Expanded Access Programme for the use of tecovirimat for the treatment of monkeypox infection: A study protocol for an Expanded Access Programme.

BACKGROUND: Monkeypox is a viral zoonotic disease commonly reported in humans in parts of Central and West Africa. This protocol is for an Expanded Access Programme (EAP) to be implemented in the Central African Republic, where Clade I monkeypox virus diseases is primarily responsible for most monkeypox infections. The objective of the programme is to provide patients with confirmed monkeypox with access to tecovirimat, a novel antiviral targeting orthopoxviruses, and collect data on clinical and virological outcomes of patients to inform future research. METHODS: The study will be conducted at participating hospitals in the Central African Republic. All patients who provide informed consent to enrol in the programme will receive tecovirimat. Patients will remain in hospital for the duration of treatment. Data on clinical signs and symptoms will be collected every day while the patient is hospitalised. Blood, throat and lesion samples will be collected at baseline and then on days 4, 8, 14 and 28. Patient outcomes will be assessed on Day 14 -end of treatment-and at Day 28. Adverse event and serious adverse event data will be collected from the point of consent until Day 28. DISCUSSION: This EAP is the first protocolised treatment programme in Clade I MPXV. The data generated under this protocol aims to describe the use of tecovirimat for Clade I disease in a monkeypox endemic region of Central Africa. It is hoped that this data can inform the definition of outcome measures used in future research and contribute to the academic literature around the use of tecovirimat for the treatment of monkeypox. The EAP also aims to bolster research capacity in the region in order for robust randomised controlled trials to take place for monkeypox and other diseases. TRIAL REGISTRATION: {2a & 2b}: ISRCTN43307947.

Prospecting for yaws in the Mbaïki Health District in the Central African Republic.

Introduction: yaws is endemic in the Central African Republic. The last cases of yaws notified by CAR to WHO date back to 2012. The objective of this study was to measure the prevalence of yaws in the health district of Mbaïki and to describe its clinical and epidemiological characteristics. Methods: this is a descriptive cross-sectional study, conducted from April 10 to 18, 2020 in the Mbaïki health district. Yaws cases were sought in 570 households in the 38 selected villages of the district. Any consenting individual over the age of one year with yaws-like skin lesions was a suspected case of yaws and included in the study. Blood was taken from suspected cases for serological testing (TDR, RPR and TPHA). Any suspected case of yaws with positive RPR and TPHA was considered a confirmed case. Results: a total of 1967 people were examined, of whom 113 were considered suspected cases of yaws. All suspected cases were RPR-positive, 41 TPHA-positive and 13 RDT-positive. Forty-one cases of yaws were confirmed in 18 (47.37%) villages. The prevalence of yaws in the Mbaïki health district was 2.08%. Among the cases, 38.94% were children aged 1 to 14. The sex ratio was 1.69. Lesions clinically suggestive of yaws were papilloma-like in 77.00% of cases, followed by micropapules (8.00%) and ulcerations (5.00%). Conclusion: eight of the nine communes in the Mbaïki health district are yaws-endemic. This result suggests the need to implement the Morges strategy in the Mbaïki health district.

Seroprevalence of anti-SARS-CoV-2 antibodies before and after implementation of anti-COVID-19 vaccination among hospital staff in Bangui, Central African Republic.

Healthcare workers (HCWs) are at high to very high risk for SARS-CoV-2 infection. The persistence of this pandemic worldwide has instigated the need for an investigation of the level of prevention through immunization and vaccination against SARS-CoV-2 among HCWs. The objective of our study was to evaluate any changes in anti-COVID-19 serological status before and after the vaccination campaign of health personnel in the Central African Republic. We carried out a repeated cross-sectional serological study on HCWs at the university hospital centers of Bangui. Blood samples were collected and tested for anti-SARS-CoV-2 IgM and IgG using the ELISA technique on blood samples. A total of 179 and 141 HCWs were included in the first and second surveys, respectively. Of these staff, 31.8% of HCWs were positive for anti-SARS-CoV-2 IgG in the first survey, whereas 95.7% were positive for anti-SARS-CoV-2 IgG in the second survey. However, the proportion of HCWs positive for SARS-CoV-2 IgM antibodies was low (9.7% in the first survey and 3.6% in the second survey). These findings showed a sharp increase in seroprevalence over a one-year period. This increase is primarily due to the synergistic effect of the infection and the implementation of vaccines against COVID-19. Further studies to assess the persistence of anti-SARS-CoV-2 antibodies are needed.

Facteurs de risque de la tuberculose pulmonaire multirésistante à Bangui / Risk factors of multidrug-resistant pulmonary tuberculosis in Bangui

ntroduction.. La prévalence de la tuberculose pulmonaire multirésistante est passé de 0,4% en 2011 à 3,8% en 2021 soit 9,5 fois plus. L'objectif de notre étude était de déterminer les principaux facteurs de risque associés à la survenue de la tuberculose pulmonaire multi résistante (TBMR) chez les patients hospitalisés pour tuberculose au Centre National Hospitalier Universitaire de Bangui (CNHUB). Méthodologie. Il s'agissait d'une étude rétrospective allant du 1 er janvier 2019 au 30 juin 2021. Les cas étaient les patients atteints de tuberculose pulmonaire multi-résistante. Les témoins étaient ceux atteints de tuberculose pulmonaire pharmaco-sensible.Résultats.Nous avons inclus 210 patients dont 70 cas et 140 témoins avec une moyenne d'âge de 35 ans (± 14,09) pour un sex ratio de 1,6. Les ouvriers étaient la classe professionnelle la plus retrouvée(41,43% des cas et 32,85% des témoins). Les patients avaient pour la plupart un revenu mensuel faible (92,86% des cas et 77,14% des témoins). L'antécédent de tuberculose pulmonaire était retrouvé chez 61,42% des cas et 17,85% destémoins. La notion de tuberculose multi-résistante dans lafamille était présente chez 10%cas. Les facteurs significativement associés à la survenue de la tuberculose multi résistante étaient: le faible niveau de revenu (0R=3.8 [1,42-10,38] p=0,004), la consommation de tabac (OR=2 [1,06-3,72] p=0,03), un antécédent de Tuberculose (0R=7.84 [3,83-13,99] p<0,000), et la notion de tuberculose multi résistante dans la famille (0R=15.44 [1,86-128,20] p=0,001).Conclusion.Le niveau de revenu faible, la consommation de tabac, un antécédent de tuberculose, et une notion de tuberculose multi résistante dans la famille étaient les principaux facteurs de risques à la survenue de TBMR. L'émergence de cette forme de tuberculose peut être minimisée par le renforcement des stratégies de lutte

ntroduction.The prevalence of multidrug-resistant pulmonary tuberculosis has increased from 0.4% in 2011 to 3.8% in 2021, which is 9.5 times more. The aim of our study was to determine the main risk factors associated with the occurrence of multidrug-resistant pulmonary tuberculosis (MDR-TB) in patients hospitalized for tuberculosis at the Bangui National University Hospital Center (CNHUB). Methodology.This was a retrospective study from January 1, 2019 to June 30, 2021. The cases were patients with multidrug-resistant pulmonary tuberculosis. The controls were those with drug-sensitive pulmonary tuberculosis. Results.We included 210 patients, of which 70 cases and 140 controls, with a mean age of 35 years (± 14.09) and a sex ratio of 1.6. Workers were the most represented professional class (41.43% of cases and 32.85% of controls). Most patients had a low monthly income (92.86% of cases and 77.14% of controls). A history of pulmonary tuberculosis was found in 61.42% of cases and 17.85% of controls. The presence of multidrug-resistant tuberculosis in the family was present in 10% of cases. Factors significantly associated with the occurrence of multidrug-resistant tuberculosis were: low income level (OR=3.8 [1.42-10.38] p=0.004), tobacco consumption (OR=2 [1.06-3.72] p=0.03), history of tuberculosis (OR=7.84 [3.83-13.99] p<0.000), and the presence of multidrug-resistant tuberculosis in the family (OR=15.44 [1.86-128.20] p=0.001). Conclusion.Low income level, tobacco consumption, history of tuberculosis, and the presence of multidrug-resistant tuberculosis in the family were the main risk factors for the occurrence ofMDR-TB. The emergence of this form of tuberculosis can be minimized by strengthening control strategies.