[The Neisseria meningitidis W135 epidemic in 2012 in Burkina Faso]. / L'épidémie de méningite à Neisseria meningitidis W135 en 2012 au Burkina Faso.

We describe the main features of a meningitis outbreak caused by Neisseria meningitidis W135 which occurred in Burkina Faso from January to April 2012. Data were collected from the health districts. Meningitis cases were defined as suspected cases, probable or confirmed, according to clinical and laboratory criteria. The epidemic reached 13 health districts with a total of 5300 reported cases and 553 deaths (10.4%), mainly in the age group 5-14 years. The sex ratio was 1.3 for males. N. meningitidis W135 was reported in 49 of 63 (78%) districts and identified by latex test in 68% of cerebrospinal fluid. Three health districts have benefited from a reactive vaccination campaign with the tetravalent vaccine polysaccaridic (A, C, Y, W135). Patients were treated with ceftriaxone or ampicillin, in accordance with national guidelines. This study emphasized the necessity to strengthen the epidemiological surveillance and laboratory capacities, and make available the tetravalent conjugated vaccine in order to improve the response to meningitis outbreaks.

[People living with HIV: daily life and management of the risk of transmission in the infected person's entourage: study in Ouagadougou]. / Les personnes vivant avec le VIH, vécu quotidien et gestion du risque de transmission à l'entourage: étude à Ouagadougou.

HIV infection has modified social relationships not only within various population subgroups but also at the family level. Patient management has been seriously affected. In 2001 we undertook a descriptive study among a population of PLHIV treated in an ambulatory center in order to 1(o)) describe the socio-demographical characteristics of PLHIV admitted to the center and 2(o)) identify the strategies adopted by PLHIV and their families to control the risk of HIV transmission in the entourage. Patients were systematically included over a period of two weeks. Each patient was asked to indicate the name of a family member that could be interviewed by the research team. A total of 188 PLHIV (122 women) ranging in age from 19 to 55 years were questioned. Interviews were conducted in 66 families. Most PLHIV had received some formal education ranging from primary school to university. Over one third (36.4%) had known that they were seropositive for at least one year. Almost three-fourths (73.4%) were aware that HIV was transmissible to other people. The most frequently mentioned transmission hazards were handling contaminated articles (51.5%), unprotected sexual intercourse (46.4%), contact with blood (34.8%), and sharing personal toilet articles (11.6%). The most commonly mentioned preventive measures were abstinence from sex (27.1%), use condoms (28.7%), and protection from pointed or cutting objects (19.1%). According to responding family members, the most common protective measures against HIV transmission were observing hygiene measures (36.5%), discarding any fluids from the ill person in the toilet (26.5%), wearing gloves (25%), and protecting against handling contaminated objects (5.8%). These data suggest that programs aimed at educating PLHIV and their families on the risk of HIV transmission and preventive measure has had a positive impact on the quality of life.

[HIV infection and modification of social relationships: study of 188 HIV-infected persons in Ouagadougou (Burkina Faso)]. / Infection à VIH et modifications des relations sociales: étude auprès de 188 personnes infectées par le VIH à Ouagadougou (Burkina Faso).

HIV infection creates diverse representations among sick people, their families, the community and healthcare workers, representations that modify social relationships. To analyze the interpersonal relationships in families of people living with HIV, we began a cross-sectional descriptive study in 2001 of a population of HIV patients treated at an outpatient center in Ouagadougou. Our objectives were to: 1 degree) describe the changes in the social relationships between the subjects and members of their families; 2 degrees) itemize the difficulties they met within their families and identify the different types of discrimination they may suffer there. The systematic inclusion of HIV patients at the treatment center made it possible to question 188 subjects, including 122 women and 66 men aged 19 to 55 years. With the subjects' consent, 66 family members were also interviewed. According to these patients, the principal significant events experienced after disclosing their HIV status were absence of sexual intercourse with the partner (16.0%), rejection by their family (9.6%), taunting, criticism and contempt (6.4%). This conduct came from siblings (25%), other family members (20.8%), neighbours (20.8%), in-laws (16.7%), and the spouse (4.2%). Among our subjects, 74.5% informed their families that they were HIV-positive. Of the family members questioned, 82.1% considered the subject to be a victim and 17.9% considered him or her guilty. After receiving this information 21.5% of the families modified their relationships with the subjects. Despite information and awareness campaigns, HIV infection is laden with emotion and prejudice and subjects its victims to discriminatory behavior. Further public education is necessary to improve acceptance of people with this disease by their family and friends.

Molecular characteristics of Neisseria meningitidis strains isolated in Burkina Faso in 2001.

In the course of an epidemic of meningitis in Burkina Faso in 2001, 27 cerebrospinal fluid samples from patients in 7 districts were forwarded to Norway for isolation and characterization of the causative agents. Neisseria meningitidis was isolated from 13 (48%) samples. The isolates were analysed using serological and genetic methods. Of the 13 strains, 4 were serogroup A, serotype 21:P1.9, sequence type (ST)-5 and belonged to clonal subgroup III, while the remaining 9 strains were serogroup W135, serotype 2a:P1.5,2, ST-11 and belonged to the electrophoretic type-37 complex. PCR analyses revealed meningococcal DNA in 13/14 culture-negative samples. Sequence analysis of the PCR products demonstrated that at least 3 different meningococcal strains were responsible for these 13 cases. Our results show that the W135 strain associated with the 2000 hajj (Muslim pilgrimage) outbreak was a significant cause of disease in Burkina Faso in 2001. Further studies are warranted to determine whether W135 is about to replace serogroup A in sub-Saharan Africa.

[Apropos of a case of rabies occurring despite vaccination after exposure]. / A propos d'un cas de rage survenu malgré une vaccination après exposition.

Rabies is endemic in Sub-Saharan Africa. Control is based on vaccination of subjects at high-risk for exposure and prompt post-exposure treatment. However the severity of some animal bites and early mismanagement can lead to development of rabies despite post-exposure treatment. This danger is illustrated by the case described herein involving a 35-year-old man who was bitten by a rabid dog and treated with 5 doses of antirabies vaccine. The wound, which consisted of two deep punctures on the forearm, was promptly washed with water and disinfected. Despite this treatment, characteristic clinical manifestations of rabies appeared one month after exposure and the patient died 48 hours later. This case raises the question of the causes for failure of the preventive recommendations proposed by the WHO for category III animal bites. In our case, two possible causes of failure and subsequent lethal outcome are that serotherapy was not associated and the incubation period was short. Other possible causes of rabies after post-exposure therapy are discussed with reference to the literature.