Functional host-specific adaptation of the intestinal microbiome in hominids.

Fine-scale knowledge of the changes in composition and function of the human gut microbiome compared that of our closest relatives is critical for understanding the evolutionary processes underlying its developmental trajectory. To infer taxonomic and functional changes in the gut microbiome across hominids at different timescales, we perform high-resolution metagenomic-based analyzes of the fecal microbiome from over two hundred samples including diverse human populations, as well as wild-living chimpanzees, bonobos, and gorillas. We find human-associated taxa depleted within non-human apes and patterns of host-specific gut microbiota, suggesting the widespread acquisition of novel microbial clades along the evolutionary divergence of hosts. In contrast, we reveal multiple lines of evidence for a pervasive loss of diversity in human populations in correlation with a high Human Development Index, including evolutionarily conserved clades. Similarly, patterns of co-phylogeny between microbes and hosts are found to be disrupted in humans. Together with identifying individual microbial taxa and functional adaptations that correlate to host phylogeny, these findings offer insights into specific candidates playing a role in the diverging trajectories of the gut microbiome of hominids. We find that repeated horizontal gene transfer and gene loss, as well as the adaptation to transient microaerobic conditions appear to have played a role in the evolution of the human gut microbiome.

Epidemiology of community-onset bloodstream infections in Bouaké, central Côte d'Ivoire.

Bacterial bloodstream infections (BSI) account for considerable morbidity worldwide, but epidemiological data from resource-constrained tropical settings are scarce. We analysed 293 blood cultures from patients presenting to a regional referral hospital in Bouaké, central Côte d'Ivoire, to determine the aetiology of community-onset BSI. The prevalence of bacteraemia was 22.5%, with children being most commonly affected. Enterobacteriaceae (predominantly Klebsiella pneumoniae and Salmonella enterica) accounted for 94% of BSI. Staphylococcus aureus was the only relevant Gram-positive pathogen. Clinical signs and symptoms were not significantly associated with blood culture positivity after controlling for malaria.

Detection of Enteroviruses in Water Samples from Yopougon, Côte d'Ivoire by Cell Culture and Polymerase Chain Reaction.

The objective of this study was to compare sensitivities of enterovirus isolation from wastewater in different cell lines as well as to compare the sensitivity and specificity of isolation in cell culture with direct detection by reverse transcription polymerase chain reaction (RT-PCR). Sixty-eight samples of wastewaters were collected between September 2008 and January 2009 in Yopougon, Abidjan. Enteroviruses were concentrated according to World Health Organization recommendations. Viruses were inoculated into various cell lines while direct RT-PCR was performed on water concentrates. The buffalo green monkey kidney cell line was the most sensitive with 58.8 % of viral isolation. This was followed by the rhabdomyosarcoma cell line with sensitivity of 51.6 %, with human epidermoid carcinoma cell line showing sensitivity of 50 % and fibroblastic cells derived from transgenic mice LTK-1 (L20B) cell showing 23.50 % sensitivity. However, a lower specificity of 2.9 % was observed with the L20B cell line. 44.1 % of the samples were positive by direct RT-PCR detection while 51.47 % samples were positive by using RT-PCR on infected cell cultures. No difference in percentage positivity was observed using RT-PCR on infected tissue culture isolates or using RT-PCR directly on wastewater samples.

[Detection of enteroviruses in urban wastewater in Yopougon, Abidjan]. / Détection d'entérovirus dans les eaux usées urbaines à Yopougon, Abidjan.

AIM: The aim of this study was to determine prevalence of enteroviruses in raw municipal wastewater and specify serotypes circulating. METHODS: After virus concentration by WHO recommend method, aqueous phase of 68 samples was inoculate on BGM, RD, L20B and Hep2 cells lines. Typing after titration was performed by microplate neutralization test with specific horse immune serum against EV (kit RIVM/WHO). NPEV strains were confirmed by RT-PCR test in 5'NC genomic region. Antigenic and molecular tests of Polioviruses intratypic differentiation were performed to determine vaccine or wild origin of Poliovirus strains. RESULTS: Viral isolation obtained 43/68 (65.15 %) positives samples. Among these 35/43 (81. 39%) were EV and 8/43 (19.04 %) non EV strain. Among EVs, 34/35 (97.14 %) were NEPV and 2/35 (5.71 %) vaccinal Poliovirus strains type 2 (Sabin-like). NEPV typing gave 77 % untypeable strains by conventionally method. The average virus concentration estimated in the raw sewage is 4.28×10(5) PFU/L. CONCLUSION: Various contacts between people and these waters expose them to health risks.

Surveillance for avian influenza and Newcastle disease in backyard poultry flocks in Côte d'Ivoire, 2007-2009.

Between 2007 and 2009, active surveys were conducted on backyard poultry (chickens, guinea fowls and ducks) in four areas of Côte d'Ivoire, including two areas where avian influenza H5N1 outbreaks occurred in 2006. Each bird underwent clinical examination. In total, 5,578 sera, 4,580 tracheal swabs and 5,120 cloacal swabs were collected, plus tissues from 35 sick chickens. Using the haemagglutination inhibition (HI) test, 277 and 36 serum samples were positive for H5 and H7, respectively; all were negative for H9. All samples were negative by reverse transcription polymerase chain reaction. These results confirm the circulation of H5 and H7 influenza subtypes in backyard poultry in Côte d'Ivoire. Given that the seropositive birds were healthy, the circulating subtypes may be low pathogenicity avian influenza strains. Half (2,680) of the sera collected from chickens were tested by HI for Newcastle disease virus (NDV) antibody: 531 were positive. The seroprevalence of 19.8% confirms the endemic status of NDV, but may underestimate its true prevalence in Côte d'Ivoire.

Molecular characterization and genotyping of human rotavirus strains in Abidjan, Cote d'Ivoire.

In this study, we characterized human rotavirus strains recovered from infants and young children with acute diarrhea in Abidjan, Cote d'Ivoire, during 2000-2004. In total, 719 fecal specimens were collected from children aged 1-60 months with acute infantile gastroenteritis. Examination with a commercial enzyme-linked immunosorbent assay showed the presence of group A rotavirus antigen in 208 diarrheal specimens (28.9%). Polyacrylamide gel electrophoresis of the RNA extracted from rotavirus-positive stools yielded a variety of "long" and "short" RNA electropherotypes, which were used to help select strains for VP4 and VP7 genotyping. VP7 genotype G1 strains were circulating most commonly during the study period (53%), followed by G2 (22%) and G3 (5%) strains. Strains with multiple VP7 genotype reactivity were observed in 7.6% of specimens, and a similar number (8%) could not be typed at all. VP4 P[6] and P[8] strains circulated at similar levels (33%). Strains demonstrating multiple VP4 types were quite common (9%); however, 20% of the strains were untypeable by the methods used. Rotavirus strain diversity in Cote d'Ivoire was similar to that observed in other West African countries.

Detection of viral RNA by RT-PCR from serum for molecular diagnosis of measles.

Measles continues to be a cause of morbidity and mortality in Côte d'Ivoire although the death rates are weak (2.4%). The monitoring and elimination programme of this disease require a laboratory confirmation testing by diverse methods of diagnosis needing diverse biological products. Serum is usually used for IgM detection. This study has therefore assessed the importance of the measles virus RNA detection from sera of measles suspected cases for confirmation of the case and determination of the genotype. A total of 45 sera tested were split into two groups according to the interval between the rash appearance and the day of blood collection: Group 1 (day 1 to day 3); group (2 day 4 to day 7). Four sera from Group 1 of the 45 (8.9 %) were positive by RT-PCR technique while 10 (22.2%) sera were positive for IgM anti- measles virus by ELISA test. RT-PCR and ELISA showed the same performance in group 1 with a positivity rate of 13.79 %. The B3 genotype was found. This result showed that the viral RNA can be detected in the serum but only from those sera collected the first 3 days after the rash appearance and could be used as palliative in case it is impossible to obtain other biological products.

[Diagnosis of non Poliovirus enteroviruses in Abidjan from 1996 to 2004]. / Diagnostic des entérovirus non Poliovirus à Abidjan de 1996 à 2004.

Non Poliovirus enteroviruses (NPEV) are infectious agents which can determine various infections. They are more and more isolated within the context of the surveillance of acute flaccid paralysis (AFP) and raise a problem of antigenic identification. In Côte d'Ivoire the serotypes of NPEV circulating are unknown. In order to determine the epidemiological and virology characteristics of human (NPEV) stemming from virology investigations from 1996 to 2004, enteroviruses strains isolated from stools and from cerebrospinal fluid have been analysed. The biological products have been tested according to the procedures recommended by the World Health Organisation (WHO) within the context of the virology surveillance of acute flaccid paralysis and the antigenic identification by seroneutralization and serotyping has been done. Out of 144 isolates obtained from 10187 specimens, 637 were Poliovirus strains and 807 NPEV strains (7.9%). Among them 16.3% have been isolated during carrier studies and 83.7% were associated with cases of AFFP Out of the 807 strains of NPE, 218 strains have been tested by serotyping and the serotype of 77 strains (35.32%) has been determined: Coxsackievirus B (41.6%) and different serotypes of Echovirus (58.4%). The proportion of untypable strains (62.3%) confirms the difficulties to identify NPEV with the conventional available reagents. The molecular diagnosis is becoming necessary in order to establish a list of the serotypes of NPEV circulating and associated with clinical features in the country

[Epidemiological and virological aspects Rotavirus diarrhoea in Abidjan, Côte d'Ivoire (1997-2000)]. / Aspects épidémiologiques et virologiques des diarrhées dues aux Rotavirus à Abidjan, Côte d'Ivoire (1997-2000).

Viruses, mainly rotaviruses are aetiological agents in more than 80% of the cases of acute diarrhoea in children. In order to determine the epidemiological characteristics and genotypes of human rotaviruses involved in gastroenteritis in diarrheic children aged from 0 to 5 years old in Abidjan, 642 specimens of stools were collected between 1997 and 2000 in the urban health centres and University Teaching Hospitals in Abidjan. The antigenic detection of rotaviruses carried out by ELISA test was followed by the antigenic (VP6 sub-groups) and molecular characterization: polyacrylamide gel electrophoresis and genetic typing. The general prevalence of Rotavirus diarrhoea was 27.9%. Among the children who were found positive, those whose age ranged from 0 to 11 months old accounted for 45.8% against 41.3% and 12.9% for those whose age ranged from 1 to 2 and 3 to 5 years old respectively proving thus the precocity of rotavirus infection. From an electrophoretypical and antigenic point of view 74.5% of 141 extracts of RNA had a "long" profile and belonged to the VP6 II sub-group against 24.8% of "short" profile belonging to sub-group I. The electrophoretypes with short profile were identified in majority in infants whose age ranged from 0 to 2 years old. Out of the P genotypes identified, the P [8] genotype (59.6%) was predominant followed by the P [6] genotype (26.2%), P [4] (2.8%) and one mosaic genotype P[6,8] which represented 11.4%. These results will need to be completed by the determination of VP7 genotypes in order to provide interesting information on rotaviruses before the introduction of anti-Rotavirus vaccines in the country.

[Results of two-year surveillance of flu in Abidjan, Côte d'Ivoire]. / Bilan de deux années de surveillance de la grippe à Abidjan.

Influenza (flu) is a seasonal viral disease that may have a favorable outcome or be associated with a high morbidity and mortality rate during epidemics. In view of the lack of epidemiological and virological data about flu in Côte d'Ivoire, a surveillance network was set up in Abidjan to monitor the spread of flu and characterize isolated viruses. Over the 24-month period from January 2003 to December 2004, nasal secretions were collected in patients presenting with flu syndrome at various heath care centers in Abidjan. Laboratory identification of viruses was performed by the ELISA technique using anti-A and anti-B monoclonal antibodies (immunocapture) and by isolation on MDCK cells. A fraction of the original samples and isolates was sent for confirmation to the Pasteur Institute in Paris, France and to the National Institute for Communicable Diseases (NICD) in Johannesburg, South Africa. Amongst the 211 samples analyzed, 30 (12.8%) proved positive for flu virus. Twenty-two isolates were positive for influenza virus A including 21 for A (H3N2) type and one for A (H1N1) type. The remaining 8 isolates were positive for influenza virus B. Most of these strains were isolated from patients in two age ranges, i.e. 0 to 5 years (34%) and 15 to 59 years (47%). More than 60% of the strains were isolated in June and October but the study duration was too short to define a flu season. Further surveillance data will allow better determination of flu season and definition of clinical and biological characteristics as a prerequisite for a preventive immunization program.

Bilan de deux années de surveillance de la grippe à Abidjan

La grippe est une maladie virale saisonniere qui peut etre benigne ou redoutable du fait du taux de morbidite et de mortalite occasionne lors des epidemies. En absence de donnees epidemiologiques et virologiques en Cote d'Ivoire; un reseau de surveillance de la grippe a ete mis en place a Abidjan pour determiner le niveau de circu-lation de virus grippaux et caracteriser les virus isoles. De janvier 2003 a decembre 2004; soit pendant 24 mois; des secretions nasales ont ete collectees dans les formations sanitaires de la ville d'Abidjan. L'identification des virus grippaux au laboratoire a ete realisee par technique ELISA utilisant des anticorpsmonoclonaux anti-A et anti-B (immunocapture) et par isolement sur cellulesMDCK. Une partie des echantillons d'origine et les isolats ont ete envoyes pour confirmation a l'Institut Pasteur de Paris (2003) et au National Institute for Communicable Diseases (NICD) a Johannesburg. Parmi les 211 echantillons analyses; 30 (12;8) se sont reveles positifs : 22 isolats de virus InfluenzaA dont 21 de typeA (H3N2) et une souche de typeA (H1N1); et 8 isolats de virus Influenza B. Ces souches ont ete isolees majoritairement chez des patients de 0-5 ans (34) et 15-59 ans (47). Bien que plus de 60des souches aient ete isolees en juin et en octobre; il est difficile de definir une saisonnalite du fait de la courte duree de l'etude. La poursuite de cette etude permettra une meilleure appreciation de la saisonnalite; des caracteristiques virologiques et cliniques pour envisager une prevention par la vaccination

[Detection of anti-Lassa antibodies in the Western Forest area of the Ivory Coast]. / Detection des anticorps anti-virus de Lassa dans l'ouest forestier de la Côte d'Ivoire.

Lassa fever is an African viral hemorrhagic fever (VHF) known to be endemic in a number of West African countries including Nigeria, Sierra Leone, Liberia and Guinea. Despite having common borders with Liberia and Guinea, Côte d'Ivoire has never reported any cases of Lassa fever. In March 2000, as part of a research project on VHF--mainly yellow fever, Lassa fever and Ebola fever--in Guinea and Cote d'Ivoire, an exploratory survey was conducted to assess knowledge about VHF and immunological status against Lassa virus among forest workers in the Duekoue and Guiglo regions. One hundred and sixty-three male forest workers were interviewed using a questionnaire designed to assess risk factors for VHF exposure and personal medical history over the last 12 months. Detection of IgG antibodies against Lassa virus was performed by immunofluorescence assay with Lassa virus antigens from the Josiah and Las/AV strains. The overall prevalence of IgG antibodies was 26% (42/161). Among the Lassa IgG positive subjects, 38.5% were loggers including 20% that were positive at a serum dilution of 1/40 and 46.7% were national park workers or forest rangers including 69% that were positive at a dilution of 1/40 and more. Forty-one percent of subjects had heard of VHF including 14% who attributed it to animals and 2% who attributed it to plants. Contact with rodents was frequent and more than 50% of subjects had either eaten or skinned rodents. Although the prevalence of anti-Lassa IgG antibodies seemed high in the study population, no conclusion can be about level of exposure to Lassa virus.

Detection des anticorps anti-virus de Lassa dans l'ouest forestier de la Cote d'Ivoire

La fievre de Lassa est une fievre hemorragique virale (FHV) africaine endemique en Afrique de l'Ouest; notamment au Nigeria; en Sierra Leone; au Liberia et en Guinee. La Cote d'ivoire qui part age des frontieres avec le Liberia et la Guinee n'a jamais notifie de cas de fievre de Lassa. Dans le cadre d'un projet de recherche sur les fievres hemorragiques virales principalement la fievre jaune; la fievre de Lassa et la fievre Ebola en Guinee et en Cote d'Ivoire; une enquete a ete realisee en mars 2000 chez des travailleurs forestiers des prefectures de Guiglo et Duekoue; dans le but de determiner le niveau de connaissance sur les fievres hemorra-giques virales et le statut immunitaire vis a vis du virus de Lassa. Cent soixante-trois sujets de sexe masculin professionnels de la foret ont ete interroges a l'aide d'un questionnaire sur les facteurs de risque d'exposition aux FHV et leurs antecedents medicaux des 12 dern i e rs mois. Les anticorps seriques de type IgG anti-virus de Lassa ont ete detectes par technique d'immunofluorescence utilisant les antigenes Lassa des souches Josuah et LAS/AV. La prevalence globale en IgG obtenue etait de 26(42/161). Pa rmi les sujets positifs; 38;5etaient des bucherons dont 20positifs au 1/40; 46;7des agents du parc national ou gardes forestieres dont 69positifs au 1/40 et plus. De plus; 41des sujets avaient entendu parler des FHV; 14ont attribue leur origine a des animaux et 2a des plantes. Les contacts avec les rongeurs etaient frequents et plus de 50des personnes ont deja consomme ou depece des rongeurs. La proportion de sujets porteurs d'anticorps IgG anti-virus de Lassa dans cette population semblait elevee. Cependant cette prevalence ne permet pas de conclure a une exposition particuliere au virus de Lassa

[Methicillin-resistance of Staphylococcus aureus in Abidjan (1998-2001): a new hospital problem]. / La méticillino-résistance de Staphylococcus aureus isolés à Abidjan (1998-2001): un nouveau problème en milieu hospitalier.

OBJECTIVE: The authors had for aim to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains on infections in Abidjan as well as their susceptibility to other antibiotics. METHODS: Three hundred and forty strains of S. aureus from various samples of hospitalized patients were studied. Methicillin-resistance was assessed using oxacillin disk diffusion in agar. The MRSA, once detected, were confirmed by screening in Mueller-Hinton agar containing oxacillin at 6 microg/ml. The susceptibility to other antibiotics was analyzed using an antibiogram in agar medium. RESULTS: Twenty-five percent of strains were resistant to methicillin (MRSA strains). Those MRSA were identified mainly in blood culture (14.2%), pus (4%) and urine (1.9%). Samples were collected in neonatal unit (13%), surgical units (5.4%) and intensive care unit (3.4%). A variable proportion of MRSA expressed resistance to other families of antibiotics: aminoglycosides 77.6%, rifampicin 8.8%, fluoroquinolones 34.1% and vancomycin 5.9%. CONCLUSION: Circulation of multidrug resistant MRSA in hospital, especially in neonatal unit, should lead to surveillance. Risk factors and other associated markers need to be identified.

[The spread of the wild Poliovirus in the rural environment, the case of the Adzopé health district, Côte d'Ivoire]. / Circulation de Poliovirus en milieu rural, cas du district sanitaire d'Adzopé, Côte d'Ivoire.

Wild Poliovirus spreading in rural environment in Adzopé, Côte d'Ivoire In order to determine the level of wild Poliovirus spreading among rural children in an endemic poliomyelitis country 469 stools samples, from children aged between three weeks and twelve years old were processed according to WHO procedures for transportation, conservation, isolation and identification of Poliovirus. Intratypic differenciation was performed by an antigenic method using monoclonal antibodies and a genomic RFLP (Restriction Fragment Length Polymorphism). 50 Poliovirus strains (10.7%) were isolated and analyzed: 15 vaccine-like Poliovirus type 1 (30%), 30 vaccine-like Poliovirus type 2 (60%), 4 vaccine-like Poliovirus type 3 (8%) and one wild Poliovirus type 3 (2%). As expected, in the major cases the duration of post-vaccinal viral excretion did not exceed two months. However, in 14% of cases, it varied between 3 and 9 months after the third OPV dose. This long excretion could be due to an inefficient local intestinal immunity or no local immunity at all, in spite of the three OPV doses. These results argue in favor of an increase of the number of OPV doses in such endemic zones. Moreover, OPV strains are well-known to revert to pathogenicity in vaccinees, therefore, the long term excretion of pathogenic OPV derived strains by a certain amount of vaccinees needs to be considered quite seriously.

[Nasal carriage of meticillin-resistant Staphylococcus aureus among health care personnel in Abidjan (Côte d'lvoire)]. / Portage nasal de Staphylococcus aureus méticillino-résistant chez le personnel soignant hospitalier a Abidjan (Côte d'Ivoire).

To determine the prevalence of méticillino-résistant Staphylococcus aureus (MRSA) among health care personnel in Abidjan teaching hospitals as well as their resistance profile against other antibiotics, 592 health care personnel from various surgical and medical services: the intensive care unit, gynaecology and obstetrics and third-degree burns services of the Cocody, Treichville and Yopougon Teaching Hospitals were included. The previous nasal pits of each subject included were swabbed. The isolation of S. aureus strains was run in a Chapman medium followed by Identification based on morphological and biochemical characteristics. The resistance profile of the strains to antibiotics was determined by standard Kirby-Bauer disk diffusion method and a 1 microg disc of oxacillin was used for the detection of meticillin-resistance S. aureus strains according to NCCLS (National Committee for Clinical Laboratory Standards) guidelines. 269 members of the studied personnel were carriers of S. aureus, either a rate of portage of 45.4%. Among the 269 S. aureus isolates, 38.7% were MRSA strains and the carriage rate of MRSA in the population was 17.8%. The health care personnel working in surgery was the more colonized (36.7%) follow-up of those of the medical services (31.4%) and of the the intensive care unit (12.4%). A variable proportion of strains of MRSA also expressed resistances to the other families of antibiotics: 27% to aminosids of which 13.5% of phénotype kanamycine, tobramycine, gentamycine (KTG), 58.7% to macrolids and related (MLS), 37.5% to fluoroquinolons, 14.4% to cyclines and 40% to the cotrimoxazole. This confirms their multi-resistant character. The prevalence of MRSA carriage among health care personnel is high; this personnel constitutes an infectious risk for the hospitalized patients who are so exposed to nosocomial infections caused by MRSA.

[Agents of community acquired purulent meningitis in the child: epidemiologic trends in Abidjan, Côte d'Ivoire, from the year 1995 to 2000]. / Agents des méningites purulentes communautaires de l'enfant: tendance épidémiologique à Abidjan, Côte d'Ivoire, de 1995 à l'an 2000.

OBJECTIVE: To assess prevalence and trends of community acquired bacterial meningitis in childhood in a tertiary-care hospital before introduction of the HIB conjugate vaccine. STUDY DESIGN: Laboratory based data were recorded from January 1995 to December 2000 on two hundred and eighty seven children with bacterial meningitis. Identification of bacterial agents was performed with conventional methods. Information including age, gender, bacterial aetiology of meningitis, month and annual prevalence of agents was examined. RESULTS: The age of infected children ranges from 1 to 10 years with an average and median age of 34.2 months and 12 months respectively. Fifty five percent of children were male. The overall prevalence of agents were respectively 47.8% for Streptococcus pneumoniae followed by Haemophilus influenzae 39% and Neisseria meningitidis 13.2% with predominance of serogroup C. Stratification by age group shows that Haemophilus influenzae was the most common agent among children < 1 year of age following by S. pneumoniae and N. meningitidis. After 5 years, the number of cases of S. pneumoniae and N. meningitidis was prevalent. After 10 years, N. meningitidis was the first aetiology of bacterial meningitis. The six years data recorded highlighted the high and stable prevalence of H. influenzae B and S. pneumoniae and the low prevalence of N. meningitidis and high incidence of invasive meningococcal, pneumococcal and Haemophilus influenzae during the six years between September and February. CONCLUSION: Conjugated HIB vaccine is needed in our country to lower incidence of H. influenzae meningitis as already seen in developed countries. Continuous surveillance is necessary to monitor the disease trends, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against community acquired bacterial meningitis.

[Detection and management of the yellow fever epidemic in the Ivory Coast, 2001]. / Detection et gestion de l'epidemie de fievre jaune en Cote d'Ivoire, 2001.

From March to December 2001, an outbreak of yellow fever was observed in Cote d'Ivoire. Sentinel surveillance for hemorrhagic fever allowed detection of the first case in the Duekoue health district in the heavily wooded western part of the country. A weekly reporting system was established. For each suspected case recorded and reported to the Epidemiological Surveillance Department at the National Institute of Public Hygiene, a sample was collected and sent for confirmation at the Pasteur Institute of the Cote d'Ivoire. The outbreak progressed from West to East reaching Abidjan, the economic capital of the country located in the southeast. The epidemic emergency plan consisted of setting up a crisis committee to implement epidemiological, entomological and virological surveillance, mass vaccination campaigns in areas around confirmed cases, and vector control. A total of 280 cases were reported including 32 confirmed cases and 6 deaths. Eleven out of 62 districts were affected with most cases occurring in cities with more than 10000 inhabitants. Over 3.7 million persons were vaccinated for an overall coverage of 92.2% in the areas where campaigns were carried out. As a result of this outbreak, surveillance for potentially epidemic diseases has been reinforced and surveillance of viral transmission is now being considered. A vaccination program for adults has also been established.