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1.3.6.NIC Cameroon, Richard Njouom, Cameroon

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Pandemic influenza (H1N1) 2009 in Cameroon: Epidemiological, Genetic and Antigenic characterization Richard Njouom1, Cyrille F. Djoko2, Lucy Ndip3 and Jean-Marc Reynes1 for the Cameroon Network of Laboratories for human influenza surveillance. 1. National Influenza Centre, Centre Pasteur du Cameroun , Yaounde, Cameroon 2. Global Viral Forecasting , Yaounde, Cameroon 3. Laboratory for Emerging Infectious Disease, University of Buea, Buea, Cameroon Outline of the presentation 1. Geographic situation of Cameroon 2. Cameroon Network of influenza surveillance 3. Virological surveillance of influenza in Cameroon from November 1007 to November 2010 4. Characterization of pandemic influenza A(H1N1) 2009 in Cameroon 5. Conclusions/Challenges/Way forward WHO Global NIC Meeting, Hammamet, Tunisia Page 1 of 7 30 November 2010 - 3 December 2010 Geographic situation of Cameroon The World Africa 20 millions inhab. Age structure 10 regions 475,000 km2 0-14 years (42%) Raining season (June to Oct.) 15-64 years (55%) Dry season (Nov. to May) 65 years and over (3%) Cameroon Cameroon Network of influenza surveillance 45 sentinel sites located in 8 different regions. Extension in January 2010/UB North West Region Bamenda Extension in January 2009 1 Health Centre North Region Garoua South West Region 2 Health Centres Mutengene, Kumba, Manfe 3 Health Centres Yaounde : November 2007 Centre Region West Region Yaounde Bafoussam, Bandjoun, Foumban 5 Health Centres 3 Health Centres 8 Health Centres Littoral Region South Region East Region Douala HEVECAM, Kribi Abong Mbang, Bertoua 3 Health Centres 15 Health Centres 5 Health Centres Extension in January 2010/GVF WHO Global NIC Meeting, Hammamet, Tunisia Page 2 of 7 30 November 2010 - 3 December 2010 Virological surveillance of influenza in Cameroon Number of samples tested and rate of influenza detection per month 500 450 400 350 2008 300 250 from Nov 2007 to Nov 2010 200 samples tested ° 150 N 100 50 2009 0 Nov 07 Jan 08 Mar 08 Mai 08 SeasonalityJuil of 08 influenza infection in Cameroon ? 2010 Sep 08 Nov 08 Jan 09 Mar 09 60,0% Virological surveillance of influenza in CameroonMai 09 Juil 09 50,0% Sept 09 40,0% 2007 Nov 09 120 Types/subtypes of influenza viruses identify per month Jan 10 30,0% Mar 10 100 Mai 10 20,0% 80 Juil 10 10,0% 2008 2009 2010 Sep 10 60 from Nov 2007 to Nov 2010 Nov 10 0,0% % influenza virus detected 40 20 Page 3 of 7 WHO Global NIC Meeting, Hammamet,Number Tunisia of Virus identify 30 November 2010 - 3 December 2010 0 Nov 07 Dec 07 Jan 08 Feb 08 Mar 08 Apr 08 A/H1N1/2009May 08 juin-08 juil-08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08 Jan 09 Feb 09 Mar 09 Apr 09 A/H1N1May 09 juin-09 juil-09 Aug 09 Sept 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 A/H3N2Mar 10 Apr 10 May 10 Juin 10 Juil 10 Aout 10 Sep 10 Oct 10 Nov 10 B Virological surveillance of influenza in Cameroon Evolution of pandemic influenza H1N1 (2009) from August 2009 to Nov 2010 159 cases in Cameroon since August 2009, Mild and No death 2009: 2010: 152 cases 7 imported cases Community circulation with two periods of high circulation 120 100 80 60 40 of virus identified ° 20 N 0 Aug 09 Sept 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Juin 10 Juil 10 Aout 10 Sep 10 Oct 10 Nov 10 A/H1N1/2009 A/H1N1 A/H3N2 B Epidemiological characteristic of the 152 local cases of pandemic influenza A(H1N1) 2009 detected in Cameroon Geographic localization of cases in the country North West Region North Region 14 cases 4 cases West Region Centre Region 7 cases 60 cases South West Region East Region 27 cases 8 cases Littoral Region South Region 2 cases 10 cases WHO Global NIC Meeting, Hammamet, Tunisia Page 4 of 7 30 November 2010 - 3 December 2010 Epidemiological characteristic of the 152 local cases of pandemic influenza A(H1N1) 2009 detected in Cameroon Age distribution of the cases 50 45 40 35 30 25 20 15 Number of cases 10 5 0 < 5 5-10 11-20 21-30 31-40 41-50 >50 Age group Genetic characteristic of pandemic influenza A(H1N1) 2009 detected in Cameroon 10 viruses selected (4 in 2009 and 6 in 2010) and sequenced in NA region Two main clusters A/Cameroun/353/2009 A/Cameroun/357/2009 Clade 7 was the dominant pH1N1 0.0005 A/NewYork/06/2009 lineage in Cameroon during the IP A/Cameroun/382/2010 A/NewYork/4735/2009 Clade 7 (2009 period) A/CanadaPQ/RV1758/2009 A/CanadaMB/RV1964/2009 A/Cameroun/479/2010 Circulating pH1N1 viruses during A/Cameroun/751/2009 the AP (2010 period) were grouped A/California/14/2009 in a new cluster. A/Amagasaki/1/2009 Clade 4 A/Osaka/1/2009 A/Sakai/1/2009 None of these isolated clustered A/Cameroun/463/2009 97 A/Cameroun/666/2010 Cameroon with the 2010 H1N1 vaccine strain. A/Cameroun/748/2010 Clade A/Cameroun/812/2010 A/Cameroun/813/2010 A/SouthCarolina/09/2009 A/California/06/2009 Clade 2 All 10 NA sequences displayed an A/Colorado/03/2009 H275, the genetic marker for A/NewYork/3177/2009 Clade 3 A/California/04/2009 Clade 1 sensitivity to Oseltamivir. A/California/07/2009 WHO Global NIC Meeting, Hammamet, Tunisia Page 5 of 7 30 November 2010 - 3 December 2010 Antigenic characteristic of pandemic influenza A(H1N1) 2009 detected in Cameroon : Interim Report WHO CC London Good levels of reactivity of all the Cameroonian strains with the panel of antisera used including the current recommended vaccine strain A/California 7/09 Post infection ferret sera Viruses Collection Passage A/Cal A/Cal A/Eng A/Auck A/Bayern A/Lviv A/HK date History 4/09 7/09 195/09 3/09 69/09 N6/2009 2212/2010 C4/F14/09 F05/10 F06/10 C4/17/09 C4/33/09 C4/34/09 F18/10T/C A/California/4/2009 C1,E3 1280 1280 2560 2560 1280 2560 1280 A/California/7/2009 E8 640 1280 640 640 1280 2560 640 A/England/195/2009 MDCK5 1280 2560 2560 2560 1280 1280 1280 A/Auckland/3/2009 Ex+3 1280 2560 1280 2560 640 1280 1280 A/Bayern/69/2009 MDCK5 160 160 40 40 320 320 80 A/Lviv/N6/2009 MDCK4/SIAT2 640 320 80 80 640 640 80 A/HK/2212/2010 MDCK5 640 640 640 1280 320 640 640 TEST VIRUSES A/Cameroon/463/2009 09/10/2009 SIAT1 2560 2560 2560 5120 1280 2560 A/Cameroon/566/2009 30/10/2009 SIAT1 1280 1280 1280 2560 640 1280 A/Cameroon/666/2010 2010-03-05 MDCK3 2560 2560 5120 2560 2560 2560 2560 A/Cameroon/812/2010 2010-03-23 MDCK3 640 1280 640 1280 320 640 640 A/Cameroon/381/2010 2010-02-10 C4/MDCK1 1280 1280 1280 2560 640 1280 1280 A/Cameroon/479/2010 2010-02-17 C2/MDCK1 2560 2560 2560 5120 1280 2560 2560 A/Cameroon/748/2010 2010-03-16 C3/MDCK1 1280 1280 2560 2560 1280 1280 1280 A/Cameroon/813/2010 2010-03-23 C2/MDCK1 320 640 160 320 640 1280 320 1. < = 40 Conclusions/Challenges/Way forward 1. Influenza is of public health importance in Cameroon. However, only virological surveillance is effective in Cameroon. Need to develop syndromic surveillance in order to better determine the seasonality of influenza in Cameroon. 2. Only ILI surveillance is effective in Cameroon Need to develop SARI surveillance in order to better determine the disease burden of influenza in Cameroon WHO Global NIC Meeting, Hammamet, Tunisia Page 6 of 7 30 November 2010 - 3 December 2010 Conclusions/Challenges/Way forward 3. Genetic and antigenic analyses highlight the importance of continuing surveillance and characterization of emerging influenza drift variant in sub-Saharan Africa Need of training and setup of genetic and antigenic characterization as well as antiviral drug susceptibility monitoring of influenza viruses at the level of NIC in Africa. Acknowledgments All the staff of the different health centres for assistance in sample collection. Collaboration 1) The WHO Global Influenza Surveillance Network and the WHO AFRO, 2) WHO Collaborative Centre of London UK and the CDC Atlanta 3) NIC of the Pasteur Institute in Paris Financial support 1) The French Ministry of Health 2) The American Department of Health and Human Services. 3) The Global Emerging Infectious Surveillance and Response System (GEIS) a division of the Armed Forces Health Surveillance Centre (AFHSC) 4) The SANOFI-PASTEUR Laboratory Contact : Dr Richard Njouom, Head National Influenza Centre Cameroon E.mail: [email protected]; Tel: 00237 79 87 36 04 WHO Global NIC Meeting, Hammamet, Tunisia Page 7 of 7 30 November 2010 - 3 December 2010.
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