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Syndromic Surveillance of Potentially Epidemic Infectious Diseases

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Syndromic Surveillance of Potentially Epidemic Infectious Diseases Infectious Disease Reports 2019; volume 11:7701 Syndromic surveillance from 5 to 9 years, 6.3% (n=5) of children of potentially epidemic were aged 10 to 15 years and 8.9% (n=7) Correspondence: Jean Bernard Lekana-Douki, were 15 years and older. 53.3% (16/30) Centre International de Recherches Médicales infectious diseases: were laboratory confirmed. This measles de Franceville (CIRMF), BP 769 Franceville, Detection of a measles outbreak reiterates the importance of main- Gabon. epidemic in two health centers taining a high level of vaccine coverage in Tel: +241.06259590/+241.02521250. Gabon for vaccine-preventable diseases, as Fax: +241.01677295. in Gabon, Central Africa E-mail: [email protected] well as the usefulness of a near-real-time surveillance system for the detection of Key words: Network; Infectious diseases; Pater Noster Sir-Ondo-Enguier,1,2 infectious diseases. Measles; Detection; Gabon. Edgard Brice Ngoungou,3 4 Yves-Noel Nghomo, Acknowledgements: We wish to thank all the Larson Boundenga,2 participants of this study, as well as the health Priscille Moupiga-Ndong,5 Introduction professionals in Oyem and Libreville. We Euloge IBINGA,3 Xavier Deparis,1 Despite remarkable advances in the acknowledge the CIRMF which is funded by Total, the Gabonese governement, SESSTIM Jean-Bernard Lékana-Douki2,6 fields of management and medical research, infectious diseases still represent the second in Marseille, and Shell Gabon. Finally, we also 1UMR 912 Sciences Economiques et cause of death worldwide, mainly due to the thank Heïdi Lançon for the English revision of Sociales de la Santé et Traitement de the manuscript. period emergence or re-emergence of them I’Information Médicale, Université in the human population In the last few d’Aix-Marseille, Marseille, France; Contributions: PNSOE designed and conduct- years, vaccination has been an essential tool ed this study and participated in writing the 2Unité, Evolution, Épidémiologie et in the fight against infectious diseases and it manuscript, YNN and PMN participated in the Résistances Parasitaires, Centre has greatly reduced the overall burden of data collection, EBN, EI and LB participated International de Recherches Médicales infectious diseases according to the World in data analysis for the revised version of the de Franceville - CIRMF, Franceville, Health Organization (WHO).1 Several vac- paper,only XD coordinated the study and the writ- Gabon; 3Département d’Epidémiologie cination campaigns have been performed ing of the paper, JBLD conceived and con- Biostatistiques et Informatique around the world to fight against numerous ducted the study and wrote the article. Médicale (DEBIM), Faculté de diseases. Nonetheless, vaccine preventable Conflict of interest: the authors declare no Médecine, Université des Sciences de la diseases remain a major public health con- usepotential conflict of interest. Santé, Libreville, Gabon; 4Centre cern in the world. Hospitalier Régional d’Oyem, Oyem, Measles is among the infectious dis- Funding: none. Gabon; 5Centre de Santé de Nzeng- eases which have had an impact on the evo- 6 lution of human society. It is a highly con- Ayong, Libreville, Gabon; Département Received for publication: 4 April 2018. tagious respiratory infection that is caused de Parasitologie-Mycologie et de Revision received: 27 March 2019. by a virus that grows in the cells lining the Accepted for publication: 10 April 2019. Médecine Tropicale, Faculté de throat and lungs. This disease is transmitted Médecine, Université des Sciences de la mainly through air because the virus This work is licensed under a Creative Santé, Libreville, Gabon spreads whenever someone who is infected Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). coughs or sneezes. The Measles Virus (MV) is an enveloped virus with a long non-seg- ©Copyright P.N. Sir-Ondo-Enguieret al., 2019 2 mented RNA genome of negative polarity. Licensee PAGEPress, Italy Abstract MV belongs to the Paramyxovirus family Infectious Disease Reports 2019; 11:7701 Measles is a respiratory disease caused and the Morbillivirus genus. It is character- doi:10.4081/idr.2019.7701 by the measles virus (MV) belonging to the ized by the fact that it exclusively uses a Paramyxovirus family and the human reservoir.3 People who catch the dis- Morbillivirus genus. Due to a failureNon-commercial in ease develop an overall body skin rash and tion recommendations, epidemics of child- maintaining immunization coverage in symptoms such as fever, cough, and a runny hood diseases continue to occur. The aim of some countries, measles is a re-emerging nose. Without vaccination, measles can this study was to assess the effectiveness of disease in the human population, especially induce several complications such as ear a syndromic surveillance system able of in Africa. The aim of this study was to infection, pneumonia, and encephalitis. detecting new or re-emerging infections describe a measles epidemic in Gabon. At Therefore, this highly contagious disease such as measles in our population. first, a syndromic surveillance was set up. which mainly affects children could be Blood samples from febrile patients with avoided with vaccine. Measles was respon- maculopapular rash were taken and sent to sible for 139,300 deaths in sub-Saharan the measles reference center in Cameroon Africa in 2010. Beside endemic cases, some 4 Materials and Methods for laboratory confirmation. Between deaths occurred during epidemics. March and May 2016, 79 clinically suspect- In Gabon, many cases of measles have Ethical considerations ed cases were reported including 82.3% been reported during the past few years.5 All work was carried out with the (n=65) and 17.7% (n=14) in Oyem and However, the total number of cases of authorization from the Gabonese Ministry Libreville, respectively. In total, 39.2% measles reported annually has declined sub- of Health (authorization No. 292). The (n=31) of children were 11 months-old, stantially, as is the case worldwide. study was conducted in two hospital centers 34.2% (n=27) were children aged 1 to 4 Nonetheless, despite the availability of vac- in Gabon, in the cities of Libreville and years, 11.4% (n=9) were older children cines and the existence of public immuniza- Oyem. All the samples obtained were only [page 16] [Infectious Disease Reports 2019; 11:7701] Article collected in patients who came to the hospi- tal centers for a consultation and were sus- pected to be infected by the measles virus. National clinical and epidemiological data were manually notified, electronically recorded and transmitted monthly to the Ministry of Health for compilation via the regional epidemiological database. Study sites This cross-sectional study was conduct- ed in Oyem at the Regional Hospital Center and in Libreville at the Nzeng-ayong Medical Center (Figure 1). These hospitals participate in the syndromic surveillance network for infectious diseases with epi- demic potential (SuSyMIPE). Case-definition A suspected case of measles was defined as a fever ≥38°C with a macu- lopapular rash which extends from the face to the extremities with at least one of the Figure 1. Geographical location of cases reported during the measles outbreak, Libreville- following manifestations: cough, coryza or Oyem, March-May 2016. conjunctivitis. The investigation was car- only use Non-commercial Figure 2. Architecture of the monitoring network for the syndromic surveillance of infectious diseases and potential epidemics. [Infectious Disease Reports 2019; 11:7701] [page 17] Article ried out in the field by the SuSyMIPE net- Outbreak declaration and management patient’s name, place of residence, age, sex, work teams who investigated the cases in The data of the services participating in date of consultation, date of onset of symp- two of the four health facilities participating the SuSyMIPE Network (Syndromic toms, date of onset of rash, vaccination sta- in the network in Libreville and Oyem. Surveillance of Potential Epidemic tus, and epidemiological relationship with a Infectious Diseases) were systematically known case. Immunization status was deter- Confirmation of cases collected on a standardized questionnaire. mined by the history and/or examination of Serum samples from suspected patients The information collected included the the vaccination record. The syndromic diag- were confirmed using Real-Time Polymerase Chain Reaction (RT-PCR). RNA was extracted from blood and the measles virus was diagnosed according to the previously described protocol.6 National surveillance system This system presents a pyramidal organization with three levels that coexist without any formal relationship of comple- mentarity: the peripheral, intermediate and central levels. Integrated national surveil- lance of diseases, including measles, was effective in health facilities in the various health departments of Gabon. Collected samples were sent for analysis at the National Virology Laboratory of the Health Sciences University in Libreville and the Figure 3. Distribution of measles cases by age, grouponly and sex, Libreville-Oyem, March- Pasteur Institute of Cameroon for the con- May 2016. firmation of different suspected cases. use Non-commercial Figure 4. A) Weekly syndromic data notified by all the emergency services. B) Number of measles cases reported per epidemiological week during the Gabonese epidemic: Libreville-Oyem, March-May 2016 (N=79). [page 18] [Infectious Disease Reports 2019; 11:7701] Article noses of the physically examined patients In total, 39.2% (n=31) of children were 11 tion of symptoms in the acute phase was 7 were expressed in codes. At the end of the months old, 34.2% (n=27) were children days (range: 1 to 24 days). Hospitalization afternoon, these data were sent by the doc- aged 1 to 4 years, 11.4% (n=9) were older was required for 38 patients (48.1%) with tor responsible for the study site to the children from 5 to 9 years, 6.3% (n=5) of more pronounced manifestations, and the SuSyMIPE network base, directly via Short children were aged 10 to 15 years and 8.9% average length of stay was 2.6 days (1-6 Message Service (Figure 2).
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