Impact of the Ebola outbreak on Trypanosoma brucei gambiense infection medical activities in coastal Guinea, 2014-2015: A retrospective analysis from the Guinean national Human African Trypanosomiasis control program.,PLOS Neglected Tropical Diseases

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Impact of the Ebola outbreak on Trypanosoma brucei gambiense infection medical activities in coastal Guinea, 2014-2015: A retrospective analysis from the Guinean national Human African Trypanosomiasis control program.
PLOS Neglected Tropical Diseases ( IF 3.4 ) Pub Date : 2017-11-13 , DOI: 10.1371/journal.pntd.0006060
Mariame Camara ₁ , Eric Ouattara _{2,

3,

4} , Alexandre Duvignaud _{2,

3,

4} , René Migliani ₂ , Oumou Camara ₁ , Mamadou Leno ₁ , Philippe Solano ₅ , Bruno Bucheton ₅ , Mamadou Camara ₁ , Denis Malvy _{2,

3,

4}

Affiliation

BACKGROUND The 2014-2015 Ebola outbreak massively hit Guinea. The coastal districts of Boffa, Dubreka and Forecariah, three major foci of Human African Trypanosomiasis (HAT), were particularly affected. We aimed to assess the impact of this epidemic on sleeping sickness screening and caring activities. METHODOLOGY/PRINCIPAL FINDINGS We used preexisting data from the Guinean sleeping sickness control program, collected between 2012 and 2015. We described monthly: the number of persons (i) screened actively; (ii) or passively; (iii) treated for HAT; (iv) attending post-treatment follow-up visits. We compared clinical data, treatment characteristics and Disability Adjusted Life-Years (DALYs) before (February 2012 to December 2013) and during (January 2014 to October 2015) the Ebola outbreak period according to available data. Whereas 32,221 persons were actively screened from February 2012 to December 2013, before the official declaration of the first Ebola case in Guinea, no active screening campaigns could be performed during the Ebola outbreak. Following the reinforcement and extension of HAT passive surveillance system early in 2014, the number of persons tested passively by month increased from 7 to 286 between April and September 2014 and then abruptly decreased to 180 until January 2015 and to none after March 2015. 213 patients initiated HAT treatment, 154 (72%) before Ebola and 59 (28%) during the Ebola outbreak. Those initiating HAT therapy during Ebola outbreak were recruited through passive screening and diagnosed at a later stage 2 of the disease (96% vs. 55% before Ebola, p<0.0001). The proportion of patients attending the 3 months and 6 months post-treatment follow-up visits decreased from 44% to 10% (p <0.0001) and from 16% to 3% (p = 0.017) respectively. The DALYs generated before the Ebola outbreak were estimated to 48.7 (46.7-51.5) and increased up to 168.7 (162.7-174.7), 284.9 (277.1-292.8) and 466.3 (455.7-477.0) during Ebola assuming case fatality rates of 2%, 5% and 10% respectively among under-reported HAT cases. CONCLUSIONS/SIGNIFICANCE The 2014-2015 Ebola outbreak deeply impacted HAT screening activities in Guinea. Active screening campaigns were stopped. Passive screening dramatically decreased during the Ebola period, but trends could not be compared with pre-Ebola period (data not available). Few patients were diagnosed with more advanced HAT during the Ebola period and retention rates in follow-up were lowered. The drop in newly diagnosed HAT cases during Ebola epidemic is unlikely due to a fall in HAT incidence. Even if we were unable to demonstrate it directly, it is much more probably the consequence of hampered screening activities and of the fear of the population on subsequent confirmation and linkage to care. Reinforced program monitoring, alternative control strategies and sustainable financial and human resources allocation are mandatory during post Ebola period to reduce HAT burden in Guinea.

中文翻译：

埃博拉疫情对几内亚沿海布鲁氏锥虫感染医疗活动的影响，2014-2015年：来自几内亚国家人类非洲锥虫病控制计划的回顾性分析。

背景2014年至2015年的埃博拉疫情在几内亚造成了严重打击。非洲非洲锥虫病（HAT）的三个主要病灶波法，杜布雷卡和福雷卡里亚等沿海地区受到的影响尤其严重。我们旨在评估该流行病对昏睡病筛查和护理活动的影响。方法/主要发现我们使用了几内亚昏睡控制程序的先前数据，该数据是2012年至2015年间收集的。（ii）或被动地；（iii）为HAT治疗；（iv）参加治疗后的随访。根据现有数据，我们比较了埃博拉疫情爆发之前（2012年2月至2013年12月）和期间（2014年1月至2015年10月）的临床数据，治疗特征和伤残调整生命年（DALYs）。而32 从2012年2月至2013年12月，在几内亚首例埃博拉疫情正式宣布之前，有221人被积极筛查，埃博拉疫情爆发期间无法进行任何主动筛查活动。在2014年初加强和扩展HAT被动监视系统后，2014年4月至9月之间，每月进行被动测试的人数从7人增加到286人，然后突然减少到180人，直到2015年1月，而在2015年3月之后没有人。213名患者开始了HAT治疗，在埃博拉之前有154（72％），在埃博拉爆发期间有59（28％）。那些在埃博拉疫情爆发期间开始进行HAT治疗的患者是通过被动筛查招募的，并在疾病的第二阶段进行诊断（96％比埃博拉之前的55％，p <0.0001）。接受治疗后3个月和6个月随访的患者比例分别从44％降至10％（p <0.0001）和从16％降至3％（p = 0.017）。假设病死率为2％，埃博拉疫情爆发前产生的DALY估计为48.7（46.7-51.5），并增加到168.7（162.7-174.7），284.9（277.1-292.8）和466.3（455.7-477.0）。漏报的HAT病例分别为5％和10％。结论/意义2014-2015年的埃博拉疫情对几内亚的HAT筛查活动产生了深远的影响。积极的筛选活动已停止。被动筛查在埃博拉期间显着减少，但趋势无法与埃博拉之前的时期进行比较（数据不可用）。很少有患者在埃博拉期间被诊断出患有更晚期的HAT，并且随访的保留率降低了。由于HAT发病率下降，在埃博拉疫情期间新诊断的HAT病例下降的可能性不大。即使我们无法直接证明它，也很可能是筛查活动受阻的结果，也是人们对随后的确认和与治疗联系的恐惧。在埃博拉之后时期，必须加强计划监测，替代控制策略以及可持续的财政和人力资源分配，以减轻几内亚的HAT负担。这很可能是筛查活动受阻的结果，也是人们对随后的确认和与护理联系的恐惧。在埃博拉之后时期，必须加强计划监测，替代控制策略以及可持续的财政和人力资源分配，以减轻几内亚的HAT负担。这很可能是筛查活动受阻的结果，也是人们对随后的确认和与护理联系的恐惧。在埃博拉之后时期，必须加强计划监测，替代控制策略以及可持续的财政和人力资源分配，以减轻几内亚的HAT负担。

更新日期：2017-11-14

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