Under-reporting of COVID-19 and the limited information about circulating SARS-CoV-2 variants remain major challenges for many African countries. We analyzed SARS-CoV-2 infection dynamics in Addis Ababa and Jimma, Ethiopia, focusing on reinfection, immunity, and vaccination effects. We conducted an antibody serology study spanning August 2020 to July 2022 with five rounds of data collection across a population of 4723, sequenced PCR-test positive samples, used available test positivity rates, and constructed two mathematical models integrating this data. A multivariant model explores variant dynamics identifying wildtype, alpha, delta, and omicron BA.4/5 as key variants in the study population, and cross-immunity between variants, revealing risk reductions between 24% and 69%. An antibody-level model predicts slow decay leading to sustained high antibody levels. Retrospectively, increased early vaccination might have substantially reduced infections during the delta and omicron waves in the considered group of individuals, though further vaccination now seems less impactful.

Introduction Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients’ needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing. Objective The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) . Methods Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals. Ethics and dissemination The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.

This study aimed to retrospectively assess the cost-effectiveness of various COVID-19 vaccination strategies in Ethiopia. It involved healthcare workers (HCWs) and community participants; and was conducted through interviews and serological tests. Local SARS-CoV-2 variants and seroprevalence rates, as well as national COVID-19 reports and vaccination status were also analyzed. A cost-effectiveness analysis was performed to determine the most economical vaccination strategies in settings with limited vaccine access and high SARS-CoV-2 seroprevalence. Before the arrival of the vaccines, 65% of HCWs had antibodies against SARS-CoV-2, indicating prior exposure to the virus. Individuals with prior infection exhibited a greater antibody response to COVID-19 vaccines and experienced fewer new infections compared to those without prior infection, regardless of vaccination status (5% vs. 24%, p < 0.001 for vaccinated; 3% vs. 48%, p < 0.001 for unvaccinated). The cost-effectiveness analysis indicated that a single-dose vaccination strategy is optimal in settings with high underlying seroprevalence and limited vaccine availability. This study underscores the need for pragmatic vaccination strategies tailored to local contexts, particularly in high-seroprevalence regions, to maximize vaccine impact and minimize the spread of COVID-19. Implementing a targeted approach based on local seroprevalence information could have helped Ethiopia achieve higher vaccination rates and prevent subsequent outbreaks.

Under-reporting of COVID-19 cases and the lack of information about circulating SARS-CoV-2 variants remain major challenges for many African countries to date. To address this, we present a comprehensive analysis of the dynamics of SARS-CoV-2 infections in Ethiopia, focusing on reinfection dynamics, (variant-specific) immunity, and the impact of vaccination rates. We conducted an antibody serology study, sequenced positive polymerase chain reaction tests, used available test positivity rates, and constructed two mathematical models integrating these data sets. A multivariant model was used to explore the variant dynamics and differential susceptibility to reinfection based on genetic distances between variants, identifying wildtype, alpha, delta, and omicron BA.4/5 as the four most important variants in Ethiopia. Cross-immunity between variants is investigated, revealing immunities ranging from 24% to 69% risk reduction. A second, antibody-level focused model, predicts slow antibody decay, particularly for Anti-S antibodies, leading to sustained high antibody levels until present times. Retrospectively, it suggests that increased early vaccination could have substantially reduced infections during the delta and omicron waves. However, as a large proportion of the population might have already had multiple infections that led to a strong immune response, further vaccination is less likely to have a significant impact now. *The authors would like to note that Simon Merkt, Solomon Ali, Esayas Kebede Gudina, Jan Hasenauer, Arne Kroidl, and Andreas Wieser respectively contributed equally.

Objective The objective of this study was to determine the impact of obtaining a second opinion consultation on time to knee arthroplasty (KA). We further examined the frequency of KA and the determinants of KA following the second opinion. Design Prospective cohort study. Setting The second opinion programme was implemented at the Ludwig Maximilian University Hospital in Munich. Participants Participants comprised patients with knee osteoarthritis who were insured with one of the largest statutory health insurance Allgemeine Ortskrankenkasse Bayern (mean age 64.3±9.6 years). Patients participated in a second-opinion programme and completed questionnaires on site before and after personal presentation for the second opinion consultation. Follow-up questionnaires were delivered by post at 3 and 12 months after the second opinion consultation. Of the 142 patients included in the study, 47 (33.1%) underwent KA within 12 months after obtaining the second opinion. Primary outcome measures Primary outcome measure was time until patients received KA. Cox proportional hazard modelling was used to calculate the associations between the selected predictors and time that elapsed between receipt of the second opinion to KA. Results Mean time until KA was 17 weeks. Kaplan-Meier curves showed significant differences in time to KA according to the recommendation given at second opinion consultation, knee-related quality of life and Kellgren-Lawrence grade. In multivariate Cox proportional hazard modelling, second opinion recommendation (HR 5.33, 95% CI 1.16, 24.41) and knee-related quality of life (HR 1.03, 95% CI 1.01, 1.06) were significant predictors of time from second opinion to KA. Conclusions Obtaining a second opinion had significant impact on time to knee replacement. Those who were recommended immediate surgery also underwent surgery more quickly after the second opinion. The effect of knee-related quality of life supports the importance of patient-reported outcome measures in the decision for or against KA.

Background: Surgical site infections (SSIs) are healthcare-associated infections that can occur following surgical procedures, either at admission or within 30 days post-discharge. This study aimed to assess the incidence and associated risk factors for superficial SSI at a Tertiary Hospital in Ethiopia. Methods: A longitudinal study was conducted among patients undergoing surgery at Jimma University Specialized and Comprehensive Hospital (JUSCH) from 1 June to 30 September 2022. Pus, wound swab, or abscess samples were inoculated on Blood and MacConkey Agar for culture. Bacterial isolates were identified using MALDI-TOF, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method, and the results were interpreted according to EUCAST 2022 breakpoints. Incidence rates, Kaplan–Meier analysis, extended Cox regression, and violin plots were utilized to analyze and present the findings. Results: Among 1205 participants, 629 (52.2%) were male, and the median age was 27 years (IQR: 16–40). The incidence of SSI was 9.2 per 1000 person-days. Most SSIs occurred during hospitalization (81.1%), and the remaining primarily developed within the first week post-discharge. The culture positivity rate was 72.7%, yielding 252 isolates comprising 36 bacterial species. The most frequently identified organisms were E. coli (22.2%), Acinetobacter (20.2%), and Klebsiella (14.7%). Over 67% of Gram-negative bacteria were ESBL producers. Age, gender, residence, hospital ward, surgery area, emergency surgery, longer hospitalization, and the number of staff attending the surgery were identified as important risk factors. Conclusions: This study revealed a high incidence of SSI during hospitalization, with significant proportion identified post-discharge. The high rates of multidrug-resistant Gram-negative pathogens underscore the urgent need for comprehensive infection prevention and control measures.