SARS-CoV-2 Neutralizing Antibodies in Three African Countries Following Multiple Distinct Immune Challenges.

BACKGROUND: The COVID-19 pandemic has affected Madagascar, Cameroon, and the Central African Republic (CAR), with each experiencing multiple waves by mid-2022. This study aimed to evaluate immunity against SARS-CoV-2 strains Wuhan (W) and BA.2 (BA.2) among healthcare workers (HCWs) in these countries, focusing on vaccination and natural infection effects. METHODS: HCWs' serum samples were analyzed for neutralizing antibodies (nAbs) against W and BA.2 variants, with statistical analyses comparing responses between countries and vaccination statuses. RESULTS: Madagascar showed significantly higher nAb titers against both strains compared to CAR and Cameroon. Vaccination notably increased nAb levels against W by 2.6-fold in CAR and 1.8-fold in Madagascar, and against BA.2 by 1.6-fold in Madagascar and 1.5-fold in CAR. However, in Cameroon, there was no significant difference in nAb levels between vaccinated and unvaccinated groups. CONCLUSION: This study highlights the complex relationship between natural and vaccine-induced immunity, emphasizing the importance of assessing immunity in regions with varied epidemic experiences and low vaccination rates.

Association between mental disorders with detectable viral load and poor adherence to antiretroviral therapy among adolescents infected with Human Immunodeficiency Virus on follow-up at Chantal Biya Foundation, Cameroon.

INTRODUCTION: Perinatally HIV-Infected Adolescents (HIVIA) are more likely to have mental health problems than their uninfected peers. In resource-limited settings, mental health disorders are rarely taken into account in the care offered to HIVIA and have an impact on their routine follow-up. The objective of this study was to assess the baseline socio-demographic factors and mental health conditions associated with detectable viral load or poor ART adherence in HIVIA on ART followed at the Mother and Child Centre of the Chantal Biya Foundation in Yaoundé (CME-FCB), Cameroon. METHODS: A cross-sectional study was conducted in HIVIA aged 10 to 19 years, followed at CME-FCB during the period from December 2021 to March 2022. Sociodemographic, clinical, and mental characteristics were collected using a structured questionnaire administered face-to-face by trained healthcare providers. The primary outcome was viral load ≥ 40 copies/mL in HIVIA on ART for at least six months. The secondary outcome was poor ART adherence, defined as ≥ 1 missed dose of antiretroviral therapy within the last past three days. The main exposure variables were mental health disorders, including the level of anxiety, depression and low self-esteem. RESULTS: In total, 302 adolescents were interviewed, 159 (52.7 %) were girls and median age was 15.2 years (IQR: 12.0-17.5). Having missed at least 1 dose of ART drugs during the last 3 days before screening concerned 53 (35.0 %) cases. Of the 247 adolescents with an available viral load (VL) in the last 12 months prior to screening, 33 (26.7 %) had a VL ≥ 40 copies/mL. Among participating adolescents, 29.1 % presented with high or very high anxiety, 26.5 % with severe depression, 36.4 % with history of suicidal ideation, and 20.5 % low self-esteem. Low self-esteem was strongly associated with a higher risk of poor ART adherence (adjusted odds ratio(aOR) (95 % confidence interval (95 %CI)): 2.2 (1.1-4.3); p = 0.022). Living with the father (aOR (95 %CI): 0.6 (0.3-1.1); p = 0.085) or in a household with a televisor (aOR (95 %CI): 0.5 (0.2-1.1); p = 0.069) were slightly associated with a lower risk of poor adherence to ART. Having both parents alive (aOR (95 %CI): 0.4 (0.2-0.9); p = 0.031) or receiving ART with efavirenz or dolutegravir (aOR (95 %CI): 0.5 (0.2-0.9); p = 0.047) was strongly associated with a lower likelihood of having a detectable VL. Moreover, detectable viral load was slightly less frequent in adolescents whose household was equipped with a television (p = 0.084) or who were completely disclosed for HIV status (p = 0.070). CONCLUSION: This study found that co-morbid low self-esteem had higher odds of poor ART adherence in HIVIA. Moreover, both poor ART adherence, and detectable viral load were associated with impaired life conditions in HIVIA.

High seroprevalence of severe acute respiratory syndrome coronavirus 2 among healthcare workers in Yaoundé, Cameroon after the first wave of Covid-19 pandemic and associated factors.

BACKGROUND: Healthcare workers (HWs) are at a high risk of exposure to emerging health threats. Following the first wave of the coronavirus disease 2019 pandemic in Cameroon, we explored the presence and persistence of naturally acquired antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the factors associated with seropositivity in HWs. METHODS: Staff at two referral hospitals in Yaoundé or two Health District Hospitals in Obala and Mbalmayo were included in a 6-month prospective cohort analysis or cross-sectional survey, respectively. Seroprevalence and associated factors were determined, and Kaplan-Meier curves and Cox proportional hazards models were used to assess antibody persistence or positive seroconversion over time. RESULTS: From August 2020 to March 2021, 426 HWs (median age: 31 years, interquartile range: 27-37 years; 66.4% female) were enrolled. The overall seroprevalence of anti-SARS-CoV-2 antibodies was 54.0% (95% confidence interval [CI]: 49.1-58.8) and was significantly different between study sites (p = 0.04). Of the 216 HWs included in the 6-month cohort, 109 (50.5%) HWs were seropositive at inclusion; the probability of persistent antibodies or of becoming seropositive was 93.8% (95% CI: 84.2-100) and 78.9% (95% CI: 61.7-88.4), respectively. Seroconversion was associated with study site and occupation but not with infection prevention and control (IPC) practices. CONCLUSIONS: We observed high seroprevalence of SARS-CoV-2 antibody and seroconversion among HWs associated with occupational risk. This suggests low compliance to the COVID-19 control measures. Continued training and implementation of IPC measures and accelerated preparedness are needed to better tackle future threats.

Spread of SARS-CoV-2 Infection in Adult Populations in Cameroon: A Repeated Cross-Sectional Study Among Blood Donors in the Cities of Yaoundé and Douala.

Over a period of about 9 months, we conducted three serosurveys in the two major cities of Cameroon to determine the prevalence of SARS-COV-2 antibodies and to identify factors associated with seropositivity in each survey. We conducted three independent cross-sectional serosurveys of adult blood donors at the Central Hospital in Yaoundé (CHY), the Jamot Hospital in Yaoundé (JHY) and at the Laquintinie Hospital in Douala (LHD) who consented in writing to participate. Before blood sampling, a short questionnaire was administered to participants to collect their sociodemographic and clinical characteristics. We included a total of 743, 1202, and 1501 participants in the first (January 25-February 15, 2021), second (May 03-28, 2021), and third (November 29-December 31, 2021) surveys, respectively. The adjusted seroprevalence increased from 66.3% (95% CrI 61.1-71.3) in the first survey to 87.2% (95% CrI 84.0-90.0) in the second survey, and 98.4% (95% CrI 96.8-99.7) in the third survey. In the first survey, study site, participant occupation, and comorbid conditions were associated with SARS-CoV-2 seropositivity, whereas only study site remained associated in the second survey. None of the factors studied was significantly associated with seropositivity in the third survey. Together, the data suggest a rapid initial spread of SARS-CoV-2 in the study population, independent of the sociodemographic parameters assessed.

Observed versus estimated actual trend of COVID-19 case numbers in Cameroon: A data-driven modelling.

Controlling the COVID-19 outbreak remains a challenge for Cameroon, as it is for many other countries worldwide. The number of confirmed cases reported by health authorities in Cameroon is based on observational data, which is not nationally representative. The actual extent of the outbreak from the time when the first case was reported in the country to now remains unclear. This study aimed to estimate and model the actual trend in the number of COVID -19 new infections in Cameroon from March 05, 2020 to May 31, 2021 based on an observed disaggregated dataset. We used a large disaggregated dataset, and multilevel regression and poststratification model was applied prospectively for COVID-19 cases trend estimation in Cameroon from March 05, 2020 to May 31, 2021. Subsequently, seasonal autoregressive integrated moving average (SARIMA) modeling was used for forecasting purposes. Based on the prospective MRP modeling findings, a total of about 7450935 (30%) of COVID-19 cases was estimated from March 05, 2020 to May 31, 2021 in Cameroon. Generally, the reported number of COVID-19 infection cases in Cameroon during this period underestimated the estimated actual number by about 94 times. The forecasting indicated a succession of two waves of the outbreak in the next two years following May 31, 2021. If no action is taken, there could be many waves of the outbreak in the future. To avoid such situations which could be a threat to global health, public health authorities should effectively monitor compliance with preventive measures in the population and implement strategies to increase vaccination coverage in the population.

Update on laboratory data of animal rabies at the Centre Pasteur of Cameroon from 2014 to 2021.

Rabies is a worldwide zoonotic disease mainly transmitted to humans by an infected dog bite. Despite the endemicity of rabies in dogs and few documented cases in Cameroon, there is still not enough data on frequency of rabies cases in animals. The present study aims to update data on the circulation of rabies in animals screened at the Centre Pasteur of Cameroon (CPC) between 2014 and 2021. The detection of rabies in animals was based on passive surveillance. Animal rabies cases were confirmed on brain biopsies using fluorescent antibody test and SYBR green based real-time RT-PCR for negative results confirmation. The total nucleoprotein (N) gene of animal-derived RABV isolated were amplified by hemi nested RT-PCR and subjected to phylogenetic analyses. From 2014 to 2021, a total of 92 animals including 86 dogs (93.5%), 3 cats, 2 pigs and 1 chiropteran were screened for rabies at the CPC. From the 86 dog sampled, 62.3% (54/86) were tested positive for rabies and 1 out of 3 cat samples was also tested positive. The PEP demand was very high (59,371) during the study period. Phylogenetic analyses assigned all 15 studied isolates successfully sequenced to the Africa-1a lineage belonging to the Cosmopolitan clade. The study highlights the frequent circulation of rabies in Cameroon and the role of dogs and cat as main reservoir and vector of rabies.

Mental health troubles among Cameroonian adolescents perinatally infected with Human Immunodeficiency Virus.

INTRODUCTION: Adolescents living with HIV are more likely to experience mental health challenges compared to their peers who do not have HIV. However, there is a lack of data regarding the mental health of adolescents living with HIV in Cameroon. Understanding risk factors and protective factors that influence mental health amongst adolescents is critical for effective programming. The purpose of this study was to estimate the prevalence and the factors associated with depression in adolescents infected with HIV and receiving ART in a Cameroonian referral hospital. METHODS: This was a cross-sectional study which enrolled adolescents perinatally infected with HIV, aged 10-19 years, on antiretroviral treatment and cared for at "Centre Mère et Enfant de la Fondation Chantal Biya", Yaounde, Cameroon. Structured questionnaires, including validated French versions of the Coopersmith Child Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and the Coopersmith Self Esteem Inventory (SEI), were administered to the study participants by the healthcare providers. RESULTS: All in all, 302 adolescents were recruited in the study at a median age of 15.2 years (interquartile range : 12.0 - 17.5), including 159 (52.7 %) girls. Both parents had died for 57 (18.9 %) adolescents ; only the father was alive for 64 (21.2 %) ; only the mother was alive for 48 (15.9 %), both parents were alive for 133 (44.0 %). This study found prevalence of 26.5 % for severe depression, 36.4 % for suicidal ideation, 29.1 % for high/very high anxiety, and 20.5 % for low self-esteem. No factor was found significantly associated with severe depression but there was a trend towards decreased risk of severe depression among adolescents whose mother was alive [OR= 0.4 (0.1-1.0), p = 0.084]. CONCLUSION: This study found that elevated depression, anxiety, and low self-esteem symptoms were prevalent among Cameroonian adolescents perinatally infected with HIV. Services and systems should go beyond clinical management of HIV and address the psychosocial and mental health of adolescents. The indicators of mental health among adolescents infected with HIV should be included in HIV program reporting.

Detection and molecular characterization of rabies virus isolates from humans in Cameroon.

Despite the enzootic cycle of rabies in dog populations, laboratory confirmation of human rabies has been hardly reported in Cameroon. This study aimed to determine the rate of molecular detection and phylogenetic relatedness of Rabies Virus (RABV) isolates from suspected human rabies cases in Cameroon. From 2014 to 2018, 21 suspected human rabies cases were tested for RABV genomic RNA. Full-length sequence of the nucleoprotein (N) coding gene of RABV isolates detected were generated and subjected to phylogenetic analyses. As results, skin biopsies and/or saliva samples from 10 of the 21 suspected human rabies cases were positive for genomic RABV RNA. Four new N gene sequences were generated from confirmed cases. The studied RABV isolates fell into the Cosmopolitan clades, sub-clades Africa-1a and 1b. This study showed a low rate of molecular detection of RABV in suspected human rabies cases; thus, underscoring the interest of systematic laboratory confirmation.

African countries from the Pasteur Network reexamine their syndromic sentinel surveillance system associated with household contact within the AFROSCREEN program.

Surveillance to better detect and respond to new pathogens remains a major challenge for global public health. The Pasteur Network recently held a brainstorming workshop located in Cameroon attended by Pasteur epidemiological teams from Niger, Central African Republic (CAR), Cameroon, Senegal, and Madagascar to discuss how the Pasteur Network in Africa could use the lessons of COVID-19 to set-up a pilot sentinel surveillance scheme given its expertise and involvement during the pandemic. The possibility of coupling sentinel syndromic and biological surveillance already implemented for influenza surveillance with the recent sequencing capacity put in place by the AFROSCREEN program prompted us to consider strengthening surveillance tools to target "Pathogen X" detection in Africa. The perspective project provided by the Pasteur Network teams and shared with other partners of the AFROSCREEN program will target strengthening of the diagnosis of severe acute respiratory infections (IRAS) and the surveillance of IRAS, the evaluation of the impact of SARS-CoV-2 on the epidemiology of IRAS, and the addition of the detection of new pathogens, called "Pathogen X," based on sequencing capacity and epidemiological criteria from One Health approaches.

Improving the management and security of COVID 19 diagnostic test data with a digital platform in resource-limited settings: The case of PlaCARD in Cameroon.

During the COVID 19 pandemic, round-the-clock demand for COVID -19 laboratory tests exceeded capacity, placing a significant burden on laboratory staff and infrastructure. The use of laboratory information management systems (LIMS) to streamline all phases of laboratory testing (preanalytical, analytical, and postanalytical) has become inevitable. The objective of this study is to describe the architecture, implementation, and requirements of PlaCARD, a software platform for managing patient registration, medical specimens, and diagnostic data flow, as well as reporting and authentication of diagnostic results during the 2019 coronavirus pandemic (COVID -19) in Cameroon. Building on its experience with biosurveillance, CPC developed an open-source, real-time digital health platform with web and mobile applications called PlaCARD to improve the efficiency and timing of disease-related interventions. PlaCARD was quickly adapted to the decentralization strategy of the COVID 19 testing in Cameroon and, after specific user training, was deployed in all COVID 19 diagnostic laboratories and the regional emergency operations center. Overall, 71% of samples tested for COVID 19 by molecular diagnostics in Cameroon from 05 March 2020 to 31 October 2021 were entered into PlaCARD. The median turnaround time for providing results was 2 days [0-2.3] before April 2021 and decreased to 1 day [1- 1] after the introduction of SMS result notification in PlaCARD. The integration of LIMS and workflow management into a single comprehensive software platform (PlaCARD) has strengthened COVID 19 surveillance capabilities in Cameroon. PlaCARD has demonstrated that it can be used as a LIMS for managing and securing test data during an outbreak.

Couple oriented counselling improves male partner involvement in sexual and reproductive health of a couple: Evidence from the ANRS PRENAHTEST randomized trial.

BACKGROUND: Male partner involvement (MPI) has been recognized as a priority area to be strengthened in Prevention of Mother to Child Transmission (PMTCT) of HIV. We explored the impact of Couple Oriented Counselling (COC) in MPI in sexual and reproductive health and associated factors. METHOD: From February 2009 to October 2011, pregnant women were enrolled at their first antenatal care visit (ANC-1) and followed up until 6 months after delivery in the Mother and Child Center of the Chantal Biya Foundation within the randomized prenahtest multicentric trial. The MPI index was defined using sexual and reproductive health behaviour variables by using multiple correspondence analysis followed by mixed classification. Men were considered as highly involved if they had shared their HIV test results with their partner, had discussed on HIV or condom used, had contributed financially to ANC, had accompanied their wife to ANC or had practiced safe sex. Factors associated to MPI were investigated by the logistic model with GEE estimation approach. RESULTS: A total of 484 pregnant women were enrolled. The median age of the women was 27 years (IQR: 23-31) and 55.23% had a gestational age greater than 16 weeks at ANC-1. Among them, HIV prevalence was 11.9% (95% CI: 9.0-15.4). The median duration of the women's relationship with their partner was 84 months (IQR: 48-120). MPI index at 6 months after delivery was significantly greater in the COC group than the classical counselling group (14.8% vs 8,82%; p = 0,043; Fig 1). The partners of the women who participated in the COC were more likely to be involved during follow up than others (aOR = 1.45; 95% CI = 1.00-2.10). Partners with no incoming activity (aOR = 2.90; 95% CI = 1.96-4.29), who did not used violence within the couple (aOR = 1.70; 95% CI = 1.07-2.68), and whose partner came early for ANC-1 (aOR = 1.37; 95% CI = 1.00-1.89) were more likely to be involved than others. CONCLUSION: MPI remains low in stable couples and COC improves partner involvement. Our findings also support the need of strengthening outreach towards "stable" couples and addressing barriers. This could go a long way to improve PMTCT outcomes in Cameroon. TRIAL REGISTRATION: PRENAHTEST, NCT01494961. Registered 15 December 2011-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01494961.

Long-term outcomes of early initiated antiretroviral therapy in sub-Saharan children: a Cameroonian cohort study (ANRS-12140 Pediacam study, 2008-2013, Cameroon).

BACKGROUND: In most studies, the virological response is assessed during the first two years of antiretroviral treatment initiated in HIV-infected infants. However, early initiation of antiretroviral therapy exposes infants to very long-lasting treatment. Moreover, maintaining viral suppression in children is difficult. We aimed to assess the virologic response and mortality in HIV-infected children after five years of early initiated antiretroviral treatment (ART) and identify factors associated with virologic success in Cameroon. METHODS: In the ANRS-12140 Pediacam cohort study, 2008-2013, Cameroon, we included all the 149 children who were still alive after two years of early ART. Virologic response was assessed after 5 years of treatment. The probability of maintaining virologic success between two and five years of ART was estimated using Kaplan-Meier curve. The immune status and mortality were also studied at five years after ART initiation. Factors associated with a viral load < 400 copies/mL in children still alive at five years of ART were studied using logistic regressions. RESULTS: The viral load after five years of early ART was suppressed in 66.8% (60.1-73.5) of the 144 children still alive and in care. Among the children with viral suppression after two years of ART, the probability of maintaining viral suppression after five years of ART was 64.0% (54.0-74.0). The only factor associated with viral suppression after five years of ART was achievement of confirmed virological success within the first two years of ART (OR = 2.7 (1.1-6.8); p = 0.033). CONCLUSIONS: The probability of maintaining viral suppression between two and five years of early initiated ART which was quite low highlights the difficulty of parents to administer drugs daily to their children in sub-Saharan Africa. It also stressed the importance of initial viral suppression for achieving and maintaining virologic success in the long-term. Further studies should focus on identifying strategies that would enhance better retention in care and improved adherence to treatment within the first two years of ART early initiated in Sub-Saharan HIV-infected children.

Coding-Complete Genome Sequence and Phylogenetic Relatedness of a SARS-CoV-2 Strain Detected in March 2020 in Cameroon.

We describe the coding-complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain obtained in Cameroon from a 58-year-old French patient who arrived from France on 24 February 2020. Phylogenetic analysis showed that this virus, named hCoV-19/Cameroon/1958-CMR-YAO/2020, belongs to lineage B.1.5 and is closely related to an isolate from France.

Virological failure and antiretroviral resistance among HIV-infected children after five years follow-up in the ANRS 12225-PEDIACAM cohort in Cameroon.

OBJECTIVE: In the present study, we aimed to evaluate the virological failure (VF) and drug resistance among treated HIV-infected children after five years follow-up in the ANRS-Pediacam cohort in Cameroon. METHODS: From November 2007 to October 2011, HIV-infected children born to HIV-infected mothers were included in the ANRS-PEDIACAM study and followed-up for more than 5 years. Plasma viral load (VL) was measured at each visit (every three months until month 24 and every 6 months thereafter). VF was the main outcome and HIV drug resistance test was performed using the ANRS procedures and algorithm. RESULTS: Data from 155 children were analyzed. The median age at combination antiretroviral therapy (cART) initiation was 4.2 months (interquartile range (IQR): 3.2-5.8), with 103 (66.5%) children taking LPV/r-containing regimen and 51 (32.9%) children taking NVP. After five years follow-up, 63 (40.6%; CI: 32.9-48.8) children experienced VF. The median duration between cART initiation and VF was 22.1 months (IQR: 11.9-37.1) with a median VL of 4.8 log10 (IQR: 4.0-5.5). Among the 57 children with HIV drug resistance results, 40 (70.2%) had at least one drug resistance mutation. The highest resistance rates (30.4-66.1%) were obtained with Lamivudine; Efavirenz; Nevirapine and Rilpivirine. CONCLUSIONS: These results show high resistance to NNRTI and emphasize the need of VL and resistance tests for optimal follow-up of HIV-infected people especially children.

Dog rabies control in West and Central Africa: A review.

Rabies is a neglected but preventable zoonotic disease that predominantly affects the most vulnerable populations living in remote rural areas of resource-limited countries. To date, every country on the African mainland is considered endemic for dog-mediated rabies with an estimated 21'500 human rabies deaths occurring each year. In 2018, the United Against Rabies collaboration launched the Global Strategic Plan to end human deaths from dog-mediated rabies by 2030. The epidemiology of rabies from most Western and Central African countries remains poorly defined, making it difficult to assess the overall rabies situation and progress towards the 2030 goal. In this review, we attempt to provide an overview of the current rabies situation in 22 West and Central African countries based on published scientific literature and information obtained from rabies focal points. To this end, information was collected on i) established surveillance, ii) diagnostic capacity, iii) post-exposure prophylaxis (PEP) availability and coverage, iv) dog population estimates, v) dog vaccination campaigns, vi) animal and human health communication (One Health), vii) molecular studies, viii) Knowledge, Attitude and Practices (KAP), ix) cost estimates and x) national control strategies. Although rabies is a notifiable disease in the majority of the studied countries, national surveillance systems do not adequately capture the disease. A general lack of rabies diagnostic capacity has an additional negative impact on rabies surveillance and attempts to estimate rabies burden. Recurrent shortages of human rabies vaccine are reported by all of the countries, with vaccine availability usually limited to major urban centers but no country has yet adopted the new WHO-recommended 1-week intradermal vaccination regimen. Most countries carry out subsidized mass dog vaccination campaigns on World Rabies Day. Such activities are indispensable to keep rabies in the public consciousness but are not of the scale and intensity that is required to eliminate rabies from the dog population. Countries will need to scale up the intensity of their campaigns, if they are to progress towards the 2030 goal. But more than half of the countries do not yet have reliable figures on their dog populations. Only two countries reached stage 2 on the Stepwise Approach towards Rabies Elimination ladder - indicating that their national governments have truly prioritized rabies elimination and are thus providing the necessary support and political buy-in required to achieve success. In summary, the sub-region of West and Central Africa seems to be divided into countries which have accepted the challenge to eliminate rabies with governments committed to pushing forward rabies elimination, while other countries have achieved some progress, but elimination efforts remain stuck due to lacking government commitment and financial constraints. The possibility to meet the 2030 goal without international solidarity is low, because more than two-thirds of the countries rank in the low human development group (HDI ≤ 152). Leading countries should act as role models, sharing their experiences and capacities so that no country is left behind. Unified and with international support it is possible to reach the common goal of zero human rabies deaths by 2030.

Institut Pasteur International Network's efforts to guide control measures against the coronavirus disease 2019 (COVID-19) epidemic among healthcare workers in Africa.

During epidemic periods, HCW are vulnerable. In Africa, cohort studies implemented by the Institut Pasteur International Network in five countries showed after 3-month follow-up around 40% of the HCW have been infected by the SARS-CoV-2. So advocacy for HCW protection strategy need to be fostered and sustained by the health authorities all over the African continent.

Evaluation of a mobile health approach to improve the Early Warning System of influenza surveillance in Cameroon.

BACKGROUND: Rapid reporting of surveillance data is essential to better inform national prevention and control strategies. OBJECTIVES: We compare the newly implemented smartphone-based system to the former paper-based and short message service (SMS) for collecting influenza epidemiological data in Cameroon. METHODS: Of the 13 sites which collect data from persons with influenza-like illness (ILI), six sites send data through the EWS, while seven sites make use of the paper-based system and SMS. We used four criteria for the comparison of the data collection tools: completeness, timeliness, conformity and cost. RESULTS: Regarding the different collection tools, data sent by the EWS were significantly more complete (97.6% vs 81.6% vs 44.8%), prompt (74.4% vs n/a vs 60.7%) and of better quality (93.7% vs 76.1% vs 84.0%) than data sent by the paper-based system and SMS, respectively. The average cost of sending a datum by a sentinel site per week was higher for the forms (5.0 USD) than for the EWS (0.9 USD) and SMS (0.1 USD). The number of outpatient visits and subsequently all surveillance data decreased across the years 2017-2019 together with the influenza positivity rate from 30.7% to 28.3%. Contrarily, the proportion of influenza-associated ILI to outpatient load was highest in the year 2019 (0.37 per 100 persons vs 0.28 and 0.26 in the other 2 years). CONCLUSION: All sentinel sites and even other disease surveillance systems are expected to use this tool in the near term future due to its satisfactory performance and cost.

Dog demographics and husbandry practices related with rabies in Cameroon.

Dog demographics are considered as one of the main factors in the control of rabies. Having reliable data on dog population and husbandry practices on how they are managed is a key point in the elaboration of any control program to fight against human deaths due to rabies which are mainly due to dogs. However, the lack of data regarding dog population is one of the main hindrances to elaborate effective fighting projects in developing countries, particularly in Africa. In order to contribute for reliable data on dog demographics and husbandry practices related to rabies, this study was carried out in the cities of Ngaoundéré, Garoua and Yaoundé, respectively located in Adamaoua, North and Centre regions of Cameroon from October 2013 to April 2014. A survey was conducted within 2500 households selected randomly to which 45 questions were addressed, while the vaccine status of dogs was checked in the houses by verifying the vaccination booklet and in public and private veterinary clinics. Various aspects of dogs such as dog population, husbandry practices, ownership and age distribution were assessed. Out of these households, 45% of them (1118) had exploitable data. From these, 46% of them owned at least 1 dog for a total of 707 dogs, with a dog per household ratio of 6.3:10 for a dog per human ratio of 1.16:10. The age distribution of these dogs showed that the mean age of male and female was around 2 years with a male per female ratio of 29:10. The estimation of roaming dogs gave a ratio of 2.3:10 per human. Concerning the reasons for having a dog, the main motivation was guarding (76%) and company (17%). Husbandry practices applied to these dogs were a complete restrained (52%), semi-restrained (29%) and a complete roaming (18%). In relation to rabies, only 34% of dog owners were able to prove the effective vaccination of their dogs and no reason was given to explain the non-vaccination by the majority (78%) of the owners. So this study provides for the first time a baseline on dog population for an objective fighting program but also shows that the husbandry practices applied by the owners can be a hindrance to a fighting program against rabies.

Early treated HIV-infected children remain at risk of growth retardation during the first five years of life: Results from the ANRS-PEDIACAM cohort in Cameroon.

BACKGROUND: Long-term growth in HIV-infected infants treated early in resource-limited settings is poorly documented. Incidence of growth retardation, instantaneous risk of death related to malnutrition and growth parameters evolution during the first five years of life of uninfected and early treated HIV-infected children were compared and associated factors with growth retardation were identified. METHODS: Weight-for-age (WAZ), weight-for-length (WLZ), and length-for-age (LAZ) Z-scores were calculated. The ANRS-PEDIACAM cohort includes four groups of infants with three enrolled during the first week of life: HIV-infected (HI, n = 69), HIV-exposed uninfected (HEU, n = 205) and HIV-unexposed uninfected (HUU, n = 196). The last group included HIV-infected infants diagnosed before 7 months of age (HIL, n = 141). The multi-state Markov model was used to describe the incidence of growth retardation and identified associated factors. RESULTS: During the first 5 years, 27.5% of children experienced underweight (WAZ<-2), 60.4% stunting (LAZ<-2) and 41.1% wasting (WLZ<-2) at least once. The instantaneous risk of death observed from underweight state (35.3 [14.1-88.2], 84.0 [25.5-276.3], and 6.0 [1.5-24.1] per 1000 person-months for 0-6 months, 6-12 months, and 12-60 months respectively) was higher than from non-underweight state (9.6 [5.7-16.1], 20.1 [10.3-39.4] and 0.3 [0.1-0.9] per 1000 person-months). Compared to HEU, HIL and HI children were most at risk of wasting (adjusted HR (aHR) = 4.3 (95%CI: 1.9-9.8), P<0.001 and aHR = 3.3 (95%CI: 1.4-7.9), P = 0.01 respectively) and stunting for HIL (aHR = 8.4 (95%CI: 2.4-29.7). The risk of underweight was higher in HEU compared to HUU children (aHR = 5.0 (CI: 1.4-10.0), P = 0.001). Others associated factors to growth retardation were chronic pathologies, small size at birth, diarrhea and CD4< 25%. CONCLUSIONS: HIV-infected children remained at high risk of wasting and stunting within the first 5 years period of follow-up. There is a need of identifying suitable nutritional support and best ways to integrate it with cART in pediatric HIV infection global care.

Low rate of early vertical transmission of HIV supports the feasibility of effective implementation of the national PMTCT guidelines in routine practice of referral hospitals in Cameroon.

Background: Vertical (VT) transmission of HIV remains a public health concern in sub-Saharan Africa. Objective: To investigate the VT rate and factors associated with transmission in routine practice in three referral hospitals in Cameroon. Methods: All HIV-infected mothers who delivered in maternity wards or sought paediatric services during the first postnatal week from November 2007 to October 2010 were invited to participate in the ANRS-Pediacam cohort. Their infants were followed at 6, 10 and 14 weeks of life and HIV status was determined from the 6th week of life using real-time PCR. For those who were breastfed and negative at the first PCR, a second test was performed 6 weeks after breast-feeding was stopped. Logistic regression was performed to identify the independent risk factors of VT. Results: Overall, 2053 HIV-exposed infants were enrolled. Of these, 1827 were tested for HIV including 1777 before the age of 3 months, and 59 were HIV-infected, resulting in an overall early VT rate of 3.3% (CI 2.5-4.3). The VT rate was significantly associated with the type of maternal exposure to ART (0.5%, 2/439, p<0.001, CI 0.0-1.6) in mothers who commenced HAART before pregnancy, 1.9% (6/321, CI 0.7-4.0) in mothers who commenced HAART during pregnancy, 4.1% (34/837, CI 2.8-5.6) in those on short-course ART and 11.1% (17/153, CI 6.6-17.2) in mothers not receiving ART. On multivariate analysis, the type of exposure to ART remained significantly associated with being small for gestational age (aOR 5.0, CI 2.4-10.3, p < 0.001) and female gender (aOR 2.1, CI 1.2-3.8, p = 0.01). Conclusion: The successfully low rate of VT transmission of HIV in mothers who commenced HAART in early pregnancy strongly supports the need to improve access to diagnosis and early treatment of all women of childbearing age with HIV through the national PMTCT programme. Abbreviations: ANRS: French National Agency for Research on AIDS and Viral Hepatitis; ART: antiretroviral therapy; ARV: antiretroviral; AUDIPOG: Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie; CHM/MCC-CBF: The Central Hospital Maternity/Mother and Child Centre of the Chantal Biya Foundation; EHC: Essos Hospital Centre; EPI: Expanded Programme on Immunization; HAART: highly active antiretroviral therapy; HBV: hepatitis B virus; IQR: interquartile range; LH: Laquintinie Hospital; MTCT: mother-to-child transmission; NVP: nevirapine; Pediacam: Pediatrie Cameroun; PMTCT: prevention of mother-to-child transmission; SGAG: small for gestational age and gender; UNAIDS: Joint United Nations Program on HIV/AIDS; WHO: World Health Organization; ZDV: zidovudine; 3TC: lamivudine.