Epidemiologic profile of measles in Central African Republic: A nine year survey, 2007-2015.

INTRODUCTION: Measles remains a major public health problem in many developing countries in which vaccination coverage is poor, as is the case in the Central African Republic (CAR). At the beginning of the 2000s, a surveillance system was established in the country, and samples from suspected cases are regularly tested in the laboratory for serological confirmation. Since 2007, when case-by-case monitoring with standardized laboratory databases and monitoring, was set up, no assessment have been performed. Therfore, 9 years later it seemed appropriate to make a first assessment. The aim of the study reported here was to describe the epidemiology of measles in the CAR on the basis of surveillance and laboratory data. METHOD: A descriptive retrospective study was conducted, based on the databases of the measles surveillance programme and of the Institut Pasteur laboratory in Bangui during the period 2007-2015. RESULTS: During this study period, the surveillance programme notified 3767 cases. Of these, 2795 (75%) were sent for laboratory confirmation, and 24.6% (687/2795) were confirmed serologically. Of the 1797 cases of measles declared during this period by the surveillance programme, 1110 (61.8%) were confirmed clinically or by epidemiological linkage. The majority of confirmed cases (83.7%; 575/687) occurred in children under 10 years, over half of whom (44.2%; 304/687) were aged 1-4 years. Epidemics occurred regularly between 2011 and 2015, with > 10% of laboratory-confirmed cases. The rate of laboratory investigation was < 80% between 2011 and 2013 but nearly 100% in the other years. CONCLUSION: Measles remains a common, endemic illness in the CAR. Improved detection will require better measles surveillance, increased vaccination coverage, revision of the investigation forms to include the WHO case definition and training of the health personnel involved in case-finding in the field.

[Epidermal Tuberculosis in an orphan living with HIV in the Pediatric Unit of Bangui (Central African Republic)]. / Tuberculose cutanee chez un orphelin vivant avec le VIH au complexe pediatrique de Bangui (Republique Centrafricaine).

We report the case of ulceration of the anterior chest region in a non BCG vaccinated adolescent. Tuberculosis confirmations has been made by the isolation of M. tuberculosis from the pus culture in Löwenstein-Jensen medium. Topography and chronology of the clinical manifestations argue in favour of scrofuloderma. For technical reasons, we were not able to distinguish scrofuloderma from the gum. The use of the single standard regime of tuberculosis treatment according to the immunological status has provided a healing of skin injury in children living with HIV. In addition, this observation emphasises the medical interest to implement systematic vaccination against tuberculosis and to ensure effective control of the disease, particularly in orphans.

Nous rapportons le cas d'une ulcération de la région antérieure du thorax chez un adolescent non vacciné par le BCG. L'étiologie tuberculeuse a été prouvée par l'isolement de M. tuberculosis à la culture du pus sur milieu de Löwenstein Jensen. La topographie et la chronologie des manifestations cliniques plaident en faveur d'un scrofuloderme. Cependant, les moyens d'investigation disponibles n'ont pu mettre en évidence de foyer infectieux contigu de sorte qu'il n'a pas été possible de discriminer le scrofuloderme du gomme. La mise en route du seul régime standard de traitement de la tuberculose, au regard du niveau d'immunocompétence, a permis d'obtenir une cicatrisation de la lésion cutanée chez cet adolescent atteint de VIH. En outre, cette observation souligne l'intérêt non seulement de vacciner contre la tuberculose mais d'en assurer le contrôle de l'efficacité par la suite; notamment chez les orphelins.