Health Sciences, Kampala,Uganda;8Dept. of Infectious Diseases and Microbiology, Oxford UniversityHospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK

Introduction: Hepatitis B virus (HBV) prevalence varies considerablybetween settings on the African continent. Reasons for these differencesremain poorly understood, as does their impact on interventionstrategies. Most studies on chronic HBV infection (CHB) focus on theviral surface antigen (HBsAg), a biomarker of active infection. Exposureto HBV in immunocompetent adults leads to natural clearance in >90%cases, generating life-long immunity. The prevalence of HBV exposuremay therefore be informative for intervention strategies.Aim: We examined the relationship between HBV exposure and CHB inAfrica and explored the extent to which this information can be used toinfer transmission patterns and plan interventions.Methods: We defined exposure (conferring immunity) to HBV as HBVcore antibody (anti-HBc) positive and HBsAg negative. In June 2018,we systematically searched public databases using PRISMA guidelinesto identify publications from adult African cohorts that included datafor both anti-HBc and HBsAg prevalence. We used the United Nationsgeoscheme to define a list of African nations and to classify the continentinto Northern (NorthernA), Southern (SouthernA), Western (WesternA),Eastern and Central Africa (CentalA).Results: In total, we identified 89 studies spanning 65% Africannations. Across Africa, HBsAg prevalence is positively correlated withtotal anti-HBc, p<0·0001. Anti-HBc prevalence was ≥70% in 24%studies, indicating high exposure to HBV. WersternA had the highestprevalence of both HBsAg and anti-HBc positivity, and the lowest inNorthernA. We observed a two-fold difference in HBsAg prevalencebetween NorthernA and SouthernA (p=0.04) without any signifi-cant change in anti-HBc prevalence (p=0.99). CentralA was the onlyregion where there was no correlation between HBsAg and anti-HBc(p=0.99).Conclusion: We identified distinct regional associations between expo-sure and CHB in Africa. Factors including age at exposure, route of infec-tion, host genetics and viral genotype, are likely underestimated deter-minants of CHB prevalence in Africa.

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We suggest that regions with high HBsAg and comparatively low anti-HBcprevalence may benefit most from antenatal screening and intervention,as vertical transmission may be driving high CHB rates. Populations withhigh anti-HBc prevalence have a low proportion of susceptible individuals,and diagnosing and treating infected individuals may be a more effectiveapproach in such populations.

P069

THE LABORATORY ASSESSMENT OF BEHAVIOURAL AND PHYSI-OLOGICAL RESPONSES OF ANOPHELES GAMBIAE TO PIPERONYLBUTOXIDE

Mthawanji R.1, Foster G.21Vector Biology, Malawi Liverpool Wellcome Trust, Blantyre,Malawi,2Vector Behaviour group, Liverpool School of Tropical Medicine,Liverpool, UK

Introduction: Malaria occurrence has decreased remarkably across sub-Saharan Africa and this is largely due to the mass distribution of insecti-cide treated bed nets. However, over the years, mosquitoes have acquiredresistance to pyrethroids and this threatens the future effectiveness ofbed nets, therefore alternative solutions and compounds are urgentlyneeded. Piperonyl Butoxide (PBO) incorporation in nets treated with LLINsis one potential solution as it is a synergist that enhances the pyrethroidactivity by inhibiting the P450 enzymes. However, little is currently knownregarding whether exposure to this compound in an LLIN affects the wayin which mosquitoes interact with the net.Aim: This project assessed the impacts of exposure to PBO-LLINs onAnopheles gambiae with focus on longevity, behaviour, host-seeking andreproductive capacity.Methods: The thumb test assay (developed by the McCall group at LSTM)was used to assess mosquito behaviour at the net interface, these werecoded on BORIS and exported to SPSS. The experiment compared twostrains of Anopheles gambiae, Kisumu and Banfora.Results: The study observed three study arms; untreated net, deltamethrinonly and PBO- deltamethrin combination net (Permanet3.0 roof). Theresults showed a reduction in net contact time and blood feedingduration on the treated nets in comparison to the untreated, additionally,Banfora spent more time on the treated net than the untreated, whileKisumu spent more time on the untreated net. The study also showedthat blood meal concentration and oviposition rates are affected bynet type and Deltamethrin only net showed higher hatch rates thanother treated net types in the Banfora. It was observed that PBOLLINs exhibit repellency properties in Kisumu strain. The experimentrevealed mortalities of 100% with the PBO net on both the resistantand susceptible strain.Conclusion: The PBO LLIN (PN3) is very effective and has significanteffects on the longevity, fecundity and blood feeding duration of suscep-tible and resistant vectors.

P070IMPLEMENTATION OF THE WHO HAND HYGIENE STRATEGY INFARANAH REGIONAL HOSPITAL, GUINEAMüller S.A.1, Wood R.1, Tounkara O.2, Arvand M.1, Diallo M.2,Borchert M.11ZIG, Robert Koch Institute, Berlin, Germany;2Regional Hospital Faranah, Faranah, Guinea

Introduction: Nosocomial infections are the most frequent adverseevent in healthcare worldwide, with highest burdens in resource-

limited settings. Recent epidemics emphasised the disastrous impactthat the spread of infectious agents within healthcare facilities canhave, accentuating the need for improvement of infection controlpractices. Hand hygiene measures are considered to be the pri-mary effective tool to prevent nosocomial infections, thus makingimportant contributions to improving patient safety. However, knowl-edge and compliance are low, especially in vulnerable settings suchas Guinea.Aim: To improve hand hygiene, increase patient safety and strengthenhospital performance by introducing the WHO Hand Hygiene Strategyincluding the local production of alcohol-based hand disinfectant.Methods: All currently contracted health care workers in the FaranahRegional Hospital were invited to participate. Hand hygiene knowledge,perception and compliance as well as hospital needs were assessed 12months before and directly after the intervention. A second follow upafter 6 months is planned. The tailored implementations consisted of atraining adapted to the needs identified in the baseline assessment andthe regeneration of local hand disinfectant production. Before-and-aftercomparison was used to assess the effectiveness of the implementationin this hospital.Results: The survey included the vast majority (baseline 72.9%, 62/85;follow-up 84.7%, 72/85) of all health care workers, with representationof every ward and profession. Baseline knowledge and compliance werelow (52.4% and 23.4%, respectively), despite previous training in themajority of participants (88.7%). Follow-up found a significant increasein knowledge (75.6%; p<0.0001). Follow-up observation of compliance isongoing. Perception surveys showed high awareness and receptivenessto hygiene campaigns throughout.Conclusion: The WHO Hand Hygiene strategy is a feasible and adaptablestrategy to improve hand hygiene. This study highlights a potential forfurther improvement of the strategy by adopting the questionnairesto local conditions, language and level of education. Preliminary find-ings suggest the intervention’s effectiveness and sustainability, whilefurther analysis of compliance and a second follow-up are pending.Involving the hospital hygiene committee, who incorporated project-specific tasks into their routine responsibilities, enhances prospects ofsustainability.

P071

A LABORATORY BIOASSAY TO EVALUATE INSECTICIDES ASINDOOR RESIDUAL SPRAYED (IRS) WALL TREATMENTS FORMALARIA VECTOR CONTROL

Murphy A.1, Matope A.1, Seniya C.2, Voloshin V.2, Foster G.1,Towers C.2, Ranson H.1, Towers D.2, McCall P.11Vector, Liverpool School of Tropical Medicine, Liverpool;2Engineering, University of Warwick, Coventry, UK

Indoor Residual Spraying (IRS) is widely used for malaria vectorcontrol in Africa, but under threat from widespread insecticide resis-tance in targeted anopheline malaria vector populations. The needfor novel insecticides to manage resistance and maintain reduc-tions in human disease requires better assays to evaluate newchemistries and to understand their impacts on the vector’s biology andbehaviour.The “IRS-Box” is a laboratory-bench assay that exposes mosquitoesto insecticide-treated wall surfaces in a mid-sized closed environment,where they are maintained for the duration of a gonotrophic cycle. Thetest chamber (40 x 40cm2) comprises four vertical walls, assembled fromplywood or other timber, or mud/cement poured into moulds that, whenset, clip together to from the walls. The clear perspex horizontal surfacesallow access to the chamber (top) or illumination and camera (below). Aninfra-red video system records resting or flying test mosquitoes through-

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out, while adding motion detection software significantly reduces the sizeof data files generated.The IRS-Box allows discrimination between an insecticide’s repellencyand contact irritant properties, and the measurement of any delayedor sub-lethal effects of exposure, while also providing a video record ofmosquito behavioural responses to treatments by surface treatment andmosquito resistant status. This assay has the potential to better describethe repellent properties of existing and new insecticides for use in IRS.Preliminary studies are investigating the effects on Anopheles gambiae,using the pyrethroid-susceptible (Kisumu) and resistant (Banfora) strains,and selected insecticides from the range currently used in Africa or beingconsidered for use against highly pyrethroid resistant populations, appliedto wood, mud and other wall surfaces, either painted or unfinished. TheIRS-Box is a simple rapid test intended to precede whole room testingin the search for new vector control tools, in any laboratory or field siteworking to that goal.

P073

IMPACT OF THE INDIGO ICE FREE VACCINE SYSTEM ON ROU-TINE IMMUNIZATION IN PAY KONGILA HEALTH ZONE, DEMO-CRATIC REPUBLIC OF THE CONGO

Mvumbi M.G.1, Okitolonda.V.1, Hoff N.A.2, Rimoin A.3, MasisaM.1,2, Okitolonda W.E.1,3, Muyembe J.J.31Dept. of Epidemiology, Kinshasa School of Public Health/FELTP-DRC, DR Congo;2UCLA Fielding School of Public Health, Los Angeles, USA;3Faculty of Medicine, Université de Kinshasa, DR Congo

Background: Poor infrastructure and difficult terrain isolate many villagesin the Democratic Republic of the Congo (DRC) making vaccine delivery,supply and storage under proper conditions difficult. These issuescan compromise vaccine efficacy and result in sub-optimal immunitydespite vaccination. Health indicators remain a significant concernin the DRC. Although infant and under-five mortality rates declinedfrom 165 � and 98 � respectively during the 1997-2002 and 148� and 92 � 2002-2007 period, the maternal mortality rate remainsunchanged, at 1289 per 100,000 live births. Furthermore, the estimatednumber of unvaccinated children exceeds 600,000, with WHO/U-NICEF estimating that in 2011, the three-dose DTC coverage was atonly 70%.Aim: Evaluate the new vaccine system – Indigo (freeze-free, ice-free,rechargeable, and portable).Methods: We conducted a study to evaluate the impact of replacing ice-based vaccine carriers with the indigo vaccine carrier in the health zoneof Pay Kongila in the Kwilu province of the Democratic Republic of Congoin infants less than one year of age and pregnant women who attendedroutine vaccination clinics from July 2017-April 2018. Data was collectedby the health care workers who were charged with vaccination in 5 out of21 vaccine distribution axes.Results: 8495 children were vaccinated using Indigo during the fieldevaluation as compared to 4 672 children vaccinated with ice based.

• The Number of immunization locations using ice-based carriers waslimited to select outreach locations (40). With Indigo, vaccinatorsincreased the number of outreach locations as they traveled tovillages in the community (147);

• Mother are not required to walk as far to outreach locations to obtainvaccinations – burden of travel is effectively shifted up the supplychain;

Conclusion: The introduction of Indigo is changing distribution practicesfor routine Immunization, resulting in more outreach locations accessedby vaccinators using indigo.

P074

TUBERCULOSIS AND THE SPINE: MOVING TO THE UNDER-STANDING OF THE BURDEN AT KIGALI UNIVERSITY TEACHINGHOSPITAL

Ntambara K.N.1, Kailani L.2, Ntacyabukura B.31University of Rwanda-school of medicine and pharmacy, Kigaliuniversity teaching hospital, Rwanda;2Kigali University Teaching Hospital, HRH attending, Geisel schoolof medicine, Dartmouth, USA;3University of Rwanda-school of medicine and pharmacy, Kigaliuniversity teaching hospital, Kigali, Rwanda

Introduction: Pott’s disease affects 20% of all TB cases worldwide,accounts a half of all skeletal tuberculosis, and HIV/AIDS remains themajor accelerator globally. However, no research was done before in ourregion.Aim: This study aimed to understand its prevalence, clinical manifesta-tions and outcome among patients treated at Kigali University TeachingHospital (KUTH).Methods: This was a case series study from Jan 2011- Jan2016. Datawere collected from patients’ files in the archive department and analysiswas done using SPSSv23.Results: In total, 22 patients were included. Male to female ratio of 1.1:1.Only 18.2% of all patients were institutionalized. Risk factors were previ-ous TB in 47.8%, HIV in 34.8%, diabetes mellitus in 13% and malnutritionin 4.3%. All our patients presented with back pain associated with limbs’weakness at 59%, spinal deformity and paraplegia at 36.6%. The averagehospital stay was 32 days. Only 31.82% recovered completely withoutany complication or sequelae, 50% recovered with sequelae, 13.64% diedin the hospital while 4.5% developed complications during hospitalizationbut recovered.Conclusion: Pott’s disease was more prevalent in patients with previoushistory of TB infection and HIV patients. Back pain was the single reliablesymptoms and sequelae were more common. Awareness and screeningamong groups prone to the diseases is recommended as well as furtherresearch to improve outcome.

P075

TRANSFLUTHRIN PLASTIC SHIELDS FOR CONTROLLING OUT-DOOR MALARIA TRANSMISSION

Njoroge M.1,2, Hiscox A.2, Saddler A.3,4, Fillinger U.11International Centre of Insect Physiology and Ecology, Nairobi,Kenya;2Wageningen University and Research Centre, Wageningen, TheNetherlands;3Ifakara Health Institute, Ifakara, Tanzania;4Swiss Tropical Health Institute, Basel, Switzerland

Introduction: Spatial repellents are a promising tool for malaria vec-tor control as they generate areas of protection from mosquito biteswithout creating selection pressure that increases insecticide resistance.Creation of prolonged release technologies that can sustain protectionagainst bites, especially when outdoors is key to the feasibility of usingthis technology. Plastics that have been impregnated with insecticidescreate efficient ways of delivering sustained concentrations of repel-lents without the requirement for power. Transfluthrin is efficacious inreducing indoor biting rates of anopheles mosquitoes on humans. TheRaid® Shield impregnated with 1% transfluthrin has been developedfor research purposes by the SC Johnson Company and presents trans-fluthrin through simple diffusion. The impact of Raid® Shield on human

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landing catches by Anopheles arabiensis was evaluated under semi-fieldconditions.Aim: To assess the impact of transfluthrin on An. arabiensis humanlanding rates when used as a spatial repellent in the form of Raid®

Shields.Methods: Two Raid® Shields were placed either on the eaves of experi-mental huts (1.5m from the ground) or in passive emanators (∼30cmsfrom the ground). 160 insectary-reared An. arabiensis were released inthe screen houses and human landing collections took place for fourhours (1900h – 2300h). Outdoor HLCs were conducted 2.5m away fromthe experimental hut. Insectary colonies used were tested for suscepti-bility to 0.05% deltamethrin.Results: In the presence of transfluthrin Raid® Shields in passiveemanators, human landing rates were significantly reduced comparedto those in the presence of untreated shields or in control set up (noshields) (OR 0.74, 95% CI 0.59-0.94 p=0.000). There was no significantdifference in human landing rates in the presence of untreated plasticshields compared to the control. When used on the eaves of houses,the transfluthrin Raid® Shields were not associated with reduced humanlanding rates. Insectary-reared mosquitoes had 75.6% susceptibility todeltamethrin.Conclusions: Raid® Shields treated with transfluthrin have the potentialof offering protection from outdoor-biting mosquitoes, especially whenplaced just above ground level. Mosquitoes used in all assays showedresistance to 0.05% deltamethrin according to the WHO thresholds.Further studies of the protective effect of the shields in field assays wouldbe necessary.

P077SYNTHESIS AND EVALUATION OF GREEN SOLID LIPIDMICROPARTICULATE MOSQUITO REPELLENT CREAMSNwagwu C.S.1, Nwobi L.G.2, Ogbonna J.D.N.1, Nwobi O.C.3,Echezona A.C.1, Amadi B.C.4, Ezeibe E.N.5, Ozioko A.C.5, AttamaA.A.11Dept. of Pharmaceutics, University of Nigeria, Nsukka;2Dept. of Veterinary Physiology and Pharmacology, University ofNigeria, Nsukka;3Dept. of Veterinary Public Health University of Nigeria, Nsukka;4Institute for Drug-Herbal Medicine-Excipient Research and Devel-opment, University of Nigeria, Nsukka;5Dept. of Pharmaceutical Microbiology and Biotechnology, Univer-sity of Nigeria, Nsukka, Nigeria

Introduction: Mosquitoes are medically important arthropods whichhave been implicated in the transmission of certain deadly diseasessuch as malaria, and dengue fever. Many measures have been usedin the control of mosquitoes and the use of repellents has shown tobe a practical and economical way of preventing mosquito transmitteddiseases as they can mask human scent or transmit a scent that repelsmosquitoes.Aim: The aim of the study was to develop and characterize solid lipidmicroparticulate (SLM) mosquito repellent cream formulations contain-ing extracts from Ocimum gratissimum and Azadirachta indica.Methods: The extracts used for the study were obtained from the twoplants using a soxhlet apparatus and n-hexane as the solvent. Thevarious SLM batches were then prepared using hot homogenizationmethod. The stability of the formulated SLM creams was evaluatedby measuring the pH, viscosity and particle size at various timeintervals. In vitro occlusion test, skin irritation test, rheological studies,FTIR analysis, encapsulation efficiency, loading capacity, ex vivopermeability and percentage repellence for the SLM batches were alsodetermined.

Results: The study showed a significant decrease in the pH values andviscosity for the various formulation and an increase in particle size.The formulations showed higher occlusive effect and higher permeationcoefficients compared to the commercial 12% DEET cream (Odomos®)and no sign of skin irritation. The principal peaks of FTIR spectrum of theplant extracts and the plain SLM appeared in the various formulationbatches. The encapsulation efficiency values of the SLM batches werebetween 52% and 88% while loading capacity values of the variousbatches were between 2.6% and 13.3%.The rheological characterizationshowed that the batches exhibit dominant solid-like behaviour between4◦C and 40◦C and that above 40◦C there was an increase in the liquid-likebehaviour of the systems. The control (12% DEET) produced significantlyhigher percentage mosquito repellence compared to the SLM creams.However, the SLM formulations produced higher repellence than thecrude extracts.Conclusion: This study showed the performance of the SLM formulationsas a possible candidate for the delivery of plant extract for mosquitorepellent application.

P078DEVELOPMENT OF A MICROSATELLITE TYPING ASSAY FORSTUDYING GENETIC VARIATION IN MADURELLA MYCETOMATISNyuykonge B.1, Eadie K.1, Zandijk W.H.A.1, Fahal A.H.2, Desnos-ollivier M.3, van de Sande W.W.J.1, Klaassen C.H.W.11Erasmus MC, Dept. of Medical Microbiology and Infectious Dis-eases, Rotterdam, The Netherlands;2Mycetoma Research Center, Khartoum, Sudan;3Institut Pasteur, Unité de Mycologie Moléculaire, Paris, France

Introduction: Madurella mycetomatis is the major causative agent ofeumycetoma, a neglected tropical infection with large subcutaneouslesions, inflammation and grains draining from sinuses. In order to studythe epidemiology of mycetoma, a robust and highly discriminatory typingtechnique is needed. Here, we describe the use of a novel Short TandemRepeats assay for genotyping of M. mycetomatis (MmySTR) predomi-nantly from Sudan.Methods: Eight microsatellite markers (4 trinucleotide repeats and 4tetranucleotide repeats) were selected from the M. mycetomatis genome(MM55) using the Tandem Repeats Finder software. Specific labelledprimers were designed for each microsatellite marker using primer3software and amplified in a multicolor multiplex PCR assay. To determinethe genetic variation, a collection of 111 clinical isolates from differentregions was genotyped with this assay.Results:The 8 selected MmySTR markers could differentiate betweendifferent M. mycetomatis isolates from the same geographical region aswell as from different geographical regions. From this collection of 111isolates, we identified 85 different genotypes and obtained a D value of0.996.Conclusion:The MmySTR assay is a promising novel typing techniquewhich could be used to genotype isolates of M. mycetomatis. The geneticdiversity observed among the isolates could explain the different mani-festation of mycetoma.

P080PAN AFRICAN NETWORK ON PLASMODIUM VIVAX: UNDER-STANDING THE BIOLOGY, DETECTION AND ELIMINATIONQuaye I.1, Moffat S.1, Oeuvray C.2, Greco B.21Regent University of Science and Technology, Accra, Ghana;2Merck Global Health Institute, Ares Trading S.A., Switzerland, anaffiliate of Merck KGaA, Darmstadt, Germany

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Introduction: Recent reports indicate that Plasmodium vivax (Pv)infections exist in sub-Saharan Africa. Currently, there are thirteen sub-Saharan African countries with reports of Pv infections either singularlyor as coinfection with Plasmodium falciparum (Pf ). The biology of Pv isunique characterized by hypnozoite stage, early gametocyte generation,low parasitemia with predominantly asymptomatic infections comparedto Pf and complexity of treatment due to G6PD deficiency associatedhemolytic episodes. In low endemic settings without highly trainedpersonnel, Pv infections may be diagnosed as Pf . These Pv relatedinfection profiles makes interventions that are tailored to Pf unsuitableagainst Pv, which requires its own specific targeted interventions. Acareful study of Pv biology and shared expertise on detection andelimination efforts are critical.Aim: To create an African Research Network to support the implementa-tion of treatment and diagnostic of P. vivax.Methods: The global goals for reduction of malaria in Africa, targetseventual eradication through elimination. This needs to be buttressedby a strong research base that helps in coordinated efforts not onlyfor in country activities but cross border efforts to stem transmissionand facilitate elimination. The hypnozoite stage of Pv and asymptomaticinfections of both Pv and Pf requires effective tools for surveillanceand data acquisition critical for the global agenda. Through the cre-ation of a Pan-African consortium, the standard methodologies, pro-tocol, data collection and research objectives will be developed andagreed in order to inform public health policies and decisions. The Africannetwork will forge collaboration for understanding the parasite biol-ogy, exchange expertise in detection and share knowledge on efforts atelimination.

P082ECOLOGY, DISTRIBUTION AND RISK OF TRANSMISSION OFVIRAL HAEMORRHAGIC FEVERS BY AEDES MOSQUITOESAROUND THE PORT AREAS OF TEMA, SOUTHERN GHANAOjukwu K.C.1, Adabie-Gomez D.A.M.1,3, Nwankwo E.N.4, DadzieS.K.1,2

1African Regional Postgraduate Programme in Insect Science, Uni-versity of Ghana, Legon;2Noguchi Memorial Institute of Medical Research, University ofGhana, Legon;3School of Veterinary Medicine, University of Ghana, Legon, Ghana;4Dept. of Parasitology and Entomology, Nnamdi Azikiwe University,Awka, Nigeria

Introduction: The genus Aedes consists of mosquitoes of public healthimportance known to serve as vectors for several arboviruses that causediseases such as yellow fever, dengue, chikungunya, and zika. Species inthis genius are found in different parts of the world with distribution intonew geographical limits made possible by international trade and varioushuman activities, which is currently the case of Aedes albopictus.Aim: To generate baseline ecological and entomological information onthe different species of Aedes mosquitoes in the port areas of Tema, espe-cially to delineate the distribution of the invasive species Ae. albopictus.Methods: The study sites are Golden Jubilee Terminal of Tema Seaport,Tema Community One, Tema New Town. The mosquitoes from this studywere collected using human landing catches, ovitraps and larval col-lections over a period of six months covering rainy and dry seasons.House, Container and Breteau Indices were used in assessing the risk oftransmission of viral haemorrhagic fever.Results: A total of 1,092 containers were inspected in both seasons. Ofthese, 237 (21.7%) were positive for mosquito larvae and pupae in rainyseason while 181 (16.6%) were positive in dry season. A total of 6,948mosquitoes were collected; where 6,038 (92.9%) were Aedes aegypti, 337

(5.2%) Culex spp and 123 (1.9%) Anopheles gambiae. The Ae. aegyptilarvae was found breeding in various water holding containers whichincluded disposed plastic containers, earthenware pots, car tyres, plasticbarrels, plastic basins, buckets, metal drums, jerrycans and polytanks.High proportion of Ae. aegypti eggs were found in the ovitraps duringthe rainy season than the dry season in the study sites. Ae. aegyptiwas the most common mosquitoes biting mostly outdoors (65.6%), withmore bites in rainy season (63.6%) in the two residential sites (TemaCommunity One and Tema New Town). Risk of transmission of viralhaemorrhagic fever was higher in rainy season than in dry season for thestudy sites.Conclusion: The observations made indicate that the risk of transmissionof viral haemorrhagic fevers in the study sites is highly probable.

P083

IMPACT OF IVERMECTIN MASS TREATMENT FOR ONCHOCER-CIASIS ON MALARIA VECTOR POPULATION IN OGUN STATE,NIGERIA

Omitola O.O.1, Ejike C.U.1, Bayegun A.A.1, Anifowose S.A.1,Oluwole A.S.2, Awolola T.S.3, Sam-Wobo S.O.H.1, Ekpo U.F.11Dept. of Pure and Applied Zoology, Federal University of Agricul-ture, Abeokuta;2Countdown Project, Sightsavers Country Office;3Nigeria Institute of Medical Research, Yaba, Nigeria

Introduction: The control and elimination of malaria in the developingworld call for the development of new tools to overcome the adaptivenature of the Anopheles mosquito. Interests in ivermectin, used for thetreatment of onchocerciasis in endemic countries, as potential interven-tion tool against malaria requires further evidence to comprehensivelycharacterise the capacity of the endectocidal drug for vector control.Aim: To investigate the impact of ivermectin mass treatment on Anophe-les mosquito populations in four onchocerciasis endemic communities inOdeda LGA of Ogun State, Nigeria.Methods: Pyrethrum spray catch and outdoor CDC light traps wereused to collect indoor and outdoor anopheline mosquitoes from Julyto September 2018 from two rural communities, before and after theannual round of ivermectin mass treatment. These communities werepair-matched with two other control communities, where concurrentmosquito collection took place during the study period. Anophelesmosquitoes were identified morphologically, and parity status wasdetermined by microscopic observation of ovarian tracheoles. Mosquitodensity was determined, and treatment coverage evaluation surveyswere conducted in the treated communities.Results: A total of 1,227 Anopheles was collected. In Amini and Kugba-Ajagbe communities, where ivermectin mass treatment was adminis-tered, indoor density of Anopheles sp. dropped by 63.0% (P = 0.380) and13.6% (P = 0.388) respectively 2-3 days after ivermectin MAM. However,13-14 days after treatment, indoor densities were 7.4% higher and1.7% lower than the pre-treatment densities in Amini and Kugba-Ajagberespectively. Treatment coverage was 65.9% and 41.0% in Amini andKugba-Ajagbe respectively, and these correlated significantly (r = -0.972,P = 0.028) with the changes in indoor density observed. Before treatment,parity rate of indoor-sampled Anopheles sp. was 92.3% and 96.6% inAmini and Kugba-Ajagbe respectively but these reduced significantly to40.0% (P < 0.001) and 45.1% (P < 0.001) respectively 2-3 days afterivermectin MAM. Reduction in parity rate remained sustained after twoweeks in Kugba-Ajagbe (67.2%, P < 0.001) but was restored in Amini(93.1%, P = 1.000).Conclusion: The study indicated that mass ivermectin treatment foronchocerciasis might offer potential intervention tool for malaria vectorcontrol in certain local settings in Nigeria.

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P084IMPROVING EARLY INFANT DIAGNOSIS AMONG HIV EXPOSEDINFANTS IN SOUTH-SOUTH NIGERIA: A QUALITY IMPROVE-MENT STRATEGY IN A RESOURCE LIMITED SETTINGOnwubiko I.S.1, Okonkwo I.2, Adeniran A.3, Ezeanya C.4, OvihK.5, Uzoigwe C.61Prevention Care and Treatment, Achieving Health Nigeria Initia-tive, Ibadan;2Continuous Quality Improvement, Institute of Human Virology,Abuja;3Infectious Diseases, World Health Organisation, Ibadan;4Clinicals, Institute of Human Virology, Delta;5Hospital Management Board, Ministry of Health, Delta;6Clinicals, Institute of Human Virology, Delta, Nigeria

Introduction: Early Infant Diagnosis (EID) significantly improves the pre-vention of mother to child transmission (PMTCT) of human immunode-ficiency virus (HIV) and further promotes eradication of mother to childtransmission. However, uptake remains grossly suboptimal with imple-mentation impeded by several health workers and patient-related bar-riers despite high morbidity and mortality rate among children infectedwith HIV. We evaluated the use of a quality improvement approach toimprove early infant diagnosis in four high HIV burden secondary healthfacilities in south-south Nigeria.Aim: To improve early infant diagnosis of eligible HIV exposed babies from23% to 90% over a 4-month period.Methods: A 4-month pilot quality improvement (QI) project was con-ducted from January to April 2017. The facility QI committee comprisingof different cadres of staff working in the ART clinic together reviewedtheir HIV quality of care indicators which revealed that only 23% of eligibleHIV exposed babies had their dry blood spot (DBS) sampled betweenJanuary to June 2016. Maternal EID ignorance, absent/lost mother-babypairs (LMBP) tracking system, and no EID performance reviews weremajor root causes identified following a root cause analysis conductedby the QI committee. EID orientation for Clinicians and PMTCT Nurses,incorporation of EID education into routine health education during clin-ics, mentor mothers reminding mothers prior to scheduled clinic visitsand monthly performance EID review meetings were key change ideasimplemented to reduce missed opportunity and improve EID uptakeamidst overwhelming work load.Results: During the 4-month intervention, 75 HIV Exposed Infants (HEIs)were eligible for DBS cumulatively from the four hospitals. Of those eligiblefor DBS, 71(95%) had their DBS collected with 100% DBS samples sentto PCR laboratory and 100% result returned within 3 weeks of samplecollection to the health facilities.Conclusion: A QI strategy for improving EID among HEI was effective witha resultant 72% increase. QI principles such as team work and implemen-tation of change ideas targeted at addressing identified root causes ofthe problem were pivotal to the success. Continued implementation andscale up of effective change ideas to other hospitals could significantlyimprove PMTCT leading to vertical eradication of HIV.

P085

EDCTP AND CEPI IN PARTNERSHIP: ADVANCING VACCINEDEVELOPMENT FOR LASSA FEVER IN AFRICA

Pandya L.J.1, Imbault N.2, Habarugira J.M.V.1, Kristensen F.2,Olesen O.F.11International Cooperation Europe/Calls and Grants, European& Developing Countries Clinical Trials Partnership (EDCTP), TheHague, The Netherlands;

2Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Nor-way

Introduction: Vaccines have contributed enormously to the successfulcontrol and elimination of many diseases, but few have been developedyet for the prevention and control of emerging infectious diseases. Lassahaemorrhagic fever (LHF) has been added to the WHO R&D Blueprint listof diseases for which accelerated research and development is urgentlyneeded, in view of LHF’s epidemic potential, likelihood to cause a publichealth emergency, and the absence of efficacious drugs and/or vaccines.Fast-tracking the advancement of several Lassa virus (LASV) vaccinecandidates that will shortly enter clinical development is therefore a highpriority.Aim: The aim is to facilitate the development of promising LASV vaccinesby supporting epidemiological studies and preparation of investigationalsites in affected countries in readiness for performing LASV vaccine clini-cal trials.Methods: The European & Developing Countries Clinical Trials Partnership(EDCTP) and the Coalition for Epidemic Preparedness Innovations (CEPI)will partner on a joint call for proposals for LASV vaccines in 2019.Results: CEPI has recently signed partnerships to accelerate the clinicaldevelopment of five promising LASV vaccine candidates, based on diversetechnologies. Of these, two are expected to enter clinical development in2019. Consequently, there is an urgent need for the support of distinctepidemiological and strategic clinical research activities which are inte-grated with efforts to prepare and conduct large-scale clinical trials thathave the potential to achieve proof of concept and/or the demonstrationof pivotal efficacy of novel LASV candidate vaccines. CEPI will initiateepidemiological studies with partners in 5 affected countries in 2019, thatwill complement the planned EDCTP efforts for trial site preparations.Conclusion: Promising LASV vaccine candidates are currently progress-ing through the development pipeline. Continued support of the mostpromising candidates will be necessary to ensure their smooth transitionto the next clinical development phase. By enabling capacity for LASV vac-cine studies in endemic regions, and supporting the clinical developmentof promising candidates, the EDCTP-CEPI partnership will accelerate theadvancement of a future candidate vaccine towards regulatory licensure.

P086

EVALUATION OF RISK COMMUNICATION ON ZIKA VIRUSTRANSMISSION IN ITALY

Parodi P.1, Bellino S.2, Albonico M.3, Maraglino F.1, Rizzo C.41Ministry of Health, Rome;2Dept. of Infectious Diseases, National Institute of Health, Rome;3Centre for Tropical Diseases, S. Cuore Hospital, Negrar;4Pediatric Hospital Bambino Gesù, Rome, Italy

Introduction: The relevance of Zika virus for public health dramaticallyincreased in 2015, when an unprecedented epidemic spread from Brazilto the Americas and Asia. In Italy, Aedes albopictus is widespread andits competence for Zika transmission was laboratory confirmed. In Italy,surveillance of imported arbovirus includes notification of human cases,entomological surveillance and risk communication.Aim: To evaluate the effectiveness of risk communication and its abilityto reach high-risk people represented by the 101 imported Zika casesnotified in Italy in 2016.Methods: We developed a questionnaire, administered through tele-phone interview, to explore knowledge on the epidemiological situationof Zika virus in the country of destination; preventive measures; the mostused source of information; and the preferred communication channels.We conducted a descriptive analysis using Stata/MP version 13. Theresearch was approved by the Ethics committee.

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Results: Overall, 54 interviews were recorded. Results show that 39interviewed (72%) were aware of the epidemiological situation in thecountry of destination and 44 (81%) took measures against mosquitobites, with a preference for the use of insect repellents. Only threepeople indicated the use of sexual precautions. Internet and televisionresulted the most used source of information, and the most preferred.Health care providers were reported to have played a limited role inrisk communication but they were indicated as the third most preferredway to receive health information. Friend and relatives in the countryof destination covered an important role in raising awareness, but theywere rarely indicated as the preferred source of information, suggesting avicarious role.Conclusion: Findings indicate that most of the interviewed were awareof the epidemiological situation and the preventive measures linkedwith mosquito bites. Messages concerning sexual transmission shouldbe increased, due to possible implications in the spread of the infec-tion in non-endemic countries. As about one-fourth of the Zika caseswere returning travellers, it would be more appropriate to prepare multi-cultural information materials in several languages. Health care providersshould be more involved in risk communication as they are a trustedsource of information, through a stricter collaboration with scientificassociations.

P087

DEVELOPMENT, VALIDATION AND IMPLEMENTATION OFPRECLINICAL MODELS OF LOIASIS AND ONCHOCERCIASIS TOIDENTIFY CANDIDATE MACROFILARICIDAL DRUGS

Pionnier N.1, Sjoberg H.1, Metuge H.2, Chunda V.2, NjouendouA.2, Fombad F.2, Ndzeshang B.2, Taylor M.1, Wanji S2, Turner J.11Centre for Drugs & Diagnostics, Dept. for Tropical Disease Biology,Liverpool School of Tropical Medicine, Liverpool, UK;2University of Buea, Buea, Cameroon

Introduction: Onchocerciasis is a priority Neglected Tropical Disease.To achieve its elimination, alternative strategies to ivermectin(IVM)-based mass drug administration are required, especially where loiasisco-infections risk the occurrence of IVM-related serious adverse events.The development of novel, short-course macrofilaricides that areselective against Onchocerca adults are considered a potential solution.However, the lack of robust, facile preclinical in vivo models of loiasisand onchocerciasis have hitherto stymied accurate identification ofefficacious new drug candidates.Aim: Using our knowledge of Immunity to filariasis in rodents, we aimedto develop immunodeficient mouse/gerbil models of onchocerciasis andloiasis, validate them as in vivo filaricidal drug screens and implementthem to test the current preclinical candidates’ portfolio.Methods: Using a variety of immunodeficient mouse strains or gerbilsand different parasite stages of Onchocerca ochengi and Loa loa, wetested susceptibility to defined life cycle stages. The most robust modelswere validated against reference macro- or microfilaricides (doxycycline,flubendazole, ivermectin). Sufficiently robust small animal models wereimplemented in preclinical drug screens to test efficacy of candidatemolecules in collaboration with pharmaceutical partners (AbbVie, Anacor,Calibr, Celgene, Eisai, Janssen).Results: Reproducible recoveries of O. ochengi infections could beachieved 6-weeks following implantations of male worms, sourced fromnaturally-infected cattle in CB.17 severe-combined immunodeficient(SCID) mice. Lower adult recoveries were achieved using Merionesgerbils. L. loa microfilaraemic models were successfully obtained fromeither wild-type or SCID mice 7-days post-infusion with 40000 L.loa microfilariae. SCID and gerbil male Onchcoerca implant modelsresponded reproducibly with 98-100% efficacy to treatments with

reference macrofilaricides, doxycycline or flubendazole. In L. loamicrofilaraemic mice, IVM single-oral dose induced a rapid decline(>90%) in circulating microfilariae after 48h in multiple independentexperiments. We latterly deployed SCID or gerbil Onchocerca implantmodels to scrutinise the preclinical macrofilaricidal efficacy of 3repurposed anti-Wolbachia antibiotics, 4 new chemical entity (NCE) anti-Wolbachia agents, 2 repurposed anthelmintics and 2 NCE anthelmintics.Candidates were counter-screened for potential L. loa microfilaricidalefficacy.Conclusion: We have successfully developed murine models of onchocer-ciasis and loiasis and implemented them in a drug development pipelineto provide decision-making data on progression of macrofilaricidal candi-dates.

P088

MALARIA DETECTION IN TRANSFUSION MEDICINE: COMPAR-ISON OF MOLECULAR METHODS TO OPTIMISE P. FALCIPARUMDETECTION

Piubelli C., Pomari E., Perandin F., La Marca G., Moro L.,Bisoffi Z.Dept. of Infectious-Tropical Diseases and Microbiology, IRCCSSacro Cuore Don Calabria Hospital, Negrar di Valpolicella (Verona),Italy

Introduction: Transfusion-transmitted malaria may be responsible forsevere clinical symptoms. With increased travelling and migratoryphenomena, identification of blood donors at risk of malaria infectionhas become an issue. European guidelines for donors’ screening reducedthe risk of transfusion-transmitted malaria, but are still not optimal,with a high price in terms of blood donation loss. New approachesbased on more accurate and cutting-edge techniques should beintroduced to integrate serological tests and the selection of at-riskdonors.Aim: The study aim was to evaluate the applicability of three front-line molecular technologies and a possible method to concentrate ery-throcytes, in order to improve Plasmodium falciparum DNA detectionin blood. The same tests were also assessed on serum, to evaluatethe possibility of using a single matrix for both serology and moleculartests.Methods: 24 whole blood and serum paired samples from patientswith P. falciparum malaria with parasitaemia ranging from 9.5% to0.0003% were analysed with real-time PCR (rt-PCR), digital PCR (dPCR)and loop mediated isothermal amplification (LAMP). For LAMP, theIllumigene Malaria plus kit (Meridian Biosc.) was applied. rt-PCR anddPCR methods were adapted from an in-house developed TaqManassay. A centrifugation-based method was tested for erythrocyteconcentration.Results: For blood matrix, the three methods equally could reveal all theP. falciparum positive samples across the explored parasitaemia range.Only dPCR was able to easily provide quantitative results that were rep-resentative of the parasitaemia values. From results on serum samples,none of the tested methods could detect a signal in all the samples, butdPCR resulted to be the most sensitive among the three technologies.The erythrocyte concentration method allowed an increase in the rt-PCRsignal of about 0.5 Cycle threshold, that could be compared (with grossapproximation) to an equivalent increase of 0.08% in parasitaemia. Insamples with haemolysis, the concentration method did not provide anincrease in the signal.Conclusion: Due to its sensitivity and quantitative characteristic, dPCR incombination with a concentration method seems to represent the mostsuitable solution to be applied in transfusion medicine. The use of serumas unique matrix needs further exploratory studies.

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P091

SUSCEPTIBILITY AND IRRITABILITY OF ANOPHELES STEPHENSIMALARIA VECTOR AGAINST INSECTICIDES USED FOR THEINDOOR RESIDUAL SPRAYS: A FIELD SURVEY IN PAKISTAN

Rana M.S., Ather S.University Institute of Public Health, University of Lahore, Lahore,Pakistan

Introduction: Southern Punjab is malaria endemic and known to haveinsecticide resistant Anopheles and drug-resistant Plasmodium. In thispart of the country, five anopheline mosquitoes, Anopheles stephensiListon, Anopheles culicifacies Giles, Anopheles fluviatilis James, Anophelessuperpictus Grassi, and Anopheles subpictus Grassi (Diptera: Culicidae) areknown as malaria vectors1. Among these, An. culicifacies is the primaryand An. stephensi is the secondary malaria vector. Outbreaks of malariausually occur after rain2.Aims: The aim of study was to determine the susceptibility and irritabilitylevels of adult stages of Anopheles stephensi Liston and Anopheles culici-facies Giles to the discriminative dose of different insecticides.Methods: For the purpose, we used World Health Organization criteria forassessment. Mortality was calculated after one-hour exposure and 24 hrecovery period for various insecticides.Results: An. stephensi was found to be significantly resistant todichlorodiphenyltrichloroethane (DDT, an organochlorine), dieldrin (achlorinated hydrocarbon), and Malathion (organophosphorus), withlethal times (LT50) of 83.17, 52.48, and 37.53, respectively. However,the species was significantly sensitive to permethrin, deltamethrin(pyrethroids), and fenitrothion (organophosphate) with LT50 of 2.85,2.34, and 13.18, respectively. Among these, permethrin showed morepromising results against adult An. stephensi. When analyzed for irritancy,we found that among pyrethroids, permethrin was the most irritantinsecticide for both An. stephensi and An. culicifacies. DDT and dieldrinshowed least irritancy with 0.42_0.08 and 0.77_0.12 take offs per minuteper adult, respectively, against An. stephensi. The mean number of takeoffs per minute per adult with permethrin showed significant irritancy forpermethrin when compared with DDT.Conclusion: We concluded that the use of organochlorine and chlorinatedhydrocarbon should not be used until there is enough evidence, and theuse of pyrethroids should be continued for indoor residual spraying.

References:1. Ahmad, S. M., Qadir, F and Saleem, M. R. 2002. In vitro studies of anti-malarial drug resistance in Plasmodium falciparum. Punjab Univ. J. Zool.17: 23-27.2. Rana, M. S., Ali, S. S., Tanveer, A and Husain, R.1999. Vectorial capacityof Anopheles stephensi in Muzaffargarh Punjab, Pakistan. Pak. J. Health36: 40-42.

P092

TOWARD LICENSURE OF THE FIRST AND FUTURE GENERATIONSOF LIVE PARASITE PLASMODIUM FALCIPARUM SPOROZOITE(PFSPZ) VACCINES

Richie T.L.Clinical Dept., Sanaria Inc., Rockville, Maryland, USA

Introduction: In 2017, the number of malaria cases worldwide increasedfor the second year to 219 million, leading to 435,000 deaths. Thedeteriorating situation in many African countries underscores the urgentneed for a vaccine that can be used in conjunction with standard controlmeasures to halt transmission and eliminate malaria, particularly Plas-modium falciparum (Pf), the most lethal malaria parasite.

Aim: Sanaria’s platform technology produces aseptic, purified, cryopre-served metabolically active Pf sporozoites (SPZ) that meet all regulatorystandards. Sanaria aims to license a first generation vaccine by 2022,initially to protect adults, and a year later to protect all persons >1year of age. The long-term objective is to undertake mass vaccinationprograms (MVPs) to achieve regional malaria elimination and eventualglobal eradication.Methods: Several candidate PfSPZ-based vaccines are being developedand tested, including PfSPZ Vaccine (radiation-attenuated PfSPZ), PfSPZ-CVac (fully infectious PfSPZ chemo-attenuated in vivo), and PfSPZ-GA1(genetically-attenuated PfSPZ). More than 40 research groups and gov-ernment institutions from 18 countries, organized as the InternationalPfSPZ Consortium (I-PfSPZ-C), collaborate to advance this program byproviding intellectual, clinical, and financial support. Twenty-three clinicaltrials of these vaccines have been completed in the USA, Europe andAfrica, and 4 more are underway. A first Phase 3 trial is funded for 2020.Results: Ten randomized, double-blind, placebo-controlled trials haveshown excellent safety and tolerability in infants, children and HIV-infected and uninfected adults, with no difference in adverse eventsbetween vaccinees and normal saline controls. The lead candidate, PfSPZVaccine, has demonstrated sustained (6 month) protection of 50% bytime-to-event analysis against naturally transmitted Pf in three field trialsand 90-100% protection against controlled human malaria infection(CHMI) lasting at least 59 weeks.Conclusions: PfSPZ-based vaccines are composed of PfSPZ that meetregulatory standards, are extremely safe and well tolerated, and havebeen repeatedly shown to protect against Pf. Our plan is to license PfSPZVaccine by 2022. The presentation will describe the results that supportthis plan, and also key innovations, including in vitro PfSPZ production,that will increase potency, decrease cost of goods, and enable the long-term goal of regional malaria elimination.

P093

CHRONOLOGY OF THE DISCOVERY OF THE AUTOCHTHONOUSTRANSMISSION OF SCHISTOSOMIASIS IN CORSICA

Richter J.Institute of Tropical Medicine and International Health, Berlin,Germany

In actual and retrospective articles on autochthonous schistosomiasis inCorsica the chronology of its discovery is not well described. AlthoughNapoleon’s troups were affected by urinary schistosomiasis after theircampaign to Egypt, autochthonous schistosomiasis was not discoveredin Corsica until 2014 when a German family assisted the Tropical MedicineUnit of the University in Düsseldorf, Germany on March 2014. The reasonof consultation was a hematuria that the 12-year-old son presented afterhe had swum in a river in Corsica in August 2013. There, terminal-spinedova were detected in the urine of the boy and his father, serology was pos-itive in two other siblings. Parasitologists Dr. Moné and Dr. Mouahid fromthe Laboratory IHPE at the University of Perpignan, France were contactedand urine samples of the family members were further analyzed and thehybrid character of the Schistosome species involved was suspected andlater proved by Dr. Moné and Dr. Mouahid.The cases were notified to the Vielle sanitaire, and ECDC and Robert-Koch-Institute were informed on the emergence of authochthonousschistosomiasis in Corsica.The German-French team went to trace the cases to Cavu River togetherwith the family affected in order to investigate the suspected transmis-sion sites in the Cavu River. During the mission, the team unfortunatelysuffered a serious accident leaving two of the team with severe injuriesthat required emergency surgical interventions. Nevertheless, the firstarticle during the time that two team members were inpatients and was

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published in June 2014. Later, a French team found Bulinus truncatus inthe river Cavu.

References:1. Centre of Disease Control. Rapid risk assessment: Local transmission ofSchistosoma haematobium in Corsica, France – 16 May 20142. Robert Koch Institut 19.05.2014. RKI - Archiv 2014 - Bilharziose: Häu-fung von Erkrankungsfällen bei Südkorsika-Reisenden. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2014/20/Art_02.htmlEuropean3. Holtfreter M et al. Schistosoma haematobium infections acquired inCorsica, France, August 2013. Eurosurveillance 19(22), 2014).4. Moné H et al. Introgressive hybridizations of Schistosoma haematobiumby Schistosoma bovis at the origin of the first case report of schistosomi-asis in Corsica (France, Europe). Parasitol Res. 2015; 114:4127-4133)5. Berry A et al. Schistosomiasis haematobium, Corsica, France. EmergInfect Dis. 2014 Sep; 20(9): 1595–1597.

P094

ABUNDANCE OF PHLEBOTOMINE SAND FLIES IN CHANGINGEPIDEMIOLOGICAL SETTINGS OF VISCERAL LEISHMANIASIS INNEPAL

Roy L.1, Uranw S.1, Cloots K.2, Van Bortel W.3, Das M.L.1,Boelaert M.21Tropical and infectious disease centre, B.P. Koirala Institute ofHealth Sciences, Dharan, Nepal;2Dept. of Public Health, Institute of Tropical Medicine, Antwerp;3Dept. of Biomedical Sciences, Institute of Tropical Medicine,Antwerp, Belgium

Introduction: Visceral leishmaniasis (VL) or kala-azar is a vector-borneparasitic disease, common in lowlands of Nepal. Kala-azar is a signifi-cant public health problem in the country and endemic in 18 districtsbordering North Bihar, India. The estimated population at risk is morethan 15 million. The disease is caused by parasite Leishmania donovaniand is transmitted by Phlebotomus argentipes. Since 2000, VL caseshave been reported in increasing numbers from the districts hithertoconsidered as non endemic including hilly and mountainous regions. Thepresence and abundance of vector species in these districts are so farunknown.Aim: Explore the sand fly species occurrence and abundance in VLendemic and non-endemic districts in changing epidemiological settings.Methods: Sand flies were captured in purposively selected householdsincluding the houses of past VL patients in three VL endemic and threenon-endemic districts. CDC light traps were used inside the house and/orcattle shed for two consecutive nights supplemented by mouth aspirationfor 15 minutes the following morning to catch resting sand flies bytrained insect collectors. Only one time survey was conducted in eachdistrict during the month of July and November in the year 2017 – 2018.Collected specimens were preserved in 80% ethanol and transported tothe entomology laboratory for further analysis. We reviewed the epidemi-ological surveillance data of the Ministry of Health & Population for theperiod 2015–2018.Results: We captured a total of 1773 sandflies in endemic districts and586 in non-endemic districts. These were morphologically identified andsegregated into P.argentipes (63.97%), P. papatasi (5.34%), Sergento-myia spp. (20.52%) and other Phlebotomine species (10.17%). OtherPhlebotomine species were identified as P. longiductus, P. neglectus, P.keshishiani-like, and P. halepensis-like in the survey villages at higheraltitude above 1300m asl in non-endemic districts.Conclusion: Survey indicate that P. argentipes is the most abundantspecies in both VL endemic and non-endemic districts suggestive ofactive transmission and needs special attention of the VL control program

for regular vector intervention in these areas to sustain the VL eliminationtarget in Nepal.

P095

TYPE OF TREMATODES INFECTING FRESHWATER SNAILS INMAHA SARAKHAM PROVINCE, THAILAND

Saijuntha W., Bunchom N.Walai Rukhavej Botanical Research Institute, Mahasarakham Uni-versity, Maha Sarakham, Thailand

Introduction: Digenetic trematodes need freshwater snail(s) as inter-mediate host to complete their lifecycle. Several freshwater snails serveas intermediate host of medically and veterinary important parasitictrematodes. Many species of freshwater snails were reported to beintermediate host in Thailand. Only a few studies have been concernedwith the cercarial infectious potential in Maha Sarakham province,Thailand.Aim: To investigate the prevalence and type of trematode cercariaeinfection in freshwater snails collected from Maha Sarakham province,Thailand.Methods: The freshwater snails were collected from 51 localities in MahaSarakham province, Thailand. The snails were examined for trematodeinfections by cercarial emergence immediately after collection. Type ofcercaria was classified by morphological method following the guide tothe identification of cercariae from freshwater snail1.Results: A total of 3,757 snail individuals were collected and classifiedinto six genera, namely Bithynia, Indoplanorbis, Lymnaea, Pila, Filopalu-dina, and Thiaridae. Overall, 10.17% of the snails were found to beinfected by some type of trematode cercariae. Five species of snailswere found to have infections, and the Bithynia was found to be themost heavily infected. The overall prevalence of Bithynia was 15.24%,subsequently by Lymnaea (6.50%), Thiaridae (4.80%), Indoplanorbis(1.57%), and Filopaludina (0.60%). Totally, nine different morphotypesof cercariae were found in this study, namely monostom, cystophorous,xiphidio, amphistome, furcocercous, longifurcate-pharyngeate, mutabile,ophthalmoxiphidio, and echinostomes. The most commonly foundcercaria was echinostomes (1.89%).Conclusion: This study indicated that freshwater snails, as intermediatehost of trematodes, play an medically important role in Maha Sarakhamprovince, Thailand. For further prevention and control of trematodesinfection of human and livestock in these areas, all significant freshwatersnail hosts should be concerned.

Reference:1. Frandsen F., Chrstensen N.O. An introductory guide to the identificationof cercariae from African freshwater snails with special reference tocercariae of trematode species of medical and veterinary importance.Acta Tropica 1984; 41(2);181-202.

P096

PRELIMINARY REPORT ON THE STATUS OF SCHISTOSOMIASISAND DIFFERENT TYPES OF SNAIL INTERMEDIATE HOST WITHRESPECT TO ELIMINATION

Sam-Wobo S.O., Awoyale A.1Dept. of Pure and Applied Zoology, College of Biosciences;2Federal University of Agriculture, Abeokuta, Nigeria

Schistosomiasis is a vector borne disease that affects the urinary tractor intestines of infected human and animals in sub-tropics and tropicalcountries across the world. This study which is on-going is evaluating

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the status of schistosomiasis in human and grazing cattle, their snailintermediate hosts, water quality and the prospects of mollucscidingusing niclosamide. The study is conducted in 12 stratified-selected com-munities (Kugba-Ajagbe, Akintoye, Adepegba, Onireke; Alaha, Ajebo, Aki-nola, Olosun; Ikatedo, Isale Ogun, Ikereku, Alamala) of Odeda, Obafemi-Owode and Abeokuta North Local Government Areas respectively of OgunState, Nigeria. Consented pre-school and school aged children betweenthe ages of 1-15 years were enrolled for the study. The study stratified1343 participants into 2 categories namely: 840 participants in categoryA submitted urine only, and category B comprising 503 participantssubmitted stool only. Parasitological analysis was conducted using urinefiltration and Kato- Katz to quantify the prevalence of S. haematobiumand S, mansoni respectively. Results from the study showed a meanprevalence of 42.98% and 13.32% for S. haematobium and S.mansoniacross the communities with a significant difference (p<0.05) in theirprevalence level across communities. On sex-related prevalence, thestudy observed a mean prevalence of 21.79% for female and 21.19%for male respectively but with no significant difference (p>0.05). Highestprevalence of 17.14% was observed among the age group 6-10years,while it was varied among the other age-groups. On snail study, 537snails comprising five different snail species (namely Lymnae natalensis,Bulinus foskalii, Bulinus globosus Biomphalaria pfeifferi and Melanoidestubuculata) were collected from December 2017 – February 2018 acrossall the communities. Patent infection of 0.93% was also detected in someof the vector-snails collected. Temperature and pH of the water bodieswere evaluated and it ranges from 23-250C and 5.6-6.9 respectively.Second phase of the study which involves cattle evaluation for schistoso-miasis and the mollusciding with niclosamide to determine acceptanceby communities is ongoing.

P097

EPIDEMIOLOGICAL MONITORING OF THE TWO LAST OUT-BREAKS OF YELLOW FEVER IN BRAZIL – AN OUTLOOOK FROMPORTUGAL

Selemane I.Public Health Unit, Unidade Local de Saúde do Litoral Alentejano(ULSLA), Grândola, Portugal

Introduction: Yellow Fever (YF) is a high fatality rate disease (30-50%)caused by Flavivirus, present in some countries of Africa and SouthAmerica.In the last decades, outbreaks in Brazil follow sylvatic (jungle) cycle, byHaemogogus and Sabethes mosquitoes, from monkeys to humans; urbancycle by Aedes aegypt mosquitoes between humans doesn’t exist since1942.The rationale for this study were the higher demand for vaccines in sometravel outpatient clinics, raising fears of urban cycle transmission andspread of disease by Aedes aegypti and need of individual risk-benefitanalysis prior to vaccination.Aim: In order to determine the magnitude and epidemiological distri-bution of YF cases, vaccination coverage and most affected regions inBrazil, a descriptive epidemiological study monitoring the 2017 and 2018outbreaks was undertaken in Portugal.Methods: The Brazilian database “Portal da Saude” was used to collectdata on cases of YF. We used Microsoft Excel on a weekly basis to updatethe suspected, confirmed and mortality cases as well as the case fatalityrate and epizootics in non-human primates.Results: There were 777 confirmed cases of YF in 2017 and 1376 con-firmed cases of YF in 2018. Case Fatality Rate was 34% in 2017 and 35%in 2018. A total and 82% of confirmed cases were males in 2017 and83% in 2018. Both outbreaks predominantly affected 2 south-easternstates, Minas Gerais and Espírito Santo in 2017 and 3 south-eastern

states, S. Paulo, Minas Gerais and Rio de Janeiro in 2018, all with a verylow vaccination coverage.Conclusion: The 2 last outbreaks of YF in Brazil were by far the largestobserved over the last few decades! Until the emergence of this outbreak,Espírito Santo, Bahia and Rio de Janeiro were states of low risk for YF andthe vaccine not previously recommended. The World Health Organisa-tion’s “Global Strategy to Eliminate Yellow Fever Epidemic” (EYE) should beon the way, to prevent YF outbreaks in Brazil and other countries in Africaand South America.

References:1. Selemane, personal communication, May 18 2017, submitted to“Jornades Catalanes de Salut International”, X edició, Barcelona, 18-19May 2017 - available at: http://www.jornadascatalanas.org/presentacions-20172. Selemane, I., Travel Medicine and Infectious Disease, https://doi.org/10.1016/j.tmaid.2018.12.008

P099

ESTABLISHING SENTINEL SITES TO SUPPORT VISCERAL LEISH-MANIASIS ELIMINATION IN INDIA

Singh R.P.1, Deb R.M.1, Srikantiah S.2, Mishra P.K.2, Roy N.3, SenP.K.3, Trett A.1, Coleman M.C.11Dept. of Vector Biology, Liverpool School of Tropical Medicine,Liverpool, UK;2CARE India, Patna, India;3National Vector Borne Disease Control Programme, Ministry ofHealth and Family Welfare, New Delhi, India

Introduction: India aims to eliminate Visceral Leishmaniasis (VL) by2020, The highest burden states include Bihar, Jharkhand, West Bengaland Uttar Pradesh. To achieve this goal, indoor residual spraying (IRS)with DDT and stirrup pumps was being used, however, in 2015 significantDDT resistance and poor quality of IRS was demonstrated. This led toa policy change and the implementation of alpha-cypermethrin withcompression pumps. This project set up sentinel sites to determine theimpact of this policy change. The processes required to establish andmaintain those sites has been is outlined.Aim: To establish eight sentinel sites in VL endemic areas in India andmonitor the impact of pyrethroid IRS on the vector population.Methods: Eight sentinel sites were set up in 2016 across three States:Bihar, West Bengal and Jharkhand to generate operationally relevantdata. Entomological surveillance officers and insect collectors, with ageneral science background, were recruited and trained in field routineentomology monitoring, IRS quality assurance and data managementmethods.Results: Abundance and susceptibility testing of Phlebotomus argentipessand flies was established to understand vector population dynamics.Monitoring of knock-down resistance markers enhanced the understand-ing of detected field resistance. Spray operator performance was mon-itored using pre-spray filter papers on to walls for analysis by high-performance liquid chromatography. Indoor Residual Spray coveragedata was obtained from the National Vector-borne Disease Control. Casedata was obtained from government sources and verified by CARE India.For handling of large datasets, a free web-based database system tai-lored for VL was installed and accessible at all sites.Intensive training on all survey methods was provided at the inceptionof setting up the sentinel sites. Quality checking and essential refreshertraining was provided to further develop skillsets. Issues associated withinternet access were resolved using ODK, a mobile data entry platform.Conclusion: A total of 48 members of staff were recruited for this workand 720 houses were randomly selected for continual assessment. Build-

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ing capacity in endemic areas and strengthening links with Ministry ofHealth and Family Welfare has allowed for a sustainable approach forentomological monitoring.

P100

MOLECULAR-EPIDEMIOLOGICAL STUDIES ON PATHWAYS OFTRANSMISSION AND LONG LASTING CAPACITY BUILDING TOPREVENT CYSTIC ECHINOCOCCOSIS INFECTION: OUTLINE OFPERITAS PROJECT

Tamarozzi F.1,2, Acosta-Jamett G.3, Larrieu E.4, Santivanez S.5,Uchiumi L.4, Perteguer Prieto M.J.6, Siles-Lucas M.7, Casulli A.1,2

1WHO collaborating centre for the epidemiology, detection andcontrol of cystic and alveolar echinococcosis, Dept. of InfectiousDiseases, Istituto Superiore di Sanità, Rome;2European Union Reference Laboratory for Parasites, Dept. ofInfectious Diseases, Istituto Superiore di Sanità, Rome, Italy;3Institute of Veterinary Preventive Medicine, Universidad Australdel Chile, Valdivia, Chile;4National University of Rio Negro, Choele Choel, Argentina;5Center for Global Health, Universidad Peruana Cayetano Heredia,Lima, Peru;6National Center of Microbiology, Instituto de Salud Carlos III,Madrid, Spain;7Agencia Estatal Cosejo Superior de Investigaciones Cientificas,Salamanca, Spain

Introduction: Cystic echinococcosis (CE) is neglected parasitic zoono-sis endemic in livestock-raising areas worldwide, causing high socio-economic impact in endemic areas. While the life cycle of the parasitemay be only interrupted by animal-focused interventions, humans areaccidental dead-end hosts of the parasite. Therefore, the implementationof preventive measures to avoid ingestion of infective parasite eggs isimperative to reduce consistently and sustainably in the long term theburden of human infection.Aim: PERITAS project aims, for the first time, to elucidate through anintegrated approach, the pathways of transmission of Echinococcus gran-ulosus, which are poorly understood and have never been systematicallyinvestigated.Methods: A stepwise multidisciplinary approach will be applied, inte-grating clinical, epidemiological, and molecular methodologies. Highlyendemic areas/clusters of human CE in Argentina, Chile, and Peru will beidentified by population-based ultrasound surveys and evaluation of CEcyst stages. Sampling of different matrices in the identified areas will beperformed, followed by application of molecular techniques to identifycontamination and species/genotype of the parasite.Results: The analysis of matrices contamination clusters of active humanCE infection, indicating transmission, will allow the identification of riskfactors associated with odds of CE infection. An added value will be thecollection of biological samples to feed the biological repository Echino-Biobank, to support development and validation of serological diagnostictests. Finally, the implementation of project activities, including trainingand feed of the International Register of CE (IRCE), will allow long-lastingcapacity building.Conclusion: PERITAS will have a rapid socioeconomic and scientificimpact. The project will integrate clinical, epidemiological, and molecularmethodologies to identify more precisely pathways of transmissionand risk factors for human infection. The direct applicability of projectresults will allow the implementation of more precisely-targeted human-centred control interventions, saving time and costs and increasingthe efficacy of control programs for the prevention of new humaninfections.

This work is supported by EU-LAC Health project and National fundingagencies of the participating institutions - PERITAS project (http://eulachealth.eu/).

P101PREVALENCE OF ABDOMINAL CYSTIC ECHINOCOCCOSISIN RURAL BULGARIA, ROMANIA AND TURKEY: A CROSS-SECTIONAL, ULTRASOUND-BASED, POPULATION STUDY (HER-ACLES PROJECT)Tamarozzi F.1,2, Akhan O.3, Cretu C.M.4, Vutova K.5, Fabiani M.6,Muhtarov M.7, Pezzotti P.6, Siles-Lucas M.8, Brunetti E.2,9,10,Casulli A.1,11

1WHO Collaborating Centre for the epidemiology, detection andcontrol of cystic and alveolar echinococcosis (in animals andhumans), Istituto Superiore di Sanità (ISS), Rome, Italy;2WHO Collaborating Centre for Clinical Management of CysticEchinococcosis, Pavia, Italy;3Dept. of Radiology, Faculty of Medicine, Hacettepe University,Ankara, Turkey;4C. Davila University of Medicine and Pharmacy, Colentina ClinicalHospital, Bucharest, Romania;5Specialised Hospital of Infectious and Parasitic Diseases “Prof.Ivan Kirov”, Dept. of Infectious, Parasitic and Tropical Diseases,Medical University, Sofia, Bulgaria;6Unit of Epidemiology, biostatistics and mathematical modelling,ISS, Rome, Italy;7Multi-Profile Hospital for Active Treatment "Kardzhali", Gastroen-terology Ward, Kardzhali, Bulgaria;8Instituto de Recursos Naturales y Agrobiología de Salamanca,CSIC, Spain;9Dept. of Clinical Surgical Diagnostic and Pediatric Sciences, Uni-versity of Pavia, Pavia, Italy;10Division of Tropical and Infectious Diseases, San Matteo HospitalFoundation, Pavia, Italy;11European Reference Laboratory for Parasites, ISS, Rome, Italy

Introduction: Cystic echinococcosis (CE) is a neglected parasitic zoonosisprioritized by the WHO for control efforts. Clinically diagnosed casesrepresent only a proportion of the total number of infected people; there-fore the burden of human infection in endemic areas is poorly known.Population-based ultrasound (US) surveys are required to detect cases ofinfection not reaching clinical records and allow a more precise estimateof the burden of CE.Aim: In the context of the European Community-funded FP7 projectHERACLES (602051; http://www.heracles-fp7.eu/), we aimed, for the firsttime, to estimate the prevalence of abdominal CE in rural areas ofBulgaria, Romania, and Turkey.Methods: We performed a cross-sectional survey with abdominal US onvolunteers in 50 rural villages of these countries in 2014-2015. Villageswere selected in provinces considered of mid-range endemicity accord-ing to data of national authorities, and US examinations conducted incommunity structures of villages where authorities were willing to hostthe survey. All observed lesions were examined by two sonographersfor the presence of pathognomonic US signs of CE, staged according tothe WHO-IWGE classification, and iconographic data re-assessed beforeanalysis. “CL” cysts were considered non-CE for the analysis. Age- andsex-adjusted prevalence and number of infected people were estimatedbased on country’s rural population in 2015.Results: Abdominal CE was detected in 31 of 8602 people in Bulgaria, 35of 7461 in Romania, and 53 of 8618 in Turkey. The age- and sex-adjusted

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prevalence of abdominal CE was 0,41% (0,29-0,58) in Bulgaria, 0,41%(0,26-0,65) in Romania, and 0,59% (0,19-1,85) in Turkey. Active cystswere found across all ages and in all investigated provinces. We estimatedthat 7,872 (5,520-11,220) individuals might currently have abdominal CEin rural Bulgaria, 37,229 (23,405-59,166) in rural Romania, and 106,237(33,829-330,751) in rural Turkey, about one-third of whom harbouringcysts in active stage.Conclusion: This population-based estimate gives, for the first time, areliable picture of the prevalence of abdominal CE in these endemiccountries of Eastern Europe, providing support for the planning of publichealth intervention, as envisaged by the WHO roadmap for CE control.

P102POTENTIAL RISK FACTORS ASSOCIATED WITH HUMAN CYS-TIC ECHINOCOCCOSIS INVESTIGATED THROUGH A SEMI-STRUCTURED QUESTIONNAIRE DURING THE ULTRASOUNDSURVEYS OF THE HERACLES PROJECT

Tamarozzi F.1,2,3, Akhan O.4, Cretu C.M.5, Vutova K.6, Fabiani M.7,Pezzotti P.7, Siles-Lucas M.8, Brunetti E.2,9,10, Casulli A.1,3

1WHO Collaborating Centre for the epidemiology, detection andcontrol of cystic and alveolar echinococcosis (in animals andhumans), Dept. of Infectious Diseases, Istituto Superiore di Sanità,Rome, Italy;2WHO Collaborating Centre for Clinical Management of CysticEchinococcosis, Pavia, Italy;3European Reference Laboratory for Parasites, Dept. of InfectiousDiseases, Istituto Superiore di sanità, Rome, Italy;4Dept. of Radiology, Faculty of Medicine, Hacettepe University,Ankara, Turkey;5Carol Davila University of Medicine and Pharmacy, Colentina Clin-ical Hospital, Bucharest, Romania;6Specialised Hospital of Infectious and Parasitic Diseases “Prof.Ivan Kirov”, Dept. of Infectious, Parasitic and Tropical Diseases,Medical University, Sofia, Bulgaria;7Unit of Epidemiology, biostatistics and mathematical modelling,Dept. of Infectious Diseases, Istituto Superiore di Sanità, Rome,Italy;8Instituto de Recursos Naturales y Agrobiología de Salamanca,Consejo Superior de Investigaciones Ciaentificas, Salamanca,Spain;9Dept. of Clinical Surgical Diagnostic and Pediatric Sciences, Uni-versity of Pavia, Italy;10Division of Tropical and Infectious Diseases, San Matteo HospitalFoundation, Pavia, Italy

Introduction: Cystic echinococcosis (CE) is a neglected parasitic zoonosisprioritized by the WHO for control. Hygiene education is included in CEcontrol campaigns; however, the precise pathways of transmission andrisk factors for human infection are poorly understood. Several worksinvestigated the potential risk factors through questionnaires, mostlycarried out on small samples, providing contrasting results.Aim: We present the analysis of risk factors questionnaires administeredto participants to the largest research-based prevalence study on CEconducted in 2014-2015, within the project HERACLES.Methods: A semi-structured questionnaire was administered to 24,687people from rural Bulgaria, Romania, and Turkey, who underwent abdom-inal ultrasound. Questions concerned demography, CE awareness, occur-rence of cases in the family, dog and livestock-related practices, andfood- and drinking water-related habits. “CE cases” were individuals withabdominal CE cysts detected on ultrasound. Variables associated with CE

infection at p<0.20 in bivariate analysis were included into a multivariablelogistic model, with a random effect to account for clustering at villagelevel. Adjusted odds ratio (AOR) with 95%CI were used to describe thestrength of associations. Data were weighted to reflect the relative dis-tribution of the rural population in the study area by country, age groupand sex.Results: Valid records from 22,027 people were analysed. According tothe main occupation in the past 20 years, “housewife” (AOR 3.11 [1.51-6.41]) and “retired” (AOR 2.88 [1.09-7.65]) showed a significantly higherrisk of being infected compared to non-agricultural workers. “Havingrelatives with CE” (AOR 4.18 [1.77-9.88]) was positively associated withhigher odds of CE infection. Dog-related and food/water-related factorswere not associated with human infection.Conclusion: Our results point to infection being acquired in a “domestic”rural environment and support the view that CE should be consideredmore a ”soil-transmitted” than a “food-borne” infection, acquiredthrough a “hand-to-mouth” mechanism. This result helps delineatingthe dynamics of infection transmission and have practical implicationsin the design of control campaigns. Community-specific and habits-specific questionnaires, and studies on parasite contamination ofmatrices, are needed to shed light on actual sources of infection andat-risk behaviours. This work was supported by the EU FP7, HERACLESproject (GA602051).

P103

EXPLORING THE BARRIERS AND MOTIVATORS ENCOUNTEREDBY HEALTHCARE WORKERS (HCWS) IN LOW- AND MIDDLE-INCOME COUNTRIES (LMICS) IN THE IMPLEMENTATIONOF TUBERCULOSIS INFECTION PREVENTION AND CONTROL(TBIPC)MEASURES AND HOW THEY INFLUENCE ADHERENCE:A SYSTEMATIC REVIEW

Tan C., Kallon I., Colvin C.J., Grant A.London School of Hygiene and Tropical Medicine, London, UK

Introduction: In recent years, the increasing emergence of drug-resistanttuberculosis (DR-TB) and the association between TB and human immun-odeficiency virus (HIV) have drawn attention back to controlling thespread of TB. More than half of new multidrug-resistant TB (MDR-TB)cases occur in those who have never been treatment for TB, emphasizingthe role of transmission in the spread of DR-TB. Effective TBIPC maintainsa healthy population of HCWs and prevents transmission among patients.Aim: This review aims to gain an understanding of the challengesencountered by HCWs in LMICs during the implementation of TBIPCmeasures,and suggest recommendations to address them. This willbe done by exploring the literature for (1) current barriers to TBIPCimplementation and (2) the factors which motivate HCWs to adhereto current measures.Methods: Electronic database searches were used to select quantitativeand qualitative studies for this systematic review. Thematic synthesis wascarried out on these studies. Themes were then organized according tothe macro-, meso- and micro-level framework, which breaks down theprocess of translating policy at a national level into programmes at afacility level.Results: A total of 23 studies were found to be eligible. Macro-level chal-lenges included a lack of HIV and TB programme integration, neglectingoccupational health policies as part of TBIPC and poor funding.At the meso-level, there was inadequate staff training and poor trans-lation from national policy to facility programme. Most barriers occurredat the micro-level. An amalgamation of poor motivation and a lack ofauthority given to programme managers resulted in a vicious cycle ofpoor TBIPC implementation, perpetuated by the development of a workculture accepting of this. This was further aggravated the effects of

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community stigma surrounding HIV and TB and risk perceptions of TBtransmission.Conclusion: With the current level of evidence it is not feasible to makeany recommendations to change practice. What we can conclude is aneed to change the direction of current research from documenting badpractice of understanding the context in which policy is implemented,both within individual healthcare facilities and the communities whichthey serve.

P104MOLECULAR DIFFERENTIATION OF SOUTHEAST ASIAN LUNGFLUKES, PARAGONIMUS SPP.Tantrawatpan C.1, Saijuntha W.21Dept. of Preclinical Sciences, Faculty of Medicine, ThammasatUniversity, Rangsit Campus, Pathumthani, Thailand;2Walairukhavej Botanical Research Institute (WRBRI),Mahasarakham University, Maha Sarakham, Thailand

Introduction: Paragonimiasis or lung fluke disease is caused infection bylung flukes of the genus Paragonimus, with most cases reported fromAsia. In Thailand, there are at least seven species have been currentlyrecognized, namely P. bangkokensis, P. harinasutai, P. heterotremus, P.pseudoheterotremus, P. macrorchis, P. siamensis and P. westermani. Eggof these lung flukes, which is the diagnostic stage cannot be differen-tiated. Thus the molecular method is an alternative choice for speciesdifferentiation to clarify the biodiversity and public health significance ofthe lung flukes in Thailand.Aim: We attempted to differentiate those seven species of lung flukes,collected from Thailand using nucleotide sequence of intron 2 region oftaurocyamine kinase (TkInt2) gene.Methods: The leftover DNA samples from a previous study1 were usedin this study. Full length of TkInt2 region was amplified and sequencedconsequently by using primers targeting flanking region (exon) of the tau-rocyamine kinase. The nucleotide sequences of the 160 bp DNA fragmentwere compared between seven lung flukes to find the diagnostic position.Results: Comparison of 160 bp TkInt2 region of seven lung flukes foundthat 27 variable positions were observed. Of these, 12 positions canbe used to discriminate those seven lung flukes, namely c.150C>T inP. bangkokensis, c.67G>A in P. harinasutai, c.93T>C in P. heterotremus,c.57C>T and c.117A>G in P. pseudoheterotremus, c.59A>G, c.91C>G andc.115T>C in P. macrochis, c.73G>T in P. siamensis, c.12T>C, c.87A>C, andc.102T>G in P. westermani.Conclusion: TkInt2 region has been proved to be a potential geneticmarker for discriminating seven lung flukes in Southeastern Asia includingThailand. This marker can be further used for molecular differentiationtechniques, such as pyrosequencing or real-time PCR for molecular dif-ferentiation/identification of these lung flukes infecting human or animalhosts.

Reference:1. Tantrawatpan C., Intapan P.M., Janwan P., Sanpool O., LulitanondV., Srichantaratsamee C., Anamnart W., Maleewong W. Molecular iden-tification of Paragonimus species by DNA pyrosequencing technology.Parasitology International 2013; 62(3); 341-345.

P105MORBIDITY AND MORTALITY TRENDS FOLLOWING THE IMPLE-MENTATION OF VECTOR CONTROL INTERVENTIONS: SEASONALMALARIA CHEMOPREVENTION (SMC) AND MASS DISTRIBU-TION CAMPAIGN OF MOSQUITO NETS N THE NORTH AND FAR-NORTH REGIONS OF CAMEROON BETWEEN 2015 AND 2017

Tene L.N.1, Donfack O.T.2, Achu D.31Maternal and child clinic-African genesis health, Yaounde,Cameroon;2Medical Care Development International, Malabo, EquatorialGuinea;3National Malaria Control Program, Yaounde, Cameroon

Introduction: Malaria remains the leading cause of morbidity and mor-tality among vulnerable groups in Cameroon with 90% of the populationat risk of developing the disease. Mosquito nets remain the primarymalaria control strategy in all 10 regions of the country. the Far-Northand the North regions (sahelian regions) of Cameroon have the highestmalaria morbidity and mortality; which justifies the introduction of SMCin these regions in 2016. Therefore, SMC is routinely carried each year inthe latter regions every months between July and October.Aim: Describe malaria morbidity and mortality 1 year before and 1 yearafter vector control interventions in the Far-North and North regions ofCameroon.Methods: Routine data collected by the National Malaria Control Programwas analyzed. These include national malaria data for the years 2015(before the interventions), 2016 ( the year of the interventions) and 2017(1 year after the interventions ). Monthly Malaria morbidity and mortalitytrends were described.Results: Overall malaria morbidity and mortality rates decreased inthe Far-North region. In 2015, 2016, 2017 malaria morbidity rate wererespectively 31%, 25% and 12% and Malaria mortality rates were 41,30, 23 per 10.000 inhabitants. In the North region, only the mortalityrates decreased from 55 per 10.000 inhabitants in 2015 to 33 per 10.000inhabitants in 2016 and 2017. However during SMC campaign we havea decrease in malaria morbidity and mortality rates in both regions. Inthe Far-North, malaria morbidity goes from 40% in 2015 to 34% and34% in 2016, 2017 respectively. In the North region it goes from 39% in2015 to 36% and 33% respectively in 2016 and 2017. Malaria mortalitygoes from 47 in 2015 to 26 and 25 per 10.000 inhabitants in 2016, 2017respectively in the Far-North and from 40 in 2015 to 33 and 32 per 10.000inhabitants in 2016, 2017 respectively in the North region.Conclusion: Vector control interventions in the North and Far-Northregions have led to a reduction in malaria morbidity and mortality rates,and the reduction of morbidity and mortality during the raining seasongoing from July to October may be possibly linked to SMC campaignwhich was carried out during that period since 2016.

P106

HOTSPOTS OF DENGUE TRANSMISSION IN SANTIAGO DE CUBA:RETROSPECTIVE ANALYSIS AND PROSPECTIVE VALIDATION

Toledo Romani M.E.1, Mirabal M.2, Vanlerberghe V.3, GomezPadron T.4, Popa Rosales J.C.4, Valdez L.4, Castillo R.M.4, Van derStuyft P.51Epidemiology Dept., Tropical Medicine Institute "Pedro Kouri”,Havana, Cuba;2Clinical Research and Impact Evaluation Division, Finlay VaccineInstitute, Havana, Cuba;3Public Health Dept., Tropical Medicine Institute, Antwerp, Belgium;4Epidemiology Dept., Provintial Center of Hygiene, Epidemiologyand Microbiology, Santiago de Cuba, Cuba;5Gent University, Gent, Belgium

Introduction: Arbovirus control strategies need rethinking and taking intoaccount the drivers of transmission.Aim: To describe a method for identifying dengue hotspots, combin-ing variables capturing the epidemiological, entomological, demographic

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and environmental components of past transmission risk and explorethe result’s consistency with the spatial pattern of incident zika cases inSantiago de Cuba.Methods: For the retrospective analysis we used 5 years of historicaldata (2010-2014) from Santiago de Cuba (Cuba). Variables represent-ing the abovementioned components were selected with a modifiedDelphi approach. On the one hand, the variables in the dataset werestandardized using z-scores and thereafter Principal Component Analysis(PCA) was applied to derive weights for each of them. On the otherhand, the variables were aggregated with a scoring system and thematicmaps were generated for spatial visualization of each component. Forprospective validation we relied on epidemiological data of 2016 zikacases in Santiago. The local Getis-Ord G statistic was used to test forsignificant local autocorrelation.Results: Results obtained using standardization and using score analysiswere similar. Hotspots for dengue transmissions in Santiago de Cuba werelocated in 5 areas in the central-south part of the municipality. The twofirst components in PCA analysis (an epidemiological and entomologicalone) explained 30.9 and 30.0 percent of the variance, respectively. In2016, the first zika cases were reported in the central part of the city,partially overlapping with the persistent dengue clustering on a grid sizeof 600 meter.Conclusions: Dengue spatial-temporal diffusion patterns and hotspotidentification may provide useful information to predict arbovirus spreadover critical areas and to support public health decision on prioritisingpreventive control activities.

Reference:1. Vanlerberghe V, Gómez-Dantés H, Vazquez-Prokopec G, Alexander N,Manrique-Saide P, Coelho G, et al. Changing paradigms in Aedes control:considering the spatial heterogeneity of dengue transmission. Rev PanamSalud Publica. 2017;41:e16.

P107

NASOPHARYNGEAL COLONIZATION BY STREPTOCOCCUS PNEU-MONIAE IN CUBAN PRESCHOOL CHILDREN: CROSS-SECTIONALSURVEYS BEFORE-AFTER PNEUMOCOCCAL VACCINATIONChávez Amaro D.M.1, Toledo-Romaní M.E.2, Linares-PérezN.3, Casanova González M.F.4, Rodríguez Valladares N.N.2,Rodríguez Noda L.M.3, Sosa M.M.3, Rodríguez González M.C.3,Toraño Peraza G.2, García-Rivera D.3, Valdés-Balbín Y.3,Vérez-Bencomo V.31Medical Sciences University, Cienfuegos, Cuba;2Epidemiology Dept. Tropical Medicine Institute "Pedro Kourí",Havana, Cuba;3Clinical Research and Impact Evaluation, Finlay Vaccine Institute,Havana, Cuba;4Pediatric Hospital "Paquito González Cueto", Cienfuegos, Cuba

Introduction: NPC is considered as endpoint principal in pneumococcalvaccines (PCVs) evaluation. It also was included in the clinical evaluationmodel of the new Cuban heptavalent conjugated vaccine candidate(PCV7-TT).Aim: To evaluate the changes on NPC in children 1-5 y/o enrolled in ablinded non inferiority clinical trial one year after PCVs immunization.Methods: We conducted two repeated NPC cross sectional survey. Thefirst (pre-vaccination, 2014-2015) included 1135 preschool childrendivided in two groups (PCV13 control group and PCV7-TT study group). Asubset of 555 children was randomly selected to explore NPC changesone year after (2016). Proportions and differences (%) on global andserotype specific NPC rates were estimated and compared after-beforein each group.

Results: The global proportion of NPC changed from 34.0% to 26.7%, one-year post vaccination (p=0.00878). The higher reduction was observed inchildren 2-5 y/o (from 45,8% to 17,6; (p<0.0001). In children 12 -23 m/o,the global proportion of NPC increase (48.1%) mainly due non-vaccineserotypes. Global reduction of NPC rates was 50% for the seven commonvaccine serotypes (1,5, 6B,14, 18C, 19F and 23F).Conclusions: Reduction on vaccine serotypes NPC suggest that PCV7-TTintroduction in Cuba could generated a significant impact on pneumo-coccal disease since reduce NPC rates in the target group supporting thehigher burden of colonization at community level.

References:1. Adegbola RA, DeAntonio R, Hill PC, Roca A, Usuf E, Hoet B and Green-wood BM. Carriage of Streptococcus pneumoniae and Other RespiratoryBacterial Pathogens in Low and Lower-Middle Income Countries: A Sys-tematic Review and Meta-Analysis. PLOS ONE 2014,9(8): e1032932. Toledo M, Casanova M, Linares N, García D, Toraño G, Barcos I, et al.Prevalence of Pneumococcal Nasopharyngeal Carriage Among Children2-18 Months of Age: Baseline Study Pre Introduction of PneumococcalVaccination in Cuba. Pediatr Infect Dis J. 2017 Jan;36(1):e22-e28.3. Dunia María Chávez DM, Toledo-Romaní ME, Linares-Pérez N, CasanovaMF4, Rodríguez NN, Rodríguez-Noda LM, Mirabal-Sosa M, Rodríguez MC,Toraño-Peraza G, García-Rivera D, Valdés-Balbín Y and Vérez-BencomoV.. Nasopharyngeal colonization by Streptococcus pneumoniae in Cubanpreschool children: Cross-sectional surveys before-after pneumococcalvaccination. (Submitted to) Vacunas, January 18th, 2018.

P108

THE HEALTH OF FOREST STAFF: A MULTI-SITE ASSESSMENT ATTIGER RESERVES FROM CENTRAL INDIA AND WESTERN GHATS

Gadre V.1, Trivedy C.1,2,3,4

1Wildlife Conservation Trust, Mumbai, India;2Consultant in Emergency Medicine, Brighton and Sussex Univer-sity NHS Trust;3Blizard Institute, Queen Mary University of London, London;4The Tulsi Foundation, London, UK

Introduction: The health of the forest staff (FS), who form the only lineof defence for the forests and wildlife, impacts their in-field capacities.Risk of injuries, zoonosis, and vector-borne diseases are often includedin discussions related to the challenging working conditions for the FS.However, there is limited data available globally on other health issues,specifically non-communicable disease (NCD) risks, among this popula-tion group.Aim: To identify health issues including NCD-risks among FS placed atvarious protected areas (PAs) across Central India (CI) and Western Ghats(WG).Methods: Preventive health checks, inclusive of laboratory investigationsand clinical assessment, were conducted at 18 PAs across CI and WGduring 2014-2018. The health-data of the FS was collated and analysedto assess presence of anaemia, Hepatitis-B, and NCD risk-factors (raisedblood glucose, abnormal lipid levels, raised blood pressure, body massindex, use of tobacco and alcohol).Results: The collated data comprised of 7867 FS from PAs in CI (70.2%)and WG (29.8%). 91% of the covered FS were males, and mean age was37.5 years (SD ±11.3). 17% of the FS had anaemia. The prevalence ofanaemia was higher among the female FS (36.5%) as compared to themale FS (15.1%) 1.8% of the screened FS were diagnosed with Hepatitis-B. Laboratory results showed 51.7% had abnormal lipid levels and 21.3%had raised blood glucose. 39% of FS reported use of tobacco, 21%consumed alcohol, 34.2% of the screened FS had raised blood pressure,and 19.8% were overweight. 77% of the screened FS had at least one

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NCD risk-factor. More than half of FS who reported abnormal lipid levelsor alcohol use or tobacco use were below 40 years of age. Additionally,40% of those with raised blood pressure or glucose or were overweightwere under the age of 40 years.Conclusion: This study highlights the current and probable future health-risks for the FS placed in PAs from two important conservation landscapesof India. An exploration into the health issues of importance for theFS could form the basis for identifying need-based interventions andimprove their access to healthcare at work.

P109IMPORTANT AEDES INFESTATION LEVELS IN KINSHASA, DEMO-CRATIC REPUBLIC OF CONGOWat’senga T.F.1, Fasine S.1, Manzambi E.Z.1, Bisset J.A.2,Marquetti M.C.2, Van Bortel W.3, Vanlerberghe V.31Institut National de Recherche Biomedicale (INRB), Service ofMedical Entomology, Kinshasa, Democratic Republic of Congo;2Instituto de Medicina Tropical Pedro Kourí (IPK), Dept. of VectorControl, La Habana, Cuba;3Institute of Tropical Medicine (ITM), Outbreak Research Team,Antwerp, Belgium

Introduction: Arboviruses such as dengue, yellow fever, chikungunyaand Zika are among the most important emerging infectious diseasesworldwide. Yellow fever and chikungunya outbreaks, and few denguecases have been reported in Democratic Republic of Congo (DRC) in recentyears. Although the main vectors of these arboviruses, Aedes aegypti andAedes albopictus, were reported in DRC, the lack of detailed informationon its presence and spread hampers transmission risk assessments in thisregion.Aim: To determine the seasonal Aedes infestation level in Kinshasa, DRC.Methods: In 2018, two cross-sectional surveys were realized in Kinshasaprovince, one in the rainy (January/February) and one in the dry season(July). Four hundred houses were visited in each of the four selectedcommunes (Ndjili, Mont-Ngafula, Lingwala and Kalamu). Breedingssites were recorded, larvae and pupae collected and reared to obtainadults for vector species identification (microscope and DNA-basedtechniques).Results: The most rural commune (Mont-Ngafula) had the highest infes-tation levels, with a Breteau Index of 95.0 in rainy and 20.0 in dry season.The infestation levels of the other communes Kalamu, Lingwala and Ndjilielevated to 24.3 (10.5), 45.5 (16.0) and 42.9 (9.7) in the rainy (and dry)season respectively. In the rainy season, Aedes albopictus was the mostimportant species in Lingwala (70%) and Mont-Ngafula (90%), in contrastto Kalamu (0%) and Ndjili (40%). In total, 6652 containers were inspectedover both surveys, with on average 1.0 and 3.0 water holding containerper house inspected in dry and rainy season respectively. The majority(62.8%) of the containers were found outside the houses, of which 27.3%were positive for Aedes (against 0.5% of the in-house containers). Themain breeding sites were used tires, water storage containers and trash.Conclusions: These results show that Kinshasa is highly infested withAedes aegypti and Aedes albopictus which indicates a high potentialfor arbovirus transmission in the area. The important outside breedingis in contrast with observations from Latin-America, where the mainAedes breeding and resting sites were found inside houses. This willhave an impact on the design of control strategies for these vectors inKinshasa.

P110ECOLOGICAL CHARACTERIZATION OF AEDES SPP DURING THEYELLOW FEVER EPIDEMIC IN ANGOLA, 2016

Marquetti M.C.1, Troco A.2, Cani P.2, Hidalgo Flores Y.3,Vanlerberghe V.41Instituto de Medicina Tropical Pedro Kourí (IPK), Dept. of VectorControl, La Habana, Cuba;2National Program of Malaria. Ministry of Health, Luanda, Angola;3Cuban-Angolan collaboration programme, Labiofam, La Habana,Cuba;4Institute of Tropical Medicine (ITM), Dept. of Public Health,Antwerp, Belgium

Introduction: Angola belongs to the African area at Risk for Yellow FeverVirus Transmission. In December 2015, Yellow Fever reemerged in Luandaand provoked an outbreak in the whole country and the South of itsneighboring country, Democratic Republic of Congo, resulting in 962 con-firmed infections including 393 reported deaths. Angola has ecologicalconditions that favor the proliferation of Aedes spp., its main vector.Aim: Describe the distribution and ecological characterization of Aedesspp. during the occurrence of the yellow fever epidemic in Angola, 2016.Methods: Inspection of water holding recipients, potential Aedes breed-ing sites, and subsequent larval sampling was planned in 270 neigh-borhoods or villages with yellow fever suspect and/or confirmed casesover the period February - October 2016. These sites were located in 50municipalities scattered over the 18 provinces of the country. BreteauIndex - BI (number of recipients positive for Aedes immature stages/100houses inspected) and House index - HI (number of houses with at leastone Aedes positive recipient/100 houses) were calculated.Results: Aedes aegypti was found in 16 (88.8%) of the provinces; in 41(82.0%) of the municipalities and in 251 (92.9%) of the neighborhoodssampled. In 32 of these municipalities, Aedes was never reported before.The mosquito was detected in all municipalities of Luanda with a BIranging between 14.4 and 31.7; Ingomboata, Rangel, Cacuaco, Vianaand Cazenga belonging to the most infested ones. The infestation washighest in center-west Angola with a BI between 19.6 and 52.8 andHI between 16.5 and 36.0. Larvae were collected in 54 different typesof recipients, of which wells and car tires were the most infested inrural and water storage container in urban areas. On several occasions(Luanda, Cuanza Sul and Benguela), Aedes aegypti was found associ-ated with Culex sp. and Anopheles sp. in water storage containers andcisterns.Conclusion: With this information, collected in response to an outbreak,we evidenced the geographical spread of the Yellow Fever vector inAngola. This, together with the identification of the main breedingsites, provides basic knowledge for the outbreak and vector controlstrategies.

P111

SPATIAL AND TEMPORAL DISTRIBUTION OF TWO MAJORARBOVIRUS VECTORS AEDES AEGYPTI AND AEDES ALBOPICTUSIN HAVANA, CUBA, 2018

Marquetti M.C.1, Pérez M.2, Mendizábal M.E.2, Peraza I.2,Chamizo K.2, Bisset Lazcano J.1, Leyva Silva M.1, VanlerbergheV.31Instituto de Medicina Tropical Pedro Kourí (IPK), Dept. of VectorControl, La Habana, Cuba;2Center for Hygiene, Epidemiology and Microbiology, Provincialentomology laboratory, La Habana, Cuba;3Institute of Tropical Medicine (ITM), Public Health Dept., Antwerp,Belgium

Introduction: In Cuba there is a national program of surveillance andcontrol of Aedes aegypti (L) and Aedes albopictus (S), monitoring the

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mosquito populations nationwide throughout the year. Ae. albopictuswas for the first time registered in Cuba in 1995 and since then followedup on several occasions in ecological studies. It was always found outsidethe houses.Aim: To characterize the distribution of Ae. aegypti and Ae. albopictus, andits preferred breeding sites, in the province of Havana, 2018.Methods: The national routine vector control program visits all housesonce a month in all 15 municipalities of Havana to inspect the waterholding containers for the presence of immature stages of mosquitoes.The larval samples collected in artificial and natural recipients from thesesites from January to December 2018 were sent, together with breedingsite information, to the provincial reference laboratory of entomology, forspecies identification.Results: All municipalities of Havana registered the presence of Aedesaegypti, while Aedes albopictus was only found in 13 of them. A totalof 54.471 larval samples were identified, 94.9% and 5.1% were Ae.Aegypti and albopictus respectively. The seasonal distribution over dry(November-April) and rainy (May-November) season was 41.2% and58.8% for Ae. Aegypti, and 35.1% and 64.9% for Ae. Albopictus respec-tively. Both species were mainly found in small artificial deposits locatedin the house yards and in larvitraps (a surveillance device), Ae. Aegyptiwas additionally observed in water storage tanks, and Ae. Albopictusin tree holes. Of the Ae. Albopictus positive breeding sites, 14.5% werefound inside the houses (in water storage containers, cooler drawers andspiritual vessels).Conclusion: In spite of all the efforts made by Cuba in the control of Ae.Aegypti and indirectly of Ae. albopictus, the vector remains distributedin the urban ecosystem of Havana. It was for the first time that Ae.Albopictus was evidenced inside the houses. The role of Ae. Albopictuswithin arbovirus transmission on the island is not clear, hence a constantmonitoring is warranted in the current setting of an increased distributionof different arboviruses in the Americas.

P112HUMAN T CELL RESPONSES TO JAPANESE ENCEPHALITIS (JE)AND JE VACCINE

Turtle L.1, Subramaniam K.1, Moore S.1, Ravi V.2,Satchidanadam V.3, Klenerman P.4, Solomon T.11Institute of Infection and Global Health, University of Liverpool,Liverpool, UK;2Dept of Neurovirology, National Institute of Mental Health andNeurosciences (NIMHANS), Bengaluru;3Dept of Microbiology and Cell Biology, Indian Institute of Science,Bengaluru, India;4Translational Gastroenterology Unit, Nuffield Dept. of Medicine,University of Oxford, Oxford, UK

Background: Japanese encephalitis (JE) is the most commonly diag-nosed epidemic encephalitis in Asia. JE is cause by JE virus (JEV), andis a vaccine preventable disease. Most JE vaccines work by generatingneutralising antibody, but both natural exposure to JEV and JE vac-cines also generate T cell responses. Although early data suggest arelationship between the human T cell response and outcome in JE,still relatively little is known about T cell responses to either JEV orJE vaccine.Aims: We aimed to characterise the human T cell response to natural,asymptomatic JEV exposure, clinical JE, live attenuated JE vaccine andinactivated JE vaccine. We were particularly interested in whether CD8T cell responses could cross-react between JEV and the closely relateddengue virus.Methods: Four groups were studied: recovered JE patients (n = 39),healthy naturally JEV exposed South Indians (n = 35), recipients of live

attenuated JE vaccine SA14-14-2 in a clinical trial (n = 17) and recipi-ents of inactivated JE vaccine (IXIARO) (n = 6). (PBMC) and serum wereseparated from all the participants. T cell responses were measuredby stimulating peripheral blood mononuclear cells with synthetic pep-tides of JEV in IFNg ELISpot or intracellular cytokine flow cytometryassays. Antibody responses were measured by viral plaque reductionassay.Results: Ex-vivo interferon-γ responses to JEV in healthy JEV-exposeddonors were mostly CD8+ and targeted non-structural (NS) proteins,whereas interferon-γ responses in recovered JE patients were mostlyCD4+ and targeted structural proteins and the secreted protein NS1.Amongst patients, a high quality, polyfunctional CD4+ T cell response wasassociated with complete recovery from JE. T cell responses from healthydonors showed a high degree of cross-reactivity to DENV which was lessapparent in recovered JE patients, despite equal exposure. Live JE vaccinegenerated mostly CD8+ T cell responses, whereas inactivated JE vaccinegenerated mostly CD4+ T cell responses.Conclusions: These data reveal divergent functional CD4+ and CD8+T cell responses linked to different clinical outcomes of JEV infection,associated with distinct targeting and broad flavivirus cross-reactivityincluding epitopes from DENV, West Nile and Zika virus.

P113

ORIGINAL ANTIGENIC SIN AND JAPANESE ENCEPHALITISVACCINATION

Tatullo F.1, Venkataswamy M.2, Ravi V.2, Desai A.2,Satchidanadam V.3, Solomon T.1, Turtle L.11Institute of Infection and Global Health, University of Liverpool,Liverpool, UK;2Dept. of Neurovirology, National Institute of Mental Health andNeurosciences (NIMHANS), Bengaluru;3Dept. of Microbiology and Cell Biology, Indian Institute of Science,Bengaluru, India

Background: Japanese encephalitis (JE) virus (JEV) is the main cause ofviral encephalitis in south and south-east Asia. JEV is a flavivirus and istransmitted by mosquitoes. A live attenuated vaccine is used in manyendemic countries. Dengue virus (DENV) is another flavivirus, closelyrelated to JEV, transmitted by mosquitoes which is endemic in all tropicaland subtropical countries, including India.Aims: This study aimed to analyse the antibody response to the liveattenuated JE vaccine (LAJV) and their cross-reactivity with the 4 DENVserotypes in adult Indian volunteers.Methods: Seventeen volunteers were vaccinated with the LAJV andperipheral blood mononuclear cell and serum samples were collectedbefore and after vaccination at different time points. Antibody responsesspecific to JEV and DENV were studied by plaque reduction neutralizationtest and ELISA.Results: Neutralising antibody (NAb) responses to the LAJV wereobserved in 3 out of 16 volunteers (18.75%) with a peak reciprocalgeometric mean titre of 20 at 4 weeks after vaccination. Ten volunteers(62.5%) were DENV exposed at baseline by IgG ELISA. Interestingly,original antigenic sin (OAS) was observed in 50% of DENV exposedindividuals who mounted a NAb response to DENV rather than JEVfollowing vaccination. OAS was observed both in participants whoresponded to JE vaccine, as well as those who did not. T cell responsesto JEV were detected following vaccination both in those who madeantibody responses and those who did not.Conclusions: This is the first description of OAS in response to JE vaccinegiven in a JE endemic area. Both ourselves and other investigators haveobserved poor immunogenicity of JE SA14-14-2 in India. Although ourcohort was too small to permit definitive identification of the cause of

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poor immunogenicity, OAS may represent a reason for this and could beused to inform future vaccine trial endpoints.

P115

DOES APPRECIATIVE INQUIRY DECREASE FALSE POSITIVEDIAGNOSIS DURING LEPROSY CASE DETECTION CAMPAIGNSIN BIHAR, INDIA? AN OPERATIONAL RESEARCH STUDY

Wagh A.N.1, Mugudalabetta S.1, Gutierrez N.O.2, Padebettu K.1,Pandey A.K.1, Pandey B.K.3, Thulasingam M.4, SatyanarayanaS.5, Dongre A.61Damien Foundation India Trust, Bihar, India;2Damien Foundation, Brussels, Belgium,3State Leprosy Officer, Bihar, India;4Jawaharlal Institute of Postgraduate Medical Education &Research (JIPMER), Puducherry, India;5Center for Operational Research, International Union againstTuberculosis and Lung Disease, Paris, France;6Sri Manakula Vinayagar Medical College and Hospital, Puducherry,India

Introduction: India contributes ∼60% to the global leprosy burden. Thecountry implements 14-day community-based leprosy case detectioncampaigns (LCDC) periodically in all high endemic states. Medical officersand paramedical staff of primary health centres (PHCs) are trained todiagnose and treat leprosy cases. Several new cases were detected duringthe two LCDCs held in September-2016 and February-2018. Followingthese LCDCs, a validation exercise was conducted in 8 Primary healthcentres (PHCs) of 4 districts in Bihar State by an independent expert group,to assess the correctness of case diagnosis. Just before the February 2018LCDC campaign, we conducted an “appreciative inquiry” (AI) involving thehealth care staff of these 8 PHCs using the 4-D framework (Discovery-Dream-Design-Destiny).Aim: To assess whether the incorrect case diagnosis (false positivediagnosis) reduced in the 8 PHCs between the two LCDC conducted inSeptember-2016 and February-2018 with AI as a change managementintervention.Methods: This is a three-phase mixed methods study (embedded design).The quantitative part contained a before-after study design and thequalitative intervention comprised of appreciative inquiry.Results: With the two validation exercises conducted following September-2016 and February-2018 LCDCs as quantitative phases and AI asqualitative phase. In September-2016 LCDC, 303 new leprosy cases weredetected, of which 196 cases were validated and 58 (29.6%) were falsepositive diagnosis. In February-2018 LCDC, 118 new leprosy cases weredetected of which 96 cases were validated and 22 cases (23.4%) werefalse positive diagnosis. After adjusting for the age, gender, type of casesand individual PHCs fixed effects, the proportion of false positive diagnosisreduced by -9% [95% confidence intervals (95%CI): -20.2 % to 1.7%,p=0.068].Conclusion: False positive diagnosis is a major issue during LCDCs. Thoughthe decline in false positive diagnosis is not statistically significant, thefindings are encouraging and appreciative inquiry can be used as anintervention to address deficiencies in programme implementation in thissetting.

Reference:1. Wagh AN, Mugudalabetta S, Gutierrez NO, Padebettu K, Pandey AK,Pandey BK, et al. (2018) Does appreciative inquiry decrease false posi-tive diagnosis during leprosy case detection campaigns in Bihar, India?An operational research study. PLoS Negl Trop Dis 12(12): e0007004.https://doi.org/10.1371/journal.pntd.0007004

P116URBANISATION AND SOCIO-ECOLOGICAL FACTORS AS MAINDRIVERS FOR THE ECOLOGY OF AEDES AEGYPTI AND RISK OFTRANSMISSION OF ARBOVIRUSES IN CÔTE D’IVOIREZahouli B.Z.J.1, Koudou G.B.1, Müller P.2, Malone D.3,Utzinger J.21Dept. of Research and Development, Centre Suisse de RecherchesScientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire;2Dept. of Epidemiology and Public Health, Swiss Tropical and PublicHealth Institute, Basel, Switzerland;3Olyset Net, Liverpool School of Tropical Medicine, Liverpool, UK

Introduction: Aedes mosquito-borne arboviruses are threating over 780million people in Africa. However, our ability to deal with arboviral out-breaks in highly urbanized settings is very limited.Aim: We explored the interactions of the urbanisation and socio-ecological determinants with the ecology of Ae. aegypti and risk oftransmission of yellow fever (YFV) and dengue (DENV) viruses acrossan urban-to-rural gradient within disease foci in Côte d’Ivoire.Methods: Aedes eggs, larvae and adults were collected in urban, subur-ban and rural areas using standard procedures. Household and watercontainer socio-ecological data were also sampled. Surveys were con-ducted during long dry (LDS), long rainy (LRS), short dry (SDS) and shortrainy (SRS) seasons from January 2015 to December 2016. Ae. aegyptipositive ovitrap index (POI), Stegomyia indices (house index: HI, containerindex: CI and Breteau index: BI) and biting rate were compared.Results: Ae. aegypti was the most abundant species in all areas, andhigher abundance in urban areas (n = 26,072; 99.4%). Larval infestationindices were associated with human activities and behaviours includingwater storage practices and solid waste management. Tires and dis-carded containers in all areas and water storage receptacles in urbanareas were the most productive breeding sites. Overall, Stegomyia indiceswere higher during LRS in all areas, with stronger magnitude in urbanareas. POI was higher in urban (53.5%) compared to suburban (43.1%)and rural (29.7%). Stegomyia indices were highest in urban followed bysuburban and rural areas, with respective HI of 67.2, 51.4 and 27.8, CI of57.1, 43.5 and 19.7, and BI of 95.2, 78.9 and 8.8. Ae. aegypti females werethe most anthropophilic bitter inflicting 99.7% of total biting to humans.Biting rate was higher in urban (83.5 bites/person/day), followed by sub-urban (52.1 bites/person/day) and rural (19.4 females/person/day) areas.Hence, biting rate was 4.3 and 2.7-fold higher in urban and suburban,compared to rural areas, respectively.Conclusion: Urbanisation and associated socio-ecological factors shiftedthe ecology of Ae. aegypti thus resulting in a risk of YFV and DENV trans-mission higher than the conventional thresholds in urban and suburbanareas. Integrated community-based vector control programs should beapplied.

P118DIAGNOSTIC ACCURACY IN THE ABSENCE OF LABORATORYCAPACITY IN RURAL GHANA

Zimmermann M.E.1,2, Krumkamp R.1,2, Lorenz E.1,2, GyauBoahen K.4, Eibach D.1, Sarpong N.3,Owusu-Dabo E.5, May J.1,2

1Infectious Disease Epidemiology, Bernhard Nocht Institute forTropical Medicine, Hamburg, Germany;2TTU Malaria, Deutsches Zentrum für Infektionsforschung, Braun-schweig, Germany;3Agogo Presbyterian Hospital, Agogo, Ghana;4Paediatric Fevers, Kumasi Centre for Collaborative Research,Kumasi, Ghana;

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5School of Public Health, KNUST, Kumasi, Ghana

Introduction: Febrile illness is often accompanied by unspecific symp-toms, which overlap in viral, bacterial and parasitic infections. Withoutlaboratory diagnostics, these shared symptoms may result in false treat-ment.Aim: Our goal was to estimate how accurate symptom-based diagnoseswere and quantify the false treatment of the most common infectiousdiseases in rural Ghana.Methods: We analysed data from a hospital study comprising of 1,189admissions of patients ≤ 15 years to the paediatric ward. Data col-lected included a symptom-based diagnosis at admission and a set oflaboratory diagnostics to identify the cause of disease. Diagnoses weregrouped into the most common diseases observed in the study, as wellas their indication if treatment would target the underlying pathogen orthe symptoms. Assuming the laboratory results revealed the true causeof illness, we compared these findings with the symptom-based diag-nosis and calculated sensitivity as well as specificity within each diseasegroup.Results: The most frequent causes of illness were malaria (679, 57%),pneumonia (240, 20%), lower respiratory tract infection (186, 16%),gastrointestinal tract infection (95, 8%), invasive bacterial blood-streaminfection (62, 5%) and urinary tract infection (35, 3%). In all of thesegroups, the suspected diagnosis showed either low sensitivity or speci-ficity (< 80%), or both. A total of 267 diagnoses with an indication fortreatment were missed, while in 917 cases the child would have receiveda treatment it did not need. A further 186 cases were at risk of beingover treated, while 29 were at risk of not getting a treatment theyneeded.Conclusion: Symptom-based diagnosis presented low accuracy and highnumbers of over- and under treatment, emphasizing the necessity oflaboratory diagnostics for the correct differentiation of febrile illness inrural Ghana.

P119

EFFECT OF SEASONAL MALARIA CHEMOPREVENTION INIMPROVING HEALTH OF UNDER FIVE’S IN THE REGION OFCASCADE, BURKINA FASO

Zizien Z.R.1, Guiraud I.2, Kazienga A.31Ministère de la santé, Banfora, Burkina Faso;2Institut de recherche en sciences de la Santé, Ministère de larecherche, Nanoro, Burkina Faso;3Hasselt University, Hasselt, Belgium

Introduction: Malaria is a public health concern and laudable effortsand investment have been deployed in reducing of malaria incidencein Burkina Faso (BF). Seasonal Malaria chemoprevention (SMC) has beenimplemented in BF in 2014 and since 2016 in the region of Cascade.Aim: To assess the effect of SMC on (i) uncomplicated malaria cases, (ii)several malaria cases, (iii) death due to malaria on under-five’s years oldin the region of Cascade over the period 2013 to 2018.Methods: Monthly simple malaria cases, severe malaria cases as well asthe number of death related to malaria was documented over the studyperiod. The period 2013 to 2015 was considered as the pre-interventionwhereas SMC occurred from 2016 to 2018. Segmented regression wasperformed in controlling the secular trend as well as adjusting for poten-tial serial correlation of data.Results: Before SMC, the number of cases of uncomplicated malariawas 8706 and after the implementation of SMC there was a reductionof 2678 cases but non-significant (p = 0.618). According to the sameanalysis, before SMC, there were 605 cases of severe malaria on averageper month. We then look that after the implementation of the SMC there

was a reduction of cases but not significant (p = 0.222). Also, there was nosignificant month-to-month change in the number of deaths after SMC(p = 0.307).Conclusion: We found that the SMC has no significant decrease on thethree indicators in the region of Cascade. There is a need to investigatemore deeply in estimating the real impact of the intervention.

P120

IMPORTANCE OF SOCIO-ECONOMIC FACTORS AND ENVIRON-MENTAL FACTORS ASSOCIATED WITH MALARIA FOR SUB-SAHARAN AFRICAN CHILDREN

Mfueni Bikundi E., Coppieters Y.Epidemiology, Biostatistics and Clinical Research Center, School ofPublic Health, Université Libre de Bruxelles (ULB), Brussels, Belgium

Background: Malaria is one of first causes of morbidity and mortality inthe world; 445,000 deaths in 2017 were due to malaria. The majorityof malaria cases occur in Africa. In our study, we will estimate relativeimportance of malaria risk factors for improving health policy and fightagainst malaria.Methods: Analysis is on 16 Sub-Saharan African countries with recentDemographic and Health surveys incorporating malaria tests. Longitudeand latitude of each cluster were used to extract data on temperature,precipitation, population density, conflicts events and rivers or bodies ofwater. To preserve the confidentiality of the households surveyed, urbanclusters were randomly displaced by 0–2 km, and rural clusters by 0–5 km. Children for whom inform consent was given by their guardianswere tested for malaria and included in the survey data. For achievingthe purpose of our study, we followed several ways. Variance contributionof factors were estimated with the Generalized Linear Mixed-effectsmodel. Mean Gini decrease was used for measuring importance of eachpredictor and mean decrease accuracy was used for estimating howmuch each factor reduces error. Geographical weighted Regressions wereperformed for mapping and assessing heterogeneity of relationshipsbetween environmental factors and malaria. Classification RegressionTree was performed for observing partition of data.Results: Country where the child lived was the most important factorfor malaria risk and it contributed to half of the variability of malariarisk. We found that wealth status is the first socio-economic factor thatcontributes in differences of malaria risk. While age of child the third mostimportant factors for malaria risk, his contribution in the variability ofmalaria risk among African children is very low. Even if their contributionto the difference of malaria risk in Africa were very small, quantity ofrainfall, temperature and density of population were most importantenvironmental factors. We identified also countries of high associationwith malaria risk and countries having low association with malariarisk. There was a significant difference between these two groups ofcountries in the education level of mothers, the use of bed net, the size ofhousehold and population density. We observed that the economic levelwas not a significant characteristic of difference between the two groupsof countries. Even if we cannot relocate children, comparison of thesetwo groups allows us to observe variables that are significantly differentbetween the two groups on which health policies must improve.Conclusion: Countries with low risk were Madagascar, Senegal, Angola,Benin, Tanzania, Rwanda, and Burundi; while countries with high malariarisk included Uganda, Malawi, Liberia, Mozambique, Ivory-Coast, BurkinaFaso, DR Congo, Nigeria and Mali. While in certain regions; high quantity ofrainfall, high temperature or high density of population were associatedwith an increase of malaria risk; in certain regions the relationship wasthe inverse.Main message: This study showed spatial relationship between malariarisk and certain community variables; highlighting the particularity of

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each region. Economic level of households is not significantly differentbetween malaria high risk countries and malaria low risk countries. Thestudy indicates that in the fight against malaria, community characteris-tics must be considered.

Competing Interests:The authors have declared that no competing interests exist.

P121

DETERMINANTS OF BACILLE CALMETTE-GUÉRIN VACCINE SKINREACTIONS BY 2-MONTHS AND EFFECTS BY SKIN REACTIONTYPE AND SIZE ON MORTALITY BETWEEN 2 AND 1

Schaltz-Buchholzer F.Bandim Health Project, Statens Serum Institut, Copenhagen, Den-mark

Background: Six observational studies have shown that having a BacilleCalmette-Guérin (BCG) vaccine scar is associated with a 42% (95% Con-fidence Interval 51%-31%) reduction in all-cause mortality. A meta-analysis of three randomized controlled trials (RCTs) reported that BCGreduces neonatal mortality by 38% (0.46-0.83). It has not been studiedwhether differences in local skin reactions after BCG vaccination influ-ences mortality.Methods: Observational study across five BCG RCTs conducted inGuinea-Bissau; four RCTs tested early BCG vs. delayed BCG and oneRCT compared different BCG strains. Among 6,037 infants vaccinatedwith BCG within 1 week after birth, BCG skin reactions (none, scar,pustules, papule, size of reaction) were evaluated at routine 2-monthhome-visits and infant mortality data was collected at subsequenthome-visits. We assessed the effect of 2-month BCG skin reaction typeand size on 2-12-month mortality in Cox-models providing adjustedMortality Rate Ratios (aMRRs). Within the RCT of BCG strains, we testedby binomial regression providing Risk Ratios (RRs) whether heterologousstrains and the post-vaccination wheal size influences subsequent BCGreactions.Results: By 2-months, 2,473 infants (41.0%) presented a scar, 2,901(48.1%) a pustule, 452 (7.5%) papule and 211 (3.5%) had no reaction.The BCG-Denmark and BCG-Japan strains produced more pustules andfewer non-reactors compared with BCG-Russia. Large post-vaccinationwheals were associated with a lower risk of not developing a skin reac-tion, the no-reaction large(>5mm)/small(<4mm) wheal RR being 0.17(95% Confidence Interval (CI): 0.08-0.38). Furthermore, large whealswere associated with more skin pustules, the large/small RR being 1.21(1.08-1.36). There were marked differences in mortality rates betweenthe different BCG reactions, the 2-12-month MR for scar being 2.8%,pustule 1.0%, papule 2.7% and no reaction 4.7%. Hence, having any BCGreaction versus no reaction was associated with an aMRR=0.50 (0.26-0.96) and pustules were associated with the lowest mortality, scar/pus-tule aMRR being 1.64 (1.00-2.70), papule/pustule aMRR=2.23 (1.13-4.40)and no-reaction/pustule aMRR=2.98 (1.41-6.32). Having a large 2-monthBCG skin reaction reduced subsequent mortality independent of the 2-month reaction type, the small(<4mm)/large(>5mm) aMRR being 1.58(0.93-2.67).Conclusion: The BCG strain and the wheal size are important determi-nants for presenting a skin pustule by two-months. Having a pustule by 2months likely represents the desirable trait of live-attenuated mycobac-teria persisting within the host, which enables induction of protectiveimmune responses. Local pustule skin reactions and large skin reactionsby 2-months were associated with markedly reduced all-cause mortalitybetween 2-12-months. The 2-month vaccine reaction may be an impor-tant indicator of a well-functioning immune system induced by well-applied BCG at birth.

P122

MOLECULAR DETECTION OF DENGUE FEVER VIRUS IN PATIENTSSUSPECTED OF EBOLA VIRUS DISEASE IN GHANA

Bonney J.H.K.1, Hayashi T.1,2, Dadzie S.1, Agbosu E.1, Pratt D.1,Asiedu-Bekoe F.3, Ido E.2, Sarkodie B.4, Ohta N.2, Yamaoka S.21Virology Dept., Noguchi Memorial Institute of Medical Research,University of Ghana, Legon, Ghana,2Tokyo Medical and Dental University, Tokyo, Japan;3Disease Surveillance Dept., Ghana Health Service, Accra, Ghana;4Public Health Division, Ghana Health Service, Accra, Ghana

Introduction: Dengue fever (Df) is known to be one of the most commonArthropod-borne viral infectious disease of public health importance.The disease is now endemic in more than 100 countries in Africa, theAmericas, the Eastern Mediterranean, Southeast Asia and the WesternPacific with an estimated two fifths of the world’s population being atrisk. The notable endemic Viral Hemorrhagic Fevers (VHFs) found in WestAfrica, including Yellow fever, Lassa fever, Rift Valley fever, Dengue feverand until recently Ebola have been responsible for most outbreaks withfatal consequences. These VHFs usually produce unclear acute febrileillness, especially in the acute phase of infection.Aim: We set out to investigate and characterize the presence of Df andother arboviral agents in archived residual clinical specimens of serum150 patients clinically suspected of Ebola virus disease during the EbolaVirus Disease (EVD) outbreak in West Africa.Methods: Through a surveillance system set up as part of an EVD pre-paredness and response plan to detect and rapidly respond to cases,clinical specimens of serum/plasma from patients suspected of EVD weresubmitted and tested for EVD as well as known endemic VHFs includingYellow fever, Lassa fever West Nile and Dengue fever.Results: In this study we detected the presence of 2 different serotypes(DENV-2 and DENV-3) of Df virus in 4 sera of the patients clinically sus-pected of EVD during the outbreak in West Africa with the use of serolog-ical and molecular test assays. The phylogenetic analysis of the envelopegene showed that the DENV-3 had close homology with serotype fromSenegal and India.Conclusion: This study documents molecular evidence of an indigenousDengue fever viral infection in Ghana and therefore necessitates the needto have an efficient surveillance system to rapidly detect and control thedissemination of the different serotypes in the population which has thepotential to cause outbreaks of Dengue Hemorrhagic fevers.

P123

LIST OF CANDIDATE ITEMS FOR PROTOCOLS OF OBSERVA-TIONAL STUDIES: A SCOPING REVIEW

Mahajan R.1, Burza S.1, Zeegers M.21Medecins Sans Frontieres, New Delhi, India;2Care and Public Health Research Institute, Maastricht University,Maastricht, The Netherlands

Introduction: There are currently no guidelines avalable to define orguide minimum content of protocols of observetional studies. Thereforethis scoping review was conducted within the scope of the StandardizedProtocol Items: Recommendations for Observational Studies (SPIROS)initiative. SPIROS aims to improve the completeness and use of studyprotocols of observational studies by producing expert-based recommen-dations for a minimum set of items to be addressed in those protocols.This list will be further reviewed by steering committee experts and wouldserve as input for an extensive Delphi study whose objective will be todevelop expert-driven criteria for observational study protocols.

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Aim: Aim of this review was to prepare a long-list of unambiguouscandidate items for the protocols of observational studies that could beincorporated in the draft reporting guideline.Methods: Data for this scoping review were identified by searches ofWeb of Science Core Collection and references from relevant articlesusing the search terms ´protocol ´ PLUS óbservational study ´ AND/ORćohort study ´ AND/OR ćase control study ´ AND/OR ćross sectionalstudy ´ AND/OR écological study ´ AND/OR ´prevalence study ´ AND/OR´survey ´ in advance search mode. Protocols published in English lan-guage between 1st January 2016 and May 2018 were included. Thesearch revealed 450 results. All results were then further screened inde-pendently for appropriateness to ensure that they met the inclusioncriteria. 203 were excluded on this basis, leaving 247. Of these 100were randomly selected, which were read in detail to develop a long-list of elements to be included with the intention of reaching informationthreshold saturation. Saturation was considered met after 93 protocolswere reviewed.Results: A total of 53 preliminary items were categorized into 6 themat-ics, following the structure of the STROBE (STrengthening the Reporting ofOBservational studies in Epidemiology) checklist viz. General information,Introduction, methods, ethical consideration, reporting and dissemina-tion and others.Conclusion: Our review was a first step to identify content and currentpractices within published protocols. We identified all possible candidateitems available in these protocols and added it to STROBE checklist. Theanalysis found a large disparity among protocols in regards to standard-ised structure of protocols.

P124

GASTRO-INTESTINAL HELMINTHS OF FREE-RANGING VERVETMONKEYS (CHLOROCEBUS PYGERYTHRUS) IN HUYE TOWN,RWANDA – CALL FOR ONE HEALTH APPROACH

Gashururu R.1, Mutabazi I.2, Mindje M.21School of Veterinary Medicine, University of Rwanda, Nyagatare;2Wildlife and Natural Conservation, University of Rwanda, Huye,Rwanda

Introduction: The effects of parasitism in non-human primates includingvervet monkeys are likely to extend beyond their host populations. Pat-terns of parasitism in wildlife populations are influenced by host rangingpatterns, density, intraspecific and interspecific contact rates and diet.There is an increasing population of vervet monkeys in Huye town. Owingto their close contact with people, there is a potential risk of transmittingpathogens to each other. Common intestinal parasites of human havebeen reported in primates suggesting a high potential for interspeciestransmission. Faecal materials are potential source of disease causingmicroorganisms, including helminthes.Aim: This study was conducted to assess the gastrointestinal helminthesof free-ranging vervet monkeys (Chlorocebus pygerythrus) in Huye cityfrom February to May 2017. The objective was to determine the preva-lence of gastrointestinal helminthes affecting vervet monkeys and toidentify those of which that may be of public health importance.Methods: 86 faecal samples were collected from four groups, selectedusing their living location. The samples were analyzed by using directsmear, floatation and sedimentation techniques.Results: Out of 76 faecal samples examined, 82.6% were foundto harbour one or more gastrointestinal helmiths. The nematodesinclude Trichuris Trichiura, Strongyloides Stercoralis and Ascaris spp. Thecestodes recovered were Bertiella mucronata and Taenia spp whilethe trematodes were Fasciola spp and Heterophyes sp (Haplorchispunilio). The most frequently detected helminth was Taenia spp(30.6 %) and the least found was Heterophyes spp (5.9 %). Most of the

helminths found can affect other animals (wild and domestic) as well ashumans.Conclusion: This was a baseline information on the occurrence ofhelminthic infection in vervet monkeys in the area. There is need to doconduct and deepen future studies in the area over a long period withmore groups to identify definitely these parasites and determine thepossible transmission patterns in order to confirm whether or not theseare multi-host pathogens that can be shared.

P125SEMI-DOMESTICATED DOGS AS A POTENTIAL RESERVOIRS FORZOONOTIC HOOKWORMS IN BANGKOK, THAILANDInpankaew T.1,2,3, Wongwigkan J.1,2,3, Phoosangwalthong P.1,2,3

1Center for Agricultural Biotechnology, Kasetsart University, Kam-phaeng Saen Campus, Nakhon Pathom, Bangkok;2Center of Excellence on Agricultural Biotechnology: (AG-BIO/PERDO-CHE), Bangkok;3Dept. of Parasitology, Faculty of Veterinary Medicine, KasetsartUniversity, Bangkok, Thailand

Introduction: Hookworms are parasitic nematodes that live in the smallintestine of their mammalian hosts such as humans, dogs, and cats. Thehookworm species causing the most infections in dogs are Ancylostomacaninum and Ancylostoma ceylanicum. In particular A. ceylanicum is apotentially zoonotic hookworm and can infect humans and cats through-out Asia.Aim: This study was performed to determine the prevalence and geneticcharacterization of hookworms among semi-domesticated dogs residingin monasteries of Bangkok metropolitan areas using molecular tech-niques.Methods: A total of 500 faecal samples from semi-domesticated dogswere collected from 91 temples in 48 districts of Bangkok, Thailand. Fae-cal samples were extracted and screened by internal transcribed spacer(ITS) gene PCR-RFLP. In addition, A. ceylanicum positive samples werefurther characterized to a haplotype level by analysis of the mitochondrialgene (cox1).Results: The prevalence of hookworm infection in semi-domesticateddogs was 6.2% (31/500). Hookworm infection was detected in temple-community dogs in 12 of 48 districts (25.0%), with Bang Khen and Lak Sidistrict having the highest proportion of infected dogs (22.6%). Molecularcharacterization of hookworm species revealed that 21 out of 31 positivesamples were A. ceylanicum (67.74%) while, 10 out of 31 positive sampleswere A. caninum (32.26%). Characterization of the cytochrome oxidase-1gene (cox1) in isolates of A. ceylanicum showed the presence of mixturebetween human and dog isolates.Conclusion: These findings imply that semi-domesticated dogs act as apotential source of hookworm infection to human and animal populationin Bangkok, Thailand.

P126

ZOONOTIC TUBERCULOSIS IN HIGH RISK GROUPS IN ETHIOPIA

Taye H., Fekadu E., Haile S., Belacjew B., Melese F., Berg S., WoodJ., Aseffa A., Mihret A.1, ETHICOBOTS Consortium1Armauer Hansen Research Institute, Addis Ababa, Ethiopia

Background: Mycobacterium tuberculosis is recognised as the primarycause of human tuberculosis (TB) worldwide. However, substantial evi-dence suggests that the burden of Mycobacterium bovis, the cause ofbovine tuberculosis, might be underestimated in human beings as thecause of zoonotic tuberculosis. Ethiopia is a high TB burden country with

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an estimated new case of 164/100,000 population. In Ethiopia, smearpositive, smear negative and extra-pulmonary TB contributes equally onethird of all TB cases. Bovine TB is endemic in Ethiopian cattle and itreaches an animal prevalence of 30% and a herd prevalence of over 50%,particularly in intensive dairy farms in Central Ethiopia.Objective: In this study we aim to determine the prevalence of M.bovis infection in high risk groups, suspected with pulmonary and extra-pulmonary TB.Methodology: We employed both active and passive case detectionapproaches to recruit study participants. In active case detection wescreened all farm workers working in selected farms. Smear positive andsmear negative pulmonary TB as well as extra-pulmonary TB patientsvisiting health facilities in and around Addis Ababa, Gondar, Hawassa andMekelle were recruited through passive case detection. We collected andprocessed 1990 sputum and 510 Fine-Needle Aspirate (FNA) samples andcultured for mycobacteria; samples with acid-fast stained bacilli (AFB)were further characterized by molecular typing including deletion typing.Result: In the active case detection approach we screened 360 farmworkers from whom 44 showed TB symptom; however, all their sampleswere smear and culture negative. In the passive case detection, sputumand FNA culture positivity for mycobacteria was confirmed in 476 (23.9%)and 154(30.2%) study participants, respectively. The vast majority wereidentified by molecular typing as M. tuberculosis. Only 2 (0.3%) of the 630isolates were characterized as M. bovis. The two patients with zoonoticinfection had pulmonary and extra-pulmonary TB, respectively.Conclusion: The frequency of M. bovis in both pulmonary and extra-pulmonary cases in culture positive samples were very low (0.3%) andits contribution in the overall TB epidemiology in Ethiopia is very minimal.However, the contribution of M. bovis infection in culture negative humancases remain unclear.

P127MULTIRESISTANT E COLI AND SALMONELLA SPP IN POULTRYLITTER IN AN URBAN AREA SETTING IN CAMEROON

Ngogang Djobet M.P.1, Ngogang J.2, Wade A.3, Van der SandeM.A.B.4,5

1Biomedical Sciences Dept., Institute of Tropical Medicine, Antwerp,Belgium;2Physiological Sciences, Université des Montagnes, Bagangté,Cameroon;3Veterinary Laboratory Dept., LANAVET annex, Yaounde, Cameroon;4Public Health Dept., Institute of Tropical Medicine, Antwerp,Belgium;5Julius Global Health, Utrecht University, Utrecht, The Netherlands

Introduction: Poultry litter is an affordable organic fertilizer used asmanure worldwide. It’s also a potential source of environmental con-tamination and transmission by various pathogens including foodbornebacteria such as E coli and Salmonella spp. In Cameroon, poultry litter isthe main fertilizer used but data are not available regarding the microbi-ological safety of litter.Aim: To assess the extent of contamination of poultry litters with E coliand Salmonella species and evaluate the proportion of antimicrobialresistance in the isolated bacteria, focusing on farms in a Cameroon urbanarea setting.Methods: Following authorization of competent authorities, 20 farmswere randomly selected and a questionnaire was administered. Samplesof poultry litter were aseptically collected and microbiological assayswere performed. Results were compiled and analysed with R.Results: 57 samples were collected; E coli and Salmonella spp wereisolated in 66.6% and 12.3% of samples respectively. E coli spp showedhigh resistance to sulphonamides (96%), ampicillin (93%) and tetra-

cycline (89%). All E coli spp were multiresistant, 25% being resistantto seven out of the 11 antibiotics tested. Salmonella spp showed highresistance to tetracycline (71%), sulphonamides (57%), ciprofloxacineand chloramphenicol (43%). 86% of Salmonella spp were resistant to atleast two antibiotics. High use of antibiotics and absence of treatmentof poultry litter prior to use as manure was reported by the participatingfarmers.Conclusion: The study observed a high use of antibiotics by farmers andhigh prevalence of multidrug resistant E coli and Salmonella spp in theirpoultry litter. This creates a significant risk of spread of multi drug resis-tant pathogens among poultry, humans and the environment, especiallyas no treatment is performed on litter prior disposal. Interventions areneeded to limit antibiotic use in poultry farms and to encourage post-treatment of litter before use or prior disposal.

P128

A SYSTEMATIC REVIEW ON THE EXTENT AND DIFFERENT WAYSCLIMATE CHANGE ACTS AS A THREAT MULTIPLIER IN THE LAKECHAD BASIN REGION

Wilson R.D.1, Sullivan R.2, Sawas A.31Medical School, University of Glasgow, Glasgow, UK;2Centre for Study of Conflict and Health, King’s College London,London, UK;3Climate Change and Risk Programme, Stockholm InternationalPeace Research Institute, Stockholm, Sweden

Introduction: Escalating conflict in Lake Chad Basin Region (LCBR) hascreated a massive humanitarian crisis, with 2.5 million people displacedand 3.6 million at emergency levels of food insecurity. Climate change hasbeen increasingly implicated as a threat multiplier (a factor exacerbatingexisting security risks and worsening fragile situations) in the LCBR by theUN Security Council, policymakers and local experts. However, there havebeen limited attempts to assess this evidence.Aim: To critically assess the available scientific evidence addressing theoverarching question: ‘to what extent and in what different ways doesclimate change act as a threat multiplier in the LCBR?’.Methods: Our overarching question was addressed by conducting a sys-tematic review to answer: (i) what factors mediate between climatechange and conflict? (ii) how does climate change negatively impacthealth regionally (iii) what modes of mitigation are being suggested ortested, and how effective are they? A two-stage analysis was used witha quality assessment to evaluate the strength of the evidence.Results: Climate change had a clear causal role in driving natural resourceconflicts through resource scarcity, but a more complex role in the BokoHaram insurgency. Climate variability was proposed to increase vulner-ability to recruitment and increasing fragility, permitting Boko Haram’sregional spread. This conflict has had obvious implications for healthincluding direct violent impacts, food shortages, near collapse of localhealth systems and massive refugee populations susceptible to dis-ease outbreaks and ill-health. Simultaneously, the literature suggests cli-mate variability directly impacts health through increased food insecurity,internal refugee flows and outbreaks of climate-sensitive diseases (e.g.cholera) among displaced populations. The main mitigation methodsproposed were the Lake Chad Transaqua Rejuvenation Initiative andconflict-sensitised combined climate adaptation and humanitarian reliefprogrammes.Conclusion: Climate change acts as a threat multiplier in the ongoingLCBR humanitarian crisis. However, no studies consider climate change’srole in the humanitarian crisis by linking its’ separate impacts on conflictand health. Instead, these deeply interconnected areas remain siloed.There is critical need to research this nexus of climate change, conflictand health in order to effectively mitigate the LCBR humanitarian crisis.

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P129ONE HEALTH REGIONAL NETWORK FOR THE HORN OF AFRICA

Baylis M.1, Asrat D.2, Fevre F.1,3, Kahsay M.4, Mor S.1,5, OngoreD.6, Pulford J.7, Wesonga F.81Institute of Infection and Global Health, University of Liverpool,Liverpool, UK;2College of Health Sciences, Addis Ababa University, Addis Ababa,Ethiopia;3International Livestock Research Institute, Nairobi, Kenya;4Hamelmalo Agricultural College, Eritrea;5International Livestock Research Institute, Addis Ababa, Ethiopia;6School of Public Health, University of Nairobi, Nairobi, Kenya;7Liverpool School of Tropical Medicine, Liverpool, UK;8iGAD Sheikh Technical Veterinary School, Sheikh, Somaliland

Introduction: One Health is the concept that the health and well-beingof people is linked to the health of their animals and the environment.It is nowhere more true than in the Horn of Africa, where many people’shealth and livelihoods, and even national economies, are dependent onlivestock.Aim: The HORN project is aiming to improve the health and wealthof the people of the Horn of Africa by developing a One HealthRegional Network. The network aims to strengthen the research capacityof individuals and organisations to undertake high quality researchinto the link between people’s health and that of the livestock andenvironment.Methods: HORN has 5 objectives: 1. Research capacity assessmentsof partner institutes across the Horn of Africa; 2. Provision of train-ing to research support staff; 3. Knowledge and skills advancement forresearchers; 4. Co-creation of research projects; and 5. Development ofthe One Health Regional Network and research placements.Results: HORN has developed research projects through the recruitmentof post-doctoral research associates at partner institutes and heldthe first project sandpit event, where research fellows from acrossthe region developed collaborative, interdisciplinary research projects.Training curriculums have been developed and e-learning materialshave been launched. Training events for researchers have been held,including a summer school and leadership training. Research capacityassessments have been conducted and priority action plans are currentlybeing implemented, to strengthen One Health research capacity acrossthe region.

P130SCALING UP ONE HEALTH RESEARCH AND SURVEILLANCEUSING THE HEALTH AND DEMOGRAPHIC SURVEILLANCESYSTEM (HDSS) PLATFORM IN ETHIOPIATessema F.1, Woldemichael K.1, Tiku S.1, Tegegne D.2,Abdurahaman M.2, Deneke Y.2, Tsadik M.3, Redae G.3, BerheG.3, Teferi M.3, Bsrat A.4, Afera B.4, Abebe N.4, Kebede N.5,Mekonnen W.6, Wakuma S.6, Hagos S.6, Enquselassie F.6,Cavalerie L.7,8, Mor S.7,8

1College of Public Health, Jimma University, Jimma, Ethiopia;2College of Agriculture and Veterinary Medicine, Jimma Univer-sity, Jimma, Ethiopia;3College of Health Sciences, Mekelle University, Mekelle, Ethiopia;4College of Veterinary Medicine, Mekelle University, Mekelle,Ethiopia;5Aklilu Lemma Institute of Pathobiology, Addis Ababa University,Addis Ababa, Ethiopia;

6College of Health Sciences, Addis Ababa University, Addis Ababa,Ethiopia;7Institute of Infection and Global Health, University of Liverpool,Liverpool, UK;8International Livestock Research Institute, Addis Ababa, Ethiopia

Health and demographic surveillance sites (HDSS) are the main sourceof longitudinal data in low and middle income countries (LMIC) due tothe absence of complete vital registration systems in many countries.To date, most HDSS sites have focussed on life events in humans (birth,death, marriage, migration) without major regard for livestock and theenvironment which they share. Livestock are vital as a source of livelihoodand nutrition for much of the population in LMICs, as well as an impor-tant source of zoonotic diseases. With partial support from the HORNproject, we have been exploring ways to integrate One Health approachesinto the existing HDSS platform in Ethiopia. Together researchers fromAddis Ababa University, Jimma University, Mekelle University and theUniversity of Liverpool, representing human, animal and environmentalhealth disciplines identified 4 work packages for further refinement andimplementation, namely: (1) comparative analysis of livestock trendsutilising data generated by HDSS sites to date; (2) development of adetailed livestock and environment module for baseline survey datacollection with ongoing surveillance of select indicators; (3) multi-siteassessment of knowledge, attitudes and practices related to zoonoses,food safety and environmental status, to inform future research andextension activities; and (4) multi-site morbidity (syndromic) surveillancein humans and animals in the same household. We believe that byembedding activities in existing HDSS sites there is considerable potentialto scale up One Health approaches and interventions in Ethiopia andother LMICs.

P131

BIOFERTILIZERS AND PHYTOREMEDIATION: UPTAKE OF PHESIN TOMATO SEEDLINGS GROWN IN KRUGERSDORP MINE SOIL

Arthur G.D.1, Naidoo K.K.1, Sithole N.2, Sooknundan A.1, ZithaN.1, Voko X.2, Kulkarni M.G.2, Stirk W.A.2, Van Staden J.21Mangosuthu University of Technology, Durban, KwaZulu-Natal;2Research Centre for Plant Growth and Development, Schoolof Life Sciences, University of KwaZulu-Natal Pietermaritzburg,Scottsville, South Africa

Introduction: Potentially harmful elements (PHEs) released through nat-ural and anthropogenic sources are negatively impacting directly and/orindirectly on the environment, nurturing international concerns. Aban-doned mines and their vicinities are sites for crop production particularlyat the subsistence levels with PHEs accumulating in food chain, adverselyaffecting livestock and human health.Aim: There is need to explore the effect of cost-effective biofertilizers (ver-micompost leachate and yeast) on Transfer Factor (TF), BioaccumulationFactor (BAF) and vigour in early phase of tomato seedlings grown in soil(KS1) from Mintail Gold Mines Krugersdorp, South Africa.Method: In a greenhouse experiment, tomato (‘Monica variety’) seedlingswere treated once a week for 5 weeks with vermicompost leachate (1, 5,10 and 20%) and yeast concentrations (0.5, 1, 1.5 and 2%) with water ascontrol.Result: Growth parameters were recorded and Aqua regia digestion andICP-MS analysis were used to determine PHEs present in the soil sample.Analysis of elements concentrations (mg kg-1) of As, Co, Cu, Cr, Ni and Znpresent in seedlings is in progress and will be compared with the accept-able limits set by joint expert committee on food additives FAO/WHO.Conclusion: This result will draw attention on risk inferences of PHEs intomato, a popular and globally grown vegetable crop.

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P133EREGCOM: COMMUNICATION STRATEGIES TO HEALTHCAREPROVIDERS AND WOMEN FROM AN ELECTRONIC MATERNALAND CHILD HEALTH REGISTRY – A PROTOCOL FOR CLUSTERRANDOMIZED CONTROLLED TRIAL

Bungudo B.B.1,2, Mørkrid K.1, Abu Khader K.3, Abu WardI.3, Awwad T.3, Baniode M.3, Ghanem B.3, O’Donnell F.B.1,Venkateswaran M.1,2, Frøen J.F.1,2

1Global Health Cluster, Division for Health Services, NorwegianInstitute of Public Health, Oslo, Norway;2Center for Intervention Science in Maternal and Child Health,University of Bergen, Bergen, Norway;3The Palestinian National Institute of Public Health, World HealthOrganization, Palestine

Introduction: Antenatal care provides a platform for implementation ofevidence-based interventions to ensure a positive pregnancy experience.However, due to multifaceted reasons, antenatal and postnatal serviceshave been poorly accessed or of low quality, especially in low-and middle-income countries. To ensure optimal effect, essential interventions duringantenatal and postnatal care have to be provided at the appropriategestational age and with the recommended frequencies. Digital healthinterventions targeting both clients and healthcare providers can improvetimely attendance to healthcare and the quality of services provided.Aim: The aim of this trial is to assess the effectiveness of targetedclient communication (TCC) to pregnant and postpartum women, and/orperformance feedback (PFB) to healthcare providers generated from thePalestinian electronic maternal and child health registry (MCH eRegistry),on timely attendances and quality of care.Methods: This study is a four-arm cluster randomized trial embeddedwithin the national implementation of the MCH eRegistry in Palestine. Thetrial includes 140 public primary healthcare clinics (PHC) with an averageannual enrolment rate of 344 new pregnancies. All clinics are currentlyusing the MCH eRegistry. The PHCs are randomized to control; automatedelectronic PFB, to healthcare providers; TCC, through SMS messaging, topregnant and postpartum women; or the combination of both interven-tions. The interventions are theory-based and co-designed with stake-holders. The initial prototypes of both interventions were pretested. Wecalculated the effective sample size assuming an alpha of 0.05, 90%power and an intracluster-correlation coefficient of 0.05. The control armwill be the comparator for each of the three intervention arms, and wewill apply the intention-to-treat analyses approach.Results: Designing timely, individualized and actionable information fromthe MCH eRegistry delivered through SMS to women and PFB dashboardto healthcare providers, have the potential to improve timely attendanceand appropriate care. We expect the results to provide evidence aboutoptimizing the use of data from an electronic registry, such as the MCHeRegistry, to communicate back to the clients and healthcare providers.Conclusion: The richness of data in the MCH eRegistry offers a uniqueopportunity to implement tailored digital health interventions to womenand healthcare providers.Trial registration number:ISRCTN10520687

P134

“WITHOUT ANTIBIOTICS, I CANNOT TREAT” – A MIXEDMETHODS STUDY OF KNOWLEDGE, ATTITUDES, AND PRACTICESRELATED TO ANTIBIOTIC USE IN WEST BENGAL, INDIA

Nair M.1, Tripathi S.2, Mazumdar S.2, Mahajan R.1, Harshana A.1,Pereira A.1, Jimenez C.3, Halder D.4, Burza S.1

1Médecins Sans Frontières, New Delhi, India;2Calcutta School of Tropical Medicine, Kolkata, India;3Médecins Sans Frontières, Barcelona, Spain;4Paschim Bardhaman Health District, West Bengal, India

Introduction: Inappropriate antibiotic use is widespread and contributesto antibiotic resistance, especially in less regulated health systems.Patients interact with formal and informal healthcare providers in primaryhealthcare, but the level of knowledge, attitudes, and practices of bothproviders and patients is not well documented.Methods: This mixed-methods study explored the prescribing patternsof informal and formal providers. We surveyed 384 participants (96allopathic doctors, 96 nurses, 96 informal providers, and 96 pharmacyshopkeepers) using a validated KAP questionnaire and conducted 28 in-depth interviews with providers and community members. Qualitativedata was analyzed using the framework method in an inductive anddeductive manner, while quantitative data was collated in Excel andanalyzed using SPSS.Results: Results indicate a strong dissonance between knowledge andpractice among doctors who scored highest in questions assessingknowledge (77.3%) and attitudes (87.3%), and yet, performed worst(67.6%) regarding practices. Many doctors knew that antibiotics werenot indicated for viral infections, but over 88% provided them dueto inconsistent follow up, lack of disgnostics and ‘unhygienic’ livingconditions. Odds of having a low composite score among non-doctorson regression analysis was 10.4 (95% CI 5.4, 20.0) times greater thandoctors (p<0.01).Over 95% of informal health providers, nursing staff and pharmacyshopkeepers stated knowledge of antibiotics was important in their roleas a health provider, even though none were legally permitted to pre-scribe antibiotics. 30.8% of all providers and 56/96 (58%) of all informalproviders identified pharmaceutical company representatives as a majorsource of information about antibiotics. These representatives had exten-sive networks even in the most remote areas, with informal providersclaiming their attendance at antibiotic marketing meetings was com-mon. Community members actively sought ´potent ´ medicines fromproviders, frequently switching providers if they perceived the medicineto be inadequate.Conclusions: Current initiatives to tackle ABR in Asia fail to take intoaccount patient perceptions and the relationships between differentproviders and the role of pharmaceutical company representatives. Thepivotal role played by pharmaceutical company representatives in net-working with informal providers was particularly notable which makes astrong case for tapping into these critical pre-existing networks.Ethics Statement:This study was approved by the MSF Ethical Review Board and the EthicsCommittee of the Calcutta School of Tropical Medicine, Kolkata, India.

P135ASSESSMENT AND PERCEPTION OF URBAN AND RURAL FOODENVIRONMENTS IN SOUTH AFRICASpires M.1,2, Delobelle P.1,3, Berggreen-Clausen A.4,Daivadanam M.4,5, Puoane T.1, Sanders D.11School of Public Health, University of Western Cape, Bellville,South Africa ;2Centre for Food Policy, City, University of London, London, UK ;3Chronic Disease Initiative for Africa, University of Cape Town, CapeTown, South Africa ;4Dept. of Food Studies, Nutrition and Dietetics, Uppsala University,Uppsala, Sweden ;5Dept. of Public Health Sciences, Karolinska Institutet, Stockholm,Sweden

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Introduction: Type-2 diabetes and pre-diabetes contribute increasinglyto the global burden of disease. Apart from behavioural risk factors,diet plays a key role in their onset and management, in turn largelydetermined by local food environments.Aim: This study assessed food environments and community perspec-tives on their impact on diabetes self-management in an urban and ruralsetting in South Africa.Methods: A mixed method cross-sectional design guided by a conceptualframework and including a quantitative assessment of the external foodenvironment using an adapted physical environment audit tool (EPOCH)and a qualitative assessment of community perspectives using com-munity based participatory research (PhotoVoice). We used descriptivestatistics and a deductive thematic approach for data analysis.Results: Food retail outlets were more evenly dispersed and more prod-ucts available in urban outlets but less healthy food items were moreavailable in both settings. Supermarkets provided a larger selection ofcheap fruits and vegetables in urban settings and in rural independentgroceries. Informal vendors offered fruit and vegetables at higher pricesbut were more accessible. There were twice as many fast food outlets andthree times as many pubs in the rural setting. Advertisements promotingpurchase and consumption of unhealthy foods and drinks vastly out-numbered those promoting healthier options. Community perspectivesshowed high levels of awareness regarding healthy food options, butpointed to issues of access, cost of healthy food, and food safety in ruralareas. Fast food outlets were perceived as a barrier to eating healthily inurban areas.Conclusion: Observations of urban and rural food environments indi-cated a variability in availability and accessibility of food retailers andfood items, with less healthy items aggressively promoted across bothsettings. High levels of knowledge regarding healthy food, and how tonavigate food environments, were offset by issues related to affordability,availability, and accessibility, which play a critical role in shaping foodacquisition and resulting dietary patterns. Supermarkets and informalvendors play a crucial role and need to be considered in any food relatedpolicy strategy. The findings highlight the need to identify and understandlocal food environments to enable contextualized diet-related NCD inter-vention strategies.

P137

LINKS BETWEEN SOIL COMPOSITION AND PODOCONIOSISOCCURRENCE AND PREVALENCE IN CAMEROON

Gislam H.1, Burnside N.G.1, Brolly M.1, Deribe K.2, Davey G.2,3

1School of Environment & Technology., University of Brighton,Brighton, UK;2Wellcome Trust Centre for Global Health Research., Brighton andSussex Medical School, Brighton, UK;3Centre for Environmental and Developmental Studies and Schoolof Public Health., Addis Ababa University, Addis Ababa, Ethiopia

Introduction: Podoconiosis, a form of non-filarial elephantiasis, is a geo-chemical disease associated with individuals exposed to red clay soilfrom alkalic volcanic rock. It is estimated that globally 4 million peoplesuffer from the disease1, though the exact causal agent is unknown. Thisstudy is the first analysis in Cameroon to compare high resolution ground-sampled geochemical soil variables in relation to podoconiosis prevalenceand occurrence.Aim: To investigate the associations of soil mineralogical and elementvariables in relation to podoconiosis prevalence and occurrence data inCameroon.Methods: In this study exploratory statistical and spatial data analysiswere conducted on soil and podoconiosis variables. The soil datawas comprised of 19 minerals and 55 elements including kaolinite,

quartz, mica and zirconium which have previously been associatedwith podoconisois2. An initial proximal analysis included a spatial joinbetween the prevalence data points and the closest ground-sampledsoils variables. In addition, the soil variables were interpolated to createa continuous surface using the methods: inverse distance weighting,ordinary kriging, universal kriging and empirical Bayesian kriging. Usingprediction error statistics the most suitable interpolation method wasselected for each soil variable. At each prevalence data point, soil valuesfrom the interpolated surfaces were extracted to create a new dataset. Univariate analysis including Spearman’s correlation and logisticregression analysis were carried out on both the proximal analysis dataset and the interpolated soil variables. The interpolated soil variableswere also analysed using principal component analysis, to identify anypatterns or clusters, regarding podoconiosis prevalence levels.Results: Univariate analysis of both the proximal and interpolated dataset identified several statistically significant soil variables with associ-ations with podoconiosis. Correlation analysis identified soil variableswith a statistically significant positive Spearman rho value in relation topodoconiosis prevalence. Logistic regression analysis identified severalstatistically significant soil variables with odds ratio values greater than1, with respect to the podoconiosis occurrence data.Conclusion: The findings suggest that the key minerals and elementsidentified in this study may play a role in the pathogenesis of podoconiosisor could be disease covariates.

References:1. Tekola Ayele F., Adeyemo A., Finan C., Hailu E., Sinnott P., BurlinsonN.D., Aseffa A., Rotimi C.N., Newport M.J., Davey G. HLA class II locus andsusceptibility to podoconiosis. The New England Journal of Medicine 2012;366; 1200-1208.2. Molla, Y.B., Wardrop, N.A., Le Blond, J.S., Baxter, P., Newport, M.J.,Atkinson, P.M. and Davey, G., 2014. Modelling environmental factors cor-related with podoconiosis: a geospatial study of non-filarial elephantiasis.International journal of health geographics, 13(1), p.24.

P138

LAGOS, MEGA CITY OF SLUMS: THE ECOLOGY OF ILL-HEALTH INUNHEALTHY COMMUNITIES

Olatunde O.A.1,2,3, Olufemi O.A.3,4

1Dept. of Family Medicine, Dalhousie University, Halifax, Nova Sco-tia, Canada;2Dept. of Family Medicine, University of British Columbia, Vancou-ver, British Columbia, Canada;3Society for Good Health, Ibadan, Oyo State, Nigeria;4Independent Urban Planner, Oakville, Ontario, Canada

Introduction: Health is the pulse of a city’s well-being and the mostimportant asset of any city is the health of its citizens. Today, 130 millionmore people are said to reside in urban slums. According to UN-Habitat, aslum is a contiguous settlement where the inhabitants are characterisedas having inadequate housing and basic services. Lagos, Nigeria, is amega city with an estimated population of about 22 million in 2017. Thenumber of slums in the Lagos city is about 100 and increase unabateddue to poverty, uncontrolled urbanisation, policy failure, housing deficitand affordability. About 70 per cent of Lagos population are said to livein slums located in the oldest settled areas of mainland Lagos, in marshylands and near the lagoons.Aim: This paper contends that unhealthy communities of slum dwellerspredispose them to diseases and ill-health. Slum residents’ exposureto vector-borne diseases in their communities is a precursor to poorquality of life. The paper utilizes the ecological perspective as a theoreticalapproach that emphasizes the interaction between and interdependence

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of factors within and across all levels of a health problem; and highlightspeople’s interactions with their physical and socio-cultural environments.Methods: Using an observational research methodology, authorsobtained information of the health of the slum residents’ of Oko Oba.Secondary data was obtained from existing literature in books, journalarticles and reports.Results: It was observed that the major latrine was an open areaclose to the lagoon which also serves as the garbage dump. Therewere also observed rats, cockroaches entering and exiting the poorlyerected and poorly maintained buildings of residence. There wereobserved stagnant water bodies that could potentially be good breadingplaces for vectors that could be potential carriers of malaria, diarrheadiseases etc.Conclusion: Slums constitute breeding grounds for diseases and eradica-tion of this type of community might not be feasible. There is need forresident’s empowerment, information sharing, community organizing,health promotion, advocacy and education. Lastly, both governmen-tal and non-governmental organizations, slum community leaders andmajor stakeholders must be involved in health policy, education andenvironmental planning.

P139

RISK FACTORS FOR MALNUTRITION AMONG SCHOOL-AGEDCHILDREN: A CROSS-SECTIONAL STUDY IN RURAL MADAGAS-CAR

Aiga H.1,2, Abe K.3, Andrianome V.N.4, Randriamampionona E.5,Razafinombana A.3, Murai T.6, Hara M.31Japan International Cooperation Agency (JICA), Tokyo, Japan;2The George Washington University, Washington DC, USA;3Japan International Cooperation Agency (JICA), Antananarivo,Madagascar;4Ministry of National Education, Antananarivo, Madagascar;5Association des consultants a la recherche au devellopementeconomique et social (ACREDES), Antananarivo, Madagascar

Introduction: For over 20 years, Madagascar has been challenged bycontinued high prevalence of stunting, underweight and wasting amongchildren under five years of age. Yet, nutritional status of post-under-five age group have been never assessed in the country, despite itsimportance in relation not only to physical health but also to cognitivecapacity and educational achievements.Aim: This study aims to estimate prevalence of malnutrition amongschoolchildren aged 5-14 years in Madagascar. It further attempts toidentify the possible risk factors for their malnutrition. This is the firststudy that estimates prevalence of malnutrition of school-aged childrenin Madagascar.Methods: A cross-sectional household survey was conducted inAntananarivo-Avaradrano district, Analamanga region, Madagascar.The study targeted 399 first and second graders 5-14 years of ageenrolled at 10 primary schools, where school-feeding was implemented.Data were collected from anthropometric measurements and theirsubsequent household structured interviews and observations. Bivariate(Chi-square test or Mann-Whitney’s U test) and multivariate (logisticregression) analyses were performed, to identify factors associated withmalnutrition.Results: The overall prevalence rates of stunting, underweight and thin-ness were 34.8%, 37.6% and 11%, respectively. Nineteen children (4.8%)suffered from all the three forms of undernutrition. Older schoolchildrenhad a significantly greater likelihood of being stunted, underweight andthin. The greater number of members a household had, the higherlikelihood of being stunted, underweight and thin its schoolchild had.

Children having lower Household Dietart Diversity Score were more likelyto be underweight. Yet, ‘Had lunch at school yesterday’ was associatedneither with being stunted nor with being underweight and thin. Thisimplies room for improvement of the current school feeding program.Conclusion: Prevalence rates of stunting and underweight among themwere as high as those among children under five years of age. Adequatefood availability and dietary diversity over a sufficient period (incl. 5-14years of age) are necessary for increasing likelihood of catch-up in height-for-age and weight-for-age,2,3 which are expectable during adolescence.To supplement inadequate household dietary diversity practices, school-feeding program may need to use more animal-protein ingredients.

References:1. United Nations Children’s Fund (UNICEF) Improving child nutrition: Theachievable imperative for global progress. New York: UNICEF; 2013.2. Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwidetiming of growth faltering: revisiting implications for interventions. Pedi-atrics. 2010;125(3): e473-e480.3. Prentice AM, Ward KA, Goldberg GR, Jarjou LM, Moore SE, Fulford AJ,Prentice A. Critical windows for nutritional interventions against stunting.Am J Clin Nutr. 2013;97(5): 911-918.

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Abstracts of Poster Presentations Tuesday, 17th of September