HIV-1 and HIV-2 infections and AIDS in West Africa.

PIP: The authors review advances in HIV-2 research since their last review of the subject, and summarize the current epidemiology of HIV-1 and HIV-2 infections and AIDS in West Africa. West Africa is considered to be comprised of those countries below the Sahara which belong to subregion 1 of the Africa Region as defined by the World Health Organization. Widely varying patterns of disease distribution exist across these countries. The epidemic spread of HIV-1 and HIV-2 in the region is recent, but these infections now occur throughout West Africa. The distribution of the two viral infections is both heterogenous and unstable. It is not clear whether social or biological reasons, or both, account for the apparently less successful epidemic spread of HIV-2. Important epidemiologic questions concerning HIV-2 which await resolution are its incubation period for disease and its efficiency of transmission compared with HIV-1. The authors note that for public health purposes, the two infections should be approached in the same fashion.^ieng

[Malaria infection during childbirth and in newborns in Bécédi (Ivory Coast)]. / Infection palustre a l'accouchement et issue de la grossesse a Bécédi (Côte-d'Ivoire).

Authors studied the parasitological and serological status of 108 new-born children from 102 deliveries during the 2nd term of 1987 at the Bécédi Maternity Hospital in Ivory Coast. The parasitism frequency of different studied bloods (mother, cord, delivery) is varying from 8 to 14%, antibodies have been found in 81 to 83% cases. The parity has an effect on the placental lesions frequency but not on the parasitism frequency. Children born with a pathogenic placenta have a lower birth weight. The retrospective study of 11,070 deliveries from last years shows that birth weight are lower while the two first pregnancies.

[Purulent meningitis at a semi-rural hospital in the forest area of the Ivory Coast]. / Les méningites purulentes dans un hopital semi-rural de la zone forestière de Cote d'Ivoire.

Authors describe 159 purulent meningitis cases among children admitted in the Dabou Protestant Hospital (56 km far from Abidjan). Etiologies are dominated by Hemophilus and Pneumococcus. The case-fatality rate varies between 22% and 78% according to age and 22,4% and 47,2% according to germ concerned. The after effect rate is about 25%.

[Prevalence of Chlamydia trachomatis in genital samples from Abidjan]. / Prévalence de Chlamydia trachomatis dans des prélèvements génitaux à Abidjan.

A study of direct genital swabs achieved in Abidjan, on 116 men and 131 women consulting for urogenital complaints, has revealed that the men show a prevalence of 28.4% Chlamydia trachomatis, and of 18.1% Neisseria gonorrhoeae. Concerning the women the prevalence of the same germs are 13.7% for Chlamydia trachomatis, and 4.6% for Neisseria gonorrhoeae. These results show the importance of Chlamydia trachomatis as a sexually transmitted disease in Abidjan (Côte-d'Ivoire). No differences were observed according to age in the two groups.

[Analysis of new criteria for increasing the specificity of commercial Western blots]. / Analyse de nouveaux critères pouvant accroître la spécificité des western blots commerciaux.

We examined the frequency of serum cross-reactivity on Western blot for HIV1 and HIV2. 661 patients with tuberculosis in Abidjan, and 4,899 asymptomatic persons for HIV1 and HIV2 infections were tested. All specimens positive on ELISA for HIV1 or HIV2 were further characterized by synthetic peptide based tests. Confirmed positive samples were tested by HIV1 and HIV2 specific Western blot criteres utilisis. Dual serologic reactivity on synthetic peptide tests was significantly more frequent in HIV positive patients with tuberculosis than asymptomatic subjects. Positive HIV1 Western blots were seen in 61%-86% of specimens positive for HIV2 only on synthetic peptide tests. [Cross-reactivity, to HIV2 Western blots by HIV1 positive specimens was significantly more frequent in patients with tuberculosis than in asymptomatic subjects.] Using recently recommended criteria for HIV1 and HIV2 Western blot interpretation (presence of 2 env bands) reduced the overall proportion of HIV1 positive specimens having a positive HIV2 Western blot from 39% to 14% and HIV2 positive specimens having a positive HIV1 Western blot from 31% to 8%.

[The pathogenicity of the human immunodeficiency virus HIV-2 as seen by epidemiologists]. / La pathogenicite du virus de l'immunodeficience humaine VIH2 vue par des epidemiologistes.

The purpose of this study is an evaluation of HIV-2 pathogenicity through an epidemiological analysis, specially in Africa. It is acknowledged that the incubation, or more specially the lapse of time between the infection and the AIDS disease, is longer with HIV-2 than with HIV-1. More over, a certain number of surveys done in Africa show that the average age is higher with HIV-2 than with HIV-1; this is a regular sign of lower pathogenicity. It appears that the sexual transmission of the virus is the same for the HIV-2 and the HIV-1, but it is less effective from mother to baby. Furthermore this type of virus is less prevalent with AIDS patients or AIDS suspects than the HIV-1; and the follow-up of HIV-2 seropositives show that fewer people fall ill than with the HIV-1. A few signs of AIDS standard diagnosis are less frequent among HIV-2 infected patients than among HIV-1 infected patients. Opportunist or associated infections, like tuberculosis or malnutrition, are less often found in HIV-2 patients.

[Infant mortality and its causes in a sub-district of the Ivory Coast]. / La mortalité infantile et ses causes dans une sous-prefecture de Côte d'Ivoire.

The authors studied the infant mortality, between 0 and 30 months of age, in a sub-district in an eastern part of Ivory Coast with a population of 240,000 inhabitants. They recorded 103 deaths, i.e. an infant mortality rate of 29,4 p.c.. Tetanus is the main factor in 10 cases, 8 of them being neonatal. These deaths are caused by the lack of care at the umbilical cord, but not by the lack of medical infrastructure. Other causes are malaria (21), undernutrition (12), meningitidis (10), diarrhea (9), pneumopathy (7), endogenous and obstetrical causes (24).

PIP: Mortality of infants aged 0-30 months was studied in a subdistrict of the eastern Ivory Coast with a population of 240,000 inhabitants. A cluster sample of the type recommended by the World Health Organization for evaluating progress of the expanded program of immunizations consisted of 2 samples with 30 clusters of 70 children each, 1 taken in urban Abengourou and the other in rural cantons of the subprefecture of Abengourou. A standardized questionnaire was administered to all the mothers about their births within the last 3 years. Supplementary questionnaires concerning all deaths of children of the sample mothers were interpreted by 3 physicians who agreed on a probably diagnosis in each case. The survey covered 2375 infants under 1 year and 1825 aged 12-30 months. The total mortality was 103 deaths in the total sample and 70 for infants aged 0-11 months, for a rate of 29.4%. The difference between the urban rate (31.7%) and the rural rate (26.8%) was not significant. The rate varied significantly by sex for deaths due to malnutrition (11 boys, 1 girl), and pneumopathies (6 girls, 1 boy). Mortality varied significantly according to treatment received and place of death. 55% received traditional treatment and 45% modern treatment. 53% died at home, 36% at a health center, and 9% at the home of a healer. Among infants aged 0-27 days, the cause of death was tetanus for 8, prematurity for 12, neonatal distress for 5, neonatal jaundice for 5, and infection for 2. Among infants aged 1-11 months the cause of death was malaria for 10, meningitis for 7, tetanus for 2, diarrhea for 9, pneumopathy for 3, measles for 4, whooping cough for 2, and unknown for 1. Among infants aged 12-30 months the cause of death was malaria for 11, malnutrition for 12, meningitis for 3, pneumopathy for 4, measles for 1, and sickle cell anemia for 2. Malaria was the single most important cause of death followed by malnutrition for the overall sample. In urban and rural areas respectively, the proportions of infants correctly vaccinated for their age groups were 78.1% and 76.0% for those under 11 months; 92.3% and 80.6% for those 12-17 months; 78.3% and 76.6% for those 18-23 months; and 66.5% and 71.4% for those 24 months and over. Mortality rates varied very significantly by vaccination status. 70 of the children dying had not been vaccinated. Their mortality rate was 19.6%, compared to .5% for children in process of vaccination, 1.1% for children incompletely vaccinated, and .9% for children correctly vaccinated.

[Epidemiological aspects of meningitis in the north of the Ivory Coast]. / Eléments d'épidémiologie des méningites dans le nord de la Côte-d'Ivoire.

Classically, the North of Ivory Coast is not part of the "meningitis belt". However, recent health statistics put in light some recent outbreaks in this part of the country, the last one in the years 1983-1985. The authors have studied this last outbreak and it can be foreseen that these epidemics will appear again as in the more Northern countries. Therefore it is desirable to set up a monitoring system to better organize the fight against this disease.

[The transmission of maternal measles antibodies to newborn infants in the Ivory Coast]. / Transmission des anticorps maternels antirougeoleux au nouveau-ne Ivoirien.

Authors studied the disappearance of mothers measles antibodies among 286 babies from Ivory Coast 250 of which were living in Adzopé, a town with 30,000 inhabitants at 100 km up North from Abidjan and the 36 other babies in Abidjan. The study of antibodies by IHA showed a higher serum incidence rate of mother antibodies among 4 months aged babies in Abidjan. The more sensitive study of antibodies by the Mann serum neutralisation, shows that when 6 months aged, 60% babies from Adzope still have antibodies and when 10 months aged, none of the babies is positive. Serum negativation is late compared to Brazzaville when antibodies level is lower.

[A comparative study of the carriage of enteric viruses in urban and rural populations in the western region of the Ivory Coast]. / Etude comparative du portage des virus entériques dans une population urbaine et rurale de l'ouest de la Côte d'Ivoire.

Stool samples were collected from 300 persons of three classes of age (less than 6, 6-15, greater than 15) coming from urban and rural areas of Ivory Coast and tested for enteric viruses. This study has shown the high frequency of enteric viruses carriage, unrelated to sex or age. Carriage rates were significantly higher in rural areas than in urban areas. Both in urban and rural areas there was no difference of carriage among males and females. Polioviruses are predominant.

[Results of active surveillance of acute flaccid paralysis in the Central African Republic and Chad from 1995 to 2000]. / Bilan de la surveillance active des paralysies flasques aigues en Republique Centrafricaine et au Tchad de 1995 a 2000.

The threefold purpose of this report is to describe the epidemiology of acute flaccid paralysis (AFP), to determine the impact of the National Immunization Days (NID), and evaluate the quality of active surveillance in the Central African Republic (CAR) and Chad. The data in this study was obtained from the Enterovirus Division of the Pastear Institute in Bangui (National WHO Inter-country Reference Laboratory for the CAR and Chad and Regional Poliovirus Reference Laboratory in Africa). An increase in the number of AFP cases was observed in the CAR between 1995 and 2000 and in Chad between 1997 and 2000, mainly as a result of enhancement of the surveillance system. The goals set by the WHO in terms of the proportion of AFP cases with 2 specimens collected within 14 days of onset of paralysis and the number of cases with 60-day follow-up have not been reached in either country. The presence of 2 strains of wild poliovirus (types 1 and 3) and several genotypes (West African 13 and West African 7 for type 1 and Central African and Nigeria-P3 for type 3) not only show that Central Africa is still a significant reservoir for poliovirus transmission but also raise serious doubts about the quality of the NID organized over the last 3 years. The priority of the next NID round must be to reach unimmunized children who have been missed by routine immunization coverage.

New diagnostic tools for neonatal sepsis: the role of a real-time polymerase chain reaction for the early detection and identification of bacterial and fungal species in blood samples.

Early diagnosis and treatment of neonatal sepsis are essential to prevent severe and life threatening complications. Consequently, rapid diagnostic tests capable to differentiate infected from non-infected newborns have the potential to make a significant impact on neonatal care. A new real-time polymerase chain reaction (PCR; LightCycler SeptiFast test M GRADE) has been proposed in the routine assessment of neonatal sepsis for the detection and identification of bacterial and fungal DNA from microorganisms which cause approximately 90% of all blood stream infections. The LightCycler SeptiFast test can detect and identify simultaneously the 25 most important bacterial and fungal species causing bloodstream infections within few hours by using a small volume of a single whole blood sample. Real-time PCR can be easily incorporated into the hospital setting for term or near-term infants admitted to the neonatal intensive care unit for sepsis evaluation.

The present and future course of the AIDS epidemic in Côte d'Ivoire.

An assessment of the current and future mortality and morbidity from acquired immunodeficiency syndrome (AIDS) in Côte d'Ivoire was made using the results of the 1989 national survey of the prevalence of human immunodeficiency (HIV) infection in the country and the AIDS projection model developed by WHO. For 1989 it was estimated that about 25,000 AIDS cases in adults and children had occurred, although the total number of cases reported for 1989 (up to 1 July 1991) was about 13% (1:6.9) of this estimated total. It is projected that by 1994 in Côte d'Ivoire the cumulative number of cases of AIDS in adults will be 89,000, and that for infants and children the corresponding number will be 41,000. It was also projected that about 371,000 uninfected children will have been born to HIV-infected mothers in Côte d'Ivoire by 1994 and that many of these children will have been orphaned by the deaths of their mothers from AIDS.

Tuberculosis and HIV infection in sub-Saharan Africa.

OBJECTIVES: To review the epidemiologic, clinical, and pathological characteristics and the public health implications of human immunodeficiency virus (HIV)-associated tuberculosis in sub-Saharan Africa. DATA SOURCES: Published medical literature (English and French) and proceedings of international and African conferences on the acquired immunodeficiency syndrome (AIDS). STUDY SELECTION: Selection by the authors of articles most pertinent to HIV infection and tuberculosis in Africa and internationally. DATA EXTRACTION: Direct reporting of quantitative data (eg, HIV seroprevalence levels) and of qualitative descriptions and conclusions from selected literature. DATA SYNTHESIS: High rates (20% to 67%) of HIV infection in patients with tuberculosis have been reported from East, West, Central, and Southern Africa. An increase in tuberculosis cases has been reported at the same time as the emergence of AIDS in several countries. Autopsies in Abidjan, Ivory Coast (Côte d'Ivoire), have shown tuberculosis as the most frequent opportunistic infection in patients dying of AIDS. Clinical differences in patients with tuberculosis who were HIV-positive and HIV-negative are reviewed, the most important being a greatly increased mortality rate in HIV-associated disease. Access to HIV testing is required for firm diagnosis, for clinical care and counseling, and for public health surveillance. CONCLUSIONS: The epidemiology of tuberculosis has been profoundly influenced by the epidemic of HIV infection in sub-Saharan Africa. Greatly increased human and material resources are required for this neglected problem in international health.

Enterohaemorrhagic Escherichia coli in Central African Republic.

PIP: A dysentery outbreak in the Central African Republic village of Zemio was diagnosed as "Shigella flexneri" by the Pasteur Institute in Bangui (IPB) in February 1996; 2 months later there was an outbreak of hemorrhagic colitis. 108 patients presented with bloody diarrhea; cramping abdominal pain, fever, nausea, and vomiting were uncommon. The illness lasted between 5 days and 3 weeks (average, 8 days). Antibiotics were ineffective. Four patients died and several developed hemolytic-uremic syndrome. Stool cultures done at IPB tested negative. PCR was used to detect enterohemorrhagic Shiga-like toxin (SLT) 1 and 2, the invasivity gene ipaH, and the attaching and effacing gene eaeA. DNA fragments of 130 and 494 nucleotides corresponding to amplified SLT1 and eaeA were found in 80% of the specimens tested. No amplification was obtained for SLT2 or for ipaH in specimens collected during the second epidemic. These results suggest the presence of enterohemorrhagic Escherichia coli and the absence of Shigella. The number of reported cases of acute bloody diarrhea in infants and adults in Bangui has increased since 1996. E. coli O157:H7 was isolated from two fatal adult cases. Smoked zebu meat was suspected in several hospital cases (bloody diarrhea, hemolytic anemia, and renal insufficiency) in which non-fermenting sorbitol E. coli O157:H7 was not isolated. In two cases of acute diarrhea, other serotypes of E. coli were indicated by retrospective PCR on stools which were positive for SLT1 and for eaeA and negative for invasivity. A study was conducted in Bangui on 290 cases (33 with bloody diarrhea) and 140 controls. Patients were not paired because of civil unrest in the city. The questionnaire included demographic and socioeconomic characteristics, environmental factors, and habitual food consumption. The major contributing factor was consumption of locally made meat pies (kanda), which were made with smoked zebu meat. Kanda is stored at ambient temperature, often for days, before it is sold in markets or along roads. Before 1996, E. coli was not reported as a cause of bloody diarrhea in the Central African Republic.^ieng

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast]. / Difficultés de la surveillance épidémiologique de la rougeole en Afrique: exemple de la Côte d'Ivoire.

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

[Pruritus after taking chloroquine and filariasis]. / Prurit après prise de chloroquine et filarioses.

A study of relations between pruritus after doses of chloroquine and on the one hand the infection by Mansonella perstans (filariasis frequent in some areas but pathogenic) and on the other hand the infection by Onchocerca volvulus (filariasis frequent in some other areas but not very pathogenic) was carried out in two villages in Ivory Coast. It is not possible to show an obvious relation between the presence of pruritus and the two filariasis.