Antibacterial Activity of Eight Medicinal Plants from the Traditional Pharmacopoeia of Niger.

The emergence of multidrug bacterial resistance poses a great public health problem and requires a constant search for new antibacterial agents. However, Niger's flora possesses several medicinal plants used in traditional medicine to cure infectious diseases and can be used as sources of bioactive ingredients. This current study was designed to evaluate the antibacterial activity of eight plants used in the traditional pharmacopeia of Niger. The extracts were prepared by maceration using ethanol, methanol, and distilled water. The obtained extracts were screened against Salmonella spp., Shigella spp., and Escherichia coli using the microdilution method coupled with a resazurin-based assay. Phytochemical screening was performed using colorimetry, while the quantification of total polyphenols, total flavonoids, and total tannins was determined by spectrophotometry. Out of the eight plants obtained, five named Cassia italica, Limeum pterocarpum, Phyllanthus pentandrus, Strychnos innocua, and Ximenia americanum exhibited antibacterial activity with MICs ranging from 500 µg/mL to 2000 µg/mL. Phytochemical screening showed the presence of alkaloids, saponosides, tannins, flavonoids, terpenes/sterols, quinones, and polyphenols. The ethanolic and methanolic extracts of X. americana contained important quantities of total polyphenols, with 43.59 ± 0.15 and 41.97 ± 0.02 mg EAG/100 mg of extract, respectively. These extracts showed the highest contents of total tannins at 46.49 g/L and 45.52 g/L, respectively. For total flavonoids, the highest content was obtained with the methanolic extract of P. pentandrus, with 3.12 ± 0.01 mg QE/100 mg of extract. These findings justify the uses of these plants in traditional medicine for the treatment of infectious diseases such as diarrhea and can be used as starting points for the development of phytodrugs against infectious diarrhea.

Evaluation of response strategies against epidemics due to Neisseria meningitidis C in Niger.

OBJECTIVE: To inform public health recommendations, we evaluated the effectiveness and efficiency of current and hypothetical surveillance and vaccine response strategies against Neisseria meningitidis C meningitis epidemics in 2015 in Niger. METHODS: We analysed reports of suspected and confirmed cases of meningitis from the region of Dosso during 2014 and 2015. Based on a definition of epidemic signals, the effectiveness and efficiency of surveillance and vaccine response strategies were evaluated by calculating the number of potentially vaccine-preventable cases and number of vaccine doses needed per epidemic signal. RESULTS: A total of 4763 weekly health area reports, collected in 90 health areas with 1282 suspected meningitis cases, were included. At a threshold of 10 per 100 000, the total number of estimated vaccine-preventable cases was 29 with district-level surveillance and vaccine response, 141 with health area-level surveillance and vaccination and 339 with health area-level surveillance and district-level vaccination. While being most effective, the latter strategy required the largest number of vaccine doses (1.8 million), similar to the strategy of surveillance and vaccination at district level (1.3 million), whereas the strategy of surveillance and vaccination at health area level would have required only 0.8 million doses. Thus, efficiency was lowest for district-level surveillance and highest for health area-level surveillance with district-level vaccination. CONCLUSION: In this analysis, we found that effectiveness and efficiency were higher at health area-level surveillance and district-level vaccination than for other strategies. Use of N. meningitidis C vaccines in a preventive strategy thus should be considered, in particular as most reactive vaccine response strategies in our analysis had little impact on disease burden.

Serogroup-Specific Characteristics of Localized Meningococcal Meningitis Epidemics in Niger 2002-2012 and 2015: Analysis of Health Center Level Surveillance Data.

To compare dynamics of localized meningitis epidemics (LE) by meningococcal (Nm) serogroup, we analyzed a surveillance database of suspected and laboratory-confirmed Nm cases from 373 health areas (HA) of three regions in Niger during 2002-2012 and one region concerned by NmC epidemics during 2015. We defined LE as HA weekly incidence rates of ≥20 suspected cases per 100,000 during ≥2 weeks and assigned the predominant serogroup based on polymerase chain reaction testing of cerebrospinal fluid. Among the 175 LE, median peak weekly incidence rate in LE due to NmA, W, X and C were 54, 39, 109 and 46 per 100,000, respectively. These differences impacted ability of the epidemic to be detected at the district level. While this analysis is limited by the small number of LE due to NmX (N = 4) and NmW (N = 5), further research should explore whether strategies for prevention and response to meningitis epidemics need to be adapted according to predominant meningococcal serogroups.

Response Strategies against Meningitis Epidemics after Elimination of Serogroup A Meningococci, Niger.

To inform epidemic response strategies for the African meningitis belt after a meningococcal serogroup A conjugate vaccine was introduced in 2010, we compared the effectiveness and efficiency of meningitis surveillance and vaccine response strategies at district and health area levels using various thresholds of weekly incidence rates. We analyzed reports of suspected cases from 3 regions in Niger during 2002-2012 (154,392 health area weeks), simulating elimination of serogroup A meningitis by excluding health area years with identification of such cases. Effectiveness was highest for health area surveillance and district vaccination (58-366 cases; thresholds 7-20 cases/100,000 doses), whereas efficiency was optimized with health area vaccination (5.6-7.7 cases/100,000 doses). District-level intervention prevented <6 cases (0.2 cases/100,000 doses). Reducing the delay between epidemic signal and vaccine protection by 2 weeks doubled efficiency. Subdistrict surveillance and response might be most appropriate for meningitis epidemic response after elimination of serogroup A meningitis.

Spatio-temporal factors associated with meningococcal meningitis annual incidence at the health centre level in Niger, 2004-2010.

BACKGROUND: Epidemics of meningococcal meningitis (MM) recurrently strike the African Meningitis Belt. This study aimed at investigating factors, still poorly understood, that influence annual incidence of MM serogroup A, the main etiologic agent over 2004-2010, at a fine spatial scale in Niger. METHODOLOGY/PRINCIPAL FINDINGS: To take into account data dependencies over space and time and control for unobserved confounding factors, we developed an explanatory Bayesian hierarchical model over 2004-2010 at the health centre catchment area (HCCA) level. The multivariate model revealed that both climatic and non-climatic factors were important for explaining spatio-temporal variations in incidence: mean relative humidity during November-June over the study region (posterior mean Incidence Rate Ratio (IRR) = 0.656, 95% Credible Interval (CI) 0.405-0.949) and occurrence of early rains in March in a HCCA (IRR = 0.353, 95% CI 0.239-0.502) were protective factors; a higher risk was associated with the percentage of neighbouring HCCAs having at least one MM A case during the same year (IRR = 2.365, 95% CI 2.078-2.695), the presence of a road crossing the HCCA (IRR = 1.743, 95% CI 1.173-2.474) and the occurrence of cases before 31 December in a HCCA (IRR = 6.801, 95% CI 4.004-10.910). At the study region level, higher annual incidence correlated with greater geographic spread and, to a lesser extent, with higher intensity of localized outbreaks. CONCLUSIONS: Based on these findings, we hypothesize that spatio-temporal variability of MM A incidence between years and HCCAs result from variations in the intensity or duration of the dry season climatic effects on disease risk, and is further impacted by factors of spatial contacts, representing facilitated pathogen transmission. Additional unexplained factors may contribute to the observed incidence patterns and should be further investigated.

A five-year field assessment of rapid diagnostic tests for meningococcal meningitis in Niger by using the combination of conventional and real-time PCR assays as a gold standard.

BACKGROUND: Meningococcocal meningitis represents an important cause of mortality and morbidity in sub-Saharan countries. Confirmatory bacteriological or molecular diagnosis is essential for patient management/treatment and meningitis surveillance, but many laboratory tests are expensive and rarely available for low-income countries. A rapid diagnostic test (RDT) represents a valuable alternative to improve case management and surveillance. METHODS: A dipstick RDT developed in early 2000s that detects Neisseria meningitidis serogroups A, C, W and Y but for which a new conjugated antibody (L4-8) for the detection of serogroup A replaced the original K15-2 was assessed in the field by trained staff from health centres and district hospitals in Niger. The results were compared to those obtained in the reference laboratory and the sensitivity and specificity of RDTs were determined using conventional and real-time PCR assays as a gold standard. RESULTS: RDT results from field staff and the reference laboratory obtained for 2095 cerebrospinal fluid (CSF) specimens presented a strong concordance of 94% with Cohen's κ coefficient of 0.88. The observed concordance between RDTs operated by staff from the reference laboratory vs combination of conventional and real-time PCR assays was 89% with Cohen's κ coefficient of 0.76 indicating very good agreement. The theoretical overall sensitivity for RDT was 91.5% and the specificity 84.6%. CONCLUSIONS: RDT has proven to be relatively sensitive and specific for the detection of meningococcal serogroups A/C/Y/W. We confirmed that these RDTs can be reliably operated by trained but non-specialised staff in basic health facilities.