M. Soumaré

AIDS caused by HIV1 and HIV2 infection: are there clinical differences? Results of AIDS surveillance 1986-97 at Fann Hospital in Dakar, Senegal.

Summary objective  To compare the clinical manifestations observed in AIDS patients infected with HIV2 and HIV1 infection.

Poor serologic responses five to seven years after immunization with high and standard titer measles vaccines

BACKGROUND Few data exist on the persistence of measles antibodies after vaccination of West African infants. Therefore we examined measles antibody titers 5 to 7 years after children in rural Senegal had received high titer Edmonston-Zagreb (EZ-HT), high titer Schwarz (SW-HT) or standard titer Schwarz (SW-STD) measles vaccines in infancy. METHODS Children had received either high titer vaccines at 5 months of age or standard titer at 10 months of age. Finger prick blood samples were tested for measles antibody 5 to 7 years later by the hemagglutinin inhibition test. RESULTS Persistence of antibody after high titer vaccines was poor with the result that 39 and 50% of the EZ-HT and the SW-HT groups had low titers of hemagglutinin inhibition measles antibodies (< or =125 mIU/ml). Nineteen percent of the children in the SW-STD group had low titers which is a lower prevalence than in the high titer groups [relative risk (95% confidence intervals), 0.05 (0.28 to 0.88) vs. EZ-HT; relative risk, 0.38 (0.22 to 0.66) vs. SW-HT]. Geometric mean (95% confidence interval) antibody titers in children with detectable values were 616 (435 to 871) in the EZ-HT, 1106 (616 to 1866) in the SW-HT and 1271 (871 to 1741) mIU/ml in the SW-STD groups, respectively. Multivariant regression analysis showed that mean titers were 2.00 (1.03 to 3.89) times higher for children with low prevaccination antibody titers (< or =125 mIU/ml) and 3.06 (1.90 to 4.94) times higher if blood was collected in the rainy season. INTERPRETATION Given the rapid decline in antibody titers over a 5- to 6-year period in an area where measles vaccine coverage was high, it seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody concentrations (>125 mIU/ml) in West Africa. The role of subclinical boosting by exposure to natural measles and the possible role of malaria, which increases immunoglobulin turnover, in influencing long term antibody persistence after vaccination deserve further investigation.

Low mortality after mild measles infection compared to uninfected children in rural West Africa.

BACKGROUND It has been assumed that measles infection may be associated with persistent immune suppression and long-term excess mortality. However, few community studies of mortality after measles infection have been carried out. We examined long-term mortality for measles cases, sub-clinical measles cases, and uninfected contacts after an epidemic in rural Senegal. METHODS The study was carried out in Niakhar, a rural area of Senegal. Index cases of measles were identified and children less than 7 years of age exposed to measles in the same compound had acute and convalescent blood samples collected. Clinically diagnosed measles cases were serologically confirmed. Children without clinical symptoms were classified as sub-clinical cases if they had a four-fold or greater change in antibody levels between samples collected at exposure and 1 month later and as uninfected if there was no or a two-fold change in antibody levels. RESULTS There were 31 index cases, and among 184 exposed contacts, 35 (19%) children developed clinical measles. Among contacts that did not develop clinical measles, 45% had sub-clinical infection. Measles cases, sub-clinical cases, and uninfected contacts did not differ with respect to nutritional status. However, uninfected children without clinical symptoms and change in antibody level had higher initial measles specific IgG antibody levels and less intensive exposure to the index case. No index or secondary case of measles died in the acute phase of infection nor did any of the children exposed to measles die in the first 2 months after exposure. Exposed children developing clinical measles had lower age-adjusted mortality over the next 4 years than exposed children who did not develop clinical measles (P<0.05). Sub-clinical measles cases tended to have low mortality and compared with uninfected children, exposed children with clinical or sub-clinical measles had lower age-adjusted mortality (mortality ratio (MR)=0.20 (0.06-0.74)). Controlling for background factors had no impact of the estimates. CONCLUSIONS When measles infection is mild, clinical measles has no long-term excess mortality and may be associated with better overall survival than no clinical measles infection. Sub-clinical measles is common among immunised children and is not associated with excess mortality.

Increased long term mortality associated with rash after early measles vaccination in rural Senegal

OBJECTIVES To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality. DESIGN Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines. PATIENTS Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash. RESULTS There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)]. CONCLUSIONS These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

Acute and Long-term Changes in T-lymphocyte Subsets in Response to Clinical and Subclinical Measles. A Community Study from Rural Senegal.

To investigate the possibility of long-term suppression of T-lymphocyte subsets, we examined children exposed to measles at home during an epidemic in rural Senegal, at time of exposure and 1 and 6 months later. The measles case fatality ratio was 1%. Subclinical measles was common among vaccinated children exposed to measles (45%). Both clinical and subclinical cases of measles showed a significant rise in absolute CD4 count in the incubation period. In the prodromal phase and the first week after the rash, the lymphocyte percentage, the white blood cell count and the absolute CD4 cell numbers were significantly reduced. There was no persistent decrease of absolute CD4 or CD8 numbers at 1 or 6 months after exposure. Measles infection was followed by significant changes in the subset composition, both CD4 and CD8 percentages being significantly higher in the second month after measles than among non-seroresponders. These changes were more marked among girls, since they had significantly higher CD4 percentages and CD4/CD8 ratios than boys in the convalescence phase. In conclusion, measles infection is not associated with a long-term suppression of CD4+ or CD8+ T-lymphocytes.

Profil actuel des patients infectés par le VIH hospitalisés à Dakar (Sénégal)

Ten years after the introduction of the Senegalese Antiretroviral Drug Access Initiative in 1998, we conducted a retrospective study of the epidemiological and clinical profiles and outcome of HIV-infected patients hospitalized in the Infectious Diseases Clinic of Fann Teaching Hospital in Dakar between 2007 and 2008. During these 2 years, 527 HIV-positive patients were included. The average age of the patients was 41 ± 10 years, and the sex-ratio (F/M) was 1.1; 56% of patients were married. The average interval before admission was 40 ± 57 days. Fever (83%), loss of weight (83%) and cough (54%) were the principal symptoms. Tuberculosis (40.9%) and gastrointestinal candidiasis (38.9%) were the commonest opportunistic infections. Most patients were diagnosed at the AIDS stage (88%) and the CD4+ T lymphocyte count was ≤ 200/mm3 in 86% of cases. Hospital fatality was 44% (231/527). Tuberculosis (36%), bacterial pneumonia (18%) and encephalitis (12%) were the most frequent causes of death. Despite the availability of and free access to antiretroviral drugs in Senegal, the mortality associated with HIV infection remains very high due to late diagnosis. The population must be educated to boost early screening and care.

Tétanos localisé: étude rétrospective à propos de 12 cas observés à la clinique des maladies infectieuses du CHU de Dakar

Resume Objectif — Cette etude retrospective avait pour but de decrire les aspects epidemiologiques, cliniques et evolutifs du tetanos localise a Dakar. Materiel et methodes — Les dossiers de malades hospitalises a la clinique des maladies infectieuses du CHU de Fann de janvier 1990 a decembre 1996 ont ete evalues. Resultats — Douze cas de formes localisees de tetanos ont pu etre colliges, representant 0,85 % de l’ensemble des formes cliniques de tetanos et un taux de prevalence de 0,15 %; 58,3 % des patients etaient âges de 20 ans au plus. La porte d’entree tegumentaire a ete la plus frequemment retrouvee (huit cas) avec une predominance des plaies cephaliques (cinq cas). D’autres portes d’entree ont ete notees: injection intramusculaire (deux), trauma par prothese dentaire (un), otite purulente (un). Aucun patient n’etait correctement vaccine contre le tetanos et un seul avait recu une serotherapie apres la survenue de la porte d’entree. Dans tous les cas, la periode d’incubation etait superieure a sept jours. II a ete observe sept cas de tetanos cephalique (58,3 %) dont trois formes cephaliques de Rose associees dans un cas a un tetanos ophtalmoplegique de Worms. Dans cinq cas, le tetanos etait localise a un membre. Un seul deces a ete enregistre sous traitement, soit un taux de letalite de 8,3 %. Conclusion — La sensibilisation des populations, le renforcement du programme elargi de vaccination et l’amelioration de la prise en charge des malades devraient permettre de reduire encore davantage la morbidite et la mortalite liees au tetanos.

H-03 Aspects épidémio-cliniques et psychosociaux au cours du sida à Dakar : étude préliminaire prospective

Introduction et objectifs Decrire les aspects epidemio-cliniques et psychosociaux au cours du sida a Dakar. Materiels et methodes Etude prospective realisee chez les patients VIH positif hospitalises au service des maladies infectieuses Ibrahima DIOP Mar du CHU de Fann du 1 er janvier 2008 au 31 mars 2008. Resultats Ont ete inclus 65 patients dont l’âge moyen etait de 38 ans ± 8,13 ans. Le sex-ratio etait de 1, 2 et 34 % des patients etaient sans profession. Dans 92 % des cas, les patients n’avaient pas informe leur conjoint de leur statut serologique. Ils etaient accompagnes durant leur hospitalisation par le conjoint ou un membre de la famille au premier degre dans 95 % des cas. Le delai moyen de consultation etait de 109 ± 80 jours et a l’annonce de la serologie, les patients ont surtout exprime un sentiment de mort imminente (55 % des cas) et de punition divine (35 % des cas). Les principales affections opportunistes etaient la candidose buccale (40 % des cas), la tuberculose pulmonaire (30 % des cas) et la diarrhee chronique (37 % des cas). Un ou plusieurs examens complementaires n’ont pas pu etre effectues chez 30 % des patients. Le taux moyen de lymphocytes T CD4 etait de 110 ± 80 /mm 3 . Le cout moyen de l’hospitalisation par patient a ete estime a 65 000 francs CFA ± 45 000 Francs CFA. (99 € ± 69 €). Une letalite globale de 26 % a ete notee. Conclusion La prise en charge mutidisciplinaire multidisciplinaire des sujets infectes par le VIH devrait etre renforcee dans toutes ses composantes surtout psycho-sociales et economiques.

Knowledge, Attitudes and Practices towards Ebola Virus Disease among Participants in an Ebola Vaccine Trial in Dakar, Senegal

The 2014 Ebola outbreak in West Africa was the trigger to mobilize efforts in order to promptly obtain safe and effective vaccine. The objectives of this survey conducted during an Ebola vaccine trial were assessing the knowledge, attitudes and practices of participants about Ebola and vaccine and determining the association of key sociodemographic characteristics with knowledge of transmission mode, reservoir, stigma and hand washing. A cross sectional study was designed and a semi-closed questionnaire was used to collect data of the 250 participants. The main identified sources of information were television and radio. The motivations for being part of the study were confidence in doctors (79.6%) and example given by the medical staff (75.6%). Knowledge of transmission mode was low among respondents (22.1%) while that on the reservoir was rather high (73.8%). Stigma was noted in 49.2% of participants. Behavioural change through hand washing was adopted in 74.4% of respondents. Factors associated with knowledge of transmission mode were age group, urban origin, marital status and education level. Fear and geographic origin were associated to stigma and hand washing. To better prevent and control the spread of Ebola virus disease, a focus needs to be placed on modes of transmission and hand washing, and health personnel could play a major role in improving the acceptability of the vaccine.

Réactivation d’une hépatite B occulte chez un patient drépanocytaire homozygote: cas clinique et revue de la littérature

Occult Hepatitis B corresponds to the presence of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) in serum and/or in liver of a patient despite HBsAg negativity. Clinically, it is usually asymptomatic. Its reactivation is rare and commonly occurs in immunosuppressed individuals. We report the case of a 21-year old patient from Senegal, with homozygous sickle cell disease, presenting with cholestatic jaundice. Laboratory tests showed reactivation of occult Hepatitis B. This study emphasizes the need to systematically investigate the presence of occult Hepatitis B in patients with sickle cell disease suffering from acute liver disease.