Estimating the number of probable new SARS-CoV-2 infections among tested subjects from the number of confirmed cases.

OBJECTIVES: In most African countries, confirmed COVID-19 case counts underestimate the number of new SARS-CoV-2 infection cases. We propose a multiplying factor to approximate the number of biologically probable new infections from the number of confirmed cases. METHODS: Each of the first thousand suspect (or alert) cases recorded in South Kivu (DRC) between 29 March and 29 November 2020 underwent a RT-PCR test and an IgM and IgG serology. A latent class model and a Bayesian inference method were used to estimate (i) the incidence proportion of SARS-CoV-2 infection using RT-PCR and IgM test results, (ii) the prevalence using RT-PCR, IgM and IgG test results; and, (iii) the multiplying factor (ratio of the incidence proportion on the proportion of confirmed -RT-PCR+- cases). RESULTS: Among 933 alert cases with complete data, 218 (23%) were RT-PCR+; 434 (47%) IgM+; 464 (~ 50%) RT-PCR+, IgM+, or both; and 647 (69%) either IgG + or IgM+. The incidence proportion of SARS-CoV-2 infection was estimated at 58% (95% credibility interval: 51.8-64), its prevalence at 72.83% (65.68-77.89), and the multiplying factor at 2.42 (1.95-3.01). CONCLUSIONS: In monitoring the pandemic dynamics, the number of biologically probable cases is also useful. The multiplying factor helps approximating it.

[Realities for a Sickle Cell Disease Control Strategy in the World Health Organization African Region]. / Réalités pour une stratégie de lutte contre la drépanocytose dans la région africaine de l'Organisation Mondiale de la Santé: Compte rendu du 7e Symposium International du Réseau d'Étude de la Drépanocytose en Afrique Centrale (REDAC https://www.redacnetwork.org/) Antananarivo, Madagascar. 13 - 15 juin 2018.

The Network for the Study of Sickle Cell Disease in Central Africa or REDAC, is a network of African, European and American researchers whose aim is to combat sickle cell disease. Its congresses take place every year in the partner countries with international symposia alternating with workshops. REDAC enables host countries to obtain from local authorities a real involvement in the fight through resolutions in line with national strategies of fight. The Seventh International Symposium of REDAC was held in 2018 in Antananarivo, Madagascar under the auspices of the Malagasy Minister of Health and the Malagasy Senate Authorities. The theme chosen was that of strategies to combat sickle cell disease recommended by the WHO. The presentations focused on neonatal screening, early diagnosis, management of sickle cell disease and new therapies (marrow transplant, gene therapy and treatment with hydroxyurea).

Evaluation of the application of national malaria treatment guidelines in private pharmacies in a rural area in the Democratic Republic of Congo.

In the Democratic Republic of the Congo, the first recourse in case of suspected malaria in the health system is the private pharmacy sector. This study was therefore designed to assess private provider adherence to national case management guidelines in Kimpese, a rural area of Central Kongo province. A descriptive cross-sectional survey of 103 pharmacies took place in March 2016. The study included 97 pharmacies. The artemether-lumefantrine combination recommended as the first-line treatment for uncomplicated P. falciparum malaria was available in 100% of pharmacies but only 3% stocked quality-assured medicines. The sulfadoxine-pyrimethamine recommended for intermittent preventive treatment of malaria in pregnant women and quinine, which is no longer part of national policy, were widely available (>97.0% of pharmacies). Among providers, fewer than 20% were aware of the national malaria treatment guidelines. The main reasons for non-adherence to national guidelines among private dispensers was the high cost (up to 10 times more expensive than sulfadoxine-pyrimethamine treatment) and adverse effects of artemisinin-based combination therapies. Governmental interventions to improve private sector engagement in implementation of the national guidelines and to prevent the spread of ineffective and non-quality assured antimalarial medicines must be intensified.

Access to artemisinin-based combination therapies and other anti-malarial drugs in Kinshasa.

OBJECTIVE: Artemisinin-based combination therapies have been available since 2005 in the Democratic Republic of the Congo to treat malaria and to overcome the challenge of anti-malarial drug resistance as well as to improve access to effective treatments. The private sector is the primary distribution source for anti-malarial drugs and thus, has a key position among the supply chain actors for a rational and proper use of anti-malarial drugs. We aimed to assess access to nationally recommended anti-malarial drugs in private sector pharmacies of the capital-city of Kinshasa. METHOD: We performed a cross-sectional survey of 404 pharmacies. RESULTS: Anti-malarial drugs were stocked in all surveyed pharmacies. Non-artemisinin-based anti-malarial therapies such as quinine or sulfadoxine-pyrimethamine, were the most frequently stocked drugs (93.8% of pharmacies). Artemisinin-based combination therapies were stocked in 88% of pharmacies. Artemether-lumefantrine combinations were the most frequently dispensed drugs (93% of pharmacies), but less than 3% were quality-assured products. Other non-officially recommended artemisinin-based therapies including oral monotherapies were widely available. CONCLUSION: Artemisinin-based combination therapies were widely available in the private pharmacies of Kinshasa. However, the private sector does not guarantee the use of nationally recommended anti-malarial drugs nor does it give priority to quality-assured anti-malarial drugs. These practices contribute to the risk of emergence and spread of resistance to anti-malarial drugs and to increasing treatment costs.

[Iron status in 72 Congolese patients with sickle cell anemia]. / Le statut martial chez soixante-douze drépanocytaires homozygotes congolais.

Multiple blood transfusions, intestinal parasites, and high iron needs during the growth period are all factors that influence iron status in African children. To determine their iron status and its association with these factors, we studied 72 homozygous sickle-cell patients in a steady state in Kinshasa. Iron status was determined by a combination of several indicators: ferritin, transferrin, blood count, total iron binding capacity, transferrin saturation, and C-reactive protein. These results were compared with those from a matched control group without sickle-cell disease. Compared to the control group, 5 patients (11%) were iron-deficient, while 18 (35%) had an iron overload, probably due to multiple blood transfusions. This study shows the importance of periodic assessments of iron status in homozygous sickle cell patients to prevent and manage any iron imbalance.

Foetal haemoglobin, erythrocytes containing foetal haemoglobin, and hematological features in congolese patients with sickle cell anaemia.

High HbF levels and F cells are correlated with reduced morbidity and mortality in sickle cell disease (SCD). This paper was designed to determine the HbF and F cells levels in Congolese sickle cell anemia (SCA) patients in order to determine their impact on the expression of SCD. Population and Method. HbF levels were measured in 89 SCA patients (mean age 11.4 yrs) using a standard HPLC method. F cell quantitation was done in a second group of SCA patients (n = 42, mean age 8.9 yrs) and compared with a control group (n = 47, mean age 5 yrs). F cells were quantified by a cytofluorometric system (MoAb-HbF-FITC; cut off at 0.5%). Results. The mean value of HbF was 7.2% ± 5.0 with heterogeneous distribution, most patients (76%) having HbF < 8%. Mean values of F-cells in SCA patients and control group were 5.4% ± 7.6 (median: 2.19%; range 0,0-30,3%) and 0.5% ± 1.6 (median 0.0, range 0-5.18), respectively. SCA patients with F cells >4.5% developed less painful crisis and had higher percentage of reticulocytes. Conclusion. Congolese SCA patients displayed low levels of HbF and F-cells that contribute to the severity of SCD.

[Hemogram findings in Congolese children with sickle cell disease in remission]. / L'hémogramme de l'enfant drépanocytaire congolais au cours des phases stationnaires.

INTRODUCTION: Sickle cell disease is associated with a wide range of clinical and laboratory findings depending on genetic modulators and environmental factors. The most severe forms of sickle cell disease occur in patients with the Bantu haplotype. The purpose of this study was to determine the hematological profile of Congolese patients with homozygous sickle cell disease during periods of remission. PATIENTS AND METHODS: Hemograms were performed in two series of patients with sickle cell disease in remission, i.e., one including 89 patients with a mean age of 8.7 years and the other including 42 patients with a mean age of 8.9 years. Hemograms were performed using an automated counter and reticulocytes were counted manually on peripheral blood smears. Fetal hemoglobin level (HbF) was measured by chromatography (HPLC). The mean values obtained were compared with those obtained in a sickle-cell-disease-free control group. Some parameters were also compared with those obtained in a group of patients exhibiting complications of sickle cell disease. RESULTS: Hemograms in the first series of patients demonstrated the following values: Hb: 7.2 g/dl; Hct 23.1%, red cells: 2.47 tera/L, leukocytes: 14.9 giga/L; VGM: 95.3 fL; CCMH:30.3% L and platelets:345,3 giga/L. Blood count showed 30.4% of polynuclear neutrophils, 33% de lymphocytes, 0.8% of polynuclear basophiles, 14% of monocytes, 7.8% of polynuclear eosinophils and 14% of erythroblasts. Mean HbF level was 7.2% and reticulocytes were at 88%. In the sickle cell disease-free group, the leukocyte rate was almost three fold higher than in the patient group exhibiting sickle cell disease in remission even though rates were higher than during complications. CONCLUSION: Hemogram profiles in Congolese patients with sickle cell disease are similar to those reported in the literature for subjects exhibiting the Bantou haplotype. Leukocytosis was associated with esinophilia and monocytosis suggested a topical state and chronic inflammation.

[Protein profile in 45 Congolese children with sickle cell anaemia]. / Etude du profil protéique de 45 enfants drépanocytaires homozygotes congolais.

Sickle cell anemia (SCA) is a genetic disorder characterized by severe hemolytic anemia, frequent vaso-occlusive events and infections. In tropical environment, people are continuously in contact with infection agents. The present study was undertaken to measure 10 protein parameters in order to test humoral immunity, nutrition status and the relation between inflammation and hemolysis in sickle cell anemia patients in 45 Congolese sickle cell children (15 females and 30 males, median age: 7 yrs) and a control group of 43 well healthy congolese group (18 females, 25 males; median age 18 yrs). Mean values for immunoglobulins (IgG, IgM, IgA), nutrition proteins (albumin, transthyretin and transferrin) and inflammatory and hemolysis markers (C3, CRP, A1GP: alpha1-Glycoprotein acid and haptoglobin) were compared between two groups. Hyperstimulation of humoral immunity was observed in the SCA group. Most significative difference was found with IgA (p < 0,001). Intravascular hemolysis was illustrated by a significant decrease of the haptoglobin/A1GP ratio, and was constantly present in SCA patients. We also described a significative decrease (p < 0,001) of haptoglobin/A1GP ratio between SCA patients with inflammatory syndrom when compared to those without inflammation. All data confirm that haemolysis is quite linked to inflammation in SCA. In addition, nutrition parameters were significantly decreased in SCA group vs healthy congolese group.

Neonatal screening for sickle cell anaemia in the Democratic Republic of the Congo: experience from a pioneer project on 31 204 newborns.

BACKGROUND: Despite the high prevalence of sickle cell disease in Africa, a neonatal screening programme is available in only a few countries in the sub-Saharan region. AIM: To describe our experience of a pioneer study on 31,304 newborns screened systematically in the Democratic Republic of the Congo. METHODS: The prevalence of haemoglobinopathies was determined by a thin-layer isoelectric focusing method on dry filter-paper samples. RESULTS: Of the 31,204 newborns screened by isoelectric focusing, 5,276 (16.9%) displayed sickle cell trait and 428 (1.4%) were homozygous for haemoglobin S. No statistical differences were observed in the different ethno-linguistic groups, but some tribes displayed a higher prevalence of the betaS gene, attributable to a higher prevalence of malaria, and a greater frequency of haemoglobin S homozygotes, in part attributable to an endogamic marriage system. CONCLUSION: The neonatal screening programme has now been introduced in the Democratic Republic of the Congo, but the main challenges are to track all the new cases for a confirmatory test and to initiate early management.

Neonatal screening and clinical care programmes for sickle cell disorders in sub-Saharan Africa: lessons from pilot studies.

OBJECTIVES: Despite the widespread use of neonatal screening programmes for sickle cell disease in Western regions, few studies have focused on the special healthcare needs in sub-Saharan African countries. The purpose of this review is to evaluate the need for a neonatal screening programme for sickle cell disease, and if justified, to propose a realistic healthcare programme for sickle cell newborns in those countries based on personal experiences in Kinshasa (Democratic Republic of the Congo) and Ouagadougou (Burkina Faso) as well as from a review of the literature. REVIEW: There are well-established criteria for the development of neonatal screening programmes for sickle cell disease in sub-Saharan African countries. In particular, in regions where incidence of the disease is 0.5 per 1000 or higher, a sickle cell screening programme can be proposed that includes the systematic screening of all newborns, or the targeted screening of those newborns who have a mother with a sickle cell or haemoglobin C trait. Screening should be preferentially organized using cord blood, with a simple, effective and affordable screening method such as isoelectric focusing. If necessary, confirmation of results should be performed using another cost-effective technique such as citrate agar electrophoresis at an acidic pH. There is also a need for a sickle cell disease clinical care programme which should include: infection prophylaxis with penicillin and malarial prophylaxis; family training to identify early severe or persistent symptoms and the gravity of malarial crises; the evaluation of nutritional status and adequate fluid intake; and the importance of regular medical visits. Improved knowledge of the diagnosis was found to reduce the need for unnecessary and unsafe blood transfusions. CONCLUSIONS: This paper provides an overview of practices employed in neonatal screening and clinical care programmes for sickle cell disease in sub-Saharan African countries. The development of these programmes is pivotal to improving the health care of those affected by haemoglobin disorders. However, such programmes require major economic and organizational resources, which must taken into account and balanced against other local health priorities.

[Human papillomavirus genotype profile in Kinshasa, Democratic Republic of the Congo: implications for vaccination]. / Profil génotypique du papillomavirus humain rencontré dans l'environnement de Kinshasa: intérêt vaccinal.

UNLABELLED: Proposed anti-human papillomavirus (HPV) vaccines, i.e., Cervarix (Glaxomith-Kline) and Gardasil (Merck), are designed to prevent infection by two high-risk HPV types, i.e., 16 and 18, for which estimation mainly in Western Europe and North America have demonstrated a prevalence 60 to 70%. OBJECTIVE: The purpose of this study was to determine the genotype profile of HPV strains encountered in the women of childbearing age in Kinshasa, Democratic Republic of the Congo and discuss the implications of this profile for anti-HPV vaccination. METHODS: Data and specimen collection was carried out at a voluntary HIV screening and treatment facility. Genotyping of HPV was performed in 55 patients presenting dysplastic lesions of the uterine cervix including 47 (85.5%) who were HIV-seropositive. Detection and typing of HPV were performed using the Inno-Lipa technique (Innogenetics Line Probe Assay) from Glaxo-Smith-Kline. RESULTS: Tests for HPV were positive in 54 patients (98.2%). A total of 153 HPV strains were isolated. Twenty-three HPV types were identified including 83.0% with high oncogenic activity. In order of frequency the oncogenic types were as follows: 68, 35, 51, 52, 16, 31, 18, 17, 33, 45, 56, 58 and 59. Strain frequency per patient ranged from 1 to 8 (mean +/- standard deviation, 2.8 +/- 2,0). Types 16 and 18 accounted for 11.8% of the isolated strains (18/153) and were observed in 33.3% of patients (18/54). CONCLUSION: The findings of this study suggest that the HPV genotype profile in Kinshasa differs from the profile observed in Western Europe and North America. If confirmed by larger-scale studies, this result bodes poorly for the efficacy of anti-HPV vaccines in Kinshasa.

Profil genotypique du papillomavirus humain rencontre dans l'environnement de Republique democratique du Congo : interet vaccinal

Les vaccins anti-HPV proposés, Cervarix® de Glaxo-Smith-Kline et Gardasil® deMerck, ciblent deux types du HPV à haut risque, le 16 et 18, dont la prévalence a été évaluée surtout en Europe de l'Ouest et enAmérique du Nord entre 60 et 70%. L'objectif de l'étude était de caractériser génétiquement les souches du HPV rencontrées dans la population des femmes en âge de procréer vivant à Kinshasa et d'en discuter les conséquences sur le plan de la vaccination anti-HPV. La collecte des données et le prélèvement des spécimens s'étaient déroulés à Kinshasa dans des sites de dépistage volontaire et du traitement duVIH. Le génotypage du HPV était conduit sur 55 cas portant des lésions dysplasiques du col utérin, dont 85,5%(47/55) étaient séropositifs pour le VIH. La détection et le typage du HPV étaient réalisés par la technique Inno-Lipa® (Innogenetics Line ProbeAssay) de Glaxo-Smith-Kline. La recherche du HPV était positive chez 98,2%(54/55) des patientes ; sur 153 HPV isolés, 23 types de HPV étaient identifiés dont 83,0%(127/153) à haut pouvoir oncogène, en ordre décroissant de fréquence suivant : 68, 35, 51, 52, 16, 31, 18, 17, 33, 45, 56, 58 et 59. La fréquence des souches trouvées par patiente variait de 1 à 8 (moyenne ± écart-type : 2,8 ± 2,0). Les types 16, 18, représentant 11,8%des isolats (18/153), ont été détectés chez 33,3%(18/54) des patientes. Le spectre génotypique du HPV trouvé à Kinshasa semble différent de celui trouvé en Europe et en Amérique du Nord. Ce résultat, s'il est confirmé par des études plus étendues, présage une faible efficacité des vaccins anti-HPV dans l'environnement de Kinshasa

Expérience d'utilisation de la moustiquaire imprégnée d'insecticide en zone de haute transmission palustre de Kinshasa

PROBLEMATIQUE. En zone de transmission pérenne du paludisme où la lutte semble s'enliser, la moustiquaire imprégnée d'insecticide (MII) s'impose comme un dispositif efficace de lutte au niveau des ménages. Nos OBJECTIFS DE RECHERCHE consistait à évaluer l'impact sur la morbidité de l'enfant dans une zone de haute transmission du paludisme de Kinshasa, du taux d'utilisation ainsi que l'intégrité de la MII, d'une part, et d'autre part, l'influence de l'âge, des saisons et du standing familial. METHODOLOGIE. Une cohorte de 1.400 enfants d'âge préscolaire habitant dans une zone de haute transmission du paludisme de Kinshasa, a été mise sous MII avec l'accord éclairé des parents, et suivie durant 11 mois. RESULTATS. Le risque fébrile, pour ne prendre que ce paramètre, qui était de 13,5% au début de l'étude, a été divisé pratiquement par trois à la fin de la période d'observation (Rapport de chances = 0,29). Une ou deux nuits passées sans la MII (RC=1,81), de même que la présence d'un seul trou dans la MII (RC=2,2), ont pratiquement doublé ce risque. Ce risque a diminué graduellement avec l'âge. La présence de plus de 10 personnes à charge dans le ménage a augmenté ce risque de près de 20% (RC=1,19). Six décès, dont deux imputés à la rougeole, ont été enregistrés après 4 et 9 mois d'utilisation de la MII. CONCLUSIONS. Pour autant qu'elle soit régulièrement utilisée et que son intégrité soit assurée, la MII réduit significativement le risque morbide imputable au paludisme. L'hypothèse de la perte de la prémunition a été invoquée pour expliquer les décès de cause non définie, probablement due au paludisme, survenus en dépit de l'utilisation régulière supposée de la MII

Diagnostic des dysplasies cervicales associees a l'infection VIH : perte d'efficacite de la cytologie conventionnelle

Problematique : l'absence d'un programme national de depistage du cancer du col uterin en Republique Democratique du Congo ne permet pas de prendre en charge efficacement cette pathologie dont le risque est de surcroit amplifie par l'infection a VIH. Le choix des techniques diagnostiques se pose de facon critique surtout en condition de faibles ressources ou se trouvent la plupart des pays subsahariens. Objectifs de la recherche : Evaluer ; d'une part; les qualites diagnostiques des frottis conventionnels (FC); facilement realisable en conditions de faibles ressources comparativement aux frottis en couche mince (FCM) pris comme reference; et d'autre part; l'influence de l'infection par le VIH sur les performances de ces techniques diagnostiques. Methodologie : Les examens cytopathologiques cervicaux ont ete realises sur 128 patientes VIH et 132 patientes VIH+ consentantes selectionnees dans deux centres de depistage volontaire de VIH a Kinshasa. Le consentement eclaire etait obtenu apres conseil et explication sur l'interet de cet examen pour la femme en activite sexuelle. Resultats : Les lesions dysplasiques de haut grade et les cancers du col uterin (CCU) etaient 10;3 fois plus frequentes chez les sujets VIH+ comparativement aux sujets VIH- (Odds ration=10;3 ; IC95=3;7 a 31;1). La sensibilite; la specificite; les valeurs predilectives positive et negative; et l'efficacite diagnostique des FC etaient respectivement de 66; 7; 98;2; 87;6; 89;4pour les sujets VIH+ contre 80;0; 100; 100;0; 99;2et 99;2pour les sujets VIH-. Le risque de faux negatif comparativement aux risque de faux positifs etait significativement plus eleve chez le sujets VIH+ (x2 de Mc; Nemar = 10;3 ; p = 0;001) que chez les sujets VIH- (x2 de Mc; Nemar = 0 ; p = 1). Conclusion : La sensibilite; l'efficacite diagnostique des FC; d'une part; le taux de concordance (Kappa entre les FC et les FCM; d'autre part; etaient effondrees en presence de l'infection par le VIH; occasionnant un taux eleves de faux negatifs et une faible valeur predilective negative; probablement du fait de l'intensification des reactions inflammatoires. La frequence des examens de controle devrait etre plus rapprochee en cas d'infection a VIH

Blood transfusion rate in Congolese patients with sickle cell anemia.

OBJECTIVE: The main objective of this study was to evaluate the rate of blood transfusion in African Sickle Cell Patients and the risks related to the use of total blood. METHODS: 186 sickle cell patients (95 males and 91 females) aged 0-21 years were regularly followed over a 3 years period in Katanga province, DR Congo. Indications for blood transfusion were mainly based on clinical criteria and Hb level (less than 5g% ml or a drop of 2g% under the steady state value). All the subjects, who were transfused, wer screened for hepatitis B surface antigen (HBs Ag) and Human Immune deficit Virus (HIV). RESULTS: Of 186 patients, 150 (80.6%) were transfused and the average blood transfusion requirement was 0.4 units per patient-year. According to the age of first transfusion, 75.3% (113/150) of them were transfused before the 6th year of life; but the frequency of transfusions seemed to decline in children aged more than 13 years. The risk of HIV infection from blood transfusion was estimated at 1 per 37.1 units or 26 per 1000 blood units. The hepatitis B surface antigen was detected in 15 cases (10%) and HIV serology was positive in 17 patients (11.3%). CONCLUSION: Because of the complications related to blood transfusions in Africa, efforts are needed in order to reduce the frequency of transfusions, by preventive measures (early diagnosis, malarial and penicillin-prophylaxis) and to use more rational indications.

[Medicine and health in the Democratic Republic of Congo: from Independence to the Third Republic]. / Médecine et santé en République Démocratique du Congo: de l'Indépendance à la 3e République.

The birth and mortality rates in the Democratic Republic of Congo (DRC), a former Belgian colony, are high, i.e., 48.9/1000 and 17/1000 respectively. The DRC also has one of the highest maternal death rates in the world, i.e., 1289/100,000 live births. Health conditions have not improved since independence. Access to drinking water is limited, living conditions are poor, and food availability in households is low. The mean health services utilization rate in the DRC is estimated to be 0.15 visits/inhabitant/year. The incidence of transmissible diseases is rising. This increase is observed even for illnesses that were under control before independence such as sleeping sickness, onchocerciasis, leprosy, and tuberculosis. One the main causes of mortality and morbidity in the population is malaria that is responsible for the deaths of 150,000 to 250,000 children under the age of 5 every year. The HIV prevalence rate is 4.5% with 1.19 million persons with AIDS and 930,000 orphans whose parents died of AIDS. Other potentially epidemic diseases including bubonic plaque and Ebola hemorrhagic fever are serious threats. Non-transmissible diseases are also on the rise including diabetes, systemic arterial hypertension, cancer and neglected diseases such as sickle cell anemia. To meet these challenges, the country's health authorities have established a program called the Strategy for Reinforcement of the Health System (SRHS). One goal of the SRHS is to develop health zones in order to improve access to quality health care for the whole population.

[Is therapeutic progress in the management of sickle cell disease applicable in sub-Saharan Africa?]. / Les progrès thérapeutiques dans la prise en charge de la drépanocytose sont-ils applicables en Afrique subsaharienne?

The life expectancy of patients with sickle cell disease has improved in the United States and Europe thanks to the use of penicillin prophylaxis, appropriate immunizations, neonatal screening, implementation of a quality transfusional policy, hydroxyurea therapy, detection and treatment of cerebral vasculopathy, recognition of situations that can benefit from allogenic marrow transplantation, and improvements in bone marrow transplantation techniques. The cost of almost all these techniques is far beyond the means of health care systems in Africa where they cannot be used. However at least three, i.e., penicillin, vaccines, and hydroxyurea, could be easily accessible in the framework of defined therapeutic strategies. If daily penicillin and pneumococcal vaccine Pneumo 23 are required, it would likely be necessary to select a conjugated vaccine other than Prevenar that does not provide protection against all strains present in Africa. Neonatal screening is still a rare procedure in sub-Saharan countries. Periodic transfusion is steadily improving but exchange transfusion programs aimed in particular at preventing neurological complications are still unfeasible. Indications for hydroxyurea therapy in Africa are more common due to the lack of access to chronic transfusion and must be based on consensus decision. Use of bone marrow transplantation, i.e., the only currently available curative treatment, is still possible only in northern hemisphere countries where it is still restricted to children with severe forms and an HLA-compatible family donor.

Les progres therapeutiques dans la prise en charge de la drepanocytose sont-ils applicables en Afrique sub-saharienne?

L'esperance de vie des patients drepanocytaires s'est considerablement amelioree aux Etats-Unis et en Europe du fait de la penicillinotherapie preventive; des vaccinations; du depistage neonatal; de la mise au point d'une politique transfusionnelle de qualite; de l'hydroxyuree; de la detection et du traitement de la vasculopathie cerebrale; du discernement des situations redevables d'une greffe de moelle allogenique et des ameliorations des techniques de greffe. La quasi-totalite de ces soins ont un cout exorbitant en Afrique ou ils ne peuvent pas etre appliques. Pourtant; la penicilline; les vaccins; l'hydroxyuree pour le moins devraient y etre accessibles sans reserve; avec des strategies therapeutiques codifiees. Si la penicilline quotidienne et le vaccin anti-pneumococcique Pneumo 23r sont justifies; il est probable qu'il faudrait selectionner un autre vaccin conjugue que le Prevenarr qui ne couvre pas toutes les souches presentes en Afrique. Le depistage neonatal est encore tres exceptionnellement fait. La transfusion ponctuelle est en constante amelioration; mais les programmes d'echange transfusionnel; destines en particulier a prevenir les complications neurologiques; restent impossibles. Les indications de l'hydroxyuree en Afrique sont plus frequentes du fait de l'inaccessibilite de la transfusion chronique et devrait faire l'objet d'un consensus. Enfin; la greffe de moelle; seul traitement curatif a ce jour; reste l'apanage des pays du Nord; ou toutefois elle reste reservee aux enfants porteurs de formes graves et ayant un donneur intra-familial HLA-compatible