Case study of a 2022 pertussis epidemic in the Baoro sub-prefecture (Central African Republic).

OBJECTIVE: The objective of this survey was to describe epidemiological characteristics and evaluate vaccine effectiveness against pertussis in the sub-prefecture of Baoro (Central African Republic). METHOD: We conducted a case control study from June to July 2022 in the sub-prefecture of Baoro in the district of Baour-Baoro. Community-based definitions of surveillance were applied to include cases and controls. RESULTS: All in all, 143 confirmed and suspected cases and 166 controls were enrolled in this investigation. The epidemic had affected 12 neighborhoods and 9 villages. The village of Bugbassem alone had 32 patients, and 50% of the patients lived in rural areas. The age groups of 12 to 59 months accounted for 58% of cases. Patients were female in 54% of cases (p = 0.8). The attack rate among unvaccinated patients (65%) was higher than that of vaccinated patients (40%), while 15% (N = 21) of children were hospitalized with no recorded deaths. Pentavalent 3rd dose vaccination coverage was 49% in controls versus 33% in cases. Vaccination provided a significant protective effect (Odds Ratio = 0.3; 95% CI: 0.2-0.6). All told, vaccine efficacy against pertussis was 38%. CONCLUSION: Pertussis is a re-emerging disease currently occurring as a result of low pertussis vaccination coverage. It strongly affects rural areas with low vaccination rates. Vaccination strategy requires reinforcement in rural areas.

[Discovery of Foci of Type-2 Poliovirus Derived from Oral Polio Vaccine in Central African Republic in 2019]. / Découverte de Foyers de Poliovirus de Type-2 Dérivé du Vaccin Antipoliomyélitique Oral en République Centrafricaine en 2019.

Objective: In 2019, the Central African Republic identified foci of circulating vaccine-derived poliovirus 2 (PVDV2c). The objective of this work is to describe the vaccination status of children paralyzed by PVDV2c and their contacts and to assess the circulation of this strain in these contacts. Patients and method: The study population of this retrospective survey consists of children with acute flaccid paralysis (AFP) and their contacts. We included paralyzed children whose sequencing results showed the presence of PVDV2c. Results: A total of 21 children paralyzed by PVDVc and 64 contacts were enrolled in the survey. Fourteen out of 21 children who are paralyzed (66%) received at least one dose of bivalent oral polio vaccine (OPV) compared to 36 out of 64 contacts (57%, non-significant difference). Of the vaccinated patients, 7 had received less than three doses. For the injectable polio vaccine (IPV), vaccination coverage for both patients and contacts was 33%.The proportion of children who received both doses of OPV and IPV was 33% among patients and 25% in contacts. Contacts with VDPV2 were vaccinated with OPV and IPV, respectively 55 and 27%. VDPV2 and Sabin 2 were also found in contact stools, 34% and 9% respectively. Conclusion: The absence or inadequacy of IPV vaccination has a serious impact on children by the occurrence of virus derived from the vaccine responsible for life-old paralysis. Protecting children from poliomyelitis requires a combination of a good cold chain, multiple doses and adherence to the vaccine schedule.

[Responses to the Risk of Canine and Human Rabies in the City of Sibut, Central African Republic]. / Les réponses au risque de rage canine et humaine dans la ville de Sibut, République centrafricaine.

In Sibut (CAR), the increase in bites by stray dogs and two cases of human rabies alerted health authorities in 2019. The answers were the vaccinations of humans and of dog (780 dogs). Among the 127 humans bitten and identified, 87% received a first injection of post-exposure prophylaxis. The drop-out between the first and third doses was 41%. Communication on rabies and the provision of vaccines and serums to the population are necessary, but difficult to achieve in the crisis conditions of the country.

À Sibut (RCA), la multiplication des morsures par des chiens en divagation et deux cas de rage humaine ont alerté les autorités sanitaires en 2019. Les réponses ont été la vaccination de 780 chiens. Parmi les 127 humains mordus et identifiés, 87 % ont reçu une première dose de prophylaxie postexposition. Le taux d'abandon vaccinal entre la première et la troisième dose a été de 41 %. La communication sur la rage et la mise à la disposition de la population de vaccins et sérums sont nécessaires, difficiles à réaliser dans les conditions de crise que connaît le pays.

Malnutrition aiguë chez les enfants âgés de plus de 5 ans. A propos de 26 cas, dans un site des populations déplacées à Alindao

Introduction : Nous avons réalisé une enquête sur des cas de malnutrition inhabituelle dans le site de populations déplacées en post crise militaro-politique dans le district sanitaire d'Alindao. L'objectif de cette étude était de décrire les aspects sociodémographiques et cliniques de la maladie chez les enfants hors cibles de la malnutrition aiguë dans un site des personnes déplacées à Alindao. Matériels et méthode : A l'aide d'un questionnaire, les données sociodémographiques et cliniques ont été collectées chez les enfants de plus de 5 ans atteints de malnutrition aiguë dans le site des déplacés dans la sous-préfecture d'Alindao en octobre 2018. Résultats : Au total 26 enfants souffrant de la malnutrition aiguë ont été enrôlés dans l'étude. Dix-huit (69,2%) malades provenaient de la ville contre 8 (30,8%) du milieu rural. 76,9% des mères de ces enfants n'avaient aucun niveau d'instruction et 23,1% avaient un niveau primaire. Treize enfants sur 26 (50%) avaient déjà été hospitalisés pour la malnutrition aiguë. Les âges extrêmes étaient 6 et 10 ans. L'âge, le poids et la taille moyens étaient respectivement de 7,2 ans [écart type ; 1,3], 13,9 kg [écart type ; 2,8] et 104 cm [écart type ; 12,9]. Dix-neuf (73,1%) malades étaient du sexe féminin. 57,6% (n=15) d'enfants avaient un indice de masse corporelle inférieur à 13 et deux enfants étaient en surpoids (IMC à 20,5 et 23,3). Les principaux signes cliniques observés étaient la décoloration des cheveux (88,5%), la fièvre (76,9%), la diarrhée (73,1%) et l'amaigrissement (69,2%). Conclusion : En situation de déplacement une attention particulière doit être apportée aux enfants en général et surtout ceux du sexe féminin souvent plus affecté par la malnutrition aiguë. Une stratégie particulière doit d'être développée en faveur des mères d'enfants à faible niveau d'instruction pour une bonne alimentation de leurs enfants

Investigation of an outbreak of monkeypox in an area occupied by armed groups, Central African Republic.

BACKGROUND: Monkeypox is a zoonosis caused by an Orthopoxvirus of the Poxviridae family. Human infections are often severe and are a public health problem. PATIENTS AND METHOD: We conducted a monkeypox outbreak investigation of suspected case patients in five villages of the Alindao-Mingala Health District following blood sample confirmation of the virus by the Institut Pasteur in Bangui. We aimed to determine disease characteristics, to describe the context and the risk factors, and to measure the incidence and case fatality. Patients were reported in the villages of Rehou 4, 5, Dalakere 1, Kongbo, and Pavika from August to October 2016. Data was collected on individual records when interviewing patients or parents. RESULTS: A total of 26 patients were identified. The˂10 years and 21-30 years age groups were the most affected. The overall attack rate was 5 per 1000 inhabitants and the case fatality was 7.7%. Young age and the absence of smallpox vaccination were associated with severe presentations in 87.5% of cases. CONCLUSION: The annual number of monkeypox outbreaks increases in the Central African Republic with severe presentations and a high case fatality especially in children. Reinforcing the surveillance and characterization of circulating strains will provide information on the need for vaccine production.

[Twelve cases of monkeypox virus outbreak in Bangassou District (Central African Republic) in December 2015]. / Epidémie de 12 cas de maladie à virus monkeypox dans le district de Bangassou en République Centrafricaine en décembre 2015.

An outbreak of monkeypox occurred in the district of Bangassou in 2015. The monkeypox is a re-emerging zoonosis of viral origin highly contagious. It is an eruptive fever which evolves in an epidemic manner. An investigation was held December 10, 2015, to February 10, 2016 in the focus of the epidemic. Its objective was to describe the epidemic according to the time, places and people and to determine the incidence and lethality of the disease. This was a descriptive study. The data collection was made by interview and using a linear plug composed of several sections. All suspected cases were taken into account. The interview was done with patients or the parents of sick children. The blood and the contents of the lesions were collected and sent to the laboratory of the Institut Pasteur in Bangui for confirmation. Our data were analyzed with Epi info7. In total 12 patients had been registered including 9 secondary cases. Patients aged 31 to 40 years and less than 10 years were most affected. In addition, adults were most affected by the disease (8/12). The average age was 25 years with extremes at 15 months and 41 years. The sex male/female ratio was 1. The overall attack rate of disease and lethality were 0.2 per 1000 inhabitants and 25% respectively. The fatality was 67% among children less than 10 years. Fever and rash were the main symptoms of the disease. Lymphadenopathy was present in 54.5%. Ten of the 12 patients were hospitalized (83%). The average duration of hospitalization was 13 days with the extremes 6 and 28 days. The monkeypox like smallpox remains a serious and fatal disease in children. A survey of animal reservoirs complained to identify strains of the virus is essential. During an outbreak, good communication and isolation of patients may break the chain of transmission. Other measures to limit their contact with the forest or virus reservoirs are to be encouraged.