We conducted 3 successive seroprevalence surveys, 3 months apart, using multistage cluster sampli... more We conducted 3 successive seroprevalence surveys, 3 months apart, using multistage cluster sampling to measure the extent and dynamics of the severe acute respiratory syndrome coronavirus 2 epidemic in Conakry, the capital city of Guinea. Seroprevalence increased from 17.3% (95% CI, 12.4%–23.8%) in December 2020 during the first survey (S1) to 28.9% (95% CI, 25.6%–32.4%) in March/April 2021 (S2), then to 42.4% (95% CI, 39.5%–45.3%) in June 2021 (S3). This significant overall trend of increasing seroprevalence (P < .0001) was also significant in every age class, illustrating a sustained transmission within the whole community. These data may contribute to defining cost-effective response strategies.
La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que d... more La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the cou... more Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic 1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization. At least 30 outbreaks of Ebola virus disease (EVD) have been identified since the late 1970s, the most severe of which affected Guinea, Sierra Leone and Liberia from December 2013 to June 2016 1,2. Guinea experienced a new outbreak of EVD in 2021, which started in Gouéké-a town about 200 km away from the epicentre of the 2013-2016 outbreak. The probable index case was a 51-year-old nurse, an assistant of the hospital midwife in Gouéké. On 21 January 2021, she was admitted to hospital in Gouéké suffering from headache, asthenia, nausea, anorexia, vertigo and abdominal pain. She was diagnosed with malaria and salmonellosis and was released two days later. Feeling ill again once at home, she attended a private clinic in Nzérékoré (40 km away) and visited a traditional healer, but died three days later. In the week after her death, her husband-as well as other family members who attended her funeral-fell ill, and four of them died. They were reported as the first suspect cases by the national epidemic alert system on 11 February. On 12 February, blood was taken from two suspect cases admitted to
Southern African Journal of Infectious Diseases, 2021
Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 mill... more Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 million deaths in children under 5 years. The objectives of this study were to estimate the vaccination coverage of children from 0 to 59 months and identify factors associated with incomplete vaccination coverage.Methods: A cross-sectional study was carried out in a dispensary in Conakry, Guinea between January and February 2020. Sociodemographic and vaccination information was collected from mothers of 380 randomly select children aged 0 to 59 months. Information on immunisation coverage was gathered from records vaccination cards and maternal reports. Logistic regression was used to identify factors independently associated with incomplete immunisation coverage.Results: Most (66.5%) children aged 12 months were up-to-date with their vaccinations. Factors associated with incomplete vaccination in this age group included: unavailability of vaccination cards (adjusted odds ratio [aOR] 7.58; ...
Zoonoses can constitute a threat for public health that can have a global importance, as seen wit... more Zoonoses can constitute a threat for public health that can have a global importance, as seen with the current COVID-19 pandemic of severe acute respiratory syndrome coronavirus (SARS-CoV2). Bats have been recognized as an important reservoir of zoonotic coronaviruses (CoVs). In West Africa, where there is a high diversity of bat species, little is known on the circulation of CoVs in these hosts, especially at the interface with human populations. In this study, in Guinea, we tested a total of 319 bats belonging to 14 genera and six families of insectivorous and frugivorous bats across the country, for the presence of coronaviruses. We found CoVs in 35 (11%) of the tested bats—in three insectivorous bat species and five fruit bat species that were mostly captured close to human habitat. Positivity rates varied from 5.7% to 100%, depending on bat species. A wide diversity of alpha and beta coronaviruses was found across the country, including three sequences belonging to SarbeCoVs an...
The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the disc... more The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the discovery of the virus in 1976. During this epidemic, more than 11,000 cases were notified with a lethality of over 67%. Several means of transmission have been described. The great difficulty noted during the epidemic was the estimation of the number of asymptomatic and pauci symptomatic cases, however there is evidence that this population has been in contact with the virus for some time. Thus, they could be a source for the spread of the epidemic. In this paper, we report in Guinea-Conakry three stories of probable paucisymptomatic form of ebola disease that would have been the cause of massive infection in a population sorely tried by the epidemic between 2014 and 2015 in Guinea.
Background: In hospitals, antibiotics are one of the most prescribed drug classes. The purpose of... more Background: In hospitals, antibiotics are one of the most prescribed drug classes. The purpose of this study was to describe the extent and factors associated with the prescription of antibiotics in the Internal Medicine Department of Donka National Hospital. Material and Methods: A cross-sectional study was conducted from July 30, 2018 to January 31, 2019 among prescribers and patients hospitalized or seen on an outpatient basis. Data were collected by direct interview and through patient records. A multivariate logistic regression was performed to identify the factors associated with antibiotic prescribing. Results: Out of a total of 400 consultants, 82 (21%) patients received antibiotic therapy. Beta-lactam antibiotics were the most prescribed antibiotic (45%) and urogenital infections (24.3%) were the most common indication. In univariate analysis, the consultation by a trainee physician [OR = 3.06 (95% CI: 1.56-6)] was associated with a prescription for antibiotics. Students/students [OR = 1.85 (95%
Background With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illust... more Background With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illustrated by recent epidemics, good knowledge on extent of viral persistance or RNA detection in body fluids from survivors is urgently needed. Methods Ebola viral RNA shedding was studied with molecular assays in semen (n=1,368), urine (n=1,875), cervico-vaginal fluid (n=549), saliva (n=900), breast milk (n=168) and feces (n=558) from EVD survivors in Guinea (POSTEBOGUI cohort, n=802) at a regular base until 40 months after inclusion. Results 27/277 (9.8%) male survivors tested positive for Ebola RNA in at least one semen sample. The probability of remaining positive for Ebola RNA in semen was estimated at 93.02% and 60.12% after three and six months. Viral RNA in semen was more frequent in patients with eye pain (p=0.036), joint pain (p=0.047), and higher antibody levels to Ebola virus antigens (NP (p=0.001), GP (p=0.05) and VP40 (p=0.05)). Ebola RNA was only rarely detected in other body ...
Clinical follow-up of Ebola virus disease (EVD) survivors revealed a persistence of clinical symp... more Clinical follow-up of Ebola virus disease (EVD) survivors revealed a persistence of clinical symptoms and higher risk of mortality. Long-term analyses of the immune and inflammatory profiles of EVD survivors are currently lacking. Here, we evaluate immune profile status and gene expression profiles in 35 Guinean EVD survivors (EBOV_S) from the last West African outbreak, a median of 23 months (IQR [18-25]) after discharge from the Ebola treatment center. We show a persistent increase of several biomarkers of inflammation, immune activation and gut tissue damage in EBOV_S compared to healthy donors living in the same area. These results are confirmed by phenotypic characterization of immune cell subsets revealing increases in activation marker expression and the frequencies of CD8+ T cells, exhausted B cells, non-classical NK cells and circulating dendritic cells. All survivors have EBOV-specific IgG antibodies and robust and polyfunctional EBOV-specific memory T-cell responses. Deep...
Background The prevalence of Ebola virus infection among people who have been in contact with pat... more Background The prevalence of Ebola virus infection among people who have been in contact with patients with Ebola virus disease remains unclear, but is essential to understand the dynamics of transmission. This study aimed to identify risk factors for seropositivity and to estimate the prevalence of Ebola virus infection in unvaccinated contact persons. Methods In this retrospective, cross-sectional observational study, we recruited individuals between May 12, 2016, and Sept 8, 2017, who had been in physical contact with a patient with Ebola virus disease, from four medical centres in Guinea (Conakry, Macenta, N'zérékoré, and Forécariah). Contact persons had to be 7 years or older and not diagnosed with Ebola virus disease. Participants were selected through the Postebogui survivors' cohort. We collected selfreported information on exposure and occurrence of symptoms after exposure using a questionnaire, and tested antibody response against glycoprotein, nucleoprotein, and 40-kDa viral protein of Zaire Ebola virus by taking a blood sample. The prevalence of Ebola virus infection was estimated with a latent class model. Findings 1721 contact persons were interviewed and given blood tests, 331 of whom reported a history of vaccination so were excluded, resulting in a study population of 1390. Symptoms were reported by 216 (16%) contact persons. The median age of participants was 26 years (range 7-88) and 682 (49%) were male. Seropositivity was identified in 18 (8•33%, 95% CI 5•01-12•80) of 216 paucisymptomatic contact persons and 39 (3•32%, 5•01-12•80) of 1174 (2-4) asymptomatic individuals (p=0•0021). Seropositivity increased with participation in burial rituals (adjusted odds ratio [aOR] 2•30, 95% CI 1•21-4•17; p=0•0079) and exposure to blood or vomit (aOR 2•15, 1•23-3•91; p=0•0090). Frequency of Ebola virus infection varied from 3•06% (95% CI 1•84-5•05) in asymptomatic contact persons who did not participate in burial rituals to 5•98% (2•81-8•18) in those who did, and from 7•17% (3•94-9•09) in paucisymptomatic contact persons who did not participate in burial rituals to 17•16% (12•42-22•31) among those who did. Interpretation This study provides a new assessment of the prevalence of Ebola virus infection among contact persons according to exposure, provides evidence for the occurrence of paucisymptomatic cases, and reinforces the importance of closely monitoring at-risk contact persons.
Bats are considered a reservoir species for Ebola viruses, but nonhuman primates (NHPs) have repr... more Bats are considered a reservoir species for Ebola viruses, but nonhuman primates (NHPs) have represented a source of infection in several outbreaks in humans. Here we report serological screening of blood or fecal samples from monkeys (n = 2322) and apes (n = 2327). Thirty-six NHP species from Cameroon, Democratic Republic of the Congo, and Ivory Coast were tested with a sensitive and specific Luminex-based assay for immunoglobulin G antibodies to 4 Ebola virus species. Using the simultaneous presence of antibodies to nucleoproteins and glycoproteins to define positivity, we showed that specific Ebola virus antibodies are not widespread among NHPs. Only 1 mustached monkey (Cercopithecus cephus) from Cameroon was positive for Sudan ebolavirus. These observations support that NHPs are most likely intermediate hosts for Ebola viruses. With the increasing frequency of Ebola outbreaks, it is crucial to identify the animal reservoir and understand the ecology of Ebola viruses to inform di...
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 14, 2017
This study modeled the presence of EBOV-RNA in the semen of male Ebola survivors participating in... more This study modeled the presence of EBOV-RNA in the semen of male Ebola survivors participating in the Postebogui study in Guinea. The median time of RT-PCR negativity was 46.4 days after symptom onset (95% CI: [11; 82.6]). The results emphasize the importance of the WHO recommendations for survivors' management.
The Ebola outbreak of 2013-2016 severely affected West Africa and resulted in 2544 deaths and 127... more The Ebola outbreak of 2013-2016 severely affected West Africa and resulted in 2544 deaths and 1270 survivors in Guinea, the country where it began. This Ebola virus was the Zaire strain of the virus family Filoviridae. In this outbreak the case fatality rate was about 67%. The survivors, declared cured after two negative blood PCR results, face psychosocial disorders, rheumatic, ear-nose-throat, neurocognitive, and ophthalmological complications. The goal of this study was to detect and describe ocular complications afflicting these survivors and to observe their occurrence and recurrences. prospective observational cohort study. This prospective observational multicenter cohort study was initiated in March 2015. The cohort study included 341 survivors followed up in the infectious disease ward of Conakry, Forecariah and Nzérékoré as of May 2016. The patients received multidisciplinary medical follow-up expected to last at least one year that included an eye examination as part of c...
The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) ... more The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) has raised several new issues: long-term clinical complications, psychosocial consequences, risks of EVD reactivation, and secondary transmission due to viral persistence in body fluids. We aimed to assess long-term clinical, psychosocial, and viral outcomes in EVD survivors in Guinea. In this multidisciplinary observational cohort study, we recruited patients aged 1 year or more in four sites in Guinea (Donka National Hospital, Conakry; Macenta Prefectoral Hospital, Macenta; N'zérékoré Regional Hospital, N'zérékoré; and Forécariah Prefectoral Hospital, Forécariah) following discharge from any Ebola treatment centre in Guinea. Eligible patients had had laboratory-confirmed EVD and had then been declared clear of the virus in the blood. All consenting patients were included, with no exclusion criteria. Trained clinicians assessed patients at enrolment to the cohort, recording clin...
The recent Zaire Ebola virus (EBOV) outbreak in West Africa illustrates clearly the need for addi... more The recent Zaire Ebola virus (EBOV) outbreak in West Africa illustrates clearly the need for additional studies with humans and animals to elucidate the ecology of Ebola viruses (EBVs). In this study, we developed a serological assay based on the Luminex technology. Nine recombinant proteins representing different viral regions (nucleoprotein [NP], 40-kDa viral protein [VP40], and glycoprotein [GP]) from four of the five EBV lineages were used. Samples from 94 survivors of the EBOV outbreak in Guinea and negative samples from 108 patients in France were used to calculate test performance for EBOV detection and cross-reaction with other Ebola virus lineages. For EBOV antibody detection, sensitivities of 95.7%, 96.8%, and 92.5% and specificities of 94.4%, 95.4%, and 96.3% for NP, GP, and VP40, respectively, were observed. All EBOV-negative samples that presented a reaction, except for one, interacted with a single antigen, whereas almost all samples from EBOV survivors were simultaneo...
The bacterium Tropheryma whipplei, which causes Whipple disease in humans, is commonly detected i... more The bacterium Tropheryma whipplei, which causes Whipple disease in humans, is commonly detected in the feces of persons in Africa. It is also associated with acute infections. We investigated the role of T. whipplei in febrile patients from 2 rural villages in Senegal. During June 2010-March 2012, we collected whole-blood finger-prick samples from 786 febrile and 385 healthy villagers. T. whipplei was detected in blood specimens from 36 (4.6%) of the 786 febrile patients and in 1 (0.25%) of the 385 apparently healthy persons. Of the 37 T. whipplei cases, 26 (70.2%) were detected in August 2010. Familial cases and a potential new genotype were observed. The patients' symptoms were mainly headache (68.9%) and cough (36.1%). Our findings suggest that T. whipplei is a cause of epidemic fever in Senegal.
The American journal of tropical medicine and hygiene, Jan 25, 2016
Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bactere... more Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bacteremias exist but are under assessed. This study aimed to assess bacteremias and malaria in children from urban and rural areas in Gabon. DNA extracts from blood samples of 410 febrile and 60 afebrile children were analyzed using quantitative polymerase chain reaction. Plasmodium spp. was the microorganism most frequently detected in febrile (78.8%, 323/410) and afebrile (13.3%, 8/60) children, (P < 0.001). DNA from one or several bacteria were detected in 17 febrile patients (3.7%) but not in the controls (P = 0.1). This DNA was more frequently detected as coinfections among febrile children testing positive for Plasmodium (4.6%, 15/323) than in those testing negative for Plasmodium (0%, 0/87; P = 0.04). The bacteria detected were Streptococcus pneumoniae 2.4% (10/410), Staphylococcus aureus 1.7% (7/410), Salmonella spp. 0.7% (3/410), Streptococcus pyogenes 0.2% (1/410) and Tropheryma w...
International Journal of Infectious Diseases, 2014
Background: Tropheryma whipplei, the agent of Whipple's disease, was still recently considered as... more Background: Tropheryma whipplei, the agent of Whipple's disease, was still recently considered as a rare bacterium causing a rare chronic disease, mainly in white male of 50 year-old. In fact, T. whipplei is highly frequent in rural Senegal with a prevalence reaching 75% in feces of children of less than 5 year-old. Preliminary data suggested also a role of T. whipplei in febrile patients. This study aimed to analyze the epidemiology of T. whipplei. Methods & Materials: From June 2010 to March 2012, a prospective study was conducted on 2,024 blood specimens from febrile patients of 5 different areas in Senegal and 400 non-febrile individuals from 1 of this area. Quantitative real-time PCR targeting T. whipplei was performed. In parallel, an epidemiologic survey was performed in the Sine-Saloum area to compare 5 households with a high prevalence of T. whipplei to 3 others where it has never been detected in order to detect risks factors. The presence of T. whipplei was also analyzed using specific PCR in 1,002 environmental samples (dusts from households, feces from pets, and arthropods). Results: Overall, the prevalence of T. whipplei bacteremia was 2.8% in febrile patients; only 1 individual without fever was slightly positive. Its prevalence was the highest (4.7%) in the Sine-Saloum area. Besides, in August 2010, an outbreak has been detected in this area involving 26 patients out of 42 sampled at this time (61.9%). T. whipplei genotyping has allowed the significant detection of the same unknown genotype in these patients. Finally, the only significant difference noted between the households was the lack of toilets in the concessions where the prevalence was high (1/5 vs. 3/3 vs; p = 0,01). Among all environmental samples, only 4 were slightly positive. Conclusion: T. whipplei is an agent of fever in Senegal. Currently, humans are the main reservoir and source of T. whipplei identified in these populations. The only strongly associated risk factor for T. whipplei is the lack of toilet and its transmission is probably interhuman, either through fecal-oral or oro-oral routes depending of hygiene conditions.
We conducted 3 successive seroprevalence surveys, 3 months apart, using multistage cluster sampli... more We conducted 3 successive seroprevalence surveys, 3 months apart, using multistage cluster sampling to measure the extent and dynamics of the severe acute respiratory syndrome coronavirus 2 epidemic in Conakry, the capital city of Guinea. Seroprevalence increased from 17.3% (95% CI, 12.4%–23.8%) in December 2020 during the first survey (S1) to 28.9% (95% CI, 25.6%–32.4%) in March/April 2021 (S2), then to 42.4% (95% CI, 39.5%–45.3%) in June 2021 (S3). This significant overall trend of increasing seroprevalence (P < .0001) was also significant in every age class, illustrating a sustained transmission within the whole community. These data may contribute to defining cost-effective response strategies.
La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que d... more La reproduction ou représentation de cet article, notamment par photocopie, n'est autorisée que dans les limites des conditions générales d'utilisation du site ou, le cas échéant, des conditions générales de la licence souscrite par votre établissement. Toute autre reproduction ou représentation, en tout ou partie, sous quelque forme et de quelque manière que ce soit, est interdite sauf accord préalable et écrit de l'éditeur, en dehors des cas prévus par la législation en vigueur en France. Il est précisé que son stockage dans une base de données est également interdit.
Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the cou... more Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak-between 14 February and 19 June 2021-near the epicentre of the previous epidemic 1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization. At least 30 outbreaks of Ebola virus disease (EVD) have been identified since the late 1970s, the most severe of which affected Guinea, Sierra Leone and Liberia from December 2013 to June 2016 1,2. Guinea experienced a new outbreak of EVD in 2021, which started in Gouéké-a town about 200 km away from the epicentre of the 2013-2016 outbreak. The probable index case was a 51-year-old nurse, an assistant of the hospital midwife in Gouéké. On 21 January 2021, she was admitted to hospital in Gouéké suffering from headache, asthenia, nausea, anorexia, vertigo and abdominal pain. She was diagnosed with malaria and salmonellosis and was released two days later. Feeling ill again once at home, she attended a private clinic in Nzérékoré (40 km away) and visited a traditional healer, but died three days later. In the week after her death, her husband-as well as other family members who attended her funeral-fell ill, and four of them died. They were reported as the first suspect cases by the national epidemic alert system on 11 February. On 12 February, blood was taken from two suspect cases admitted to
Southern African Journal of Infectious Diseases, 2021
Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 mill... more Background: The Expanded Program on Immunisation has made it possible to prevent more than 3 million deaths in children under 5 years. The objectives of this study were to estimate the vaccination coverage of children from 0 to 59 months and identify factors associated with incomplete vaccination coverage.Methods: A cross-sectional study was carried out in a dispensary in Conakry, Guinea between January and February 2020. Sociodemographic and vaccination information was collected from mothers of 380 randomly select children aged 0 to 59 months. Information on immunisation coverage was gathered from records vaccination cards and maternal reports. Logistic regression was used to identify factors independently associated with incomplete immunisation coverage.Results: Most (66.5%) children aged 12 months were up-to-date with their vaccinations. Factors associated with incomplete vaccination in this age group included: unavailability of vaccination cards (adjusted odds ratio [aOR] 7.58; ...
Zoonoses can constitute a threat for public health that can have a global importance, as seen wit... more Zoonoses can constitute a threat for public health that can have a global importance, as seen with the current COVID-19 pandemic of severe acute respiratory syndrome coronavirus (SARS-CoV2). Bats have been recognized as an important reservoir of zoonotic coronaviruses (CoVs). In West Africa, where there is a high diversity of bat species, little is known on the circulation of CoVs in these hosts, especially at the interface with human populations. In this study, in Guinea, we tested a total of 319 bats belonging to 14 genera and six families of insectivorous and frugivorous bats across the country, for the presence of coronaviruses. We found CoVs in 35 (11%) of the tested bats—in three insectivorous bat species and five fruit bat species that were mostly captured close to human habitat. Positivity rates varied from 5.7% to 100%, depending on bat species. A wide diversity of alpha and beta coronaviruses was found across the country, including three sequences belonging to SarbeCoVs an...
The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the disc... more The ebola epidemic that raged in West Africa between 2013 and 2016 was the largest since the discovery of the virus in 1976. During this epidemic, more than 11,000 cases were notified with a lethality of over 67%. Several means of transmission have been described. The great difficulty noted during the epidemic was the estimation of the number of asymptomatic and pauci symptomatic cases, however there is evidence that this population has been in contact with the virus for some time. Thus, they could be a source for the spread of the epidemic. In this paper, we report in Guinea-Conakry three stories of probable paucisymptomatic form of ebola disease that would have been the cause of massive infection in a population sorely tried by the epidemic between 2014 and 2015 in Guinea.
Background: In hospitals, antibiotics are one of the most prescribed drug classes. The purpose of... more Background: In hospitals, antibiotics are one of the most prescribed drug classes. The purpose of this study was to describe the extent and factors associated with the prescription of antibiotics in the Internal Medicine Department of Donka National Hospital. Material and Methods: A cross-sectional study was conducted from July 30, 2018 to January 31, 2019 among prescribers and patients hospitalized or seen on an outpatient basis. Data were collected by direct interview and through patient records. A multivariate logistic regression was performed to identify the factors associated with antibiotic prescribing. Results: Out of a total of 400 consultants, 82 (21%) patients received antibiotic therapy. Beta-lactam antibiotics were the most prescribed antibiotic (45%) and urogenital infections (24.3%) were the most common indication. In univariate analysis, the consultation by a trainee physician [OR = 3.06 (95% CI: 1.56-6)] was associated with a prescription for antibiotics. Students/students [OR = 1.85 (95%
Background With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illust... more Background With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illustrated by recent epidemics, good knowledge on extent of viral persistance or RNA detection in body fluids from survivors is urgently needed. Methods Ebola viral RNA shedding was studied with molecular assays in semen (n=1,368), urine (n=1,875), cervico-vaginal fluid (n=549), saliva (n=900), breast milk (n=168) and feces (n=558) from EVD survivors in Guinea (POSTEBOGUI cohort, n=802) at a regular base until 40 months after inclusion. Results 27/277 (9.8%) male survivors tested positive for Ebola RNA in at least one semen sample. The probability of remaining positive for Ebola RNA in semen was estimated at 93.02% and 60.12% after three and six months. Viral RNA in semen was more frequent in patients with eye pain (p=0.036), joint pain (p=0.047), and higher antibody levels to Ebola virus antigens (NP (p=0.001), GP (p=0.05) and VP40 (p=0.05)). Ebola RNA was only rarely detected in other body ...
Clinical follow-up of Ebola virus disease (EVD) survivors revealed a persistence of clinical symp... more Clinical follow-up of Ebola virus disease (EVD) survivors revealed a persistence of clinical symptoms and higher risk of mortality. Long-term analyses of the immune and inflammatory profiles of EVD survivors are currently lacking. Here, we evaluate immune profile status and gene expression profiles in 35 Guinean EVD survivors (EBOV_S) from the last West African outbreak, a median of 23 months (IQR [18-25]) after discharge from the Ebola treatment center. We show a persistent increase of several biomarkers of inflammation, immune activation and gut tissue damage in EBOV_S compared to healthy donors living in the same area. These results are confirmed by phenotypic characterization of immune cell subsets revealing increases in activation marker expression and the frequencies of CD8+ T cells, exhausted B cells, non-classical NK cells and circulating dendritic cells. All survivors have EBOV-specific IgG antibodies and robust and polyfunctional EBOV-specific memory T-cell responses. Deep...
Background The prevalence of Ebola virus infection among people who have been in contact with pat... more Background The prevalence of Ebola virus infection among people who have been in contact with patients with Ebola virus disease remains unclear, but is essential to understand the dynamics of transmission. This study aimed to identify risk factors for seropositivity and to estimate the prevalence of Ebola virus infection in unvaccinated contact persons. Methods In this retrospective, cross-sectional observational study, we recruited individuals between May 12, 2016, and Sept 8, 2017, who had been in physical contact with a patient with Ebola virus disease, from four medical centres in Guinea (Conakry, Macenta, N'zérékoré, and Forécariah). Contact persons had to be 7 years or older and not diagnosed with Ebola virus disease. Participants were selected through the Postebogui survivors' cohort. We collected selfreported information on exposure and occurrence of symptoms after exposure using a questionnaire, and tested antibody response against glycoprotein, nucleoprotein, and 40-kDa viral protein of Zaire Ebola virus by taking a blood sample. The prevalence of Ebola virus infection was estimated with a latent class model. Findings 1721 contact persons were interviewed and given blood tests, 331 of whom reported a history of vaccination so were excluded, resulting in a study population of 1390. Symptoms were reported by 216 (16%) contact persons. The median age of participants was 26 years (range 7-88) and 682 (49%) were male. Seropositivity was identified in 18 (8•33%, 95% CI 5•01-12•80) of 216 paucisymptomatic contact persons and 39 (3•32%, 5•01-12•80) of 1174 (2-4) asymptomatic individuals (p=0•0021). Seropositivity increased with participation in burial rituals (adjusted odds ratio [aOR] 2•30, 95% CI 1•21-4•17; p=0•0079) and exposure to blood or vomit (aOR 2•15, 1•23-3•91; p=0•0090). Frequency of Ebola virus infection varied from 3•06% (95% CI 1•84-5•05) in asymptomatic contact persons who did not participate in burial rituals to 5•98% (2•81-8•18) in those who did, and from 7•17% (3•94-9•09) in paucisymptomatic contact persons who did not participate in burial rituals to 17•16% (12•42-22•31) among those who did. Interpretation This study provides a new assessment of the prevalence of Ebola virus infection among contact persons according to exposure, provides evidence for the occurrence of paucisymptomatic cases, and reinforces the importance of closely monitoring at-risk contact persons.
Bats are considered a reservoir species for Ebola viruses, but nonhuman primates (NHPs) have repr... more Bats are considered a reservoir species for Ebola viruses, but nonhuman primates (NHPs) have represented a source of infection in several outbreaks in humans. Here we report serological screening of blood or fecal samples from monkeys (n = 2322) and apes (n = 2327). Thirty-six NHP species from Cameroon, Democratic Republic of the Congo, and Ivory Coast were tested with a sensitive and specific Luminex-based assay for immunoglobulin G antibodies to 4 Ebola virus species. Using the simultaneous presence of antibodies to nucleoproteins and glycoproteins to define positivity, we showed that specific Ebola virus antibodies are not widespread among NHPs. Only 1 mustached monkey (Cercopithecus cephus) from Cameroon was positive for Sudan ebolavirus. These observations support that NHPs are most likely intermediate hosts for Ebola viruses. With the increasing frequency of Ebola outbreaks, it is crucial to identify the animal reservoir and understand the ecology of Ebola viruses to inform di...
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 14, 2017
This study modeled the presence of EBOV-RNA in the semen of male Ebola survivors participating in... more This study modeled the presence of EBOV-RNA in the semen of male Ebola survivors participating in the Postebogui study in Guinea. The median time of RT-PCR negativity was 46.4 days after symptom onset (95% CI: [11; 82.6]). The results emphasize the importance of the WHO recommendations for survivors' management.
The Ebola outbreak of 2013-2016 severely affected West Africa and resulted in 2544 deaths and 127... more The Ebola outbreak of 2013-2016 severely affected West Africa and resulted in 2544 deaths and 1270 survivors in Guinea, the country where it began. This Ebola virus was the Zaire strain of the virus family Filoviridae. In this outbreak the case fatality rate was about 67%. The survivors, declared cured after two negative blood PCR results, face psychosocial disorders, rheumatic, ear-nose-throat, neurocognitive, and ophthalmological complications. The goal of this study was to detect and describe ocular complications afflicting these survivors and to observe their occurrence and recurrences. prospective observational cohort study. This prospective observational multicenter cohort study was initiated in March 2015. The cohort study included 341 survivors followed up in the infectious disease ward of Conakry, Forecariah and Nzérékoré as of May 2016. The patients received multidisciplinary medical follow-up expected to last at least one year that included an eye examination as part of c...
The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) ... more The high number of survivors from the 2013-16 west African outbreak of Ebola virus disease (EVD) has raised several new issues: long-term clinical complications, psychosocial consequences, risks of EVD reactivation, and secondary transmission due to viral persistence in body fluids. We aimed to assess long-term clinical, psychosocial, and viral outcomes in EVD survivors in Guinea. In this multidisciplinary observational cohort study, we recruited patients aged 1 year or more in four sites in Guinea (Donka National Hospital, Conakry; Macenta Prefectoral Hospital, Macenta; N'zérékoré Regional Hospital, N'zérékoré; and Forécariah Prefectoral Hospital, Forécariah) following discharge from any Ebola treatment centre in Guinea. Eligible patients had had laboratory-confirmed EVD and had then been declared clear of the virus in the blood. All consenting patients were included, with no exclusion criteria. Trained clinicians assessed patients at enrolment to the cohort, recording clin...
The recent Zaire Ebola virus (EBOV) outbreak in West Africa illustrates clearly the need for addi... more The recent Zaire Ebola virus (EBOV) outbreak in West Africa illustrates clearly the need for additional studies with humans and animals to elucidate the ecology of Ebola viruses (EBVs). In this study, we developed a serological assay based on the Luminex technology. Nine recombinant proteins representing different viral regions (nucleoprotein [NP], 40-kDa viral protein [VP40], and glycoprotein [GP]) from four of the five EBV lineages were used. Samples from 94 survivors of the EBOV outbreak in Guinea and negative samples from 108 patients in France were used to calculate test performance for EBOV detection and cross-reaction with other Ebola virus lineages. For EBOV antibody detection, sensitivities of 95.7%, 96.8%, and 92.5% and specificities of 94.4%, 95.4%, and 96.3% for NP, GP, and VP40, respectively, were observed. All EBOV-negative samples that presented a reaction, except for one, interacted with a single antigen, whereas almost all samples from EBOV survivors were simultaneo...
The bacterium Tropheryma whipplei, which causes Whipple disease in humans, is commonly detected i... more The bacterium Tropheryma whipplei, which causes Whipple disease in humans, is commonly detected in the feces of persons in Africa. It is also associated with acute infections. We investigated the role of T. whipplei in febrile patients from 2 rural villages in Senegal. During June 2010-March 2012, we collected whole-blood finger-prick samples from 786 febrile and 385 healthy villagers. T. whipplei was detected in blood specimens from 36 (4.6%) of the 786 febrile patients and in 1 (0.25%) of the 385 apparently healthy persons. Of the 37 T. whipplei cases, 26 (70.2%) were detected in August 2010. Familial cases and a potential new genotype were observed. The patients' symptoms were mainly headache (68.9%) and cough (36.1%). Our findings suggest that T. whipplei is a cause of epidemic fever in Senegal.
The American journal of tropical medicine and hygiene, Jan 25, 2016
Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bactere... more Malaria is considered to be the most common etiology of fever in sub-Saharan Africa while bacteremias exist but are under assessed. This study aimed to assess bacteremias and malaria in children from urban and rural areas in Gabon. DNA extracts from blood samples of 410 febrile and 60 afebrile children were analyzed using quantitative polymerase chain reaction. Plasmodium spp. was the microorganism most frequently detected in febrile (78.8%, 323/410) and afebrile (13.3%, 8/60) children, (P < 0.001). DNA from one or several bacteria were detected in 17 febrile patients (3.7%) but not in the controls (P = 0.1). This DNA was more frequently detected as coinfections among febrile children testing positive for Plasmodium (4.6%, 15/323) than in those testing negative for Plasmodium (0%, 0/87; P = 0.04). The bacteria detected were Streptococcus pneumoniae 2.4% (10/410), Staphylococcus aureus 1.7% (7/410), Salmonella spp. 0.7% (3/410), Streptococcus pyogenes 0.2% (1/410) and Tropheryma w...
International Journal of Infectious Diseases, 2014
Background: Tropheryma whipplei, the agent of Whipple's disease, was still recently considered as... more Background: Tropheryma whipplei, the agent of Whipple's disease, was still recently considered as a rare bacterium causing a rare chronic disease, mainly in white male of 50 year-old. In fact, T. whipplei is highly frequent in rural Senegal with a prevalence reaching 75% in feces of children of less than 5 year-old. Preliminary data suggested also a role of T. whipplei in febrile patients. This study aimed to analyze the epidemiology of T. whipplei. Methods & Materials: From June 2010 to March 2012, a prospective study was conducted on 2,024 blood specimens from febrile patients of 5 different areas in Senegal and 400 non-febrile individuals from 1 of this area. Quantitative real-time PCR targeting T. whipplei was performed. In parallel, an epidemiologic survey was performed in the Sine-Saloum area to compare 5 households with a high prevalence of T. whipplei to 3 others where it has never been detected in order to detect risks factors. The presence of T. whipplei was also analyzed using specific PCR in 1,002 environmental samples (dusts from households, feces from pets, and arthropods). Results: Overall, the prevalence of T. whipplei bacteremia was 2.8% in febrile patients; only 1 individual without fever was slightly positive. Its prevalence was the highest (4.7%) in the Sine-Saloum area. Besides, in August 2010, an outbreak has been detected in this area involving 26 patients out of 42 sampled at this time (61.9%). T. whipplei genotyping has allowed the significant detection of the same unknown genotype in these patients. Finally, the only significant difference noted between the households was the lack of toilets in the concessions where the prevalence was high (1/5 vs. 3/3 vs; p = 0,01). Among all environmental samples, only 4 were slightly positive. Conclusion: T. whipplei is an agent of fever in Senegal. Currently, humans are the main reservoir and source of T. whipplei identified in these populations. The only strongly associated risk factor for T. whipplei is the lack of toilet and its transmission is probably interhuman, either through fecal-oral or oro-oral routes depending of hygiene conditions.
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