• 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.
    • Marburg hemorrhagic fever in Durba and Watsa, Democratic Republic of the Congo: clinical documentation, features of illness, and treatment

      Colebunders, Robert; Tshomba, Antoine; Van Kerkhove, Maria D; Bausch, Daniel G; Campbell, Pat; Libande, Modeste; Pirard, Patricia; Tshioko, Florimond; Mardel, Simon; Mulangu, Sabue; et al. (2007-11-15)
      The objective of the present study was to describe day of onset and duration of symptoms of Marburg hemorrhagic fever (MHF), to summarize the treatments applied, and to assess the quality of clinical documentation. Surveillance and clinical records of 77 patients with MHF cases were reviewed. Initial symptoms included fever, headache, general pain, nausea, vomiting, and anorexia (median day of onset, day 1-2), followed by hemorrhagic manifestations (day 5-8+), and terminal symptoms included confusion, agitation, coma, anuria, and shock. Treatment in isolation wards was acceptable, but the quality of clinical documentation was unsatisfactory. Improved clinical documentation is necessary for a basic evaluation of supportive treatment.
    • Measles epidemic in the urban community of Niamey: transmission patterns, vaccine efficacy and immunization strategies, Niger, 1990 to 1991.

      Malfait, P; Jataou, I M; Jollet, M C; Margot, A; De Benoist, A C; Moren, A; Epicentre, Paris, France. (1994-01)
      From October 1, 1990, until April 28, 1991, 13,578 cases of measles were reported in the urban community of Niamey, Niger. Vaccine coverages (one dose of Schwarz vaccine given after 9 months) in urban community of Niamey were, respectively, 63% at the age of 12 months and 73% at 24 months before the epidemic. Incidence rates were the highest among children ages 6 to 8 months and 9 to 11 months and 22% of the cases were less than 1 year old. Vaccine efficacy estimates ranged from 86 to 94% according to age groups and the method used (screening method, case control study, retrospective cohort study). The risk of transmission of illness increased with the intensity of contact with a case. Contact with a health facility 7 to 22 days before onset of rash was not a risk factor. Seasonal migrants in Niamey were more likely to develop measles. Recommendations included implementation of an early two dose schedule of measles immunization during the outbreak, vaccination offered at each contact with a health facility, radio and television advertising for measles immunization and distribution of vitamin A to all measles cases.
    • Measles hotspots and epidemiological connectivity

      Bharti, N; Djibo, A; Ferrari, M J; Grais, RF F; Tatem, A J; McCabe, C A; Bjornstad, O N; Grenfell, B T; Penn State University, Biology Department and Center for Infectious Disease Dynamics, University Park, PA, USA; Ministry of Health, Niamey, Niger; Epicentre, Paris, France; University of Florida, Emerging Pathogens Institute and Department of Geography, Gainesville, FL, USA; Penn State University, Department of Geography and GeoVISTA Center, University Park, PA, USA; Penn State University, Department of Entomology, University Park, PA, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (2010-09-25)
      Though largely controlled in developed countries, measles remains a major global public health issue. Regional and local transmission patterns are rooted in human mixing behaviour across spatial scales. Identifying spatial interactions that contribute to recurring epidemics helps define and predict outbreak patterns. Using spatially explicit reported cases from measles outbreaks in Niger, we explored how regional variations in movement and contact patterns relate to patterns of measles incidence. Because we expected to see lower rates of re-introductions in small, compared to large, populations, we measured the population-size corrected proportion of weeks with zero cases across districts to understand relative rates of measles re-introductions. We found that critical elements of spatial disease dynamics in Niger are agricultural seasonality, transnational contact clusters, and roads networks that facilitate host movement and connectivity. These results highlight the need to understand local patterns of seasonality, demographic characteristics, and spatial heterogeneities to inform vaccination policy.
    • Measles Outbreak in a Refugee Settlement in Calais, France: January to February 2016

      Jones, G; Haeghebaert, S; Merlin, B; Antona, D; Simon, N; Elmouden, M; Battist, F; Janssens, M; Wyndels, K; Chaud, P (European Centre for Disease Prevention and Control, 2016-03-17)
      We report a measles outbreak in a refugee settlement in Calais, France, between 5 January and 11 February 2016. In total, 13 confirmed measles cases were identified among migrants, healthcare workers in hospital and volunteers working on site. A large scale vaccination campaign was carried out in the settlement within two weeks of outbreak notification. In total, 60% of the estimated target population of 3,500 refugees was vaccinated during the week-long campaign.
    • Measles outbreaks in the Mozambican refugee camps in Malawi: the continued need for an effective vaccine.

      Porter, J D; Gastellu-Etchegorry, M; Navarre, I; Lungu, G; Moren, A; Epicentre, Paris, France. (Oxford University Press, 1990-12)
      Between November 1988 and January 1989, measles outbreaks occurred in 11 Mozambican refugee camps in Malawi with five camps principally affected. A total of 1214 cases were reported. Despite the reduction of the age of measles vaccination to six months in 1987, attack rates were highest in children aged 6-9 months (10-26%); rates were also high in the 0-5 month age group (3-21%). The case-fatality rate was high among children less than five years old (15-21%). Children were being inappropriately vaccinated, either being vaccinated at less than six months of age (2-29%) or failing to receive a second dose if vaccinated at six months (0-25%). With vaccine coverage between 66-87%, vaccine efficacy in children less than five years old was estimated to be more than 90% in the camps principally affected. Reduction of the age of vaccination leads to logistical problems in vaccine delivery in refugee situations. These outbreaks again indicate the need to improve vaccine coverage with the existing Schwarz vaccine, and also highlight the urgent need for an effective single dose measles vaccine for children less than nine months of age.
    • Measles vaccine effectiveness in standard and early immunization strategies, Niger, 1995.

      Kaninda, A V; Legros, D; Jataou, I M; Malfait, P; Maisonneuve, M; Paquet, C; Moren, A; Epicentre, Paris, France. epimail@epicentre.msf.org (1998-11)
      BACKGROUND: An Expanded Programme on Immunization was started in late 1987 in Niger, including vaccination against measles with one dose of standard titer Schwarz vaccine given to infants after 9 months of age. During epidemics an early two-dose strategy was implemented (one dose between 6 and 8 months and one dose after 9 months). From January 1, 1995, until May 7, 1995, 13 892 measles cases were reported in Niamey, Niger. METHODS: A retrospective cohort study was conducted in a crowded area of Niamey at the end of the outbreak to assess the effectiveness of measles vaccine in standard (after 9 months) and early (before 9 months) immunization strategies under field conditions. RESULTS: Highest measles incidence rates were observed among children <1 year of age. Vaccine effectiveness estimates increased with age at vaccination from 78% with a single dose administered at 6 months of age to 95% at 9 months. Vaccine effectiveness with the early two dose strategy was 93%. CONCLUSIONS: Immunization with a single dose of standard titer Schwarz vaccine before 9 months of age provided higher clinical protection than expected from seropositivity studies. The early two dose strategy is justified in contexts where measles incidence is high before 9 months of age. Our results raise the issue of lowering the recommended age for measles vaccination in developing countries.
    • The Medecins Sans Frontieres Intervention in the Marburg Hemorrhagic Fever Epidemic, Uige, Angola, 2005. I. Lessons Learned in the Hospital.

      Jeffs, B; Roddy, P; Weatherill, D; de la Rosa, O; Dorion, C; Iscla, M; Grovas, I; Palma, P; Villa, L; Bernal, O; et al. (Published by Infectious Diseases Society of America, 2007-11-15)
      When the epidemic of Marburg hemorrhagic fever occurred in Uige, Angola, during 2005, the international response included systems of case detection and isolation, community education, the burial of the dead, and disinfection. However, despite large investments of staff and money by the organizations involved, only a fraction of the reported number of cases were isolated, and many cases were detected only after death. This article describes the response of Medecins Sans Frontieres Spain within the provincial hospital in Uige, as well as the lessons they learned during the epidemic. Diagnosis, management of patients, and infection control activities in the hospital are discussed. To improve the acceptability of the response to the host community, psychological and cultural factors need to be considered at all stages of planning and implementation in the isolation ward. More interventional medical care may not only improve survival but also improve acceptability.
    • The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. II. lessons learned in the community.

      Roddy, P; Weatherill, D; Jeffs, B; Abaakouk, Z; Dorion, C; Rodriguez-Martinez, J; Palma, P P; de la Rosa, O; Villa, L; Grovas, I; et al. (2007-11-15)
      From 27 March 2005 onwards, the independent humanitarian medical aid agency Medecins Sans Frontieres, together with the World Health Organization, the Angolan Ministry of Health, and others, responded to the Marburg hemorrhagic fever (MHF) outbreak in Uige, Angola, to contain the epidemic and care for those infected. This response included community epidemiological surveillance, clinical assessment and isolation of patients with MHF, safe burials and disinfection, home-based risk reduction, peripheral health facility support, psychosocial support, and information and education campaigns. Lessons were learned during the implementation of each outbreak control component, and the subsequent modifications of protocols and strategies are discussed. Similar to what was seen in previous filovirus hemorrhagic fever outbreaks, the containment of the MHF epidemic depended on the collaboration of the affected community. Actively involving all stakeholders from the start of the outbreak response is crucial.