Acute febrile illness (AFI) caused by very diverse pathogens (including newly emerging and re-emerging pathogens like Ebola and COVID) results in high morbidity and mortality worldwide. Ethiopia lies in the Horn of Africa, where several pathogens of security concern circulate causing recurrent epidemics. Misdiagnosis and treatment of such cases due to limited detection capacity (only based on clinical criteria) remains costly and deadly. However, the epidemiology and proportionate burden by etiology remains unknown hindering data-driven prevention and management of AFI. The proposed study will be carried out in collaboration among Ethiopian Public Health Institute (EPHI), Center for Disease Control and Prevention (CDC) and Global One Health Initiative (GOHi).
The main goal of the proposed hypothesis driven fundamental research is to strengthen bio-surveillance and laboratory detection capacity for broad range of pathogens of high security concern causing AFI and informing the public.
A prospective, healthcare facility-based cross sectional study will be applied in five referral hospitals from five of the eleven regions in Ethiopia. Over the 5 years (2020/24) implementation period, an estimated 2000-3000 febrile cases (400-600 cases per year from each sentinel site) will be detected annually. Blood and nasopharyngeal swab sample from patients meeting the AFI inclusion criteria (Aged ≥5 years old and experienced acute fever (≥38.0°C) for 2-14 days) will be collected using systematic random sampling. Rapid point of care (POC) tests, polymerase chain reaction (PCR), serological and Taqman Array Cards (TAC) testing methods will be applied for detection of 15 prioritized pathogens with biosecurity concern and epidemic potential.
The proposed study project will have regional (country) impacts in strengthening national capacity to detect a wider array of pathogens, improving biosafety and biosecurity capacity and building up the national bio-surveillance system. The biological impact includes detection of pathogens and creating an opportunity to detect new pathogens. Also have non-scientific impact in improving partnership, cross-border coordination and information sharing. It will provide evidence-based information to the public through development and distribution of community education materials, fact sheets, and publications for appropriate primary and secondary control measures. Surveillance and base line disease data obtained from the study will help to effectively determine when an intentional release of bio-warfare agents has occurred.