Publications

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2021
Chikwana N, Maina EN, Gavamukulya Y, Bulimo W, Wamunyokoli F. Antiproliferative Activity, c-Myc and {FGFR}1 Genes Expression Profiles and Safety of Annona muricata Fruit Extract on Rhabdomyosarcoma and {BALB}/c Mice. Journal of Complementary and Alternative Medical Research. 2021:30-46. AbstractWebsite
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Umuhoza T, Bulimo WD, Julius Oyugi, Musabyimana JP, Kinengyere AA, Mancuso JD. Prevalence of human respiratory syncytial virus, parainfluenza and adenoviruses in East Africa Community partner states of Kenya, Tanzania, and Uganda: A systematic review and meta-analysis (2007–2020). PLOS ONE. 2021;16(4):e0249992-. Abstractjournal.pone_.0249992.pdfjournal.pone_.0249992.pdfWebsite

Background Viruses are responsible for a large proportion of acute respiratory tract infections (ARTIs). Human influenza, parainfluenza, respiratory-syncytial-virus, and adenoviruses are among the leading cause of ARTIs. Epidemiological evidence of those respiratory viruses is limited in the East Africa Community (EAC) region. This review sought to identify the prevalence of respiratory syncytial virus, parainfluenza, and adenoviruses among cases of ARTI in the EAC from 2007 to 2020. Methods A literature search was conducted in Medline, Global Index Medicus, and the grey literature from public health institutions and programs in the EAC. Two independent reviewers performed data extraction. We used a random effects model to pool the prevalence estimate across studies. We assessed heterogeneity with the I2 statistic, and Cochran’s Q test, and further we did subgroup analysis. This review was registered with PROSPERO under registration number CRD42018110186. Results A total of 12 studies met the eligibility criteria for the studies documented from 2007 to 2020. The overall pooled prevalence of adenoviruses was 13% (95% confidence interval [CI]: 6–21, N = 28829), respiratory syncytial virus 11% (95% CI: 7–15, N = 22627), and parainfluenza was 9% (95% CI: 7–11, N = 28363). Pooled prevalence of reported ARTIs, all ages, and locality varied in the included studies. Studies among participants with severe acute respiratory disease had a higher pooled prevalence of all the three viruses. Considerable heterogeneity was noted overall and in subgroup analysis. Conclusion Our findings indicate that human adenoviruses, respiratory syncytial virus and parainfluenza virus are prevalent in Kenya, Tanzania, and Uganda. These three respiratory viruses contribute substantially to ARTIs in the EAC, particularly among those with severe disease and those aged five and above.

Ogana W, Juma VO, Bulimo WD. A SIRD model applied to COVID-19 dynamics and intervention strategies during the first wave in Kenya. medRxiv. 2021:2021.03.17.21253626. AbstractWebsite

The first case of COVID-19 was reported in Kenya in March 2020 and soon after non-pharmaceutical interventions (NPIs) were established to control the spread of the disease. The NPIs consisted, and continue to consist, of mitigation measures followed by a period of relaxation of some of the measures. In this paper, we use a deterministic mathematical model to analyze the dynamics of the disease, during the first wave, and relate it to the intervention measures. In the process, we develop a new method for estimating the disease parameters. Our solutions yield a basic reproduction number, R0 = 2.76, which is consistent with other solutions. The results further show that the initial mitigation reduced disease transmission by 40% while the subsequent relaxation increased transmission by 25%. We also propose a mathematical model on how interventions of known magnitudes collectively affect disease transmission rates. The modelled positivity rate curve compares well with observations. If interventions of unknown magnitudes have occurred, and data is available on the positivity rate, we use the method of planar envelopes around a curve to deduce the modelled positivity rate and the magnitudes of the interventions. Our solutions deduce mitigation and relaxation effects of 42.5% and 26%, respectively; these percentages are close to values obtained by the solution of the SIRD system. Our methods so far apply to a single wave; there is a need to investigate the possibility of extending them to handle multiple waves.Competing Interest StatementThe authors have declared no competing interest.Clinical TrialNot a clinical trialFunding StatementNo funding supportAuthor DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:KNH-UoN Ethics and Research Committee https://erc.uonbi.ac.keAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData sources: All the data used is in the public domain [1, 44, 56, 57]

Baba MM, Bitew M, Fokam J, Lelo EA, Ahidjo A, Asmamaw K, Beloumou GA, Bulimo WD, Buratti E, Chenwi C, Dadi H, D'Agaro P, De Conti L, Fainguem N, Gadzama G, Maiuri P, Majanja J, Meshack W, Ndjolo A, Nkenfou C, Oderinde BS, Opanda SM, Segat L, Stuani C, Symekher SL, Takou D, Tesfaye K, Triolo G, Tuki K, Zacchigna S, Marcello A. Diagnostic performance of a colorimetric RT -LAMP for the identification of SARS-CoV-2: A multicenter prospective clinical evaluation in sub-Saharan Africa.. 2021;40:101101. Abstract1-s2.0-s2589537021003813-main-1.pdf1-s2.0-s2589537021003813-main-1.pdfWebsite

BackgroundManagement and control of the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus SARS-CoV-2 is critically dependent on quick and reliable identification of the virus in clinical specimens. Detection of viral RNA by a colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) is a simple, reliable and cost-effective assay, deployable in resource-limited settings (RLS). Our objective was to evaluate the intrinsic and extrinsic performances of RT-LAMP in RLS.
Methods
This is a multicenter prospective observational study of diagnostic accuracy, conducted from October 2020 to February 2021 in four African Countries: Cameroon, Ethiopia, Kenya and Nigeria; and in Italy. We enroled 1657 individuals who were either COVID-19 suspect cases, or asymptomatic and presented for screening. RNA extracted from pharyngeal swabs was tested in parallel by a colorimetric RT-LAMP and by a standard real time polymerase chain reaction (RT-PCR).
Findings
The sensitivity and specificity of index RT LAMP compared to standard RT-PCR on 1657 prospective specimens from infected individuals was determined. For a subset of 1292 specimens, which underwent exactly the same procedures in different countries, we obtained very high specificity (98%) and positive predictive value (PPV = 99%), while the sensitivity was 87%, with a negative predictive value NPV = 70%, Stratification of RT-PCR data showed superior sensitivity achieved with an RT-PCR cycle threshold (Ct) below 35 (97%), which decreased to 60% above 35.
Interpretation
In this field trial, RT-LAMP appears to be a reliable assay, comparable to RT-PCR, particularly with medium-high viral loads (Ct < 35). Hence, RT-LAMP can be deployed in RLS for timely management and prevention of COVID-19, without compromising the quality of output.

Ngayo MO, Oluka M, Bulimo WD, Okalebo FA. Influence of Social Psychological Status On Efavirenz And Nevirapine Plasma Concentration Among HIV Patients In Kenya. Research Square; 2021. Abstract

HIV-related stigma, lack of disclosure and social support are still a hindrance to HIV testing, care, and prevention. We evaluated the influence of these socio-phycological status on nevirapine (NVP) and efavirenz (EFV) plasma concentrations among HIV patients in Kenya. Blood samples were obtained from 254 and 312 consenting HIV patients on NVP and EFV based first-line Antiretroviral therapy (ART) respectively and a detailed structured questionnaire was administered. The NVP and EFV plasma level was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). The median duration of living with HIV infection was 5 years (IQR = 1–11years) and a median duration since ART initiation was 3 years (IQR = 1–8 years). There were 68.1% and 65.4% of the patients on NVP and EFV respectively who did not feel guilty for being HIV positive. The disclosure rate was about 96.1% and 94.6% of patients on NVP and EFV respectively. About 85% and 78.2% of patients on NVP and EFV respectively who got social support as much as needed. The non-adherence to ART in the past 30 days was 64.6% and 66.3% patients on NVP and EFV respectively. The median (IQR) plasma concentration were [6237.5 ng/mL, IQR 45188–8964 ng/mL] for NVP and [2739.5 ng/mL, IQR 1878 –4891.5 ng/mL] for EFV. There were 14.2% and 4.5% patients on NVP and EFV respectively with suboptimal plasma concertation associated with poor viral suppression. Multivariate linear regression analysis showed feeling guilty for being HIV positive (adjusted β = 954 , 95% CI = 192.7 to 2156.6 ; p =0.014) or feeling worthless for being HIV positive (adjusted β = 852 , 95% CI = 64.3 to 1639.7 ; p =0.034); being certain of telling the primary sexual partner about HIV positive status (adjusted β 363, 95% CI, 97.9 to 628.1; p = 0.007); disclosing HIV status to neighbors (adjusted β = 1731 , 95% CI = 376 to 3086 ; p =0.012) and getting transportation to hospital whenever needed (adjusted β = -1143.3, 95% CI = -1914.3 to -372.4 ; p =0.004) were associated with NVP/EFV plasma levels. The NVP and EFV plasma level was highly heterogenous with a significant proportion of patients reporting levels correlated with poor viral suppression. The patient’s stigma, lack of disclosure and social support contributes significantly on the overall ART treatment outcome. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success

MM B, M B, J F, EA L, A A, K A, GA B, WD B, E B, C C, H D, P D', L DC, N F, A M. Diagnostic performance of a colorimetric RT -LAMP for the identification of SARS-CoV-2: A multicenter prospective clinical evaluation in sub-Saharan Africa. EClinicalMedicine. 2021. Abstract
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Chikwana N, Maina EN, Gavamukulya Y, Bulimo W, Wamunyokoli F. Antiproliferative Activity, c-Myc and FGFR1 Genes Expression Profiles and Safety of Annona muricata Fruit Extract on Rhabdomyosarcoma and BALB/c Mice. Journal of Complementary and Alternative Medical Research. 2021;14(4):30-46.
Bahati V, Bulimo W, Gachara G. Comparative Seroprevalence of Hepatitis B Virus among in-Mates and Low Risk Voluntary Blood Donors in Garissa, Kenya. Journal of Biosciences and Medicines. 2021;09:85-95. AbstractWebsite
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2020
Githaiga JI, Angeyo HK, Kaduki KA, Bulimo WD. Chemometrics-Enabled Raman Spectrometric Qualitative Determination and Assessment of Biochemical Alterations during Early Prostate Cancer Proliferation in Model Tissue. Journal of Spectroscopy. 2020;2020:8879985. AbstractWebsite

The use of Raman spectroscopy combined with multivariate chemometrics for disease diagnosis has attracted great attention from researchers in recent years. This is because it is a noninvasive and nondestructive detection approach with enhanced sensitivity. However, a major challenge when analyzing spectra from biological samples has been the detection of subtle biochemical alterations buried in background and fluorescence noise. This work reports a qualitative chemometrics-assisted investigation of subtle biochemical alterations associated with prostate malignancy in model biological tissue (metastatic androgen insensitive (PC3) and immortalized normal (PNT1a) prostate cell lines). Raman spectra were acquired from PC3 and PNT1a cells at various stages of growth, and their biochemical alterations were determined from difference spectra between the two cell lines (for prominent alterations) and principal component analysis (PCA) (for subtle alterations). The Raman difference spectra were computed by subtracting the normalized mean spectral intensities of PNT1a cells from the normalized mean spectral intensities of PC3 cells. These difference spectra revealed prominent biochemical alterations associated with the malignant PC3 cells at 566 ± 0.70 cm−1, 630 cm−1, 1370 ± 0.86 cm−1, and 1618 ± 1.73 cm−1 bands. The band intensity ratios at 566 ± 0.70 cm−1 and 630 cm−1 suggested that prostate malignancy can be associated with an increase in relative amounts of nucleic acids and lipids, respectively, whereas those at 1370 ± 0.86 cm−1 and 1618 ± 1.73 cm−1 suggested that prostate malignancy can be associated with a decrease in relative amounts of saccharides and tryptophan, respectively. In the analysis using PCA, intermediate-order and high-order principal components (PCs) were used to extract the subtle biochemical fingerprints associated with the cell lines. This revealed subtle biochemical differences at 1076 cm−1, (1232, 1234 cm−1), (1276, 1278 cm−1), (1330, 1333 cm−1), (1434, 1442 cm−1), and (1471, 1479 cm−1). The band intensity ratios at 1076 cm−1 and 1232 cm−1 suggested that prostate malignancy can be associated with an increase in subtle amounts of nucleic acids and amide III components, respectively. The method reported here has demonstrated that subtle biochemical alterations can be extracted from Raman spectra of normal and malignant cell lines. The identified subtle bands could play an important role in quantitative monitoring of early biomarker alterations associated with prostate cancer proliferation.

Kivata MW, Mbuchi M, Eyase F, Bulimo WD, Kyanya CK, Oundo V, Mbinda WM, Sang W, Andagalu B, Soge OO, McClelland RS, Distelhorst J. Plasmid mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates from Kenya.. 2020;20(1):703. Abstractkivata_et_al-2020-bmc_infectious_diseases.pdfkivata_et_al-2020-bmc_infectious_diseases.pdfWebsite

Treatment of gonorrhea is complicated by the development of antimicrobial resistance in Neisseria gonorrhoeae (GC) to the antibiotics recommended for treatment. Knowledge on types of plasmids and the antibiotic resistance genes they harbor is useful in monitoring the emergence and spread of bacterial antibiotic resistance. In Kenya, studies on gonococcal antimicrobial resistance are few and data on plasmid mediated drug resistance is limited. The present study characterizes plasmid mediated resistance in N. gonorrhoeae isolates recovered from Kenya between 2013 and 2018.

EM N', WD B, V M, S O, E M. Genetic Analysis of HA1 Domain of Influenza A/H3N2 Viruses Isolated in Kenya During the 2007 to 2013 Seasons Reveal Significant Divergence from WHO-Recommended Vaccine Strains. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2020. Abstract
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Opanda S, Bulimo W, Gachara G, Ekuttan C, Amukoye E. Assessing antigenic drift and phylogeny of influenza A (H1N1) pdm09 virus in Kenya using HA1 sub-unit of the hemagglutinin gene. PLoS One. 2020;15(2):e0228029. Abstractpone.0228029.pdf

Influenza A (H1N1) pdm09 virus emerged in North America in 2009 and has been established as a seasonal strain in humans. After an antigenic stasis of about six years, new antigenically distinct variants of the virus emerged globally in 2016 necessitating a change in the vaccine formulation for the first time in 2017. Herein, we analyzed thirty-eight HA sequences of influenza A (H1N1) pdm09 strains isolated in Kenya during 2015-2018 seasons, to evaluate their antigenic and molecular properties based on the HA1 sub-unit. Our analyses revealed that the A (H1N1) pdm09 strains that circulated in Kenya during this period belonged to genetic clade 6B, subclade 6B.1 and 6B.2. The Kenyan 2015 and 2016 isolates differed from the vaccine strain A/California/07/2009 at nine and fourteen antigenic sites in the HA1 respectively. Further, those isolated in 2017 and 2018 correspondingly varied from A/Michigan/45/2015 vaccine strain at three and fifteen antigenic sites. The predicted vaccine efficacy of A/California/07/2009 against Kenyan 2015/2016 was estimated to be 32.4% while A/Michigan/45/2015 showed estimated vaccine efficacies of 39.6% - 41.8% and 32.4% - 42.1% against Kenyan 2017 and 2018 strains, respectively. Hemagglutination-inhibition (HAI) assay using ferret post-infection reference antiserum showed that the titers for the Kenyan 2015/2016 isolates were 2-8-fold lower compared to the vaccine strain. Overall, our results suggest the A (H1N1) pdm09 viruses that circulated in Kenya during 2015/2016 influenza seasons were antigenic variants of the recommended vaccine strains, denoting sub-optimal vaccine efficacy. Additionally, data generated point to a swiftly evolving influenza A (H1N1) pdm09 virus in recent post pandemic era, underscoring the need for sustained surveillance coupled with molecular and antigenic analyses, to inform appropriate and timely influenza vaccine update.

Nyang'au EM, Bulimo WD, Mobegi V, Opanda S, Magiri E. Genetic Analysis of HA1 Domain of Influenza A/H3N2 Viruses Isolated in Kenya During the 2007 to 2013 Seasons Reveal Significant Divergence from WHO-Recommended Vaccine Strains. Int J Infect Dis. 2020. Abstractnyagau_et_al_2020.pdf

BACKGROUND: Influenza viruses evolve rapidly and cause regular seasonal epidemics in humans challenging effective vaccination. The virus surface HA glycoprotein is the primary target for the host immune response. Here, we investigated the vaccine efficacy and evolution patterns of human influenza A/H3N2 viruses that circulated in Kenyan in the period before and after the 2009 A/H1N1 pandemic, targeting the HA1 domain. MATERIALS AND METHODS: A hundred and fifteen HA sequences of Kenyan virus viruses were analyzed relative to the corresponding WHO vaccine reference strains using bioinformatics approaches. RESULTS: Our analyses revealed varied amino acid substitutions at all the five antigenic sites (A-E) of the HA1 domain, with a majority the changes occurring at sites A and B. The Kenyan A/H3N2 viruses isolated during 2007/2008 seasons belonged to A/Brisbane/10/2007- like viruses lineage, while those circulating in 2009 to 2012 belonged to the lineage of A/Victoria/361/2011-like viruses. The 2013 viruses clustered in clade 3C.3 of the A/Samara/73/2013-like viruses. The mean evolutionary rate of the A/H3N2 viruses analyzed in the study was at 4.17×10(-3) (95% HPD=3.09×10(-3) to 5.31×10(-3)) nucleotide substitutions per site per year, whereas the TMRCA was estimated at 11.18 (95% HPD=9.00-14.12) years ago from 2013. The Prediction of vaccine efficacy revealed modest vaccine efficaciousness during 2008, and 2010 influenza seasons, whilst sub-optimal effectiveness was registered in 2007,2009, 2012 and 2013. Further, the overall selective pressure acting on the HA1 domain was estimated at 0.56 (ω<1), suggesting that a majority of codon sites in the HA1 epitopes were evolving under purifying selection. CONCLUSIONS: Generally, our results highlight the genetic plasticity of A/H3N2 viruses and reveal considerable disparity in vaccine efficaciousness against the A/H3N2 viruses that circulated in Kenya, specifically during 2007,2009, 2012, and 2013 influenza seasons. Our findings underscore the importance and need for consistent surveillance and molecular characterization of influenza viruses, to inform decision making and enhance early of detection of strains with epidemic/pandemic potential as well as benefit in guiding decisions regarding the appropriate annual influenza vaccine formulations.

Elusah J, Bulimo WD, Opanda SM, Symekher SL, Wamunyokoli F. Genetic diversity and evolutionary analysis of human respirovirus type 3 strains isolated in Kenya using complete hemagglutinin-neuraminidase (HN) gene. PLOS ONE. 2020;15(3):e0229355. Abstractelusa_et_al_2020.pdfWebsite

Human respirovirus type 3 (HRV3) is a leading etiology of lower respiratory tract infections in young children and ranks only second to the human respiratory syncytial virus (HRSV). Despite the public health importance of HRV3, there is limited information about the genetic characteristics and diversity of these viruses in Kenya. To begin to address this gap, we analyzed 35 complete hemagglutinin-neuraminidase (HN) sequences of HRV3 strains isolated in Kenya between 2010 and 2013. Viral RNA was extracted from the isolates, and the entire HN gene amplified by RT-PCR followed by nucleotide sequencing. Phylogenetic analyses of the sequences revealed that all the Kenyan isolates grouped into genetic Cluster C; sub-clusters C1a, C2, and C3a. The majority (54%) of isolates belonged to sub-cluster C3a, followed by C2 (43%) and C1a (2.9%). Sequence analysis revealed high identities between the Kenyan isolates and the HRV3 prototype strain both at the amino acid (96.5–97.9%) and nucleotide (94.3–95.6%) levels. No amino acid variations affecting the catalytic/active sites of the HN glycoprotein were observed among the Kenyan isolates. Selection pressure analyses showed that the HN glycoprotein was evolving under positive selection. Evolutionary analyses revealed that the mean TMRCA for the HN sequence dataset was 1942 (95% HPD: 1928–1957), while the mean evolutionary rate was 4.65x10-4 nucleotide substitutions/site/year (95% HPD: 2.99x10-4 to 6.35x10-4). Overall, our results demonstrate the co-circulation of strains of cluster C HRV3 variants in Kenya during the study period. This is the first study to describe the genetic and molecular evolutionary aspects of HRV3 in Kenya using the complete HN gene.

Nambati EA, Njoka M, Eyase F, Majanja J, Njuguna N, Gitonga SM, Mwikwabe N, Lelo E, Mwangi M, kingoro A, Kimani F, Lubano K, Bulimo W. Multidisciplinary approach towards training of the next generation of forensic DNA analysts in Africa; a Kenyan perspective. Forensic Science International: Synergy. 2020;2:123-5. Abstract1-s2.0-s2589871x20300267-main.pdfWebsite

The uptake of forensic DNA testing technologies in Africa has been slow despite the revolutionary technology being discovered and adopted 3 decades ago. African governments and partners have invested in construction and equipping of forensic laboratories in Africa but the benefits are yet to be realised as the laboratories are still faced with the challenge of shortage of adequately trained personnel. This paper describes an innovative multidisciplinary training approach that was developed and used to train officers from the Directorate of Criminal Investigations Kenya. We report on the structure, implementation and effectiveness of the training. It is expected that with the increased number of trained forensic DNA analysts, there will be an improvement in quality of forensic DNA evidence presented in courts and a reduction in backlog in the forensic biology laboratories in Kenya.

Langat SK, Eyase FL, Berry IM, Nyunja A, Bulimo W, Owaka S, Ofula V, Limbaso S, Lutomiah J, Jarman R, Distelhorst J, Sang RC. Origin and evolution of dengue virus type 2 causing outbreaks in Kenya: Evidence of circulation of two cosmopolitan genotype . Virus Evol. 2020;6(1):veaa026. Abstractveaa026.pdfWebsite

Dengue fever (DF) is an arboviral disease caused by dengue virus serotypes 1-4 (DENV 1-4). Globally, DF incidence and disease burden have increased in the recent past. Initially implicated in a 1982 outbreak, DENV-2 recently reemerged in Kenya causing outbreaks between 2011 and 2014 and more recently 2017-8. The origin and the evolutionary patterns that may explain the epidemiological expansion and increasing impact of DENV-2 in Kenya remain poorly understood. Using whole-genome sequencing, samples collected during the 2011-4 and 2017-8 dengue outbreaks were analyzed. Additional DENV-2 genomes were downloaded and pooled together with the fourteen genomes generated in this study. Bioinformatic methods were used to analyze phylogenetic relationships and evolutionary patterns of DENV-2 causing outbreaks in Kenya. The findings from this study have shown the first evidence of circulation of two different Cosmopolitan genotype lineages of DENV-2; Cosmopolitan-I (C-I) and Cosmopolitan-II (C-II), in Kenya. Our results put the origin location of C-I lineage in India in 2011, and C-II lineage in Burkina Faso between 1979 and 2013. C-I lineage was the most isolated during recent outbreaks, thus showing the contribution of this newly emerged strain to the increased DENV epidemics in the region. Our findings, backed by evidence of recent local epidemics that have been associated with C-I in Kenya and C-II in Burkina Faso, add to the growing evidence of expanding circulation and the impact of multiple strains of DENV in the region as well as globally. Thus, continued surveillance efforts on DENV activity and its evolutionary trends in the region, would contribute toward effective control and the current vaccine development efforts.

Umuhoza T, Bulimo WD, Oyugi J, Schnabel D, Mancuso JD. Prevalence and factors influencing the distribution of influenza viruses in Kenya: Seven-year hospital-based surveillance of influenza-like illness (2007-2013). PLoS One. 2020;15(8):e0237857. Abstractumuhoza_et_al_2020.pdfWebsite

BACKGROUND: Influenza viruses remain a global threat with the potential to trigger outbreaks and pandemics. Globally, seasonal influenza viruses' mortality range from 291 243-645 832 annually, of which 17% occurs in Sub-Saharan Africa. We sought to estimate the overall prevalence of influenza infections in Kenya, identifying factors influencing the distribution of these infections, and describe trends in occurrence from 2007 to 2013. METHODS: Surveillance was conducted at eight district hospital sites countrywide. Participants who met the case definition for influenza-like illness were enrolled in the surveillance program. The nasopharyngeal specimens were collected from all participants. We tested all specimens for influenza viruses with quantitative reverse transcriptase real-time polymerase chain reaction (RT-qPCR) assay. Bivariate and multivariate log-binomial regression was performed with a statistically significant level of p<0.005. An administrative map of Kenya was used to locate the geographical distribution of surveillance sites in counties. We visualized the monthly trend of influenza viruses with a graph and chart using exponential smoothing at a damping factor of 0.5 over the study period (2007-2013). RESULTS: A total of 17446 participants enrolled in the program. The overall prevalence of influenza viruses was 19% (n = 3230), of which 76% (n = 2449) were type A, 21% (n = 669) type B and 3% (n = 112) A/ B coinfection. Of those with type A, 59% (n = 1451) were not subtyped. Seasonal influenza A/H3N2 was found in 48% (n = 475), influenza A/H1N1/pdm 2009 in 43% (n = 434), and seasonal influenza A/ H1N1 in 9% (n = 88) participants. Both genders were represented, whereas a large proportion of participants 55% were

Fardolo EK, Bulimo W, Aluora PO, Gachara G. Seroprevalence of Hepatitis E Virus among Voluntary Blood Donors in Nairobi County, Kenya: A Pilot Study. Journal of Biosciences and Medicines. 2020;8:78-85. Abstractjbm_2020121415213791.pdf

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Kedogo JL, Eyase F, Bulimo W, Asudi G, Kimani F, Muhia DM, Aluvaala E. Validation of a Biomeme Smartphone-Based DNA Real-Time PCR Assay for Diagnosis of Human Malaria at the Point of Care . African Journal of Health Sciences. 2020;33(3):31-44.202032-article_text-506081-1-10-20201207.pdf
Nambati EA, Njoka M, Eyase F, Majanja J, Njuguna N, Gitonga SM, Mwikwabe N, Lelo E, Mwangi M, kingoro A, Kimani F, Lubano K, Bulimo W. Multidisciplinary approach towards training of the next generation of forensic DNA analysts in Africa; a Kenyan perspective. Forensic Science International: Synergy. 2020;2:123-5. Abstract
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Kivata MW, Mbuchi M, Eyase F, Bulimo WD, Kyanya CK, Oundo V, Mbinda WM, Sang W, Andagalu B, Soge OO, McClelland RS, Distelhorst J. Plasmid mediated penicillin and tetracycline resistance among Neisseria gonorrhoeae isolates from Kenya. BMC Infectious Diseases. 2020;20. Abstract
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2019
Kivata MW, Mbuchi M, Eyase FL, Bulimo WD, Kyanya CK, Oundo V, Muriithi SW, Andagalu B, Mbinda WM, Soge OO, McClelland SR, Sang W, Mancuso JD. gyrA and parC mutations in fluoroquinolone-resistant Neisseria gonorrhoeae isolates from Kenya. BMC Microbiol. 2019;19(1):76. Abstractkivata_et_al-2019-bmc_microbiology.pdf

Phenotypic fluoroquinolone resistance was first reported in Western Kenya in 2009 and later in Coastal Kenya and Nairobi. Until recently gonococcal fluoroquinolone resistance mechanisms in Kenya had not been elucidated. The aim of this paper is to analyze mutations in both gyrA and parC responsible for elevated fluoroquinolone Minimum Inhibitory Concentrations (MICs) in Neisseria gonorrhoeae (GC) isolated from heterosexual individuals from different locations in Kenya between 2013 and 2017.

Kyany'a C, Eyase F, Odundo E, Kipkirui E, Kipkemoi N, Kirera R, Philip C, Ndonye J, Kirui M, Ombogo A, Koech M, Koech M, Bulimo W. First report of Entamoeba moshkovskii in human stool samples from symptomatic and asymptomatic participants in Kenya. Trop Dis Travel Med Vaccines. 2019;5:23.kyanya_et_al_2020.pdf
Lydia MS, Bulimo WD, Verani JR, Victor O, Ouma A, Kiplangat S, Opanda S, Imbuga M, Juma B, Godfrey B, Hunsperger E. Molecular Characterization of Human Enteroviruses Detected in Children Under Five Years Old in Kenya 2009 - 2015. African Journal of Health Sciences. 2019;32(2):15-33. Abstract195711-article_text-494299-1-10-20200512.pdf195711-article_text-494299-1-10-20200512.pdf

INTRODUCTION
Human enterovirus (HEVs) infection is common, with an extensive array of clinical
displays ranging from asymptomatic to life-threatening. Presentation include nonspecific febrile
illness often accompanied by muscle pain, sore throat, abdominal discomfort, rash, headache,
encephalitis, aseptic meningitis and acute flaccid paralysis [2].
OBJECTIVES
The study objective was to investigate the natural selection and genetic variability of HEVs
and to identify HEV serotypes in circulation among children below 5 years old with diarrhea in
an informal settlement(Kibera) in Kenya.
METHODOLOGY
Specimens (n=628) from a prospective cohort study assessing the incidence and etiology of
diarrhea from 2009-2015 were analyzed. Enteric Taqman array cards (TAC) were used for initial
screening where two hundred and nine (78%) tested positive for HEVs.
Of these specimens, 72 (42%) had a cycle threshold (Ct) ≤30 and were tested by conventional
PCR targeting the 3’ regions of the viral protein 1 (VP1) gene. A total of 48 (67%) underwent
sequencing; 11 (23%) of which yielded nucleotide sequences. Phylogenetic analyses clustered
the Kenyan serotypes to HEVs groups C, B and A. Evaluation of the VP1 amino acid sequences
revealed numerous amino acid substitutions in relation to reference strains, which were confirmed
to be due to natural selection by negative or positive selection.
CONCLUSION
The Heterogeneous nature of stool samples is known to influence disparities in viral nucleic
acid yields. TAC detected 209 of which 171 (82%) were confirmed positive for HEVs by realtime
reverse transcription polymerase chain reaction (RRT-PCR), targeting the 5’ NTR regions.
Therefore, the results may not be a representative of all circulating HEVs in the study area. Since
this was a retrospective study of previously collected samples, it is possible that some HEVs strains
may have failed to amplify.

2018
Nambati EA, Kiarie WC, Kimani F, Kimotho JH, Otinga MS, Too E, Kaniaru S, Limson J, Bulimo W. Unclear association between levels of Plasmodium falciparum lactate dehydrogenase (PfLDH) in saliva of malaria patients and blood parasitaemia: diagnostic implications? Malaria Journal. 2018;17:9. Abstractnambati_et_al_2018.pdfnambati_et_al_2018.pdfWebsite

The use of saliva in diagnosis of infectious diseases is an attractive alternative to procedures that involve blood drawing. It promises to reduce risks associated with accidental needle pricks and improve patient compliance particularly in malaria survey and drug efficacy studies. Quantification of parasitaemia is useful in establishing severity of disease and in assessing individual patient response to treatment. In current practice, microscopy is the recommended technique, despite its limitations. This study measured the levels of Plasmodium falciparum lactate dehydrogenase (PfLDH) in saliva of malaria patients and investigated the relationship with blood parasitaemia.

2017
Richard K, Faith O, Margaret O, Anne N, Wallace B. Effect of {ABCB}1 C3435T Polymorphism on Clinical Outcomes in Kenyan {HIV} Patients on Lopinavir-Based Regimens. Journal of Pharmacy and Pharmacology. 2017;5. AbstractWebsite
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Richard K, Faith O, Margaret O, Anne N, Wallace B. Effect of ABCB1 C3435T Polymorphism on Clinical Outcomes in Kenyan HIV Patients on Lopinavir-Based Regimens. Journal of Pharmacy and Pharmacology. 2017;7:478-88. Abstract13-jpp2017041704.pdf

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Butalanyi PK, Kiptoo J, Onditi A, Andala D, Bulimo W, Mwanza BK, Muchuna JK. Preliminary Studies for Evaluation of a Fibre Optical Nano Chemical Sensor for Selected Carcinogenic Compounds. Journal of the Kenya Chemical Society. 2017;10(1):40-57.
2016
Opanda SM, Wamunyokoli F, Khamadi S, Coldren R, Bulimo WD. Genotyping of enteroviruses isolated in Kenya from pediatric patients using partial {VP}1 region. {SpringerPlus}. 2016;5. AbstractWebsite
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Gachara G, Symekher S, Otieno M, Magana J, Opot B, Bulimo W. Whole genome characterization of human influenza A(H1N1)pdm09 viruses isolated from Kenya during the 2009 pandemic. Infection, Genetics and Evolution. 2016. AbstractWebsite
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Sipulwa LA, Ongus JR, Coldren RL, Bulimo WD. Molecular characterization of human coronaviruses and their circulation dynamics in Kenya, 2009-2012. Virol J. 2016;13(1):18. Abstractsipulwa_et_al_2016.pdf

Human Coronaviruses (HCoV) are a common cause of respiratory illnesses and are responsible for considerable morbidity and hospitalization across all age groups especially in individuals with compromised immunity. There are six known species of HCoV: HCoV-229E, HCoV-NL63, HCoV-HKU1, HCoV-OC43, MERS-CoV and SARS-HCoV. Although studies have shown evidence of global distribution of HCoVs, there is limited information on their presence and distribution in Kenya.

Chebon LJ, Ngalah BS, Ingasia LA, Juma DW, Muiruri P, Cheruiyot J, Opot B, Mbuba E, Imbuga M, Akala HM, Bulimo W, Andagalu B, Kamau E. Genetically Determined Response to Artemisinin Treatment in Western Kenyan Plasmodium falciparum Parasites. PLoS ONE. 2016;11:1-19. Abstractchebon_et_al_2016.pdfWebsite

Genetically determined artemisinin resistance in Plasmodium falciparum has been described in Southeast Asia. The relevance of recently described Kelch 13-propeller mutations for artemisinin resistance in Sub-Saharan Africa parasites is still unknown. Southeast Asia parasites have low genetic diversity compared to Sub-Saharan Africa, where parasites are highly genetically diverse. This study attempted to elucidate whether genetics provides a basis for discovering molecular markers in response to artemisinin drug treatment in P. falciparum in Kenya. The genetic diversity of parasites collected pre- and post- introduction of artemisinin combination therapy (ACT) in western Kenya was determined. A panel of 12 microsatellites and 91 single nucleotide polymorphisms (SNPs) distributed across the P. falciparum genome were genotyped. Parasite clearance rates were obtained for the post-ACT parasites. The 12 microsatellites were highly polymorphic with post-ACT parasites being significantly more diverse compared to pre-ACT (p < 0.0001). The median clearance half-life was 2.55 hours for the post-ACT parasites. Based on SNP analysis, 15 of 90 post-ACT parasites were single-clone infections. Analysis revealed 3 SNPs that might have some causal association with parasite clearance rates. Further, genetic analysis using Bayesian tree revealed parasites with similar clearance phenotypes were more closely genetically related. With further studies, SNPs described here and genetically determined response to artemisinin treatment might be useful in tracking artemisinin resistance in Kenya.

Chebon LJ, Ngalah BS, Ingasia LA, Juma DW, Muiruri P, Cheruiyot J, Opot B, Mbuba E, Imbuga M, Akala HM, Bulimo W, Andagalu B, Kamau E. Genetically Determined Response to Artemisinin Treatment in Western Kenyan Plasmodium falciparum Parasites. PLoS ONE. 2016;11:1-19. AbstractWebsite

Genetically determined artemisinin resistance in Plasmodium falciparum has been described in Southeast Asia. The relevance of recently described Kelch 13-propeller mutations for artemisinin resistance in Sub-Saharan Africa parasites is still unknown. Southeast Asia parasites have low genetic diversity compared to Sub-Saharan Africa, where parasites are highly genetically diverse. This study attempted to elucidate whether genetics provides a basis for discovering molecular markers in response to artemisinin drug treatment in P. falciparum in Kenya. The genetic diversity of parasites collected pre- and post- introduction of artemisinin combination therapy (ACT) in western Kenya was determined. A panel of 12 microsatellites and 91 single nucleotide polymorphisms (SNPs) distributed across the P. falciparum genome were genotyped. Parasite clearance rates were obtained for the post-ACT parasites. The 12 microsatellites were highly polymorphic with post-ACT parasites being significantly more diverse compared to pre-ACT (p < 0.0001). The median clearance half-life was 2.55 hours for the post-ACT parasites. Based on SNP analysis, 15 of 90 post-ACT parasites were single-clone infections. Analysis revealed 3 SNPs that might have some causal association with parasite clearance rates. Further, genetic analysis using Bayesian tree revealed parasites with similar clearance phenotypes were more closely genetically related. With further studies, SNPs described here and genetically determined response to artemisinin treatment might be useful in tracking artemisinin resistance in Kenya.

Opanda S, Wamunyokoli F, Khamadi S, Coldren R, Bulimo W. Genotyping of enteroviruses isolated in Kenya from pediatric patients using partial VP1 region. SpringerPlus. 2016;5:158. Abstractopanda_et_al_2016.pdfWebsite

Enteroviruses (EV) are responsible for a wide range of clinical diseases in humans. Though studied broadly in several regions of the world, the genetic diversity of human enteroviruses (HEV) circulating in the sub-Saharan Africa remains under-documented. In the current study, we molecularly typed 61 HEV strains isolated in Kenya between 2008 and 2011 targeting the 3'-end of the VP1 gene. Viral RNA was extracted from the archived isolates and part of the VP1 gene amplified by RT-PCR, followed by sequence analysis. Twenty-two different EV types were detected. Majority (72.0%) of these belonged to Enterovirus B species followed by Enterovirus D (21.3%) and Enterovirus A (6.5%). The most frequently detected types were Enterovirus-D68 (EV-D68), followed by Coxsackievirus B2 (CV-B2), CV-B1, CV-B4 and CV-B3. Phylogenetic analyses of these viruses revealed that Kenyan CV-B1 isolates were segregated among sequences of global CV-B1 strains. Conversely, the Kenyan CV-B2, CV-B3, CV-B4 and EV-D68 strains generally grouped together with those detected from other countries. Notably, the Kenyan EV-D68 strains largely clustered with sequences of global strains obtained between 2008 and 2010 than those circulating in recent years. Overall, our results indicate that HEV strains belonging to Enterovirus D and Enterovirus B species pre-dominantly circulated and played a significant role in pediatric respiratory infection in Kenya, during the study period. The Kenyan CV-B1 strains were genetically divergent from those circulating in other countries. Phylogenetic clustering of Kenyan EV-D68 strains with sequences of global strains circulating between 2008 and 2010 than those obtained in recent years suggests a high genomic variability associated with the surface protein encoding VP1 gene in these enteroviruses.

Otieno NM, Apolot OF, Dimbuson BW, Christina M, Nkatha GA, Margaret O. Impact of First Line Antiretroviral Therapy on Clinical Outcomes Among HIV-1 Infected Adults Attending One of the Largest HIV Care and Treatment Program in Nairobi Kenya. Journal of AIDS & Clinical Research. 2016;7:3-7. Abstractimpact-of-first-line-antiretroviral-therapy-on-clinical-outcomes-amonghiv1-infected-adults-attending-one-of-the-largest-hiv-care-a-2155-6113-1000615.pdf

Objective: This study evaluated the immunologic (CD4 cell count), virological (HIV RNA viral load), hepatic (alanine and aspartate aminotransferase - ALT and AST), renal (creatinine) and hematological (hemoglobin -HB, White Blood Cell - WBC, Lymphocytes - LYM and platelets - PLT) response to a six months ART treatment among HIV participants in Nairobi Kenya. Methods: Blood samples were obtained from 599 consenting HIV infected participants receiving HIV treatment in Nairobi. CD4 cell counts were measured using flow cytometer and viral load determined using real-time polymerase chain reaction. The blood hematology, liver and kidney function tests were also measured. One-way ANOVA and Linear regression analysis were conducted. Results: The median age at ART initiation was 41 years (IQR 35-47 years). The majority of participants (60.3%) were female and 56.1% started on regimens with 2 NRTIs and efavirenz based NNRTI. About 40% of the participants were failing treatment 6 month post ART initiation. The CD4 count significantly increased at the 6-month post ART initiation (301.7 ± 199.4 to 329.4 ± 305.8; P<0.05). Hepatotoxicity (ALT and AST levels >5 times the upper limit of normal - ULN) and renal abnormalities (elevated serum creatinine levels) were all high at month 6 compared to baseline; ALT (2.5 to 10.5%), AST (5.3 to 23.4%) and creatinine (63.4 to 68.84%). Fewer participants at month 6 had anemia (29.4% verses 56.4%), leucopenia (42.4% vs. 46.9%) and thrombocytopenia (6.5% vs. 84.1%) compared to baseline. In multivariable models, baseline levels of this parameter, ART regimen and duration with HIV at ART initiation were the most important determinant of month 6 levels. Conclusion: These data demonstrate sustained immunologic/virologic response to ART among participants remaining on therapy. Anemia, leucopenia and thrombocytopenia were minimized with marginal hepatotoxicity and renal impairment seen. Interventions leading to earlier HIV diagnosis and initiation of ART could substantially improve patient outcomes in Kenya.

Juma BW, Kariuki S, Waiyaki PG, Mutugi MW, Bulimo WD. Molecular characterization of fluoroquinolone resistance genes in isolates obtained from patients with diarrhea in Machakos District Hospital, Kenya. African Journal of Pharmacology and Therapeutics. 2016;5:118-27. Abstractjuma_b_et_al_2016.pdf

Background: Diarrhea caused by Enterobacteriaceae such as Shigella species and Escherichia coli (E. coli) is endemic throughout the world, and is one of the most important causes of global childhood mortality and morbidity. There is a range of antibiotics that can be used for treatment among them quinolones. However, there is emerging increase in microbial resistance to quinolones use, with E. coli and Shigellae among the species of bacteria commonly associated with quinolone resistance. Objective: To investigate the prevalence of quinolone resistance genes in Shigellae and E. coli from patients presenting with diarrhea in Machakos District Hospital. Methods: Bacteria isolates were identified to species level by biochemical methods and serology and thereafter tested for 12 different antibiotics including quinolones, cephalosporins and aminoglycosides. Those resistant to quinolones with a zone diameter of ≤20 mm were tested for the presence of quinolone resistance genes using PCR. The gyrA resistance genes were further analyzed by sequencing to determine mutations within the quinolone resistance regions. Results: There were different E. coli pathotypes and Shigellae spp. They resisted more than four antibiotics: Ciprofloxacin (4%), (Chloramphenical (28%), Cotrimoxazole (78%), Co-amoxilav (70%) Erythromycin (98%) Cefotoxime (18%) and Tetracycline (56%). Mutations responsible for fluoroquinolone resistance in the gyrA, gyrB, parC, and parE genes of E. coli and Shigella spp were: gyrA (17/30, 36%) gyrB (7/30, 23.3%) topoisomerase (parC 3/30, 10%) parE (3/30, 10%). Discussion: There is an increase in fluoroquinolone resistance in Shigellae and E.coli which points to a major challenge in current treatment strategies. In addition, detection of high resistance found to commonly used antibiotics should serve as a warning call for close surveillance and understanding of the epidemiology of the resistance. Key words:

Wadegu M, Wamunyokoli F, Osanjo G, Opanda S, Majanja J, Coldren R, Bulimo W. Molecular Surveillance of Adamantane Resistance among Human Influenza A Viruses Isolated in Four Epidemic Seasons in Kenya. African Journal of Pharmacology and Therapeutics. 2016;5:181-92. Abstractwadegu_et_al_2016.pdf

Background: Adamantanes impede influenza A virus replication and are important in the treatment and prophylaxis of disease caused by these viruses. Genotypic characterization of influenza A viruses for mutations associated with resistance to adamantanes has not been fully investigated in Kenya. Objective: To characterize susceptibility of influenza A virus subtypes that circulated in Kenya from 2008-2011 to adamantanes. Methods: Archived influenza A virus strains obtained from 2008 to 2011 were propagated in MDCK cells prior to sequencing of the matrix and hemagglutinin gene segments, followed by bioinformatics analyses. Results: Ninety two virus strains consisting of 21 A/H3N2, 18 A/H1N1 and 53 A/H1N1pdm09 were analyzed. All A/H3N2 and A/H1N1pdm09 viruses displayed resistance to adamantanes due to the S31N/S31D amino acid substitution. All A/H1N1pdm09 virus strains belonged to the N-lineage characterized by S203T amino acid substitution in the HA1. All A/H1N1 viruses were sensitive to adamantane and were characterized by K140E amino acid substitution in the HA1. Conclusion: All Kenyan influenza A/H3N2 and A/H1N1pdm09 virus strains were resistant to adamantanes while seasonal A/H1N1 strains were sensitive to these drugs. During the study period, Amantadine and Rimantadine were inappropriate for prophylaxis and treatment of influenza disease caused by A/H3N2 and A/H1N1pdm09 virus subtypes in Kenya.

Juma BW, Kariuki S, Waiyaki PG, Mutugi MM, Bulimo WD. The prevalence of TEM and SHV genes among Extended-Spectrum Beta-Lactamase-producing Klebsiella pneumoniae and Escherichia coli. African Journal of Pharmacology and Therapeutics . 2016;5(1):1-7.juma_et_al_2016.pdf
Milanoi S, Ongus JR, Gachara G, Coldren R, Bulimo W. Serotype and genetic diversity of human rhinovirus strains that circulated in Kenya in 2008. Influenza and Other Respiratory Viruses. 2016:n/a–n/a. Abstractmilanoi_et_al-2016-influenza_and_other_respiratory_viruses-2.pdfWebsite

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Mbui FM, Achilla RA, Coldren RL, Bulimo WD. Serotype Diversity of Respiratory Human Adenoviruses amongst Pediatric Patients from Western Kenya, 2010-2012. African Journal of Pharmacology and Therapeutics. 2016;5(3):142-8. Abstractmbui_et_al._2016.pdf

Background: Respiratory illnesses are common among pediatric patients in Kenya, and many are attributed to viral causes. However, there is limited knowledge of the diversity of viral etiologies associated with these illnesses. Objective: To characterize respiratory adenoviruses isolates using serological and molecular approaches. Methods: A total of 1,879 samples were collected from symptomatic pediatric patients seeking medical care at New Nyanza Provincial General Hospital during the period of June 2010 to June 2012 and screened for adenoviruses as well as other respiratory viruses. Sixteen respiratory human adenoviruses (HAdVs) were isolated in Hep 2 cell culture and characterized hem using Immunofluorescence Assay, viral DNA amplification, sequencing and phylogenomics. Results: Phylogenetic characterization of the HAdVs using the hyper variable region 7 of the hexon gene identified HAdV B and C as the major species associated with respiratory infections during the study period. Amongst these, a single B-type and four C-type serotypes were identified. The serotype distribution consisted of 31% HAdV B7, 25% HAdV C1, 25% AdV C2, 6% HAdV C5, and 13% HAdV C6. Positive selection was observed in the nucleotide sequences from HAdV B7 and HAdV C5 signaling evolution of these two serotypes. Conclusion: These finding may be useful to policy makers regarding appropriate strain selection for vaccination in Kenya.

Gachara G, Symekher S, Otieno M, Magana J, Opot B, Bulimo W. Whole genome characterization of human influenza A(H1N1)pdm09 viruses isolated from Kenya during the 2009 pandemic. Infection, Genetics and Evolution. 2016:-. Abstractwhole_genome_of_pandemic_h1n1_paper.pdfWebsite

Abstract An influenza pandemic caused by a novel influenza virus A(H1N1)pdm09 spread worldwide in 2009 and is estimated to have caused between 151,700 and 575,400 deaths globally. While whole genome data on new virus enables a deeper insight in the pathogenesis, epidemiology, and drug sensitivities of the circulating viruses, there are relatively limited complete genetic sequences available for this virus from African countries. We describe herein the full genome analysis of influenza A(H1N1)pdm09 viruses isolated in Kenya between June 2009 and August 2010. A total of 40 influenza A(H1N1)pdm09 viruses isolated during the pandemic were selected. The segments from each isolate were amplified and directly sequenced. The resulting sequences of individual gene segments were concatenated and used for subsequent analysis. These were used to infer phylogenetic relationships and also to reconstruct the time of most recent ancestor, time of introduction into the country, rates of substitution and to estimate a time-resolved phylogeny. The Kenyan complete genome sequences clustered with globally distributed clade 2 and clade 7 sequences but local clade 2 viruses did not circulate beyond the introductory foci while clade 7 viruses disseminated country wide. The time of the most recent common ancestor was estimated between April and June 2009, and distinct clusters circulated during the pandemic. The complete genome had an estimated rate of nucleotide substitution of 4.9 × 10− 3 substitutions/site/year and greater diversity in surface expressed proteins was observed. We show that two clades of influenza A(H1N1)pdm09 virus were introduced into Kenya from the \{UK\} and the pandemic was sustained as a result of importations. Several closely related but distinct clusters co-circulated locally during the peak pandemic phase but only one cluster dominated in the late phase of the pandemic suggesting that it possessed greater adaptability.

Juma BW, Kariuki S, Waiyaki PG, Mutugi MW, Bulimo WD. Molecular characterization of fluoroquinolone resistance genes in isolates obtained from patients with diarrhea in Machakos District Hospital, Kenya. African Journal of Pharmacology and Therapeutics. 2016;5. Abstract
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Juma BW, Kariuki S, Waiyaki PG, Mutugi MM, Bulimo WD. The prevalence of TEM and SHV genes among Extended-Spectrum Beta-Lactamase-producing Klebsiella pneumoniae and Escherichia coli. African Journal of Pharmacology and Therapeutics Vol. 2016;5:1-7. Abstract
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2015
Ingasia LA, Akala HM, Imbuga MO, Opot BH, Eyase FL, Johnson JD, Bulimo WD, Kamau E. Molecular Characterization of the Cytochrome b Gene and In Vitro Atovaquone Susceptibility of Plasmodium falciparum Isolates from Kenya. Antimicrob. Agents Chemother.. 2015;59:1818-21. AbstractWebsite
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Ingasia LA, Akala HM, Imbuga MO, Opot BH, Eyase FL, Johnson JD, Bulimo WD, Kamau E. Molecular Characterization of the Cytochrome b Gene and In Vitro Atovaquone Susceptibility of Plasmodium falciparum Isolates from Kenya. Antimicrob Agents Chemother. 2015;59(3):1818-21. Abstractingasia_molecular_characterization_of_the_cytochrome_b_gene_and_in_vitro_atovaquone_susceptibility_of_plasmodium_falciparum_isolates_from_kenya.pdf

The prevalence of a genetic polymorphism(s) at codon 268 in the cytochrome b gene, which is associated with failure of atovaquone-proguanil treatment, was analyzed in 227 Plasmodium falciparum parasites from western Kenya. The prevalence of the wild-type allele was 63%, and that of the Y268S (denoting a Y-to-S change at position 268) mutant allele was 2%. There were no pure Y268C or Y268N mutant alleles, only mixtures of a mutant allele(s) with the wild type. There was a correlation between parasite 50% inhibitory concentration (IC50) and parasite genetic polymorphism; mutant alleles had higher IC50s than the wild type.

Wagaiyu EG, Bulimo WD, Wanzala PN, Kaimenyi JT. Interleukin - 1 Polymorphisms And Chronic Periodontitis In A Rural Kenyan Population. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2015;14(2):36-43. Abstracti014213643.pdf

Abstract: Susceptibility to Chronic periodontitis (CP) has been associated with genetic polymorphisms in the proinflammatory cytokine, interleukin - 1 (IL - 1A and IL - 1B) isoforms but little is known about their role in rural Africans. Therefore, the aim of this study was to resolve the association between genetic polymorphisms in IL - 1A and IL - 1B isoforms and chronic periodontitis in the Taita people of Kenya. Methods: This was a case - control study. After informed consent, a clinical examination was then conducted which included assessment of dental plaque, gingival inflammation, pocket depths and gingival recession. Buccal swab samples were then obtained. Deoxyribonucleic acid (DNA) was isolated from the swabs using QIAamp DNA purification protocol followed by polymerase chain reaction (PCR) amplification using specific primers to IL - 1A (rs 1800587(- 889) & rs17561 (+48 45)) and IL - 1B (rs 16944 (- 511) & rs 11443624 (+3954). The amplicons were digested using Nco1, Fnu4H1, Ava1 and Taq1 respectively. Restriction fragment length polymorphisms (RFLP) were recorded. Association analyses of the RFLP and clinical data were carried out. Results: No deviation from the Hardy Weinberg equilibrium was observed. Carriage of allele2 at IL - 1B +3954 (i.e. combination of ‘2 - 2’ or‘1 - 2’ at locus +3954) was associated with CP in the Taita participants (OR = 1.94, 95%CI=1.01 - 3.70, p=0.045). There were no confounders or effect modifiers in the Taita participants and no association with severity of CP was observed in this population. None of the composite genotypes were associated with CP in the Taita participants. Haplotype 3 (i.e. allele1 at all the four loci) was significantly associated with CP amongst the Taita (O R=2.4, 95%CI=1.1 - 5.14, p=0.022). Conclusion: The significant association of allele2 at IL - 1B +3954 with CP in the Taita participants confirmed the importance of this genotype in disease pathogenesis. Keywords: chronic periodontitis, IL -1 polymorphisms, Rural Kenya, Taita

2014
Opanda SM, Wamunyokoli F, Khamadi S, Coldren R, Bulimo WD. Genetic Diversity of Human Enterovirus 68 Strains Isolated in Kenya Using the Hypervariable 3$\prime$- End of {VP}1 Gene. {PLoS} {ONE}. 2014;9:e102866. AbstractWebsite
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Kaburu SM, Bulimo W, Maina GG, Ongus J. Burden of human rhinovirus infections in influenza like illnesses in Kenya. International Journal of Infectious Diseases. 2014;21:222. AbstractWebsite
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Mitei K, Bulimo W, Achilla R, Majanja J, Wadegu M, Opot B, Osuna F, Mukunzi S, Muthoni J, Ochola S, Mwangi J, Njiri J, Wurapa E, Coldren R. Surveillance of non-influenza viruses in Kenya, 2007-2011. International Journal of Infectious Diseases. 2014;21:261. AbstractWebsite
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Wagaiyu, Evelyn G, Bulimo WD, Wanzala, Peter N, Kaimenyi, Jacob T. Genetic polymorphisms in IL-1A and IL-1B isoforms and their associations with chronic periodontitis in the Swahili people of Kenya. IOSR Journal of Dental and Medical Sciences. 2014;13:07-15 . Abstractb0131120715.pdfWebsite

Genetic polymorphisms in interleukin-1 (IL-1A and IL-1B) isoforms have been associated with Chronic Periodontitis (CP) in Caucasians, Asians and Arabs but little is known about their role in Africans. Therefore, this study was to resolve the association between genetic polymorphisms in IL-1A and IL-1B isoforms and chronic periodontitis in a Kenyan community. Methods: This was a case-control study. After informed consent, a clinical examination was conducted. Buccal swab samples were then obtained. Deoxyribonucleic acid was isolated from the swabs using QIAamp DNA purification protocol followed by polymerase chain reaction amplification using specific primers to IL-1A (loci -889 & +4845) and IL-1B (loci -511 & +3954). The amplicons were digested using Nco1, Fnu4H1, Ava1 and Taq1 respectively. Restriction fragment length polymorphisms (RFLP) were recorded. Association analyses of the RFLP and clinical data were carried out. Results: After screening 523 Swahili participants from old town Mombasa, 100 cases and 100 controls were included in the study. There was more plaque present in cases than controls with OR = 9.2 (95%CI = 3.7-23.1), p<0.001. Mild Chronic Periodontitis was present in 9(9%) participants, moderate CP in 35(35%) and the severe form of CP in 56(56%). Carriage of allele 1 at IL-1A-889 amongst the Swahili participants was associated with Chronic Periodontitis (OR = 3.16, 95%CI=1.644-6.083, p<0.001). Allele 1 at locus IL-1A-889 was associated with mild, (OR=5.2, 95%CI=1.445-18.71, p=0.005), moderate (OR=4.51, 95%CI = 2.08-9.79, p<0.001) and severe disease (OR=2.19, 95%CI=1.013-4.738, p=0.042). Furthermore, plaque level was an effect modifier in the association between IL-1B-511 polymorphism and CP. Conclusions: Increased susceptibility to Chronic Periodontitis was found in Swahili participants with allele 1 at IL-1A-889.

Opanda SM, Wamunyokoli F, Khamadi S, Coldren R, Bulimo WD. Genetic Diversity of Human Enterovirus 68 Strains Isolated in Kenya Using the Hypervariable 3′- End of VP1 Gene. PLoS ONE. 2014;9(7):e102866-. Abstractjournal.pone_.0102866.pdfWebsite

Reports of increasing worldwide circulation of human enterovirus-68 (EV68) are well documented. Despite health concerns posed by resurgence of these viruses, little is known about EV68 strains circulating in Kenya. In this study, we characterized 13 EV68 strains isolated in Kenya between 2008 and 2011 based on the Hypervariable 3′- end of the VP1 gene. Viral RNA was extracted from the isolates and partial VP1 gene amplified by RT-PCR, followed by nucleotide sequencing. Alignment of deduced amino acid sequences revealed substitutions in Kenyan EV68 isolates absent in the prototype reference strain (Fermon). The majority of these changes were present in the BC and DE-loop regions, which are associated with viral antigenicity and virulence. The Kenyan strains exhibited high sequence homology with respect to those from other countries. Natural selection analysis based on the VP1 region showed that the Kenyan EV68 isolates were under purifying selection. Phylogenetic analysis revealed that majority (84.6%) of the Kenyan strains belonged to clade A, while a minority belonged to clades B and C. Overall, our results illustrate that although EV68 strains isolated in Kenya were genetically and antigenically divergent from the prototype strain (Fermon), they were closely related to those circulating in other countries, suggesting worldwide transmissibility. Further, the presence of shared mutations by Kenyan EV68 strains and those isolated in other countries, indicates evolution in the VP1 region may be contributing to increased worldwide detection of the viruses. This is the first study to document circulation of EV68 in Kenya.

Omucheni DL, Kaduki KA, Bulimo WD, Angeyo HA. Application of principal component analysis to multispectral-multimodal optical image analysis for malaria diagnostics. Malar J. 2014;13(1):485. Abstract1475-2875-13-485.pdf

Multispectral imaging microscopy is a novel microscopic technique that integrates spectroscopy with optical imaging to record both spectral and spatial information of a specimen. This enables acquisition of a large and more informative dataset than is achievable in conventional optical microscopy. However, such data are characterized by high signal correlation and are difficult to interpret using univariate data analysis techniques.

Cheruiyot J, Ingasia LA, Omondi AA, Juma DW, Opot BH, Ndegwa JM, Mativo J, Cheruiyot AC, Yeda R, Okudo C, Muiruri P, Bidii NS, Chebon LJ, Angienda PO, Eyase FL, Johnson JD, Bulimo WD, Andagalu B, Akala HM, Kamau E. Polymorphisms in Pfmdr1, Pfcrt and Pfnhe1 Genes are Associated with Reduced in vitro Activities of Quinine in Plasmodium falciparum Isolates from Western Kenya. Antimicrob Agents Chemother. 2014. Abstractzac3737.pdf

In combination with antibiotics, quinine is recommended as the second-line treatment for uncomplicated malaria, alternative first-line treatment for severe malaria and for treatment of malaria in the first trimester of pregnancy. Quinine has been shown to have frequent clinical failures and yet the mechanisms of action and resistance are not been fully elucidated. However, resistance is linked to polymorphisms in multiple genes including multidrug resistance 1 (Pfmdr1), chloroquine-resistance transporter (Pfcrt) and the sodium/hydrogen exchanger gene (Pfnhe1). Here, we investigated the association between in vitro quinine susceptibility with genetic polymorphisms in Pfmdr1codons 86 and 184, Pfcrt codon 76, and Pfnhe1 ms4760 in 88 field isolates from western Kenya. In vitro activity was assessed as the drug concentration that inhibits 50% of parasite growth (IC50) and parasite genetic polymorphisms were determined by DNA sequencing. Data revealed there was significant association between polymorphisms in Pfmdr1-86Y, -184F and Pfcrt-76T with quinine susceptibility; all with p < 0.0001. Eighty two percent of parasites resistant to quinine carried mutant alleles at these codons (Pfmdr1-86Y, -184F and Pfcrt-76T) whereas seventy four percent of parasites susceptible to quinine carried the wild type allele (Pfmdr1-N86, -Y184 and Pfcrt-K76). In addition, quinine IC50 of parasites with Pfnhe1 ms4760 3 DNNND repeats was significantly higher compared to those with 1 or 2 repeats (p = 0.033 and p = 0.0043 respectively). Clinical efficacy studies are required to confirm the validity of these markers and the importance of parasite genetic background.

Juma DW, Omondi AA, Ingasia L, Opot B, Cheruiyot A, Yeda R, Okudo C, Cheruiyot J, Muiruri P, Ngalah B, Chebon LJ, Eyase F, Johnson J, Bulimo WD, Akala HM, Andagalu B, Kamau E. Trends in drug resistance codons in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase genes in Kenyan parasites from 2008 to 2012. Malar J. 2014;13:250. Abstractjuma_et_al2014.pdf

Sulphadoxine-pyrimethamine (SP), an antifolate, was replaced by artemether-lumefantrine as the first-line malaria drug treatment in Kenya in 2004 due to the wide spread of resistance. However, SP still remains the recommended drug for intermittent preventive treatment in pregnant women and infants (IPTP/I) owing to its safety profile. This study assessed the prevalence of mutations in dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes associated with SP resistance in samples collected in Kenya between 2008 and 2012.

Ocholla S, Jumba G, Bulimo W, Achilla R, Wadegu MO, Mukunzi S, Majanja JM, Opot B, Osuna F, Muthoni J, Njiri J, Mwangi J, Kibet K, Coldren R. The Appropriateness of WHO influenza B vaccine component to Kenya in 2011-2012. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: In the 1980’s, influenza B viruses were discovered to belong to two evolutionary groupings (B/Victoria/2/87-like viruses and B/Yamagata/16/88-like viruses) that continue to co-circulate globally in the human population. These viruses exist as independent lineages. Information about lineage of circulating influenza B viruses in a country is important for determination of the appropriateness of either a trivalent or a quadrivalent vaccine composition for that country.Objective: To genetically analyze the HA1 of influenza B viruses isolated in Kenya during the 2011-2012 season with reference to WHO vaccine strains recommended for Kenya.Method: Nasopharyngeal swab specimens obtained from patients meeting WHO definition criterion for ILI were screened by real-time PCR for influenza B viruses. Influenza B virus positive samples were inoculated onto MDCK cells and the lineages of the isolates determined by hemagglutination inhibition assay (HAI). To confirm the lineages, HA1 gene segments of selected isolates were amplified by PCR and sequenced and analyzed using bioinformatics tools.Results: Phylogenetic analyses revealed that all the 24 influenza B viruses that circulated between 2011- 2012 were closely related to B/Brisbane/60/2008 vaccine Strain. Comparison of the HA1 amino acid sequences of influenza B viruses with the reference vaccine strain (B/Brisbane/60/2008 lineage) revealed substitutions at 19 amino acid positions. FLU-MBG-11-02-010 had R188K amino acid change in the 120-loop antigenic receptor binding site relative to B/Brisbane vaccine reference strain. FLU-MBG-12-05-011 had V124I amino acid change in the 120-loop antigenic receptor binding site relative to the vaccine reference strain. The majority (87.5%) had I146V/A amino acid change in the 150-loop antigenic receptor binding site. All the Kenyan isolates had D197N amino acid change in the 190-helix antigenic receptor site. The other fifteen positions that showed polymorphisms were outside of the antigenic sites with these mutations being randomly distributed among the isolates.Conclusion: Our study provides evidence that the WHO vaccine strain recommendations for the southern hemisphere were appropriate for use in Kenya.

Nyambura J, Achilla R, Mitei K, Mukunzi S, Njiri J, Coldren R, Bulimo W. Co-circulation of Human Parainfluenza viruses in Kenya, Jan 2013-Sep 2013. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: Human parainfluenza viruses (HPIVs) belong to the paramyxoviridae family. HPIV is the major cause of croup in which type 1 is most frequent cause, followed by type 3 and type 2 respectively. Surveillance has shown that Human Parainfluenza viruse are a major cause of respiratory infections in Kenya. In January 2013 through an existing influenza surveillance network at the Kenyan National Influenza center, we screened for parainfluenza and other non-influenza respiratory viruses. This was done within the designated Influenza network made up of eight sentinel sites. Objective: The objective of this study was to monitor and document circulation of Human parainfluenza viruses in Kenya in the period January–September 2013. Materials and Methods: Specimens were collected from the nasopharynx using a flocked swab from consenting patients meeting the WHO influenza-like-illness (ILI) case definition. Specimens were transported to the NIC while observing the cold chain and inoculated into LLCMK2 cell line. After incubation and observation for cytopathic effect, all samples were screened by direct immunofluorescence assay (IFA) using the Respiratory Panel I Viral Screening and Identification kit (Chemicon International, Inc).Results and Discussion: A total of 972 nasopharyngeal swab specimens were collected between January – September 2013. HPIVs were detected in 108 (11%) cases. Out of these, there were 36 co-infections of the parainfluenza viruses. In general, Their seasonality patterns shows two peaks; one severe one occurring in April with 40.6% and the second milder peak occurring in June with 23.1% of all the cases. There was co-circulation of HPIV sub-types throughout the year. The three subtypes circulated between January to May with a peak in April with type 1 dominating in the month of April. They formed a second peak in June with type three dominating and type three lagging behind and appearing a month later. From our analysis we found that the conditions that trigger their occurrence are the same since their peaks are synchronized.Conclusion: This study shows that parainfluenza viruses are the major contributor of influenza in Kenya.

Wangui J, Bulimo W, Nokes J, Wurapa E, Nyaigoti C, Otieno J, Opot B, Achilla R, Coldren R. Genotypic Diversity of HRSV-A in out-patients with Acute Respiratory Infections in Kenya 2007-2010. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Introduction: Human Respiratory Syncytial Virus is the leading viral cause of bronchiolitis and pneumonia in children and infants. Amongst adults, the elderly and the immuno-compromised are also at risk of severe RSV. RSV is classified into two genetically distinct groups: RSV A and RSV B. In the case of RSV A, 11 genotypes have been reported to date. Amongst these are three new variants (NA1, NA2 and ON1). Appearance of new genotypes has been accompanied by rapid spread and near replacement of existing variants. There is need to constantly re-examine the nature of genotypic changes amongst circulating viruses. Objective: To assess the geographic distribution and genotypic diversity of RSV A in outpatients presenting with Influenza-Like-Illness from 2007 and 2010 across Kenya.Methods: Nasopharyngeal (NP) swabs were obtained from subjects ≥2 months of age presenting with fever ≥38ºC and cough or sore throat at district hospitals under surveillance across 5 regions of Kenya. RNA was extracted from the NP samples and screened using multiplex real-time RT-PCR. A 490bp fragment of the RSVA G-gene was amplified by nested RT-PCR and nucleotide sequencing carried out using the Sanger dideoxy termination method. The sequences were analyzed using a suite of bioinformatics software. Results: 159 NP samples were positive for RSV A, of which, 130 were genotyped; 21 (16%) were GA5, 39 (30%) GA2, 66 (50%) NA1, 1 GA1 and 3 (2%) GA2 variants closely related to NA2. GA2 and NA1 genotypes were identified in the highlands from 2007 – 2010. In 2009, NA1 was highest in Nairobi and Coast regions (11; 17%). GA2 genotype was highest in Northeastern (8; 21%) and was most prevalent in 2009 (44%). The Western region had the highest prevalence of GA5 in 2008 (6; 29%). Conclusion: Five genotypes were in circulation across the country in 2007 and of these NA1 genotype increased dominance year by year and spread to all the regions by 2009. These data provide insight into the dynamics of persistence of RSV strains within a national geographical area.

Achilla. RA, Bulimo. WD, Majanja. JM, Wadegu. MO, Mukunzi. SO, Mwangi. J, Mwangi. JW, Njiri. JO, Opot. BH, Wurapa. EK. Influenza surveillance in Kenya2006-2013: experiences and lessons learned . Hilton Hotel; Nairobi, Kenya.; 2014. Abstract

Background: Influenza sentinel surveillance at the KEMRI-National Influenza Centre (NIC) was rolled out in 2006. A team of collaborators from Kenya Medical Research Unit (KEMRI), US Army Medical research unit –Kenya (USAMRU-K) and Centre for Disease Control-Kenya (CDC) came together to produce a document that was used to initiate Influenza surveillance in 8 civilian hospitals and 5 military hospitals across Kenya. Setting up the surveillance sites required a lot of input from the laboratory personnel, the principal investigator, field site coordinators and field staff including clinical/nursing officers and laboratory technologists.Methods: Prior to opening any of the sentinel sites, the field staff were brought to central Lab in Nairobi for a one week intensive training on Biosafety, Quality Assurance and all the Site Specific Standard Operating Procedures (SOPs). These included sample transportation, sample collection, Inclusion and exclusion criteria and sample rejection SOPs among others.An influenza starter pack was then sent to the respective sites including transport media, cool boxes, Dry shippers, nasopharyngeal swabs, documentation, SOPs among other Laboratory supplies Patient samples were transported weekly to the NIC in dry shippers to maintain cold chain by courier. On reception in the central laboratory a robust inventory system was put in place and tests were conducted first by real time PCR.Results: Eight Sentinel sites were activated over a period of one year. A total of 17980 samples were collected during this time period. On analysis approximately 25% of the samples showed positive results on analysis. Upper respiratory viruses discovered recently like HMPV and HCoV were later introduced to the study through student programs. By real time PCR a total of 1067 influenza A and Influenza B 879 were detected. Virus Isolation yielded 2847 Isolates. Of these the most isolated virus was adenovirus at 21% and respiratory syncitial virus at 19%.Discussion and Conclusion: Over the past eight years a lot of information was acquired through this robust surveillance program. 75% of the samples still remain undiagnosed and could be a potential source for novel viruses. Next Gen sequencing would be instrumental in detected what made the patient ill enough to have fevers of >38 degrees centigrade. This program also played a significant role during the 2009 pandemic H1N1 outbreak and still has capacity to detect MERS CoV currently circulating in the Middle East and H7N9 circulating in China. Influenza and other Upper respiratory tract viruses’ surveillance remains critical in Kenya where tourism, is a major income earner. The capacity to not only detect but disseminate information in a timely manner can help contain potential outbreaks and arrest potentially dangerous situations.

Sipulwa LA, Ongus JR, Bulimo WD. Molecular characterization of human coronavirus circulating in Kenya, 2009-2012. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: The genome of a human coronavirus (HCoV) is composed of a linear, single-stranded, non-segmented, positive-sense RNA of 27-32 kb. The pol gene of HCoV found in ORF1ab, is a good molecular chronometer for molecular characterization of HCoV types because in a region of ~900bp towards the 5’, it contains two conserved flanks with a hypervariable middle. Thus, this region of the pol gene has been used to type all known HCoVs. Thus, molecular typing using this gene segment corresponds well to the classical typing based on serological cross-reactivity which groups CoVs into four groups. HCoVs cause a variety of mild and severe respiratory tract diseases including SARS and MERS. To date there are six known types of HCoVs. Although studies have shown evidence of global distribution of HCoVs and the diseases they cause, there is limited information on their presence, distribution and genetic characteristics in Kenya.Objective: To isolate, type and infer the genetic diversity of HCoVs that circulated in Kenya from 2009-2012 using the pol gene.Methods: Archived nasopharyngeal (NP) swab specimens from consenting outpatients aged ≥2 months were screened by real-time RT-PCR using HCoV-specific primers. Positive specimens were inoculated onto LLCMK2 monolayers to isolate the virus. RNA was extracted from virus isolates followed by PCR amplification of the HCoV pol gene using gene-specific primers. Nucleotide sequencing of amplicons was carried out using the BigDye chemistry prior to analyses using a suite of bioinformatics tools.Results and discussion: 29 of the 417 (7%) NP samples tested were positive for HCoV. The highest proportion (33%) were HCoV-NL63 followed by HCoV-HKU1 (30%), HCoV-OC43 (27%) and HCoV-229E (10%) respectively. SARS-CoV and MERS-CoV were not detected. Of the 29 positive samples, 14 (47%) yielded viral isolates for nucleotide sequencing. Sequence and Phylogenetic analyses identified 4 HCoV-HKU1, 5 HCoV-NL63, 4 HCoV-OC43 and 3 HCoV-229E. Mutation analyses revealed that 2/3 of the Kenyan HCoV-229E had Y4682L and one had F4821T amino acid substitutions relative to the prototype (GenBank Acc. No. NC_002645.1) The other human coronavirus types (HKU1, NL63 & OC43) had a few disparate silent mutations and were phenotypically identical to their respective prototypes. Conclusion: Four types of HCoVs circulated in Kenya during the study period. Genetic diversity in the hypervariable region of the pol gene was only observed in the HCoV-229E.

Opanda S, Wamunyokoli F, Khamadi S, Rodney C, Bulimo W. Molecular typing of respiratory human enteroviruses isolated in Kenya between 2008 -2011 using the VP1 gene. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: Human enteroviruses (genus Enterovirus, family Picornaviridae) are common infectious agents grouped into HEV-A, HEV-B, HEV-C and HEV-D species. They comprise >100 serotypes and are responsible for a wide range of human pathologies including upper and lower respiratory tract infections. There’s scanty information about serotype diversity of HEV circulating in Kenya.Objective: To molecularly type human enteroviruses isolated in Kenya between 2008 and 2011 using hypervariable 3’-end of the VP1 gene. Methods: A total of 200 HEV isolates obtained in the country from nasopharyngeal specimens were analyzed. Viral RNA was extracted and partial VP1 gene amplified using RT-PCR followed by sequencing. The resulting VP1 sequences were evaluated by sequence homology and phylogenetic analysis relative to those of prototypes retrieved from GenBank. Results: Overall, 22 different enteroviral serotypes were detected. The majority (72%) of the serotypes were from HEV-B species (72%) followed by HEV-D (21.3%) and HEV-A (6.5%). None of the identified serotypes belonged to HEV-C species. The most frequently detected serotypes we enterovirus-68 (EV68), Coxsackie-virus types –B2, -B1, -B4 and B3. The most prevalent serotypes were enterovirus-68 (EV68), Coxsackievirus types -B2, -B1, -B4 and -B3. Conclusions: Findings from this study demonstrate the existence of high serotype diversity among HEVs that circulated in Kenya between 2008 and 2011. The viruses belonging to HEV-A, HEV-B and HEV-D species played a key role in enteroviral infections in the country during this period. The absence of HEV-C known to frequently recombine with poliovirus vaccine strains indicates a low risk of emergence of vaccine derived poliovirus (VDPV) in Kenya. Typing of HEV is important in determining temporal and spatial patterns of the circulating serotypes. This information is necessary for healthcare planning and outbreak investigation studies.

Jumba G, Gachara G, Bulimo W. Neuraminidase Inhibitor activities on Influenza B isolates obtained in Kenya, 2011-2012. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Introduction: Oseltamivir and zanamivir are neuraminidase inhibitors (NAIs) with important roles as drugs for prophylaxis and treatment of influenza. Whereas there have been reports of in vivo resistance of influenza B viruses to NAIs, currently there is lack of information regarding sensitivity or resistance to these drugs in influenza B viruses circulating in Kenya. Here, we report the isolation of influenza B viruses, phenotypic assessment to NAI activities and molecular characterization of NAI-relevant mutations in viruses that circulated in Kenya in the period 2011-2012. Materials and Methods: Influenza B viruses were isolated from patient nasopharyngeal specimens by inoculation onto MDCK monolayers. For phenotypic determination, enzyme inhibition assay using fluorescent MUNANA substrate was used. Known NA inhibitor-resistant and inhibitor-sensitive viruses were included in the assays as controls. IC50 values were determined using curve fitting implemented in Grafit version 7.0 software which is based on 50% of fitted upper asymptote. For molecular characterization of the mutations relevant in NAI resistance, RNA was extracted from the isolates followed by PCR amplification of NA gene segments using gene-specific primers. Nucleotide sequencing of the amplicons were performed using the Sanger dideoxy termination chemistry implemented using the BigDye technology prior to analyses using a suite of bioinformatics tools. Results and Discussion: Twenty four influenza B viruses were isolated and assed in this study. The mean IC50s of the isolates ranged from 17.1nM - 70.1nM for Oseltamivir and 0.0nM - 12.6nM for Zanamivir which were all within the 2011 WHO sensitive limits of 8-128nM for oseltamivir carboxylate and 0.5-12nM for Zanamivir. None of the isolates analyzed depicted oseltamivir or Zanamivir resistance at the eight amino acid positions E119, R152, D198, I222, S250, H274, R371, and G402 in the neuraminidase protein previously found to be associated with resistance or reduced susceptibility to oseltamivir and/or zanamivir. In conclusion, NAIs drugs were effective in treating influenza cause type B viruses during the 2011-2012 Kenyan seasons.

Gachara G, Symekher S, Otieno M, Magana J, Opot B, Bulimo W. Origins, Molecular Epidemiology and Genetic Diversity of Influenza A(H1N1)pdm09 Virus in Kenya: A Bayesian Coalescent Analysis. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: An influenza pandemic caused by a swine-origin influenza virus A/H1N1 [A(H1N1)pdm09] spread worldwide in 2009 and is estimated to have caused between 151,700 and 575,400 deaths globally. The spread of influenza is tradi¬tionally tracked by epidemiological data; however, this approach gives lit¬tle insight into the different viral circulating vari¬ants. Genome sequencing is emerging as a surveillance tool for evolutionary and phylogenetic mapping, and to explore the origins, molecular epidemiology, and genetic diversity of epidemic/pandemic viruses. Objective: To determine the origins, molecular epidemiology and genetic diversity of Kenyan influenza A(H1N1)pdm09 viruses.Methodology: A total of 40 influenza A/H1N1pdm09 viruses isolated between July 2009 and August 2010 were selected. The eight segments from each isolate were amplified and directly sequenced. The resulting gene segments were concatenated and these genomes used for subsequent analysis. A Bayesian Markov chain Monte Carlo (MCMC) approach implemented in the BEAST package v1.7.4 was used to reconstruct the most recent common ancestor (MRCA) sequences, time the introduction of infection in the country, rates of substitution and estimate a time-resolved phylogeny. Results: The Kenyan complete genome sequences clustered with globally distributed clade 2 and clade 7 sequences. However, local clade 2 viruses did not circulate beyond the introductory foci while clade 7 viruses disseminated country wide and were sustained by multiple introductions generating complex spatial patterns. Often, the local isolates clustered with isolates from the United Kingdom than with isolates from other countries. The time of the most recent common ancestor was estimated between April and June 2009, two months before the first laboratory confirmed case. The complete genome had an estimated rate of nucleotide substitution of 4.9 X 10-3 substitutions/site/year and fast population growths characterized the population dynamics. Conclusions: Adaptive evolution and viral migration seem to play a vital role in shaping the evolutionary dynamics of local A(H1N1)pdm09 viruses. Continuous monitoring is thus essential.

Mbui FM, Achila RA, Opot BH, Wadegu MO, Majanja JM, Opanda SM, Ochola SA, Bulimo WD. Phylogenetic characterization of respiratory human adenoviruses isolated from pediatrics patients in New Nyanza Provincial General Hospital; Kenya.. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: Human adenoviruses (HAdVs) are common pathogens associated with diseases affecting the respiratory tract, gastro intestinal tract as well as various organs like the liver, kidney and the brain. Currently there are 60 human adenovirus serotypes classified into 7 species A to G on the basis of serology, genome sequencing and phylogenomics. HAdV species B, C and E are mainly implicated in respiratory tract infections whereas the other species are associated with gastrointestinal, genitourinary, and ocular infections. Globally, the respiratory HAdV species play a significant role in pediatric infections accounting for 10% of overall respiratory illnesses and 5%–11% of pneumonia cases. However the disease burden due to respiratory adenoviruses in Kenya is not well studied; there is limited data on the respiratory human adenovirus species and serotypes circulating in the country.Objective: The aim of this study was to characterize respiratory human adenoviruses using serological and molecular approaches. Specifically the study sought to determine the species and serotypes of HAdVs that were associated with pediatrics respiratory infections in New Nyanza Provincial General Hospital from June 2010 to June 2012.Methods: Respiratory human adenoviruses isolated from patient’s samples in a period of two years were characterized using serological and molecular approaches. Virus isolates in Hep-2 cell cultures were tested with specific fluorescent antibodies to confirm the presence of Human adenovirus. The loop-2 fragment of the hexon gene was PCR amplified and then sequenced using the Sanger method.Results: Phylogenomics analysis of the sequences showed that during the study period, respiratory HAdV species B and C were associated with respiratory infections accounting for approximately 1% of the overall respiratory viruses. There were no cases of infections caused by respiratory HAdV E implying that this species was not in circulation during the study period. HAdV C was the predominant species accounting for 68.75% of the reported cases with serotype distribution as HAdV C1-25%, HAdV C2-25%, HAdV C5-6.25%, and HAdV C6-12.5%. HAdV B serotype 7 was the most prevalent serotype at 31.25%. Analysis of selection pressure of the sequences revealed that HAdV C5 and HAdV B7 were under positive selection pressure indicating that these viruses are undergoing an evolutionary process which signifies instability in their genomes. Conclusions: Characterization of respiratory human adenoviruses that circulated at New Nyanza Provincial General hospital during the study period revealed that species B and C were present but not E. There was significant genetic variation in the hexon gene of the HAdVs seen at this site compared to those from other parts of the world implying continuing evolution of respiratory HAdVs. To gain a complete understanding of this evolutionary process, whole genome sequencing of these viruses is called for in order to determine genetic stability and uniqueness of these viruses.

Majanja J, Bulimo W, Achilla R, Wadegu M, Mukunzi S, Njiri J, Mitei K, Opot B, Ocholla S, Mwangi J, Osuna F, Coldren. R. Seasonal trend of Influenza in Kenya from January - October 2013. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Background: Influenza A and B viruses cause annual epidemics of respiratory illness. The Influenza surveillance network in Kenya through its sentinel surveillance sites located throughout the country has established that Influenza is a major cause of respiratory illness in Kenya.Objectives: The objective of the study was to determine the seasonal trend and circulation dynamics of Influenza viruses in Kenya from January to October, 2013.Methods: Nasopharyngeal swab specimens were collected from consenting patients meeting the ILI case definition and transported to the laboratory in liquid nitrogen dry shippers. RNA was extracted from the specimen using the QIAamp Viral RNA Mini Kit. Specimens were tested for influenza A and B viruses by using the Ag Path-ID One Step Real Time Reverse Transcription PCR (RT-PCR) Kit with CDC Human Influenza Virus RT-PCR Detection Panels (CDC, Atlanta, GA). Results: Of 945 specimens tested between January and October, 152 (16.1%) were positive for Influenza viruses. 38.8% tested positive for Influenza A/H3N2, 34.9% were positive for Influenza B while 26.3% were positive for the pdmH1N1 virus. Circulation of Influenza during this period was marked by three distinct peaks. The first peak was seen in the month of February at 22.7% followed by a steady decline to 5% in May. A second peak of 17.9% was seen in June and the highest circulation observed in August with a peak of 28.6%. PdmH1NI and Influenza A/H3N2 viruses co-circulated from January to April and then sharply declined in May. There were low levels of Influenza B in January which gradually increased peaking in June together with pdmH1N1. Influenza B and A/H3N2 co-circulated between July and September with peaks in August and low levels of pdmH1N1 during this period.Conclusion: Influenza viruses co-circulate throughout the year. Continuing surveillance will assist in determining their clinical and virological impact.

Milanoi S, Opanda S, Opot B, Gachara G, Ongus J, Bulimo W. Species and Serotype Diversity of Human Rhinoviruses from patients presenting with Influenza like illness in Kenya in 2008.. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

tract infections, the main cause of the common cold and recently have been associated with more serious respiratory infections. There are over 100 known serotypes of HRV, classified into 3 species (A, B and C). In Kenya, there is scanty information regarding the genotypic characteristics of HRV in circulation.Objective: To determine the species and serotype diversity of HRV that circulated in Kenya in 2008 among patients presenting with ILI.Methodology: 517 nasopharyngeal samples collected from patients >2months old who attended outpatient clinics included in the USAMRU-K respiratory diseases surveillance network were used. Real time RT-PCR was employed to detect HRV followed by targeted amplification of part of the 5’ non-coding region and the VP4/VP2 gene of all HRV-positive samples. Upon nucleotide sequencing, the sequences were then compared to prototype and homotypic rhinovirus reference strains to establish serotype identities and a phylogenetic tree was constructed.Results: HRV was detected in 131 (25%) samples. Of these 33 (25%) amplified successfully which upon nucleotide sequencing 29 (87%) yielded usable sequences. Phylogenetic analysis based on VP4/VP2 genomic region revealed separation of Kenyan strains into three clusters corresponding to HRV A, B and C species. Majority (n=17) belonged to HRVA species,(serotypes: 29 [n=2], -47, -1 [n=2], -56, -49[n=2], -30, -106, -20[n=2],-45, -58 [n=2], -45 and -78) three belonged to HRV B species: (-37, -84, and -91) whereas 9 belonged to HRV C species: (-2[n=3], -14, -7, -13[n=2], -31, and -36). Conclusion: This study demonstrates circulation of Human Rhinoviruses in Kenya and indicates high genetic diversity among these viruses. The findings suggest that HRV A and C strains played a key role in human respiratory infections in Kenya in 2008. Knowledge about circulating HRV strains is important as it may help guide development of therapeutic strategies against HRV infections.

B.W. J, P.G. W, W.D. B, E.K. W, M.M. M, S. K. Molecular detection of enterotoxigenic Escherichia coli surface antigens from patients in Machakos District Hospital, Kenya. East and Central Africa Medical Journal. 2014;1:62-8. Abstractmolecular_detection_of_enterotoxigenic.pdf

Introduction: Enterotoxigenic Escherichia coli (ETEC) is known for its public health importance globally, however, a protective vaccine is yet to be developed. Information regarding the immunology of ETEC’s virulence proteins that can lead to studies on vaccine development such as the heat stable toxins (ST), heat-labile toxin (LT), colonization factors (CFs) and coli surface antigens (CS) from many regions of the world is available. In Kenya, specific CFAs and CS have not been adequately characterized. This study looked at the surface antigens of diarrhoeagenic E. coli in search of indicators for vaccine materials development. Methodology: Multiplex polymerase chain reaction assay were employed to detect diarrhoeagenic E. coli pathotypes and enteroxigenic Escherichia coli surface antigens/ colonization factors antigens from 300 patients in Machakos Hospital, Kenya. Results: Enteroaggrigative Escherichia coli was the most predominant (13.7%) followed by ETEC (11%), Enteroinvesive E. coli (8.3%) and Enteropathogenic E. coli (4.3%). Among the colonization factor anti¬gens, CFAI was detected at 25 (23%), CS1, CSII 2(1.9%), CS3 1(0.9%), CS6 13(12%), CS7 2 (1.9%), CS12 1(0.9%), CS19 11 (10.25%) and those without colonization factor 37 (34.3%). Conclusions: ETEC isolates carrying ST or STLT toxins had more recoverable CFs than those with LT alone (P<0.05). The CS6 is increasing and CS19 was detected for the first time in Kenya and shown to be persistent adhesins. These may be further investigated as possible candidates for the formulation of a novel vaccine for the prevention of diarrhoea in Kenya and the region.

Majanja J, Wamunyokoli F, Mpoke S, Bulimo WD. PGF2α Synthase-Like Proteins are Expressed in Promastigotes of Old World Leishmania Species but not in New World Species. African Journal of Pharmacology and Therapeutics. 2014;3(2):67-73.majanja_et_al._2014.pdf
Ocholla S, Jumba G, Bulimo W, Achilla R, Wadegu MO, Mukunzi S, Majanja JM, Opot B, Osuna F, Muthoni J, others. The appropriateness of WHO influenza B vaccine component to Kenya in 2011-2012.. 2014. Abstract
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Wangui J, Bulimo W, Nokes J, Wurapa E, Otieno J, Opot B, Achilla R, Coldren R. Genotypic Diversity of HRSV-A in out-patients with Acute Respiratory Infections in Kenya 2007-2010.. 2014. Abstract
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Osanjo G, Aluvaala E, Wadegu M, Bulimo W, Mulaa F. HARNESSING CARBOHYDRATE ACTIVE ENZYMES AS DRUG TARGETS AND TOOLS FOR DEVELOPING GLYCOTHERAPEUTICS. In: BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY. Vol 115. WILEY-BLACKWELL 111 RIVER ST, HOBOKEN 07030-5774, NJ USA; 2014. p. 122-3. Abstract
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Achilla RA, Bulimo WD, Majanja JM, Wadegu MO, Mwangi J, Mwangi JW, Njiri JO, Opot BH, Wurapa EK. Influenza surveillance in Kenya2006-2013: experiences and lessons learned.. 2014. Abstract
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BW J, Bulimo WD, EK W, MM M, others. Molecular detection of enterotoxigenic Escherichia coli surface antigens from patients in Machakos District Hospital, Kenya. East and Central Africa Medical Journal. 2014;1. Abstract
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Wadegu M, Bulimo W, Osanjo G, Wamunyokoli F, Coldren R. Neuraminidase Inhibitor Susceptibility of Influenza A isolates obtained in Kenya, 2008-2011.. Hilton Hotel; Nairobi, Kenya; 2014. Abstract

Introduction: Neuraminidase inhibitors mainly oseltamivir and zanamivir function both as prophylactic and treatment agents for influenza infections. We characterized the antiviral susceptibility of the 2008-2011 influenza A viruses circulating in Kenya by combining both the genotypic data involving known molecular markers in neuraminidase (NA) protein responsible for drug resistance and IC50 data generated from NA inhibition assays.Materials and Methods: Nasopharyngeal swab specimen from consenting outpatients of age ≥ 2 months were obtained and transported to the National Influenza Center. RT-PCR amplification of NA gene segments was performed on the virus isolates prior to nucleotide sequencing using the BigDye chemistry. Sequences were analyzed using a suite of bioinformatics tools. Drug susceptibility was determined by fluorescent enzyme inhibition assay with known NA inhibitor-resistant and inhibitor-sensitive viruses. IC50 values were determined using curve fitting software, Grafit 7.0.Results and Discussion: Out of 836 influenza A virus isolates obtained (2008-2011), 108 (13%) were analyzed for markers of resistance to NA inhibitors. 64% (7/11) of the 2008 seasonal influenza A/H1N1 isolates depicted oseltamivir resistant marker H275Y. Influenza A/H3N2 and A/ (H1N1) pdm09 isolates lacked the H275Y mutation. A total of 28 isolates were further subjected to phenotypic susceptibility assay. The mean zanamivir IC50s were 1.75nM, 2.53nM and 1.84nM for the subtypes sH1N1, pH1N1 and H3N2 respectively. Eight of the 2008-2009 sH1N1 isolates analyzed showed highly reduced sensitivity to oseltamivir with IC50s ranges from 73nM-984nM. Pandemic A/H1N1 and A/H3N2 strains obtained between 2009-2011and 2008-2011 respectively depicted normal sensitivity. The 2011, WHO range and median IC50 values for oseltamivir carboxylate were 257nM-3455nM and 458.2nM; 132nm-2179nM and 191.3nM; 23-378 and 42.3nM for the mutant subtypes sH1N1, pH1N1and sH3N2 respectively.Conclusion: Overall genotypic and phenotypic data demonstrate oseltamivir resistance in the 2008-2009, sH1N1 viruses. The H275Y mutation increased the IC50 by 50-100 fold.

Cheruiyot J, Ingasia LA, Omondi AA, Juma DW, Opot BH, Ndegwa JM, Mativo J, Cheruiyot AC, Yeda R, Okudo C, Muiruri P, Bidii NS, Chebon LJ, Angienda PO, Eyase FL, Johnson JD, Bulimo WD, Andagalu B, Akala HM, Kamau E. Polymorphisms in Pfmdr1, Pfcrt, and Pfnhe1 genes are associated with reduced in vitro activities of quinine in Plasmodium falciparum isolates from western Kenya. Antimicrobial Agents and Chemotherapy. 2014;58:3737-43. Abstract
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Juma DW, Omondi AA, Ingasia L, Opot B, Cheruiyot A, Yeda R, Okudo C, Cheruiyot J, Muiruri P, Ngalah B, Chebon LJ, Eyase F, Johnson J, Bulimo WD, Akala HM, Andagalu B, Kamau E. Trends in drug resistance codons in Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase genes in Kenyan parasites from 2008 to 2012. Malar J. 2014;13:250. AbstractWebsite
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2013
Majanja J, Njoroge RN, Achilla R, Wurapa EK, Wadegu M, Mukunzi S, Mwangi J, Njiri J, Gachara G, Bulimo W. Impact of Influenza A(H1N1)pdm09 Virus on Circulation Dynamics of Seasonal Influenza Strains in Kenya. The American journal of tropical medicine and hygiene. 2013;88(5):940-5. Abstractajtmh_12-0147_full.pdf

We describe virus variations from patients with influenza-like illness before and after the appearance of influenza A(H1N1)pdm09 in Kenya during January 2008-July 2011. A total of 11,592 nasopharyngeal swabs were collected from consenting patients. Seasonal influenza B, A/H1N1, A/H3N2, A/H5N1, and influenza A(H1N1)pdm09 viruses were detected by real-time reverse transcription-polymerase chain reaction. Of patients enrolled, 2073 (17.9%) had influenza. A total of 1,524 (73.4%) of 2,073 samples were positive for influenza A virus and 549 (26.6%) were positive for influenza B virus. Influenza B virus predominated in 2008 and seasonal A(H1N1) virus predominated in the first half of 2009. Influenza A(H1N1)pdm09 virus predominated in the second half of 2009. Influenza A/H3N2 virus predominated in 2010, and co-circulation of influenza A(H1N1)pdm09 virus and influenza B virus predominated the first half of 2011. The reduction and displacement of seasonal A(H1N1) virus was the most obvious effect of the arrival of influenza A(H1N1)pdm09 virus. The decision of the World Health Organization to replace seasonal A(H1N1) virus with the pandemic virus strain for the southern hemisphere vaccine was appropriate for Kenya.

Arias M, Kitala P, Baboon K, Lekolol I, Okoth E, Bulimo DW, Gallardo C, Pelayo V, Macharia JM, Omore A, et al. Comparison of African swine fever virus prevalence and risk in two contrasting pig-farming systems in South-west and Central Kenya. Preventive Veterinary Medicine. 2013;110:198-205. AbstractWebsite
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Wadegu. M, Bulimo. WD, Achilla. RA, Majanja. J, Mukunzi. S, Osuna. F, Wangui. J, Mitei. K, Ocholla. S, Nyambura. J, Mwangi. J, Njiri. J, Opot. B, Wurapa. EK. Antiviral susceptibility of influenza A viruses obtained in Kenya 2008-2011 . Vienna, Austria; 2013. Abstract
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Ofula VO, Franklin AB, Root JJ, Sullivan HJ, Gichuki P, Makio A, Bulimo W, Abong'o BO, Muchai M, Schnabel D. Detection of Avian Influenza Viruses in Wild Waterbirds in the Rift Valley of Kenya Using Fecal Sampling. Vector borne and zoonotic diseases (Larchmont, NY). 2013. Abstractofula_et_al._2103.pdf

Abstract Highly pathogenic avian influenza virus A/H5N1 has been reported in 11 African countries. Migratory waterbirds have the potential of introducing A/H5N1 into east Africa through the Rift Valley of Kenya. We present the results of a wild bird surveillance system for A/H5N1 and other avian influenza viruses based on avian fecal sampling in Kenya. We collected 2630 fecal samples in 2008. Viral RNA was extracted from pools of 3-5 fecal samples and analyzed for presence of avian influenza virus RNA by real-time RT-PCR. Twelve (2.3%) of the 516 sample pools were positive for avian influenza virus RNA, 2 of which were subtyped as H4N6 viruses. This is the first report of avian influenza virus in wild birds in Kenya. This study demonstrates the success of this approach in detecting avian influenza virus in wild birds and represents an efficient surveillance system for avian influenza virus in regions with limited resources.

Nzunza R, Wurapa E, Kariuki N, Chek J, Ongus J, Bulimo W. Epidemiological and clinical description of human metapneumovirus infectious diseases in Mbagathi District Hospital, Kenya, in 2008. In: Options for the Control of Influenza VIII. Cape Town, South Africa; 2013. 600. Abstract

Background: Human metapneumovirus (hMPV), a recently identified respiratory virus, is a leading cause of acute respiratory tract infection in children, the elderly, and immune-compromised persons. Studies have been done in a hospitalized pediatric population in coastal Kenya. However, there is limited information about the prevalence, epidemiology, and clinical presentation of hMPV infections in the general population. The aim of this study was to outline the epidemiologic and clinical description of human metapneumovirus infectious disease in patients attending the outpatient department of Mbagathi District Hospital, Kenya, in 2008. Methods: A retrospective study was conducted from 2008 in patients ≥ 2 months of age presenting at the outpatient department of Mbagathi District Hospital for acute respiratory infection. Nasopharyngeal swabs were systematically tested for several respiratory viruses. Epidemiologic and clinical characteristics of hMPV-infected children were compared with those of patients with respiratory syncytial virus (RSV) and other viral infections. Results: A total of 498 patients were enrolled in this study. Viral investigations detected a total of 271 viruses. Of these, 77 (15.5%) were hMPV infections, 78 (15.7%) seasonal flu A, 60 (12%) seasonal flu B, 13 (2.6%) panenterovirus, 36 (7.2%) parainfluenza viruses, and 6 (1.2%) RSV infections. Human metapneumovirus infections were higher in males (43, 55%) than in females (34, 45%), and predominantly in children ≤ 5 years (97%), only 2 (3%) were aged between 6 and 9 years. The hMPV infection had peaked in January-February, and was uncommon after March. Most of the patients infected with hMPV were < 1 year of age, and cough (100%) and difficulty in breathing (75%) were the predominant diagnosis in these patients with clinical symptoms of a lower respiratory tract infection. The severity of the disease was similar to those of RSV patients. Conclusions: These results highlight that hMPV plays an important role in seasonal acute respiratory tract infections, especially in children, with a severity similar to RSV infections. This work is ongoing to cover the wider Kenyan population.

Mukunzi S, Bulimo W, Achilla R, Wadegu M, Majanja J, Opot B, Osuna F, Muthoni J, Njiri J, Mwangi J, Kibet K, Ochola S, Wurapa E. Genetic variants of influenza A (H1N1) pdm09 virus circulating in Kenya, 2010 to 2011. In: Options for the control of influenza VII. Capetown, South Africa; 2013. Abstract

Background: Since the emergence followed by rapid global spread to cause the 2009 pandemic, influenza A (H1N1)pdm09 viruses remained predominant among human influenza viruses that circulated in Kenya during the 2010-2011 season. In this study we sought to determine genetic variation amongst influenza A (H1N1) pdm09 viruses isolated in Kenya during the postpandemic period with reference to prototype influenza A/California/7/2009 strain and others obtained elsewhere during the same period. Materials and Methods: A total of 30 influenza A (H1N1) pdm09 isolates obtained from nasopharyngeal specimens (NP) and received from USAMRU-K’s sentinel surveillance network covering the whole of Kenya were analyzed. Virus HA1 subunit of hemagglutinin gene segment was amplified by RT-PCR and nucleotide sequences determined followed by conversion of the sequences to amino acid code before performing phylogenetic analyses. Results: The study showed all Kenyan isolates had 6 parallel amino acid substitutions when compared with the prototype A/California/07/2009 vaccine reference strain. These included P83S, D97N, S185T, S203T, I321V, and E374K. Additionally, there were further mutations that occurred stochastically in individual isolates. Most of these changes, however, did not affect virus antigenic sites; except the P83S amino acid substitution at site Cb and a few other changes at sites Ca1, Sa, and Sb in individual isolates.

Mitei. K, Bulimo. W, Achilla. R, Majanja. J, Wadegu. M, Mukunzi. S, Mwangi. J, Wangui. J, Osuna. F, Opot. B, Ochola. S, Njiri. J, Wurapa. E. Detection of Respiratory Viruses other than Influenza in Children in Kenya, 2007-2011. In: XV International Symposium on Respiratory Viral Infections. Rotterdam, Netherlands: The Macrae Foundation, Rancho Santa Fe, CA 92067; 2013. Abstract
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Osuna. F, Bulimo. W, Achilla. R, Majanja. J, Wadegu. M, Mukunzi. S, Njiri. J, Mwangi. J, Opot. B, Mitei. K, Nyambura. J, Wurapa. E. Molecular Evolution of HA1 Gene of the Influenza A (H1N1) pdm09 Strain in Kenya During the 2009-2010 Period . In: XV International Symposium on Respiratory Viral Infections. Rotterdam, Netherlands; 2013. Abstract
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Okoth E, Gallardo C, Macharia JM, Omore A, Pelayo V, Bulimo DW, Arias M, Kitala P, Baboon K, Lekolol I, Mijele D, Bishop RP. Comparison of African swine fever virus prevalence and risk in two contrasting pig-farming systems in South-west and Central Kenya. Preventive Veterinary Medicine. 2013;110(2):198-205. Abstract1-s2.0-s0167587712003765-main.pdfWebsite

We describe a horizontal survey of African swine fever virus (ASFV) prevalence and risk factors associated with virus infection in domestic pigs in two contrasting production systems in Kenya. A free range/tethering, low input production system in Ndhiwa District of South-western Kenya is compared with a medium input stall fed production system in Kiambu District of Central Kenya. Analysis of variance (ANOVA) of data derived from cluster analysis showed that number of animals, number of breeding sows and number of weaner pigs were a significant factor in classifying farms in Nhiwa and Kiambu. Analysis of blood and serum samples using a PCR assay demonstrated an average animal level positivity to ASFV of 28% in two independent samplings in South-western Kenya and 0% PCR positivity in Central Kenya. No animals were sero-positive in either study site using the OIE indirect-ELISA and none of the animals sampled exhibited clinical symptoms of ASF. The farms that contained ASFV positive pigs in Ndhiwa District were located in divisions bordering the Ruma National Park from which bushpig (Potamochoerus larvatus) incursions into farms had been reported. ASFV prevalence (P < 0.05) was significantly higher at distances between 6 and 16 km from the National Park than at distances closer or further away. One of the 8 bushpigs sampled from the park, from which tissues were obtained was PCR positive for ASFV. The data therefore indicated a potential role for the bushpig in virus transmission in South-western Kenya, but there was no evidence of a direct sylvatic virus transmission cycle in Central Kenya. ASF control strategies implemented in these areas will need to take these epidemiological findings into consideration.

Eyase FL, Akala HM, Ingasia L, Cheruiyot A, Omondi A, Okudo C, Juma D, Yeda R, Andagalu B, Wanja E, Kamau E, Schnabel D, Bulimo W, Waters NC, Walsh DS, Johnson JD. The role of Pfmdr1 and Pfcrt in changing chloroquine, amodiaquine, mefloquine and lumefantrine susceptibility in western-Kenya P. falciparum samples during 2008-2011. PloS one. 2013;8:e64299. Abstracteyase_et_al._2013.pdf

Single Nucleotide Polymorphisms (SNPs) in the Pfmdr1, and Pfcrt, genes of Plasmodium falciparum may confer resistance to a number of anti-malaria drugs. Pfmdr1 86Y and haplotypes at Pfcrt 72-76 have been linked to chloroquine (CQ) as well as amodiaquine (AQ) resistance. mefloquine (MQ) and lumefantrine (LU) sensitivities are linked to Pfmdr1 86Y. Additionally, Pfcrt K76 allele carrying parasites have shown tolerance to LU. We investigated the association between Pfmdr1 86/Pfcrt 72-76 and P. falciparum resistance to CQ, AQ, MQ and LU using field samples collected during 2008-2011 from malaria endemic sites in western Kenya. Genomic DNA from these samples was genotyped to examine SNPs and haplotypes in Pfmdr1 and Pfcrt respectively. Additionally, immediate ex vivo and in vitro drug sensitivity profiles were assessed using the malaria SYBR Green I fluorescence-based assay. We observed a rapid but steady percent increase in wild-type parasites with regard to both Pfmdr1 and Pfcrt between 2008 and 2011 (p<0.0001). Equally, a significant reciprocate decrease in AQ and CQ median IC50 values occurred (p<0.0001) during the same period. Thus, the data in this study point to a significantly rapid change in parasite response to AQ and CQ in the study period. This may be due to releasing of drug pressure on the parasite from reduced use of AQ in the face of increased Artemisinin (ART) Combination Therapy (ACT) administration following the intervention of the Global Fund in 2008. LU has been shown to select for 76K genotypes, thus the observed increase in 76K genotypes coupled with significant cross resistance between LU and MQ, may herald emergence of tolerance against both drugs in future.

Wadegu M, Bulimo W, Achilla R, Mukunzi S, Majanja J, Opot B, Osuna F, Muthoni J, Njiri J, Mwangi J, Kibet K, Ocholla S, Wurapa E. Characterization of neuraminidase inhibitor susceptibility of influenza A isolates obtained in Kenya, 2008-2011. In: Options for the Control of Influenza VII. Cape Town, South Africa; 2013. 230. Abstract

Background: Vaccines and antivirals are the mainstay for mitigation and clinical management of influenza infections. However, due to the ever-changing antigenic profile, vaccine formulations are revised every year to make them efficacious. Neuraminidase (NA) inhibitors, mainly oseltamivir and zanamivir, function both as prophylactic and as treatment agents. In NA inhibition by antivirals, inhibitor molecules mimic NA’s natural substrate and bind to the active site, preventing NA from cleaving host cell receptors and releasing new virus. Currently, there exist no data on antiviral susceptibility profiles of influenza A isolates circulating within the Eastern African region. Here we characterised the antiviral susceptibility of the 2008-2011 influenza A viruses circulating in Kenya by combining both the genotypic data involving known molecular markers in NA protein responsible for drug resistance and IC50 data generated from NA inhibition assays. Materials and Methods: Nasopharyngeal swab specimens from consenting outpatients aged ≥ 2 months were obtained and transported to the National Influenza Centre and screened by real-time RT-PCR using primers targeted at the matrix and haemagglutinin genes of influenza A subtypes. Positive specimens were inoculated onto MDCK monolayers to isolate virus. RNA was extracted from virus isolates followed by PCR amplification of NA gene segments. Nucleotide sequencing was performed using the BigDye chemistry prior to analyses using a suite of bioinformatics tools. Drug susceptibility was determined by enzyme inhibition assay using fluorescent substrate with known NA inhibitor–resistant and –sensitive viruses as controls. IC50 values were determined using curve-fitting software (Grafit 7.0), which is based on 50% of fitted upper asymptote. Results: Of 836 influenza A virus isolates obtained (2008- 2011), 108 (13%) were analysed for markers of resistance to NA inhibitors: 64% (7/11) of the 2008 seasonal influenza A/H1N1 isolates analysed showed oseltamivir-resistant marker H275Y, while all 33 (100%) influenza A/H3N2 isolates obtained showed sensitivity to oseltamivir. Genetic analyses of the A (H1N1) pdm09 isolates obtained in 2009-2010 showed that all were sensitive to oseltamivir. All 14 influenza A/H3N2 isolates obtained in 2011 were also shown to be sensitive to oseltamivir. A total of 28 isolates were further subjected to phenotypic susceptibility assay. The mean zanamivir IC50 values were 1.75, 2.53 and 1.84 nM for the subtypes H1N1, pH1N1 and H3N2, respectively. Two of the 2008 sH1N1 and one of the sH1N1 obtained in 2009 showed normal sensitivity to oseltamivir in the NA inhibitor susceptibility assay (mean IC50 of 1.28 nM). The rest of the 2008-2009 sH1N1 analysed (n = 8) showed highly reduced sensitivity to oseltamivir. The IC50 values in the fluorescent assay ranged from 73 to 984 nM. Pandemic A/H1N1 strains obtained between 2009 and 2011 indicated oseltamivir IC50 values of 1.60 to 6.32 nM—categorised as normal sensitivity. All 8 candidate influenza A/H3N2 isolates obtained between 2008 and 2011 were sensitive to oseltamivir, with IC50 values ranging from 0.16 to 0.94 nM. The 2011 WHO ranges and median IC50 values for oseltamivir carboxylate were 0.4 to 10 nM and 0.5 nM, 0.1 to 5 nM and 0.2 nM, and 0.2 to 10 nM and 0.6 nM for wild-type sH1N1, sH3N2 and pH1N1, respectively. The 2011 WHO ranges and median IC50 values for oseltamivir carboxylate were 257 to 3455 nM and 458.2 nM and 132 to 2179 nM and 191.3 nM for mutant types sH1N1 and pH1N1, respectively. The WHO IC50 values for zanamivir, both for mutant and wild-type strains, ranged from 0.2 to 3 nM for all subtypes, with no significant differences between the mutant and wild-type strains for each subtype. Conclusion: Overall, our genotypic data demonstrate that there was oseltamivir resistance in seasonal influenza A (H1N1) viruses isolated in Kenya in 2008-2009. Most of the 2008-2009 sH1N1 isolates depicted highly reduced sensitivity to oseltamivir. This was due to the presence of the H275Y mutation in the NA protein sequence. H275Y mutation increased the IC50 value by 50- to 100-fold. Resistance to NA inhibitors was found to be specific to both drug and virus subtype. The drug susceptibility profile will be best informed using both elevated IC50 vales and known molecular markers of resistance.

2012
Bulimo WD, Mukunzi S, Achilla R, Opot BH, Osuna F, Majanja J, Wadegu M, Wurapa EK. Were the WHO-recommended Human Influenza Vaccine Formulations Appropriate for Kenya During the 2010-2011 Season? Inferences from the HA1 Gene Analysis. African Journal of Pharmacology and Therapeutics. 2012;1(1):46-54. Abstract3-ajpt-mr11-0312-2_bulimo.pdfWebsite

Background: The knowledge of evolutionary patterns of the HA gene of the influenza virus is important in vaccinestrain selection.Objective: Genetic analysis of HA1 of influenza viruses isolated in Kenya during the 2010-2011 season with referenceto WHO vaccine strains.Methods: A total of twenty seven (27) influenza A (H1N1) pdm09, Nineteen (19) influenza A (H3N2) and Sixteen (16)influenza B virus isolates were analyzed. A partial HA1 gene was amplified by RT-PCR and sequenced.Results: Phylogenetic analyses revealed that influenza B viruses were closely related to B/Brisbane/60/2008 vaccinestrain while A (H1N1) pdm09 viruses were genetic variants of A/California/07/2009. The Kenyan A (H1N1) pdm09isolates had P83S, D97N, S185T, I321V and E374K amino acid substitutions. Influenza A/H3N2 isolates showed K62E,T212A and S214I simultaneous amino acid substitutions when compared to A/Perth/10/2009. The K62E changeoccurred at antigenic site E. Majority of the Kenyan H3N2 isolates further had S45N and K144N amino acidsubstitutions at sites C and A respectively, which introduced N-glycosylation motifs absent in the vaccine strain.Conclusion: The study showed that although the WHO 2010 vaccine strains recommendations for the southernhemisphere matched with influenza viruses which circulated in Kenya during the 2010-2011 season, the viruses hadevolved genetically from the vaccine strains.

Wadegu M, Bulimo W, Achilla R, Majanja J, Mukunzi S, Osuna F, Wangui J, Opot B, Njiri J, Mitei K, Nyambura J, Mwangi J, Schnabel D, Wurapa E. Genotypic characterization of antiviral susceptibility of Influenza A viruses isolated in Kenya from 2008 to 2011. Int J Infect Dis. 2012;16:E437-E438. AbstractWebsite
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Wangui J, Opot B, Njiri J, Mitei K, Wadegu M, Osuna F, Bulimo W, Mukunzi S, Achilla R, Majanja J, et al. Genotypic characterization of antiviral susceptibility of Influenza A viruses isolated in Kenya from 2008 to 2011. International Journal of Infectious Diseases. 2012;16:e437-e438. AbstractWebsite
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Muthoni J, Bulimo W, Achilla R, Majanja J, Njiri J, Wadegu M, Mukunzi S, Mwangi J, Opot B, Osuna F, Wurapa E. Initial spatial and temporal distribution/dynamics of pandemic H1N1 influenza virus in Kenya between August 2009 and December 2010. Int J Infect Dis. 2012;16:E139. AbstractWebsite
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Mukunzi S, Mwangi J, Opot B, Osuna F, Muthoni J, Wadegu M, Bulimo W, Njiri J, Achilla R, Majanja J, et al. Initial spatial and temporal distribution/dynamics of pandemic H1N1 influenza virus in Kenya between August 2009 and December 2010. International Journal of Infectious Diseases. 2012;16:e139. AbstractWebsite
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Wangui J, Nokes DJ, Nyaigoti CA, Achilla R, Onyango C, Wurapa E, Bulimo W. Prevalence of acute respiratory infections caused by RSV and Adeno viruses in Kenya in 2007-2009. Int J Infect Dis. 2012;16:E118-E119. AbstractWebsite
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Wangui J, Nokes DJ, Nyaigoti CA, Achilla R, Onyango C, Wurapa E, Bulimo W. Prevalence of acute respiratory infections caused by RSV and Adeno viruses in Kenya in 2007-2009. International Journal of Infectious Diseases. 2012;16:e118-e119. AbstractWebsite
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Mitei K, Bulimo W, Achilla R, Majanja J, Mwangi J, Njiri J, Wurapa E. A review of laboratory-confirmed cases of human parainfluenza viruses in Kenya (2007-2011). Int J Infect Dis. 2012;16:E138. AbstractWebsite
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Mitei K, Bulimo W, Achilla R, Majanja J, Mwangi J, Njiri J, Wurapa E. A review of laboratory-confirmed cases of human parainfluenza viruses in Kenya (2007-2011). International Journal of Infectious Diseases. 2012;16:e138. AbstractWebsite
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Osuna F, Bulimo W, Achilla R, Muthoni J, Wadegu M, Njiri J, Opot B, Mukunzi S, Majanja J, Wurapa E. Surveillance of respiratory syncytial virus occurrences in Kenya from 2006-2010. Int J Infect Dis. 2012;16:E142. AbstractWebsite
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Osuna F, Bulimo W, Achilla R, Muthoni J, Wadegu M, Njiri J, Opot B, Mukunzi S, Majanja J, Wurapa E. Surveillance of respiratory syncytial virus occurrences in Kenya from 2006-2010. International Journal of Infectious Diseases. 2012;16:e142. AbstractWebsite
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Wong KK, Bulimo WD, Magana J, Achilla RA, Schwarcz SK, Simwa M, Majanja JM, Wadegu MO, Osuna FA, Mukunzi SO, Mwangi JK, Wangui JM, Muthoni JN, Njiri JO, Obura BD, Opot BH, Mitei KK, Barani J, Lifumo S, Schnabel DC. Epidemiology of 2009 Pandemic Influenza A Virus Subtype H1N1 Among Kenyans Aged 2 Months to 18 Years, 2009–2010. Journal of Infectious Diseases. 2012;206:S68-S73. Abstractj_infect_dis.-2012-wong-s68-73.pdfWebsite

Background.The US Army Medical Research Unit–Kenya (USAMRU-K) conducts surveillance for influenza-like illness (ILI) in Kenya. We describe the temporal and geographic progression of A(H1N1)pdm09 as it emerged in Kenya and characterize the outpatient population with A(H1N1)pdm09 infection.Methods.We included patients with ILI aged 2 months to 18 years enrolled during June 2009–August 2010. Respiratory specimens were tested by real-time reverse-transcription polymerase chain reaction for influenza virus. Patients with A(H1N1)pdm09 infection were compared to those with seasonal influenza A virus infection and those with ILI who had no virus or a virus other than influenza virus identified (hereafter, “noninfluenza ILI”).Results.Of 4251 patients with ILI, 193 had laboratory-confirmed A(H1N1)pdm09 infection. The first pandemic influenza case detected by USAMRU-K surveillance was in August 2009; peak activity nationwide occurred during October–November 2009. Patients with A(H1N1)pdm09 infection were more likely to be school-aged, compared with patients with seasonal influenza A virus infection (prevalence ratio [PR], 2.0; 95% confidence interval [CI], 1.3–3.1) or noninfluenza ILI (PR, 3.2; 95% CI, 2.4–4.3).Conclusions.USAMRU-K ILI surveillance detected the geographic and temporal distribution of pandemic influenza in Kenya. The age distribution of A(H1N1)pdm09 infections included more school-aged children, compared with seasonal influenza A virus infection and noninfluenza ILI.

Onyango CO, Njeru R, Kazungu S, Achilla R, Bulimo W, Welch SR, Cane PA, Gunson RN, Hammitt LL, Scott AJ, Berkley JA, Nokes JD. Influenza Surveillance Among Children With Pneumonia Admitted to a District Hospital in Coastal Kenya, 2007–2010. Journal of Infectious Diseases. 2012;206:S61-S67. Abstractj_infect_dis.-2012-onyango-s61-7.pdfWebsite

Background.Influenza data gaps in sub-Saharan Africa include incidence, case fatality, seasonal patterns, and associations with prevalent disorders.Methods.Nasopharyngeal samples from children aged <12 years who were admitted to Kilifi District Hospital during 2007–2010 with severe or very severe pneumonia and resided in the local demographic surveillance system were screened for influenza A, B, and C viruses by molecular methods. Outpatient children provided comparative data.Results.Of 2002 admissions, influenza A virus infection was diagnosed in 3.5% (71), influenza B virus infection, in 0.9% (19); and influenza C virus infection, in 0.8% (11 of 1404 tested). Four patients with influenza died. Among outpatients, 13 of 331 (3.9%) with acute respiratory infection and 1 of 196 without acute respiratory infection were influenza positive. The annual incidence of severe or very severe pneumonia, of influenza (any type), and of influenza A, was 1321, 60, and 43 cases per 100 000 <5 years of age, respectively. Peak occurrence was in quarters 3–4 each year, and approximately 50% of cases involved infants: temporal association with bacteremia was absent. Hypoxia was more frequent among pneumonia cases involving influenza (odds ratio, 1.78; 95% confidence interval, 1.04–1.96). Influenza A virus subtypes were seasonal H3N2 (57%), seasonal H1N1 (12%), and 2009 pandemic H1N1 (7%).Conclusions.The burden of influenza was small during 2007–2010 in this pediatric hospital in Kenya. Influenza A virus subtype H3N2 predominated, and 2009 pandemic influenza A virus subtype H1N1 had little impact.

Bulimo WD, Achilla RA, Majanja J, Mukunzi S, Wadegu M, Osunna F, Mwangi J, Njiri J, Wangui J, Nyambura J, Obura B, Mitei K, Omariba D, Segecha S, Nderitu M, Odindo A, Adega C, Kiponda J, Mupa R, Munyazi F, Kissinger G, Mwakuzimu M, Kamola D, Muhidin E, Kamau D, Kairithia S, Koech M, Sang A, Onge'ta L, Schnabel DC. Molecular Characterization and Phylogenetic Analysis of the Hemagglutinin 1 Protein of Human Influenza A Virus Subtype H1N1 Circulating in Kenya During 2007–2008. Journal of Infectious Diseases. 2012;206:S46-S52. Abstractj_infect_dis.-2012-bulimo-s46-52.pdfWebsite

Background.Among influenza viruses, type A viruses exhibit the greatest genetic diversity, infect the widest range of host species, and cause the vast majority of cases of severe disease in humans, including cases during the great pandemics. The hemagglutinin 1 (HA1) domain of the HA protein contains the highest concentration of epitopes and, correspondingly, experiences the most intense positive selection pressure.Objectives.We sought to isolate and genetically characterize influenza A virus subtype H1N1 (A[H1N1]) circulating in Kenya during 2007–2008, using the HA1 protein.Methods.Nasopharyngeal swab specimens were collected from patients aged ≥2 months who presented to 8 healthcare facilities in Kenya with influenza-like illness. We tested specimens for seasonal influenza A viruses, using real-time reverse-transcription polymerase chain reaction (RT-PCR). Viruses were subtyped using subtype-specific primers. Specimens positive for seasonal A(H1N1) were inoculated onto Madin-Darby canine kidney cells for virus isolation. Viral RNAs were extracted from isolates, and the HA1 gene was amplified by RT-PCR, followed by nucleotide sequencing. Nucleotide sequences were assembled using BioEdit and translated into amino acid codes, using DS Gene, version 1.5. Multiple sequence alignments were performed using MUSCLE, version 3.6, and phylogenetic analysis was performed using MrBayes software.Results.We found that, similar to A/Brisbane/59/2007 (H1N1)–like virus, which was included in the southern hemisphere vaccine for the 2009 influenza season, all 2007 Kenyan viruses had D39N, R77K, T132V, K149R, and E277K amino acid substitutions, compared with A/Solomon Islands/3/2006 (H1N1)–like virus, a component of the southern hemisphere vaccine for the 2008 influenza season. However, the majority of 2008 viruses from Kenya also had R192K and R226Q substitutions, compared with A/Solomon Islands/3/2006 (H1N1)–like virus. These 2 changes occurred at the receptor binding site. The majority of the 2008 Kenyan isolates contained N187S, G189N, and A193T mutations, which differed from A/Brisbane/59/2007 (H1N1)–like virus. The A193T substitution is involved in binding the sialic acid receptor. Phylogenetically, the 2008 Kenyan isolates grouped into 2 clusters. The main cluster contained viruses with N187S and A193T changes; residue 187 is involved in receptor binding, whereas residue 193 is at antigenic site Sb.Conclusion.Overall, the major genetic variations that occurred in seasonal A(H1) viruses either affected receptor binding or altered epitopes at the immunodominant sites. These genetic variations in seasonal A(H1N1) isolated in Kenya during 2007–2008 highlight the importance of continuing surveillance and characterization of emerging drift variants of influenza virus in Africa.

Symekher. SM, Bulimo. WD, Kakai. R, Simwa. J, Sang. A, Magana. J. Epidemiology and Molecular Characterization of Influenza Viruses Isolated From Children Admitted at The Kenyatta National Hospital in April-July 2008.. In: 2nd MEDICAL AND VETERINARY VIROLOGY RESEARCH-2 symposium. Sarova Panafric Hotel Nairobi Kenya; 2012. Abstract
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Wadegu. M, Bulimo. WD, Achilla. RA, Majanja. J, Mukunzi. S, Osuna. F, Wangui J, Njiri. J, Opot. B, Schnabel. DC, Wurapa. EK. Genotypic characterization of Resistance to Neuraminidase Inhibitors amongst Influenza A viruses that circulated in Kenya from 2008 to 2011.. Sarova Panafric Hotel Nairobi Kenya; 2012. Abstract
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Mukunzi. S, Bulimo. WD, Achilla. RA, Wadegu. M, Majanja. J, Opot. B, Osuna. F, Ketta. A, Njiri. J, Mwangi. J, Wurapa. E. Molecular Characterization of Human Enterovirus 68 Strains Circulating in Kenya between 2008 to 2010.. Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract

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Achilla. RA, Bulimo. WD, Majanja. JM, Wadegu. MO, Mukunzi. SO, Mwangi. J, Mwangi. JW, Njiri. JO, Opot. BH, Wurapa. EK. Respiratory Adenovirus Species Circulating in Kenya From 2007-2010. . In: 2nd MEDICAL AND VETERINARY VIROLOGY RESEARCH-2 symposium. Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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Ketta. A, Bulimo. W, Achilla. R, Wadegu. M, Majanja. J, Opanda. S, Opot. B, Osuna. F, Muthoni. J, Mitei. K, Wangui. J, Njiri. J, Mwangi. J, Wurapa. E. Respiratory Non-Influenza viruses circulating in Kenya between January-August 2012. . Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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George G, Samwel S, Joseph M, Japheth M, Wallace B. Comparison of Selection Pressures on the Haemagglutinin (HA) Gene of Pandemic (2009) and Seasonal Influenza A Viruses in Kenya.. In: XIV International Symposium on Respiratory Viral Infections. Istanbul, Turkey.; 2012. Abstract

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Gachara G, Symekher S, Mbithi J, Magana J, Bulimo W. Sequence Analysis of the Neuraminidase (NA) Gene of Pandemic H1N1 Influenza A Virus in Kenya.. Istanbul, Turkey.; 2012. Abstract

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Osuna. F, Bulimo. W, Achilla. R, Opot. B, Wadegu. M, Opanda. S, Mitei. K, Njiri. J, Nyambura. J, Mwangi. J, Majanja. J, Wurapa. E. Amino acid changes at the hemagglutinin antigenic site amongst Kenyan Influenza A(H1N1)pdm09 viruses in 2009-2011.. In: 2nd Medical and Veterinary Virology Research -2 symposium. Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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Opot. B, Osuna. F, Gachara. G, Wadegu. M, Achilla. R, Majanja. J, Wurapa. E, Bulimo. W. Analyses of selection pressure on the Hemagglutinin gene of Influenza A/H3N2 Viruses circulating in Kenya 2007-2011. . In: 2nd Medical and Veterinary Virology Research -2 symposium. Sarova Panafric Hotel Nairobi.; 2012. Abstract
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George. G, Samuel. S, John. M, Japheth. M, Wallace. B. Analysis of Antigenic Drift in the Neuraminidase (NA) gene of Pandemic H1N1 Influenza A Virus in Kenya. . In: 3rd Annual African Network for Influenza Surveillance and Epidemiology Meeting. Crowne plaza, Nairobi.; 2012. Abstract
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Achilla. RA, Bulimo. WD, Majanja. JM, Wadegu. MO, Mukunzi. SO, Opot. BH, Mwangi. J, Mwangi. JW, Njiri. JO, Osuna. F, Nyambura. JM, Ocholla. SO, Mitei. KM, Wurapa. EK. Drastic decline of pandemic (2009) H1N1 Influenza cases in sentinel surveillance sites in Kenya; May 2011-May 2012.. In: International Society for Influenza and other respiratory virus diseases conference. Munich Germany.; 2012. Abstract
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Bulimo W, KK W, WD B, J M, RA A, SK S, M S, JM M, MO W, FA O, SO M, JK M, JM W, JN M, JO N, BD O, BH O, KK M, J B, S L, DC S. Epidemiology of 2009 pandemic influenza A virus subtype H1N1 among Kenyans aged 2 months to 18 years, 2009-2010.. 2012. AbstractWebsite
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Bulimo WD, Gachara G, Opot BH, Murage MW, Wurapa EK. Evidence in Kenya of Reassortment Between Seasonal Influenza A(H3N2) and Influenza A(H1N1)pdm09 to yield A(H3N2) Variants With the Matrix Gene Segment of A(H1N1)pdm09. African Journal of Pharmacology and Therapeutics. 2012;1:1-7. AbstractWebsite

Background: Influenza viruses evolve rapidly and undergo frequent reassortment of different gene segments leadingto emergence of novel strains with new traits possessing pandemic potential.Objectives: To determine evidence of reassortment amongst A(H1N1)pdm09 and H3N2 co-circulating influenza virussubtypes and relate these to adamantine antiviral resistance.Methodology: Nasopharyngeal swabs in virus transport medium were collected from patients with influenza-likeillness. The presence of influenza was determined using real-time PCR followed by culture in MDCK cells.Haemagglutination inhibition was carried out to confirm the identity of the virus. Complete haemagglutinin (HA),matrix (M) and neuraminidase (NA) genes were sequenced and analyzed using a suite of bioinformatics tools.Results: Influenza A(H3N2) was detected in 32 out of 708 samples collected between October and December 2010.Analysis of the HA gene confirmed it to be of the H3 subtype. However, analysis of the matrix gene showed that 28 ofthe isolates had the M gene of influenza A(H3N2) viruses while 4 had the M gene of the A(H1N1)pdm09 viruses.Discussion: Our results show that four of the 32 influenza A(H3N2) viruses isolated had acquired the M gene segmentof the A(H1N1)pdm09 virus by reassortment. This has implications in their transmissibility as the M gene isimplicated in the increased transmissibility of the A(H1N1)pdm09 viruses.

Wadegu. M, Bulimo. WD, Achilla. RA, Majanja. J, Mukunzi. S, Osuna. F, Wangui. J, Mitei. K, Ocholla. S, Nyambura. J, Mwangi. J, Njiri. J, Opot. B, Schnabel. DC, Wurapa. EK. Genotypic characterization of Oseltamivir susceptibility of Influenza A viruses isolated in Kenya from 2008 to 2011.. Bangkok Thailand; 2012. Abstract
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Mitei. K, Bulimo. W, Achilla. R, Majanja. J, Wadegu. M, Mukunzi. S, Mwangi. J, Wangui. J, Opot. B, Osuna. F, Njiri. J, Wurapa. EK. Human Parainfluenza Viruses Infections in Children, Kenya (2007-2011). . Crowne plaza, Nairobi.; 2012. Abstract
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Bulimo W, CO O, R N, S K, R A, W B, SR W, PA C, RN G, LL H, JA S, JA B, DJ N. Influenza surveillance among children with pneumonia admitted to a district hospital in coastal Kenya, 2007-2010.. 2012. AbstractWebsite
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Wadegu. M, Bulimo. WD, Achilla. RA, Majanja. J, Mukunzi. S, Osuna. F, Wangui. J, Nyambura. J, Njiri. J, Opot. B, Schnabel. DC, Wurapa. EK. Molecular Antiviral Susceptibility Testing of Influenza A Virus Isolates Obtained in Kenya in the year 2008-2009. . In: 3rd Annual African Network for Influenza Surveillance and Epidemiology Meeting. Crowne plaza, Nairobi.; 2012. Abstract
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Bulimo W, WD B, RA A, J M, S M, M W, F O, J M, J N, J W, J N, B O, K M, D O, S S, M N, A O, C A, J K, R M, F M, G K, M M, D K, E M, D K, S K, M K, A S, ' O, DC S. Molecular characterization and phylogenetic analysis of the hemagglutinin 1 protein of human influenza A virus subtype H1N1 circulating in Kenya during 2007-2008.. 2012. AbstractWebsite
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Kiptinness. J, Wurapa. E, Bulimo. W, Wamunyokoli. F. Molecular Characterization of HPIV1 in Infants Attending Mbagathi District Hospital, Nairobi, Kenya. . Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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Majanja. J, Bulimo. W, Achilla. R, Wadegu. M, Mukunzi. S, Mwangi. J, Wangui. J, Osuna. F, Nyambura. J, Opot. B, Njiri. J, Wurapa. EK. Molecular characterization of human Influenza B viruses circulating in Kenya during the period 2008-2009. . Crowne plaza, Nairobi.; 2012. Abstract
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Wangui. J, Bulimo. W, Nokes. J, Nyaigoti. C, Onyango. C, Achilla. R, Wurapa. E. Prevalence of Acute Respiratory Infections Caused by RSV and Adenoviruses, Kenya in 2007 –2009.. Bangkok Thailand.; 2012. Abstract
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Wangui. J, Bulimo. W, Nokes. J, Nyaigoti. C, Onyango. C, Achilla. R, Wadegu. M, Wurapa. E. Prevalence of Respiratory Syncytial Virus in Out-Patients with Acute Respiratory Infections in Kenya in 2007 - 2009. . Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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Mitei. K, Bulimo. W, Achilla. R, Majanja. J, Wadegu. M, Mukunzi. S, Mwangi. J, Wangui. J, Opot. B, Osuna. F, Nyambura. J, Njiri. J, Wurapa. EK. Surveillance of Human Parainfluenza viruses in Kenya during the 2007-2011 Period.. Sarova Panafric Hotel Nairobi Kenya.; 2012. Abstract
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Osuna. F, Bulimo. W, Majanja. J, Wadegu. M, Mukunzi. S, Njiri. J, Mwangi. J, Opot. B, Mitei. K, Nyambura. J, Achilla. R, Wurapa. E. Surveillance of Respiratory Syncytial Virus in Kenya from 2006-2010. . Bangkok Thailand; 2012. Abstract
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2011
Osanjo GO, Bulimo WD, Mulaa FJ. Engineering the functional fitness of transglycosidases and glycosynthases by directed evolution. Afr J Biotechnol. 2011;10:1727-35. AbstractWebsite

The artificial implementation of the Darwinian theory of evolution to create new variants of functional proteins, a process referred to as directed evolution, has acquired many applications in biochemical engineering. Directed evolution is a handy tool in the nascent science of glycobiology, where it is used in the conversion of glycosyl hydrolases into transglycosidases or for improving the transglycosylation behaviour of glycosynthases. This review focuses on recent applications of the directed evolution approach to harness the transglycosidase potential of glycosidases and to enhance the functional fitness of glycosynthases.

Visendi P, Ng'ang'a W, Bulimo W, Bishop R, Ochanda J, de Villiers EP. TparvaDB: a database to support Theileria parva vaccine development. Database. 2011;2011. AbstractWebsite

We describe the development of TparvaDB, a comprehensive resource to facilitate research towards development of an East Coast fever vaccine, by providing an integrated user-friendly database of all genome and related data currently available for Theileria parva. TparvaDB is based on the Generic Model Organism Database (GMOD) platform. It contains a complete reference genome sequence, Expressed Sequence Tags (ESTs), Massively Parallel Signature Sequencing (MPSS) expression tag data and related information from both public and private repositories. The Artemis annotation workbench provides online annotation functionality. TparvaDB represents a resource that will underpin and promote ongoing East Coast fever vaccine development and biological research.Database URL: http://tparvadb.ilri.cgiar.org

Achilla RA, Wurapa EK, Bulimo WD. Respiratory adenovirus Species Circulating In Kenya, 2007-2010.. In: 1st International Scientific Conference at the College of Health Sciences University of Nairobi. University of Nairobi, Nairobi, Kenya; 2011. Abstract

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Gachara G, Symekher S, Mbithi J, James S, Ng’ayo M, Magana J, Bulimo W. Amino acid sequence analysis and identification of mutations in the NS gene of 2009 influenza A (H1N1) isolates from Kenya. Virus Genes. 2011:1-6. AbstractWebsite

Although the important role of the nonstructural (NS) gene of influenza A virus in virulence and replication is well-established, the knowledge about the extent of variation in the NS gene of 2009 influenza A (H1N1) viruses in Kenya and Africa is scanty. This study analysed the NS gene of 31 isolates from Kenya in order to obtain a more detailed knowledge about the genetic variation of NS gene of 2009 influenza A (H1N1) isolates from Kenya. A comparison with the vaccine strain and viruses isolated elsewhere in Africa was also made. The amino acid sequences of the non-structural protein, NS1 of the viruses from this study and the vaccine strain revealed 18 differences. Conversely, the nuclear export protein (NEP) of the isolates in this study had 11 differences from the vaccine strain. Analysis of the NS1 protein showed only one fixed amino acid change I123V which is one of the characteristics of clade 7 viruses. In the NEP, the amino acid at position 77 was the most mutable with 9 (39%) of all mutations seen in this protein. A mutation A115T which is a characteristic of clade 5 viruses was noted in the isolates from Lagos, Nigeria. The study shows a substantial number of mutations in the NS gene that has not been reported elsewhere and gives a glimpse of the evolution of this gene in the region.

George. G, Samuel. S, John. M, James. S, Musa. N’, Wallace. B. Amino acid sequence analysis and identification of mutations in the NS gene of 2009 influenza A (H1N1) isolates from Kenya.. Accra, Ghana; 2011. Abstract
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Sanchez JL, Johns MC, Burke RL, Vest KG, Fukuda MM, Yoon IK, Lon C, Quintana M, Schnabel DC, Pimentel G, Mansour M, Tobias S, Montgomery JM, Gray GC, Saylors K, Ndip LM, Lewis S, Blair PJ, Sjoberg PA, Kuschner RA, Russell KL, Blazes DL, Witt CJ, Money NN, Gaydos JC, Pavlin JA, Gibbons RV, Jarman RG, Stoner M, Shrestha SK, Owens AB, Iioshi N, Osuna MA, Martin SK, Gordon SW, Bulimo WD, Waitumbi DJ, Assefa B, Tjaden JA, Earhart KC, Kasper MR, Brice GT, Rogers WO, Kochel T, Laguna-Torres VA, Garcia J, Baker W, Wolfe N, Tamoufe U, Djoko CF, Fair JN, Akoachere JF, Feighner B, Hawksworth A, Myers CA, Courtney WG, Macintosh VA, Gibbons T, Macias EA, Grogl M, O'Neil MT, Lyons AG, Houng HS, Rueda L, Mattero A, Sekonde E, Sang R, Sang W, Palys TJ, Jerke KH, Millard M, Erima B, Mimbe D, Byarugaba D, Wabwire-Mangen F, Shiau D, Wells N, Bacon D, Misinzo G, Kulanga C, Haverkamp G, Kohi YM, Brown ML, Klein TA, Meyers M, Schoepp RJ, Norwood DA, Cooper MJ, Maza JP, Reeves WE, Guan J. Capacity-building efforts by the AFHSC-GEIS program. BMC Public Health. 2011;11 Suppl 2:S4. AbstractWebsite

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.

Bulimo W, JL S, MC J, RL B, KG V, MM F, IK Y, C L, M Q, DC S, G P, M M, S T, JM M, GC G, K S, LM N, S L, PJ B, PA S, RA K, KL R, DL B, Group AF, CJ W, NN M, JC G, JA P, RV G, RG J, M S, SK S, AB O, N I, MA O, SK M, SW G, WD B, DJ W, B A, JA T, KC E, MR K, GT B, WO R, T K, VA L-, J G, W B, N W, U T, CF D, JN F, JF A, B F, A H, CA M, WG C, VA M, T G, EA M, M G, ' O, AG L, HS H, L R, A M, E S, R S, W S, TJ P, KH J, M M, B E, D M, D B, F W-, D S, N W, D B, G M, C K, G H, YM K, ML B, TA K, M M, RJ S, DA N, MJ C, JP M, WE R, J G. Capacity-building efforts by the AFHSC-GEIS program.. 2011. AbstractWebsite
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Osanjo G, Aluvaala E, Wadegu M, Bulimo W, Guantai AN, Mulaa F, Okalebo FA, Oluka M. Carbohydrate active enzymes (Cazymes) as drug targets and tools for synthesis of medicinal compounds.. 2011. Abstract
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George. G, Samuel. S, John. M, James. S, Wallace B. Changes in Haemagglutinin epitopes of human influenza B viruses in Kenya, 2005-2009. . Accra, Ghana; 2011. Abstract
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Achilla. R, Bulimo. W, Schnabel. D, Wurapa. E. Characterization of Adenoviruses Circulating in Kenya.. Accra, Ghana; 2011. Abstract
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Osuna. F, Achilla. R, Schnabel. D, Majanja. J, Wadegu. M, Mukunzi. S, Njiri. J, Opot. B, Wurapa. E, Bulimo. W. Co-circulating Respiratory Viral Pathogens during the pH1N1 Outbreak of 2009 In Kenya.. In: 1st International Scientific Conference at the College of Health Sciences University of Nairobi . University of Nairobi, Nairobi, Kenya: University of Nairobi; 2011. Abstract
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Osuna. F, Bulimo. W, Achilla. R, Gachara. G, Majanja. J, Wadegu. M, Mukunzi. S, Njiri. J, Opot. B, Obura. B, Schnabel. D, Wurapa. E. Co-Infections and Co-Circulating Respiratory Viral Pathogens during the H1N1 Outbreak of 2009 in Kenya.. In: Virology Africa 2011 conference. University of Cape Town South Africa.; 2011. Abstract
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Osanjo GO, Bulimo WD, Mulaa FJ. Engineering the functional fitness of transglycosidases and glycosynthases by directed evolution. African Journal of Biotechnology. 2011;10:1727-35. Abstract
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Hasegawa S, Hirano R, Okamoto-Nakagawa R, Ichiyama T, Shirabe K. Enterovirus 68 infection in children with asthma attacks: virus-induced asthma in Japanese children. Allergy. 2011;66:1618-20. Abstract
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Opot. B, Osuna. F, Wadegu. M, Achilla. R, Wurapa. E, Bulimo. W. Establishment of DNA sequencing capacity at the Kenyan National Influenza Centre to underpin molecular virology research at USAMRU-K. . In: 1st International Scientific Conference at the College of Health Sciences University of Nairobi. University of Nairobi, Nairobi Kenya; 2011. Abstract
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Mukunzi. S, Bulimo. WD, Achilla. RA, Wadegu. M, Majanja. J, Mwala. D, Wurapa. E. Genetic analysis of Influenza A [H3N2] viruses co-circulating with pandemic H1N1 virus in Kenya Year 2009-2010.. Accra, Ghana; 2011. Abstract
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Johns MC, Burke RL, Vest KG, Fukuda M, Pavlin JA, Shrestha SK, Schnabel DC, Tobias S, Tjaden JA, Montgomery JM, Faix DJ, Duffy MR, Cooper MJ, Sanchez JL, Blazes DL, Wangchuk S, Dorji T, Gibbons R, Iamsirithaworn S, Richardson J, Buathong R, Jarman R, Yoon IK, Shakya G, Ofula V, Coldren R, Bulimo W, Sang R, Omariba D, Obura B, Mwala D, Kasper M, Brice G, Williams M, Yasuda C, Barthel RV, Pimentel G, Meyers C, Kammerer P, Baynes DE, Metzgar D, Hawksworth A, Blair P, Ellorin M, Coon R, Macintosh V, Burwell K, Macias E, Palys T, Jerke K. A growing global network's role in outbreak response: AFHSC-GEIS 2008-2009. BMC Public Health. 2011;11 Suppl 2:S3. AbstractWebsite

A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense's (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization's (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats.

Bulimo W, MC J, RL B, KG V, M F, JA P, SK S, DC S, S T, JA T, JM M, DJ F, MR D, MJ C, JL S, DL B, Group AF, S W, T D, R G, S I, J R, R B, R J, IK Y, G S, V O, R C, W B, R S, D O, B O, D M, M K, G B, M W, C Y, RV B, G P, C M, P K, DE B, D M, A H, P B, M E, R C, V M, K B, E M, T P, K J. A growing global network{'}s role in outbreak response: AFHSC-GEIS 2008-2009.. 2011. AbstractWebsite
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Mukunzi. S, Wurapa. E, Achilla. R, Wadegu. M, Majanja. J, Wangui. J, Osuna. F, Njiri. J, Mwangi. J, Bulimo. W. Many pandemic Influenza A (H1N1) viruses that circulated in Kenya during the 2009-2010 Influenza seasons belonged to clade 7.. In: 1st International Scientific Conference at the College of Health Sciences University of Nairobi. University of Nairobi, Nairobi Kenya; 2011. Abstract
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Wadegu. M, Bulimo. WD, Achilla. RA, Majanja. J, Mukunzi. S, Osuna. F, Wangui. J, Njiri. J, Opot. B, Schnabel. DC, Wurapa. EK. Molecular Antiviral Susceptability Testing Of Seasonal Influenza A Virus Isolates Obtained In Kenya In The Year 2008-2009.. Philadelphia Marriott Downtown Philadelphia, Pennsylvania.; 2011. Abstract
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Majanja. J, Bulimo. W, Achilla. R, Wadegu. M, Mukunzi. S, Mwala. D, Mwangi. J, Wangui. J, Osuna. F, Schnabel. D, Wurapa. EK. Non-Influenza Respiratory Virus Infections in Kenya: 2007-2010. . In: The XIII International Symposium on Respiratory Viral Infections. the Rome Marriott Park Hotel, Rome, Italy; 2011. Abstract
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Osuna. F, Bulimo. W, Achilla. R, Majanja. J, Wadegu. M, Mukunzi. S, Mwala. D, Mwangi. J, Wangui. J, Schnabel. D, Wurapa. EK. Survey of Respiratory Syncytial Virus Occurrences in Kenya from 2006-2010.. The Rome Marriott Park Hotel, Rome, Italy; 2011. Abstract
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Bulimo W, P V, ' N{, W B, R B, J O, de EP V. TparvaDB: a database to support Theileria parva vaccine development.. 2011. AbstractWebsite
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Otto JL, Baliga P, Sanchez JL, Johns MC, Gray GC, Grieco J, Lescano AG, Mothershead JL, Wagar EJ, Blazes DL, Achila R, Baker W, Blair P, Brown M, Bulimo W, Byarugaba D, Coldren R, Cooper M, Ducatez M, Espinosa B, Ewings P, Guerrero A, Hawksworth T, Jackson C, Klena JD, Kraus S, Macintosh V, Mansour M, Maupin G, Maza J, Montgomery J, Ndip L, Pavlin J, Quintana M, Richard W, Rosenau D, Saeed T, Sinclair L, Smith I, Smith J, Styles T, Talaat M, Tobias S, Vettori J, Villinski J, Wabwire-Mangen F. Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005). BMC Public Health. 2011;11 Suppl 2:S5. AbstractWebsite

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.

Bulimo W, JL O, P B, JL S, MC J, GC G, J G, AG L, JL M, EJ W, DL B, Group AF, R A, W B, P B, M B, W B, D B, R C, M C, M D, B E, P E, A G, T H, C J, JD K, S K, V M, M M, G M, J M, J M, L N, J P, M Q, W R, D R, T S, L S, I S, J S, T S, M T, S T, J V, J V, F W-. Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005).. 2011. AbstractWebsite
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Nzunza. R, Achilla. R, Schnabel. D, Majanja. J, Wadegu. M, Mukunzi. S, Osuna. F, Njiri. J, Opot. B, Wurapa. EK, Bulimo. WD. Viral Etiologies of Influenza-Like-Illnesses in Kneya; January 2007 to December 2010.. In: ASTMH 60th Annual Meeting. Philadelphia Marriott Downtown Philadelphia, Pennsylvania.; 2011. Abstract
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2010
Sueker J, Blazes DL, Johns MC, Blair PJ, Sjoberg PA, Tjaden JA, Montgomery JM, Pavlin JA, Schnabel DC, Eick AA, Tobias S, Quintana M, Vest KG, Burke RL, Lindler LE, Mansfield JL, Erickson RL, Russell KL, Sanchez JL. Influenza and respiratory disease surveillance: the US military's global laboratory-based network. Influenza Other Respi Viruses. 2010;4:155-61. Abstract

The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host-country civilian and military personnel. This system represents a major part of the US Government's contributions to the World Health Organization's Global Influenza Surveillance Network and addresses Presidential Directive NSTC-7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans.

Achilla R, Majanja J, Wadegu M, Bulimo W, Schnabel D. Sentinel surveillance of pandemic influenza A H1N1 in Kenya in the period August-November 2009. Int J Infect Dis. 2010;14:E286. AbstractWebsite
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Bulimo W, J JS, DL B, MC J, PJ B, PA S, JA T, JM M, JA P, DC S, AA E, S T, M Q, KG V, RL B, LE L, JL M, RL E, KL R, JL S, Group DD. Influenza and respiratory disease surveillance: the US military{'}s global laboratory-based network.. 2010. AbstractWebsite
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