• A Large Outbreak of Hepatitis E Among a Displaced Population in Darfur, Sudan, 2004: The Role of Water Treatment Methods.

      Guthmann, J P; Klovstad, H; Boccia, D; Hamid, N; Pinoges, L; Nizou, J Y; Tatay, M; Diaz, F; Moren, A; Grais, RF; et al. (Published by: Infectious Diseases Society of America, 2006-06-15)
      BACKGROUND: The conflict in Darfur, Sudan, was responsible for the displacement of 1.8 million civilians. We investigated a large outbreak of hepatitis E virus (HEV) infection in Mornay camp (78,800 inhabitants) in western Darfur. METHODS: To describe the outbreak, we used clinical and demographic information from cases recorded at the camp between 26 July and 31 December 2004. We conducted a case-cohort study and a retrospective cohort study to identify risk factors for clinical and asymptomatic hepatitis E, respectively. We collected stool and serum samples from animals and performed a bacteriological analysis of water samples. Human samples were tested for immunoglobulin G and immunoglobulin M antibody to HEV (for serum samples) and for amplification of the HEV genome (for serum and stool samples). RESULTS: In 6 months, 2621 hepatitis E cases were recorded (attack rate, 3.3%), with a case-fatality rate of 1.7% (45 deaths, 19 of which involved were pregnant women). Risk factors for clinical HEV infection included age of 15-45 years (odds ratio, 2.13; 95% confidence interval, 1.02-4.46) and drinking chlorinated surface water (odds ratio, 2.49; 95% confidence interval, 1.22-5.08). Both factors were also suggestive of increased risk for asymptomatic HEV infection, although this was not found to be statistically significant. HEV RNA was positively identified in serum samples obtained from 2 donkeys. No bacteria were identified from any sample of chlorinated water tested. CONCLUSIONS: Current recommendations to ensure a safe water supply may have been insufficient to inactivate HEV and control this epidemic. This research highlights the need to evaluate current water treatment methods and to identify alternative solutions adapted to complex emergencies.
    • A large outbreak of Hepatitis E virus genotype 1 infection in an urban setting in Chad likely linked to household level transmission factors, 2016-2017.

      Spina, A; Lenglet, A; Beversluis, D; de Jong, M; Vernier, L; Spencer, C; Andayi, F; Kamau, C; Vollmer, S; Hogema, B; et al. (Public Library of Science, 2017-11-27)
      In September 2016, three acutely jaundiced (AJS) pregnant women were admitted to Am Timan Hospital, eastern Chad. We described the outbreak and conducted a case test-negative study to identify risk factors for this genotype of HEV in an acute outbreak setting.
    • Learning Without Borders: A Review of the Implementation of Medical Error Reporting in Médecins Sans Frontières

      Shanks, Leslie; Bil, Karla; Fernhout, Jena (Public Library of Science, 2015-09-18)
      To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF) programs.
    • Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries

      Loyse, A; Burry, J; Cohn, J; Ford, N; Chiller, T; Ribeiro, I; Koulla-Shiro, S; Mghamba, J; Ramadhani, A; Nyirenda, R; et al. (The Lancet, 2018-10-18)
      In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.
    • Leaving no one behind: Towards equitable global elimination of hepatitis C

      Dahl, EH; Zahid, H; Aslam, K; Jafri, W (Edinburgh University Global Health Society, 2020-03-14)
    • Lessons and challenges for measles control from unexpected large outbreak, Malawi

      Minetti, Andrea; Kagoli, Matthew; Katsulukuta, Agnes; Huerga, Helena; Featherstone, Amber; Chiotcha, Hazel; Noel, Delphine; Bopp, Cameron; Sury, Laurent; Fricke, Renzo; et al. (Center for Disease Control and Prevention, 2013-02-01)
      Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6-8, and 9-11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15-19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12-23 months; 57.9% for children 9-11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.
    • Lessons Learned about Pneumonic Plague Diagnosis from 2 Outbreaks, Democratic Republic of the Congo

      Bertherat, Eric; Thullier, Philippe; Shako, Jean Christophe; England, Kathleen; Kone, Mamadou Lamine; Arntzen, Lorraine; Tomaso, Herbert; Koyange, Louis; Formenty, Pierre; Ekwanzala, Florent; et al. (2011-04-25)
      Pneumonic plague is a highly transmissible infectious disease for which fatality rates can be high if untreated; it is considered extremely lethal. Without prompt diagnosis and treatment, disease management can be problematic. In the Democratic Republic of the Congo, 2 outbreaks of pneumonic plague occurred during 2005 and 2006. In 2005, because of limitations in laboratory capabilities, etiology was confirmed only through retrospective serologic studies. This prompted modifications in diagnostic strategies, resulting in isolation of Yersinia pestis during the second outbreak. Results from these outbreaks demonstrate the utility of a rapid diagnostic test detecting F1 antigen for initial diagnosis and public health management, as well as the need for specialized sampling kits and trained personnel for quality specimen collection and appropriate specimen handling and preservation for plague confirmation and Y. pestis isolation. Efficient frontline management and a streamlined diagnostic strategy are essential for confirming plague, especially in remote areas.
    • Limited effectiveness of high-dose liposomal amphotericin B (AmBisome) for treatment of visceral leishmaniasis in an Ethiopian population with high HIV prevalence.

      Ritmeijer, Koert; ter Horst, Rachel; Chane, Solomon; Aderie, Endashaw Mengistu; Piening, Turid; Collin, Simon M; Davidson, Robert N; Public Health Department, Médecins Sans Frontières, Amsterdam, the Netherlands. koert.ritmeijer@amsterdam.msf.org (2011-12)
      Due to unacceptably high mortality with pentavalent antimonials, Médecins Sans Frontières in 2006 began using liposomal amphotericin B (AmBisome) for visceral leishmaniasis (VL) patients in Ethiopia who were severely ill or positive for human immunodeficiency virus (HIV).
    • Localised transmission hotspots of a typhoid fever outbreak in the Democratic Republic of Congo

      Ali, E; Bergh, RVD; D'hondt, R; Kuma-Kuma, D; Weggheleire, AD; Baudot, Y; Lambert, V; Hunter, P; Zachariah, R; Maes, P (PAMJ-Center for Public Health Research and Information, 2017)
      In a semi-urban setting in the Democratic Republic of Congo, this study aims to understand the dynamic of a typhoid fever (TF) outbreak and to assess: a) the existence of hot spots for TF transmission and b) the difference between typhoid cases identified within those hot spots and the general population in relation to socio-demographic characteristics, sanitation practice, and sources of drinking water.
    • Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis.

      Pécoul, B; Varaine, F; Keita, M; Soga, G; Djibo, A; Soula, G; Abdou, A; Etienne, J; Rey, M; Epicentre, Paris, France. (Elsevier, 1991-10-05)
      In most developing countries, bacterial meningitis (BM) is associated with a high case-fatality rate. The search for a simple, convenient, and inexpensive antibiotic treatment remains a priority. In this study, a non-blinded, multicentre, randomised clinical trial of 528 cases of BM was done in two hospitals in Mali and Niger, between March, 1989, and May, 1990, to see whether a double injection of long-acting chloramphenicol (on admission to hospital and 48 h later) is as effective as a course of intravenous ampicillin (8 days, 4 times a day). The cumulative case-fatality rate on day 4 (principal end-point) among the chloramphenicol (254 patients) and ampicillin (274) groups were, respectively, 28% and 24.5% (relative risk 1.14, 95% confidence interval 0.86-1.52). No outbreak occurred during the study period. The hospital case-fatality rate was 33.1%. Main risk factors for death were associated with clinical condition on admission--ie, altered consciousness, convulsions, or dehydration. The case-fatality rates were 13% (21/161) for Neisseria meningitidis, 36.1% (48/133) for Haemophilus influenzae, and 67% (77/115) for Streptococcus pneumoniae. In a multiple logistic regression model, controlling for the differential distribution of potential risk factors (including bacterial species), there was no difference between treatment groups. Our findings suggest that long-acting chloramphenicol is a useful first-line presumptive treatment for BM in high-incidence countries.
    • A long-lasting measles epidemic in Maroua, Cameroon 2008-2009: mass vaccination as response to the epidemic.

      Luquero, Francisco J; Pham-Orsetti, Heloise; Cummings, D A T; Ngaunji, Philippe E; Nimpa, Marcelino; Fermon, Florence; Ngoe, Ndong; Sosler, Stephen; Strebel, Peter; Grais, RFebecca F; et al. (2011-07)
      A measles outbreak occurred in Maroua, Cameroon, from January 2008 to April 2009. In accordance with recent World Health Organization guidelines, an outbreak-response immunization (ORI) was conducted in January 2009. The aim of this study was to investigate the causes of the epidemic in order to guide vaccination strategies.
    • A look back at an ongoing problem: Shigella dysenteriae type 1 epidemics in refugee settings in Central Africa (1993-1995).

      Kernéis, Solen; Guerin, Philippe J; von Seidlein, Lorenz; Legros, Dominique; Grais, RFebecca F; Epicentre, Paris, France. (2009-02)
      BACKGROUND: Shigella dysenteriae type 1 (Sd1) is a cause of major dysentery outbreaks, particularly among children and displaced populations in tropical countries. Although outbreaks continue, the characteristics of such outbreaks have rarely been documented. Here, we describe the Sd1 outbreaks occurring between 1993 and 1995 in 11 refugee settlements in Rwanda, Tanzania and Democratic Republic of the Congo (DRC). We also explored the links between the different types of the camps and the magnitude of the outbreaks. METHODOLOGY/PRINCIPAL FINDINGS: Number of cases of bloody diarrhea and deaths were collected on a weekly basis in 11 refugee camps, and analyzed retrospectively. Between November 1993 and February 1995, 181,921 cases of bloody diarrhea were reported. Attack rates ranged from 6.3% to 39.1% and case fatality ratios (CFRs) from 1.5% to 9.0% (available for 5 camps). The CFRs were higher in children under age 5. In Tanzania where the response was rapidly deployed, the mean attack rate was lower than in camps in the region of Goma without an immediate response (13.3% versus 32.1% respectively). CONCLUSIONS/SIGNIFICANCE: This description, and the areas where data is missing, highlight both the importance of collecting data in future epidemics, difficulties in documenting outbreaks occurring in complex emergencies and most importantly, the need to assure that minimal requirements are met.
    • Maculopapular lesions in the Central African Republic

      Berthet, Nicolas; Nakouné, Emmanuel; Whist, Eline; Selekon, Benjamin; Burguière, Ana-Maria; Manuguerra, Jean-Claude; Gessain, Antoine; Kazanji, Mirdad; Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, CNRS URA 3015; Institut Pasteur, Laboratory for Urgent Responses to Biological Threats, Paris, France; Institut Pasteur in Bangui, Department of Virology, Bangui, Central African Republic d Médecins Sans Frontières, Paris, France (Elservier, 2011-10-08)
    • Maladies tropicales neglectees: dix ans de partenariat avec Medecins sans frontieres

      Chappuis F, Comte E, Vuagnat H, Loutan L, Tamrat A; MSF Suisse (2009-05)
    • [Man-water contacts and urinary schistosomiasis in a Mauritanian village]

      Etard, J F; Borel, E; Département de Parsitologie et Médecine Tropicale, Université Lyon I et Médecins sans Frontières, Paris, France. (1992)
      For the period September to December 1985, 1226 water contacts were recorded during 8 days of direct observation. Various activities were analysed in order to determine their responsibility in transmission. An index of exposure, allowing for duration of contact, body surface exposed and infectiousness of the water was calculated for each contact. Domestic contacts, primarily female, represented 62% of the observations but only 15% of total exposure. Conversely, contacts for recreational purposes mainly involved young boys and accounted for 14% of the observations and 70% of total exposure. Between 6 and 20 years of age the mean index of exposure by contact was higher in males than in females. Changing water contact behavior seems to be an unrealistic means of preventing transmission in the community studied. The most appropriate strategy of control would appear to be selective treatment of heavily infected individuals.
    • Management of Chronic Hepatitis C at a Primary Health Clinic in the High-Burden Context of Karachi, Pakistan

      Capileno, YA; Van den Bergh, R; Donchunk, D; Hinderaker, SG; Hamid, S; Auat, R; Khalid, GG; Fatima, R; Yaqoob, A; Van Overloop, C (Public Library of Science, 2017-04-27)
      The burden of hepatitis C (HCV) infection in Pakistan is among the highest in the world, with a reported national HCV prevalence of 6.7% in 2014. In specific populations, such as in urban communities in Karachi, the prevalence is suspected to be higher. Interferon-free treatment for chronic HCV infection (CHC) could allow scale up, simplification and decentralization of treatment to such communities. We present an interim analysis over the course of February-December 2015 of an interferon-free, decentralised CHC programme in the community clinic in Machar Colony, Karachi, Pakistan.
    • Managing COVID-19 in Low- and Middle-Income Countries

      Hopman, J; Allegranzi, B; Mehtar, S (American Medical Association, 2020-03-16)
    • Mandatory Notification of Chronic Chagas Disease: Confronting the Epidemiological Silence in the State of Goiás, Brazil

      da Rocha Siriano, L; Marchiol, A; Pereira Certo, M; Cubides, JC; Forsyth, C; Augusto de Sousa, F (MDPI, 2020-06-05)
      Objectives: This paper presents the results of the design and implementation process for the policy of compulsory notification of chronic Chagas disease in the Brazilian state of Goiás (Resolution No. 004/2013-GAB/SES-GO). Methods: The narrative was based on information provided by key actors that were part of the different stages of the process, built on contextual axes based on participants’ reflections about the establishment of the most accurate and coherent notification mechanisms. Results: The notification policy addressed the absence of historical data from patients in the state Chagas program, an increase in cases identified through serology, and weaknesses in vector control. Two key challenges involved human resources capacity and dissemination to public agencies and health care workers. Effective training and communication processes were key ingredients for successful implementation. Conclusions: The lack of public health measures aimed at the epidemiological surveillance of chronic Chagas cases constitutes a significant barrier for patients to access appropriate diagnosis, management and follow-up, and hampers the planning of necessary activities within health systems. The implementation of the notification policy in Goiás allows authorities to determine the real magnitude of Chagas disease in the population, so that an appropriate public health response can be mounted to meet the needs of affected people, thereby ending the epidemiological silence of Chagas disease.
    • Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales

      Lessler, J; Moore, SM; Luquero, FJ; McKay, HS; Grais, RF; Henkens, M; Mengel, M; Dunoyer, J; M'bangombe, M; Lee, EC; et al. (Elsevier, 2018-03-01)
      Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions.