• Ulcere de Buruli

      Comte E; MSF Suisse (2008-01)
    • L'Ulcère de Buruli, Un Exemple de Plaies Chroniques en Milieu Tropical

      Vuagnat, H; Comte, E; L'Hôpitaux Universaires de Genève, Suisse; Médecins Sans Frontières, Genève, Suisse (2009-06)
    • An unfolding tragedy of Chagas disease in North America.

      Hotez, Peter J; Dumonteil, Eric; Betancourt Cravioto, Miguel; Bottazzi, Maria Elena; Tapia-Conyer, Roberto; Meymandi, Sheba; Karunakara, Unni; Ribeiro, Isabela; Cohen, Rachel M; Pecoul, Bernard; et al. (PLoS, 2013-11)
    • Unique Human Immune Signature of Ebola Virus Disease in Guinea

      Ruibal, P; Oestereich, L; Lüdtke, A; Becker-Ziaja, B; Wozniak, DM; Kerber, R; Korva, M; Cabeza-Cabrerizo, M; Bore, JA; Koundouno, FR; et al. (Nature Publishing Group, 2016-05-05)
      Despite the magnitude of the Ebola virus disease (EVD) outbreak in West Africa, there is still a fundamental lack of knowledge about the pathophysiology of EVD. In particular, very little is known about human immune responses to Ebola virus. Here we evaluate the physiology of the human T cell immune response in EVD patients at the time of admission to the Ebola Treatment Center in Guinea, and longitudinally until discharge or death. Through the use of multiparametric flow cytometry established by the European Mobile Laboratory in the field, we identify an immune signature that is unique in EVD fatalities. Fatal EVD was characterized by a high percentage of CD4(+) and CD8(+) T cells expressing the inhibitory molecules CTLA-4 and PD-1, which correlated with elevated inflammatory markers and high virus load. Conversely, surviving individuals showed significantly lower expression of CTLA-4 and PD-1 as well as lower inflammation, despite comparable overall T cell activation. Concomitant with virus clearance, survivors mounted a robust Ebola-virus-specific T cell response. Our findings suggest that dysregulation of the T cell response is a key component of EVD pathophysiology.
    • Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission

      Dalziel, BD; Lau, MSY; Tiffany, A; McClelland, A; Zelner, J; Bliss, JR; Grenfell, BY (2018-01-22)
      In the recent 2014-2016 Ebola epidemic in West Africa, non-hospitalized cases were an important component of the chain of transmission. However, non-hospitalized cases are at increased risk of going unreported because of barriers to access to healthcare. Furthermore, underreporting rates may fluctuate over space and time, biasing estimates of disease transmission rates, which are important for understanding spread and planning control measures. We performed a retrospective analysis on community deaths during the recent Ebola epidemic in Sierra Leone to estimate the number of unreported non-hospitalized cases, and to quantify how Ebola reporting rates varied across locations and over time. We then tested if variation in reporting rates affected the estimates of disease transmission rates that were used in surveillance and response. We found significant variation in reporting rates among districts, and district-specific rates of increases in reporting over time. Correcting time series of numbers of cases for variable reporting rates led, in some instances, to different estimates of the time-varying reproduction number of the epidemic, particularly outside the capital. Future analyses that compare Ebola transmission rates over time and across locations may be improved by considering the impacts of differential reporting rates.
    • Unusual presentation of acute annular urticaria: A case report

      Guerrier, Gilles; Daronat, Jean-Marc; Deltour, Roger; Epicentre, Paris, France; Agence de Sant´e, Wallis, France (Hindawi Publishing Corporation, 2011-07)
      Acute urticarial lesions may display central clearing with ecchymotic or haemorrhagic hue, often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. We report a case of acute annular urticaria with unusual presentation occurring in a 20-month-old child to emphasize the distinctive morphologic manifestations in a single disease. Clinicians who care for children should be able to differentiate acute urticaria from its clinical mimics. A directed history and physical examination can reliably orientate necessary diagnostic testing and allow for appropriate treatment.
    • Urban yellow fever outbreak—Democratic Republic of the Congo, 2016: Towards more rapid case detection

      Ingelbeen, B; Weregemere, NA; Noel, H; Tshapenda, GP; Mossoko, M; Nsio, J; Ronsse, A; Ahuka-Mundeke, S; Cohuet, S; Kebela, BI (Public Library of Sciences, 2018-12-07)
      Background Between December 2015 and July 2016, a yellow fever (YF) outbreak affected urban areas of Angola and the Democratic Republic of the Congo (DRC). We described the outbreak in DRC and assessed the accuracy of the YF case definition, to facilitate early diagnosis of cases in future urban outbreaks. Methodology/Principal findings In DRC, suspected YF infection was defined as jaundice within 2 weeks after acute fever onset and was confirmed by either IgM serology or PCR for YF viral RNA. We used case investigation and hospital admission forms. Comparing clinical signs between confirmed and discarded suspected YF cases, we calculated the predictive values of each sign for confirmed YF and the diagnostic accuracy of several suspected YF case definitions. Fifty seven of 78 (73%) confirmed cases had travelled from Angola: 88% (50/57) men; median age 31 years (IQR 25–37). 15 (19%) confirmed cases were infected locally in urban settings in DRC. Median time from symptom onset to healthcare consultation was 7 days (IQR 6–9), to appearance of jaundice 8 days (IQR 7–11), to sample collection 9 days (IQR 7–14), and to hospitalization 17 days (IQR 11–26). A case definition including fever or jaundice, combined with myalgia or a negative malaria test, yielded an improved sensitivity (100%) and specificity (57%). Conclusions/Significance As jaundice appeared late, the majority of cases were diagnosed too late for supportive care and prompt vector control. In areas with known local YF transmission, a suspected case definition without jaundice as essential criterion could facilitate earlier YF diagnosis, care and control.
    • The urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in Africa

      O'Brien, Daniel P; Comte, Eric; Serafini, Micaela; Ehounou, Geneviève; Antierens, Annick; Vuagnat, Hubert; Christinet, Vanessa; Hamani, Mitima D; du Cros, Philipp; Manson Unit, Médecins Sans Frontières, London, UK; Department of Infectious Diseases, Geelong Hospital, Geelong, VIC, Australia; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia. Electronic address: daniel.obrien@amsterdam.msf.org. (Elsevier, 2013-12-02)
      Despite great advances in the diagnosis and treatment of Buruli ulcer, it is one of the least studied major neglected tropical diseases. In Africa, major constraints in the management of Buruli ulcer relate to diagnosis and treatment, and accessibility, feasibility, and delivery of services. In this Personal View, we outline key areas for clinical, diagnostic, and operational research on this disease in Africa and propose a research agenda that aims to advance the management of Buruli ulcer in Africa. A model of care is needed to increase early case detection, to diagnose the disease accurately, to simplify and improve treatment, to reduce side-effects of treatment, to deal with populations with HIV and tuberculosis appropriately, to decentralise care, and to scale up coverage in populations at risk. This approach will require commitment and support to strategically implement research by national Buruli ulcer programmes and international technical and donor organisations, combined with adaptations in programme design and advocacy. A critical next step is to build consensus for a research agenda with WHO and relevant groups experienced in Buruli ulcer care or related diseases, and we call on on them to help to turn this agenda into reality.
    • Use of a Cholera Rapid Diagnostic Test during a Mass Vaccination Campaign in Response to an Epidemic in Guinea, 2012

      Martinez-Pino, Isabel; Luquero, Francisco J; Sakoba, Kéïta; Sylla, Souleymane; Haile, Melatwork; Grais, RFebecca F; Ciglenecki, Iza; Quilici, Marie-Laure; Page, Anne-Laure; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden ; Epicentre, Paris, France. (Public Library of Science, 2013-08-15)
      During the 2012 cholera outbreak in the Republic of Guinea, the Ministry of Health, supported by Médecins Sans Frontières - Operational Center Geneva, used the oral cholera vaccine Shanchol as a part of the emergency response. The rapid diagnostic test (RDT) Crystal VC, widely used during outbreaks, detects lipopolysaccharide antigens of Vibrio cholerae O1 and O139, both included in Shanchol. In the context of reactive use of a whole-cell cholera vaccine in a region where cholera cases have been reported, it is essential to know what proportion of vaccinated individuals would be reactive to the RDT and for how long after vaccination.
    • The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg outbreak in Angola

      Grolla, Allen; Jones, Steven M.; Fernando, Lisa; Strong, James E.; Ströher, Ute; Möller, Peggy; Paweska, Janusz T.; Burt, Felicity; Pablo Palma, Pedro; Sprecher, Armand; et al. (Public Library of Science, 2011-05-24)
      Background: Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date. Methodology/Principal Findings: A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in ,4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention. Conclusions/Significance: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.
    • The Use of Ebola Convalescent Plasma to Treat Ebola Virus Disease in Resource Constrained Settings: A Perspective from the Field

      van Griensven, Johan; De Weiggheleire, Anja; Delamou, Alexandre; Smith, Peter G; Edwards, Tansy; Vandekerckhove, Philippe; Ibrahima Bah, Elhadj; Colebunders, Robert; Herve, Isola; Lazaygues, Catherine; et al. (Oxford University Press, 2015-08-10)
      The clinical evaluation of convalescent plasma (CP) for the treatment of Ebola Virus Disease (EVD) in the current outbreak, predominantly affecting Guinea, Sierra Leone and Liberia, was prioritized by the World Health Organization in September 2014. In each of these countries, non-randomized comparative clinical trials were initiated. The Ebola-Tx trial in Conakry, Guinea enrolled 102 patients by July 7, 2015; no severe adverse reactions were noted. The Ebola-CP trial in Sierra Leone and the EVD001 trial in Liberia have included few patients. While no efficacy data are available yet, current field experience supports the safety, acceptability and feasibility of CP as EVD treatment. Longer-term follow-up as well as data from non-trial settings and evidence on the scalability of the intervention are required. CP sourced from within the outbreak is the most readily available source of anti-EVD antibodies. Until the advent of effective antivirals or monoclonal antibodies, CP merits further evaluation.
    • Using European Travellers as an Early Alert to Detect Emerging Pathogens in Countries with Limited Laboratory Resources.

      Guerin, P J; Grais, RF; Rottingen, J A; Valleron, A J; Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway. philippe.guerin@epicentre.msf.org (2007)
      BACKGROUND: The volume, extent and speed of travel have dramatically increased in the past decades, providing the potential for an infectious disease to spread through the transportation network. By collecting information on the suspected place of infection, existing surveillance systems in industrialized countries may provide timely information for areas of the world without adequate surveillance currently in place. We present the results of a case study using reported cases of Shigella dysenteriae serotype 1 (Sd1) in European travellers to detect "events" of Sd1, related to either epidemic cases or endemic cases in developing countries. METHODS: We identified papers from a Medline search for reported events of Sd1 from 1940 to 2002. We requested data on shigella infections reported to the responsible surveillance entities in 17 European countries. Reports of Sd1 from the published literature were then compared with Sd1 notified cases among European travellers from 1990 to 2002. RESULTS: Prior to a large epidemic in 1999-2000, no cases of Sd1 had been identified in West Africa. However, if travellers had been used as an early warning, Sd1 could have been identified in this region as earlier as 1992. CONCLUSION: This project demonstrates that tracking diseases in European travellers could be used to detect emerging disease in developing countries. This approach should be further tested with a view to the continuous improvement of national health surveillance systems and existing European networks, and may play a significant role in aiding the international public health community to improve infectious disease control.
    • Vibrio cholerae O1 variant with reduced susceptibility to ciprofloxacin, Western Africa [letter]

      Quilici, Marie Laure; Massenet, Denis; Gake, Bouba; Bwalki, Barem; Olson, David M; Institut Pasteur, Paris, France; Centre Pasteur Cameroun, Garoua, Cameroon; State Epidemiologic Unit, Yola, Adamawa State, Nigeria; Doctors Without Borders/Médecins Sans Frontières, New York, New York (2010-10-22)
    • Viewpoint: filovirus haemorrhagic fever outbreaks: much ado about nothing?

      Borchert, M; Boelaert, M; Sleurs, H; Muyembe-Tamfum, J J; Pirard, P; Colebunders, R; Van der Stuyft, P; van der Groen, G; Institute of Tropical Medicine, Antwerp, Belgium. mborchert@itg.be (2000-05)
      The recent outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo has put the filovirus threat back on the international health agenda. This paper gives an overview of Marburg and Ebola outbreaks so far observed and puts them in a public health perspective. Damage on the local level has been devastating at times, but was marginal on the international level despite the considerable media attention these outbreaks received. The potential hazard of outbreaks, however, after export of filovirus from its natural environment into metropolitan areas, is argued to be considerable. Some avenues for future research and intervention are explored. Beyond the obvious need to find the reservoir and study the natural history, public health strategies for a more timely and efficient response are urgently needed.
    • Vulnerability to snakebite envenoming: a global mapping of hotspots

      Longbottom, J; Shearer, FM; Devine, M; Alcoba, G; Chappuis, F; Weiss, DJ; Ray, SE; Ray, N; Warrell, DA; Ruiz de Castañeda, R; et al. (Elsevier, 2018-07-12)
      Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.
    • Wartime Colon Injuries: Primary Repair or Colostomy?

      Moreels, R; Pont, M; Ean, S; Vitharit, M; Vuthy, C; Roy, S; Boelaert, M; Médecins Sans Frontières, Brussels, Belgium. (Published by the Royal Society of Medicine, 1994-05)
      A retrospective non-randomized study, comparing primary repair with colostomy, was made on a series of 102 patients with penetrating intraperitoneal colon injuries, in a war surgery programme in Cambodia. The overall case fatality rate (CFR) was 25.5%, whereas in the primary repair group CFR was 20%, compared to 30.8% in the colostomy group. The difference was not statistically significant (P = 0.30). Adjustment for possible confounding factors in the two groups did not alter the results. Considering the numerous advantages to the patient of a primary closure in the precarious situations where war surgery is often performed, this technique merits consideration.
    • We Urge WHO to Act on Cytomegalovirus Retinitis

      Heiden, David; Saranchuk, Peter; Tun, NiNi; Audoin, Bertrand; Cohn, Jen; Durier, Nicolas; Holland, Gary; Drew, W Lawrence; Hoen, Ellen 't (2014-02)
    • 'When Ebola enters a home, a family, a community': A qualitative study of population perspectives on Ebola control measures in rural and urban areas of Sierra Leone

      Gray, N; Stringer, B; Bark, G; Heller Perache, A; Jephcott, F; Broeder, R; Kremer, R; Jimissa, AS; Samba, TT (Public Library of Science, 2018-06-08)
      During the West Africa Ebola outbreak, cultural practices have been described as hindering response efforts. The acceptance of control measures improved during the outbreak, but little is known about how and why this occurred. We conducted a qualitative study in two administrative districts of Sierra Leone to understand Ebola survivor, community, and health worker perspectives on Ebola control measures. We aimed to gain an understanding of community interactions with the Ebola response to inform future intervention strategies.
    • Women experience a better long-term immune recovery and a better survival on HAART in Lao People's Democratic Republic.

      Bastard, Mathieu; Soulinphumy, Khamphang; Phimmasone, Prasith; Saadani, Ahmed Hassani; Ciaffi, Laura; Communier, Arlette; Phimphachanh, Chansy; Ecochard, René; Etard, Jean-François; Epicentre, Paris, France. (BioMed Central, 2013-01-22)
    • Wound care in resource-poor settings

      Comte E, Vuagnat H; MSF (2013)