Efficacy of three artemisinin combination therapies for the treatment of uncomplicated Plasmodium falciparummalaria in the Republic of Congo

Background: Presented here are the results of a comparative trial on the efficacy of three artemisinin-based combinations conducted from May to October 2004; in Pool Province; Republic of Congo.Methods: The main outcome was the proportion of cases of true treatment success at day 28. Recrudescences were distinguished from re-infections by PCR analysis. A total of 298 children of 6-59 months were randomized to receive either artesunate + SP (AS+SP); artesunate + amodiaquine (AS+AQ) or artemether + lumefantrine (AL); of which 15 (5) were lost to follow-up. Results: After 28 days; there were 21/85 (25) recurrent parasitaemias in the AS+SP group; 31/97 (32) in the AS+AQ group and 13/100 (13) in the AL group. The 28-day PCR-corrected cure rate was 90.1[95CI 80.7-95.9] for AS+SP; 98.5[95CI 92.0-100] for AS+AQ and 100[95.8-100] for AL; thereby revealing a weaker response to AS+SP than to AL (p=0.003) and to AS+AQ (p=0.06). A potential bias was the fact that children treated with AL were slightly older and in better clinical condition; but logistic regression did not identify these as relevant factors. There was no significant difference between groups in fever and parasite clearance time; improvement of anaemia and gametocyte carriage at day 28. No serious adverse events were reported. Conclusions: Considering the higher efficacy of AL as compared to AS+SP and the relatively high proportion of cases with re-infections in the AS+AQ group; we conclude that AL is clinically more effective than AS+SP and AS+AQ in this area of the Republic of Congo. Implementation of the recently chosen new national first-line AS+AQ should be monitored closely

[Outbreak of Ebola hemorrhagic fever in the Republic of the Congo, 2003: a new strategy?]. / L'épidémie de fièvre hémorragique à virus Ebola en République du Congo, 2003: une nouvelle stratégie?

This article describes the last Ebola haemorrhagic fever (EHF) outbreak that occurred in the Cuvette Ouest Region of the Republic of Congo from January to April 2003. Epidemiological study demonstrated that the first patient, in whom diagnosis was made retrospectively, became ill on December 25, 2002. Subsequently until May 7, 2003, a total of 143 cases were recorded in the Mbomo and Kéllé health districts including 129 fatalities. Thirteen cases were laboratory confirmed and 130 were epidemiologically linked. Fifty-three percent of patients were male. Age ranged form 5 days to 80 years. Transmission involved direct contact with an infected person especially within families. Epidemiological data traced introduction of Ebola virus into the population to three primary cases mainly involving hunters. In all three cases development of the disease followed contact with non-human primates (gorillas) and other mammals (antelope) that had either been killed or found dead. Three health care workers were infected during the epidemic but nosocomial transmission played a minor role in the epidemic. On June 5, the Minister of Health and Population of the Congo Republic officially declared that the outbreak of EHF was over in the Cuvette Ouest Region. The last case was recorded on April 22 in the small village of Ndjoukou.