• Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: a cross-sectional study.

      Mehta, Salil; Mansoor, Homa; Khan, Samsuddin; Saranchuk, Peter; Isaakidis, Petros; Médecins Sans Frontières, Mumbai, India. msfocb-asia-epidemio@brussels.msf.org. (2013-05)
      The prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).
    • Offering General Pediatric Care During the Hard Times of the 2014 Ebola Outbreak: Looking Back at How Many Came and How Well They Fared at a Médecins Sans Frontières Referral Hospital in Rural Sierra Leone

      Hermans, V; Zachariah, R; Woldeyohannes, D; Saffa, G; Kamara, D; Ortuno-Gutierrez, N; Kizito, W; Manzi, M; Alders, P; Maikere, J (BioMed Central, 2017-01-25)
      In Bo district, rural Sierra Leone, we assessed the burden of the 2014 Ebola outbreak on under-five consultations at a primary health center and the quality of care for under-15 children at a Médecins Sans Frontières (MSF) referral hospital.
    • Offering Integrated Care for HIV/AIDS, Diabetes and Hypertension within Chronic Disease Clinics in Cambodia.

      Janssens, B; Van Damme, W; Raleigh, B; Gupta, J; Khem, S; Soy Ty, K; Vun, M; Ford, N; Zachariah, R; Médecins Sans Frontières, Phnom Penh, Cambodia. b.janssens@bigfoot.com (WHO, 2007-11)
      PROBLEM: In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. APPROACH: We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. LOCAL SETTING: Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. RELEVANT CHANGES: At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. LESSONS LEARNED: Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases.
    • Operational Research during the Ebola Emergency

      Fitzpatrick, G; Decroo, T; Draguez, B; Crestani, R; Ronsse, A; Van den Bergh, R; Van Herp, M (Centers for Disease Control and Prevention, 2017-07)
      Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.
    • Organisation of Health Care During an Outbreak of Marburg Haemorrhagic Fever in the Democratic Republic of Congo, 1999.

      Colebunders, R; Sleurs, H; Pirard, P; Borchert, M; Libande, M; Mustin, J P; Tshomba, A; Kinuani, L; Olinda, L A; Tshioko, F; et al. (2004-05)
      Organising health care was one of the tasks of the International Scientific and Technical Committee during the 1998-1999 outbreak in Durba/Watsa, in the north-eastern province (Province Orientale), Democratic Republic of Congo. With the logistical support of Médecins sans Frontières (MSF), two isolation units were created: one at the Durba Reference Health Centre and the other at the Okimo Hospital in Watsa. Between May 6th, the day the isolation unit was installed and May 19th, 15 patients were admitted to the Durba Health Centre. In only four of them were the diagnosis of Marburg haemorrhagic fever (MHF) confirmed by laboratory examination. Protective equipment was distributed to health care workers and family members caring for patients. Information about MHF, modes of transmission and the use of barrier nursing techniques was provided to health care workers and sterilisation procedures were reviewed. In contrast to Ebola outbreaks, there was little panic among health care workers and the general public in Durba and all health services remained operational.
    • Outbreak of Beriberi in a Prison in Côte d'Ivoire.

      Ahoua, L; Etienne, W; Fermon, F; Godain, G; Brown, V; Kadjo, K; Bouaffou, K; Legros, D; Guerin, P J; Epicentre, 42 boulevard Richard Lenoir, Paris 75011, France. lahoua@epicentre.msf.org (2007-09)
      BACKGROUND: A beriberi outbreak occurred in the Maison d'Arrêt et de Correction d'Abidjan (MACA), a detention center in Abidjan, Côte d'Ivoire, between October 2002 and April 2003. OBJECTIVE: A retrospective investigation was conducted to document the outbreak in April 2003. METHODS: A descriptive analysis and a case-control study were performed. A probable case patient was defined as a person detained in the center between October 2002 and April 2003 with at least two of the following symptoms: bilateral leg edema, dyspnea, positive squat test, motor deficiencies, and paresthesia. A definite case patient was defined as a probable case patient who showed clinical improvement under thiamin treatment. RESULTS: Of 712 cases reported, 115 (16%) were probable and 597 (84%) were definite. The overall attack rate was 14.1%, and the case fatality rate was 1.0% (7/712). The highest attack rate was reported in the building housing prisoners with long-term sentences (16.9%). All patients were male, and the mean age was 28 years. During the period studied, the penal ration provided a fifth of the quantity of thiamin recommended by international standards. After adjustment for potential confounders, a history of cholera infection (adjusted odds ratio [OR(a)], 12.9; 95% confidence interval [CI], 2.9 to 54.1) and incarceration in the building for severe penalties (OR(a), 4.8; 95% CI, 1.3 to 18.5) were associated with the disease. CONCLUSIONS: Beriberi has been underreported among prisoners. Further attention should be given to its risk factors, especially a history of acute diarrhea. Systematic food supplementation with vitamins and micronutrients should be discussed when the penal ration does not provide the necessary nutrient intake recommended according to international standards.
    • Outbreak of Marburg hemorrhagic fever among miners in Kamwenge and Ibanda Districts, Uganda, 2007

      Adjemian, Jennifer; Farnon, Eileen C; Tschioko, Florimond; Wamala, Joseph F; Byaruhanga, Emmanuel; Bwire, Godfrey S; Kansiime, Edgar; Kagirita, Atek; Ahimbisibwe, Sam; Katunguka, F; et al. (Oxford University Press, 2011-11)
      Marburg hemorrhagic fever was detected among 4 miners in Ibanda District, Uganda, from June through September, 2007. Infection was likely acquired through exposure to bats or bat secretions in a mine in Kamwenge District, Uganda, and possibly human-to-human transmission between some patients. We describe the epidemiologic investigation and the health education response.
    • Outbreak of Pneumococcal Meningitis, Paoua Subprefecture, Central African Republic, 2016-2017

      Coldiron, Me; Touré, O; Frank, T; Bouygues, N; Grais, RFF (Center for Disease Control and Prevention, 2018-09)
      We report a pneumococcal meningitis outbreak in the Central African Republic (251 suspected cases; 60 confirmed by latex agglutination test) in 2016-2017. Case-fatality rates (10% for confirmed case-patients) were low. In areas where a recent pneumococcal conjugate vaccine campaign was conducted, a smaller proportion of cases was seen in youngest children.
    • Outbreak of West Nile virus causing severe neurological involvement in children, Nuba Mountains, Sudan, 2002.

      Depoortere, E; Kavle, J; Keus, K; Zeller, H; Murri, S; Legros, D; Epicentre, Paris, France. evelyn.depoortere@msf.be (Wiley-Blackwell, 2004-06)
      An atypical outbreak of West Nile virus (WNV) occurred in Ngorban County, South Kordophan, Sudan, from May to August 2002. We investigated the epidemic and conducted a case-control study in the village of Limon. Blood samples were obtained for cases and controls. Patients with obvious sequelae underwent cerebrospinal fluid (CSF) sampling as well. We used enzyme-linked immunosorbent assay (ELISA) and neutralization tests for laboratory diagnosis and identified 31 cases with encephalitis, four of whom died. Median age was 36 months. Bivariate analysis did not reveal any significant association with the risk factors investigated. Laboratory analysis confirmed presence of IgM antibodies caused by WNV in eight of 13 cases, indicative of recent viral infection. The unique aspects of the WNW outbreak in Sudan, i.e. disease occurrence solely among children and the clinical domination of encephalitis, involving severe neurological sequelae, demonstrate the continuing evolution of WNV virulence. The spread of such a virus to other countries or continents cannot be excluded.
    • Outbreaks in a Rapidly Changing Central Africa — Lessons from Ebola

      Munster, VJ; Bausch, DG; de Wit, E; Fischer, R; Kobinger, G; Muñoz-Fontela, C; Olson, SH; Seifert, SN; Sprecher, A; Ntoumi, F; et al. (Massachusetts Medical Society, 2018-09-27)
    • Outbreaks of cholera in the time of Ebola: pre-emptive action needed

      Azman, Andrew S; Legros, Dominique; Lessler, Justin; Luquero, Francisco J; Moore, Sean M (Elsevier, 2015-02-19)
    • Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children's Hospital, Sokoto, Nigeria.

      Farley, ES; Amirtharajah, M; Winters, RD; Taiwo, AO; Oyemakinda, MJ; Fosto, A; Torhee, LA; Mehta, UC; Bil, KA; Lenglet, AD (Oxford University Press, 2020-08-12)
      Background: Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria. Methods: A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person follow-up assessments (anthropometry, mouth opening and quality of life measurements) were conducted with patients who had surgery >6 mo prior to data collection. Results: Of the 37 patients included, 21 (56.8%) were male and 22 (62.9%) were aged >6 y. The median number of months between last surgery and follow-up was 18 (IQR 13, 25) mo. At admission, the most severely affected anatomical area was the outer cheek (n = 9; 36.0% of patients had lost between 26% and 50%). The most frequent surgical procedures were the deltopectoral flap (n = 16; 43.2%) and trismus release (n = 12; 32.4%). For the eight trismus-release patients where mouth opening was documented at admission, all had a mouth opening of 0-20 mm at follow-up. All patients reported that the surgery had improved their quality of life. Conclusions: Following their last surgical intervention, noma patients do experience some improvements in their quality of life, but debilitating long-term sequelae persist.
    • Outcomes for Mycobacterium ulcerans infection with combined surgery and antibiotic therapy: findings from a south-eastern Australian case series.

      O'Brien, D P; Hughes, A; Cheng, A C; Henry, M J; Callan, P; McDonald, A; Holten, I; Birrell, M; Sowerby, J M; Johnson, P D; et al. (Medical Society of Australia, 2007-01-15)
      OBJECTIVE: To describe the effect of antibiotics on outcomes of treatment for Buruli or Bairnsdale ulcer (BU) in patients on the Bellarine Peninsula in south-eastern Australia. DESIGN: Observational, non-randomised study with data collected prospectively or through medical record review. PATIENTS AND SETTING: All 40 patients with BU managed by staff of Barwon Health's Geelong Hospital (a public, secondary-level hospital) between 1 January 1998 and 31 December 2004. MAIN OUTCOME MEASURES: Epidemiology, clinical presentation, diagnosis, treatment and clinical outcomes. RESULTS: There were 59 treatment episodes; 29 involved surgery alone, 26 surgery plus antibiotics, and four antibiotics alone. Of 55 episodes where surgery was performed, minor surgery was required in 22, and major surgery in 33. Failure rates were 28% for surgery alone, and 19% for surgery plus antibiotics. Adjunctive antibiotic therapy was associated with increased treatment success for lesions with positive histological margins (P < 0.01), and lesions requiring major surgery for treatment of a first episode (P < 0.01). The combination of rifampicin and ciprofloxacin resulted in treatment success in eight of eight episodes, and no patients ceased therapy because of side effects with this regimen. CONCLUSIONS: Adjunctive antibiotic therapy may increase the effectiveness of BU surgical treatment, and this should be further assessed by larger randomised controlled trials. The combination of rifampicin and ciprofloxacin appears the most promising.
    • Outcomes of cholera and measles outbreak alerts in the Democratic Republic of Congo

      Makelele, JPK; Ade, S; Takarinda, KC; Manzi, M; Cuesta, JG; Acma, A; Yepez, MM; Mashak, M (International Union Against Tuberculosis and Lung Disease, 2020-09-21)
      Setting: In 1995, a rapid response project for humanitarian and medical emergencies, including outbreak responses, named ‘Pool d’Urgence Congo’ (PUC), was implemented in the Democratic Republic of Congo by Médecins Sans Frontières. Objective: To assess the outcomes of cholera and measles outbreak alerts that were received in the PUC surveillance system between 2016 and 2018. Design: This was a retrospective cross-sectional study. Results: Overall, 459 outbreak alerts were detected, respectively 69% and 31% for cholera and measles. Of these, 32% were actively detected and 68% passively detected. Most alerts (90%) required no intervention and 10% of alerts had an intervention. There were 25% investigations that were not carried out despite thresholds being met; 17% interventions were not performed, the main reported reason being PUC operational capacity was exceeded. Confirmed cholera and measles outbreaks that met an investigation threshold comprised respectively 90% and 76% of alerts; 59% of measles investigations were followed by a delayed outbreak response of 14 days (n = 10 outbreaks). Conclusion: Some alerts for cholera and measles outbreaks that were detected in the PUC system did not lead to a response even when required; the main reported reason was limited operational capacity to respond to all of them.
    • An overview of Chagas Disease and Treatment.

      Jannin, J; Villa, L; Innovative & Intensified Disease Management, Neglected Tropical Diseases, WHO, Geneva, Switzerland. janninj@who.int (2007-10-30)
      Chagas disease (American trypanosomiasis) is endemic in 21 countries of the Americas, where control is largely focused on elimination of the domestic insect vectors (Triatominae) coupled with measures to extend and improve the screening of blood donors in order to avoid tranfusional transmission. Through national programmes and multinational initiatives coordinated by WHO-PAHO, much has been accomplished in these domains in terms of reducing transmission. Attention now turns to consolidating the successes in interrupting transmission, and improved treatment for those already infected and those who may become affected in the future. This article, based on technical discussions at the "Epidemiological and Sociological Determinants of Chagas Disease, Basic Information to Establish a Surveillance and Control Policy " meeting in Rio de Janeiro, is designed to open the debate on appropriate strategies for continuation of the successful initiatives against Chagas disease.
    • Paediatric Buruli ulcer in Australia

      Walker, G; Friedman, D; Cooper, C; O'Brien, M; McDonald, A; Callan, P; O'Brien, D; MSF UK Manson Unit (2019-12-10)
      AIM: This study describes an Australian cohort of paediatric Buruli ulcer (BU) patients and compares them with adult BU patients. METHODS: Analysis of a prospective cohort of all BU cases managed at Barwon Health, Victoria, from 1 January 1998 to 31 May 2018 was performed. Children were defined as ≤15 years of age. RESULTS: A total of 565 patients were included: 52 (9.2%) children, 289 (51.2%) adults aged 16-64 years and 224 (39.6%) adults aged ≥65 years. Among children, half were female and the median age was 8.0 years (interquartile range 4.8-12.3 years). Six (11.5%) cases were diagnosed from 2001 to 2006, 14 (26.9%) from 2007 to 2012 and 32 (61.5%) from 2013 to 2018. Compared to adults, children had a significantly higher proportion of non-ulcerative lesions (32.7%, P < 0.001) and a higher proportion of severe lesions (26.9%, P < 0.01). The median duration of symptoms prior to diagnosis was shorter for children compared with adults aged 16-64 years (42 vs. 56 days, P = 0.04). Children were significantly less likely to experience antibiotic complications (6.1%) compared with adults (20.6%, P < 0.001), but had a significantly higher rate of paradoxical reactions (38.8%) compared with adults aged 16-64 (19.2%) (P < 0.001). Paradoxical reactions in children occurred significantly earlier than in adults (median 17 vs. 56 days, P < 0.01). Cure rates were similarly high for children compared to adults treated with antibiotics alone or with antibiotics and surgery. CONCLUSIONS: Paediatric BU cases in Australia are increasing and represent an important but stable proportion of Australian BU cohorts. Compared with adults, there are significant differences in clinical presentation and treatment outcomes.
    • Painless: a case of congenital insensitivity to pain in a 5-year-old male

      Al Amroh, HH; Reyes, AL; Barret Austin Hillary, J; Al Khaffaf, WH (Oxford University Press, 2020-07-24)
      Background: several genetic disorders are known to be associated with congenital insensitivity to pain (CIP), a term often used to describe an impaired ability to perceive the type, intensity and quality of noxious stimuli. Children with CIP often injure themselves severely. The injury can go unnoticed or be misdiagnosed as child abuse because it is associated with multiple and recurrent injuries which may result in permanent damage. Patient findings: we report the case of a 5-year-old boy with a history of showing no signs of pain when exposed to accidental injuries such as trauma, burns or secondary chronic lesions. Conclusion: child abuse has a much higher occurrence rate than rare neuropathies such as the one we describe. However, CIP should be considered as a diagnosis in any child presenting with a history of poor or absent responses to painful stimuli.
    • Patterns of deliberate self-burning in various parts of the world. A review.

      Laloë, V; Médecins Sans Frontières, 8 rue Saint-Sabin, 75544 Paris 11, France. veronique.laloe@bigfoot.com (Elsevier, 2004-05)
      This paper reviews the literature on deliberate self-burning (DSB) and compares patterns in various countries. Fifty-five studies of deliberate self-harm or suicide by fire published in the last 20 years were reviewed. They reported on 3351 cases of DSB, including 2296 deaths. India had the highest absolute number of cases, the highest fatality rate, and the highest contribution of self-harm to burns admissions. The highest reported incidence was from Sri Lanka. Male victims generally predominated in Western countries, and females in the Middle East and the Indian sub-continent. Patients were grossly 10 years older in Europe than in Asia. The use and nature of fire accelerants, the possible roles of ethnicity, religion/faith and imitation are discussed. Three broad groups of victims were identified: psychiatric patients (Western and Middle-Eastern countries); those committing DSB for personal reasons (India, Sri Lanka, Papua-New Guinea, Zimbabwe); and those who are politically motivated (India, South Korea). Self-mutilators and self-immolators seem to be fairly distinct groups of people.
    • Personal Protective Equipment for Filovirus Epidemics: A Call for Better Evidence

      Sprecher, Armand G; Caluwaerts, An; Draper, Mike; Feldmann, Heinz; Frey, Clifford P; Funk, Renée H; Kobinger, Gary; Le Duc, James W; Spiropoulou, Christina; Williams, Warren Jon (Oxford University Press, 2015-03-27)
      Personal protective equipment (PPE) is an important part of worker protection during filovirus outbreaks. The need to protect against a highly virulent fluid-borne pathogen in the tropical environment imposes a heat stress on the wearer that is itself a safety risk. No evidence supports the choice of PPE employed in recent outbreaks, and standard testing procedures employed by the protective garment industry do not well simulate filovirus exposure. Further research is needed to determine the appropriate PPE for filoviruses and the heat stress that it imposes.
    • Perspectives from MSF snakebite programme implementation in Agok, Abyei region, South Sudan

      Said, M; Valdespino, E; Baba, SP; Lako, R; Malm, A; Gonzalez, A; Alcoba, G (South Sudan Medical Journal, 2020-11-01)
      Introduction: Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge. Objective: Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital. Method: We describe the history, implementation, and challenges of the MSF snakebite programme. Results: The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005 snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems. Conclusion: The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list.