Journal Article > LetterFull Text
Lancet. 2022 July 2; Volume 400 (Issue 10345); 23.; DOI:10.1016/S0140-6736(22)01187-4
Abbara A, Rao B, Titanji BK, Boum Y, Zumla A
Lancet. 2022 July 2; Volume 400 (Issue 10345); 23.; DOI:10.1016/S0140-6736(22)01187-4
Journal Article > CommentaryAbstract Only
BMJ. 2023 February 6; Volume 380; e073352.; DOI:10.1136/bmj-2022-073352
Mansour R, Houston A, Majeed A, Boum Y, Nakouné E, et al.
BMJ. 2023 February 6; Volume 380; e073352.; DOI:10.1136/bmj-2022-073352
What you need to know:
-- Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms.
-- While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications.
-- A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients.
-- Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients.
-- Consider coinfections with monkeypox and other sexually transmitted infections among patients presenting with an acute rash or skin lesions and systemic symptoms.
-- While it is safe to manage monkeypox patients virtually, they may need advice to maintain infection control measures and interventions to manage complications.
-- A specialist infectious disease unit with access to novel antivirals such as tecovirimat and cidofovir should manage high risk patients.
-- Healthcare workers should be aware of the stigma surrounding monkeypox, which may result in reduced health-seeking behaviours; healthcare staff should screen patients sensitively, using inclusive language to avoid alienating patients.
Journal Article > ResearchFull Text
Sci Rep. 2023 December 8; Volume 13 (Issue 1); 21654.; DOI:10.1038/s41598-023-48773-3
Fokam J, Essomba RG, Njouom R, Okomo MCA, Eyangoh S, et al.
Sci Rep. 2023 December 8; Volume 13 (Issue 1); 21654.; DOI:10.1038/s41598-023-48773-3
While the SARS-CoV-2 dynamic has been described globally, there is a lack of data from Sub-Saharan Africa. We herein report the dynamics of SARS-CoV-2 lineages from March 2020 to March 2022 in Cameroon. Of the 760 whole-genome sequences successfully generated by the national genomic surveillance network, 74% were viral sub-lineages of origin and non-variants of concern, 15% Delta, 6% Omicron, 3% Alpha and 2% Beta variants. The pandemic was driven by SARS-CoV-2 lineages of origin in wave 1 (16 weeks, 2.3% CFR), the Alpha and Beta variants in wave 2 (21 weeks, 1.6% CFR), Delta variants in wave 3 (11 weeks, 2.0% CFR), and omicron variants in wave 4 (8 weeks, 0.73% CFR), with a declining trend over time (p = 0.01208). Even though SARS-CoV-2 heterogeneity did not seemingly contribute to the breadth of transmission, the viral lineages of origin and especially the Delta variants appeared as drivers of COVID-19 severity in Cameroon.
Journal Article > CommentaryFull Text
PLOS Glob Public Health. 2023 January 18; Volume 3 (Issue 1); e0001418.; DOI:10.1371/journal.pgph.0001418
Hodson DZ, Etoundi YM, Parikh S, Boum Y
PLOS Glob Public Health. 2023 January 18; Volume 3 (Issue 1); e0001418.; DOI:10.1371/journal.pgph.0001418
Interest in “global health” among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
Journal Article > CommentaryFull Text
N Engl J Med. 2023 February 2; Volume 388 (Issue 5); 387-390.; DOI:10.1056/NEJMp2213809
Haberer JE, Boum Y
N Engl J Med. 2023 February 2; Volume 388 (Issue 5); 387-390.; DOI:10.1056/NEJMp2213809
Journal Article > CommentaryFull Text
Lancet Infect Dis. 2023 January 19; Online ahead of print; DOI:10.1016/S1473-3099(22)00810-6
Torreele E, Boum Y, Adjaho I, Alé FGB, Issoufou SH, et al.
Lancet Infect Dis. 2023 January 19; Online ahead of print; DOI:10.1016/S1473-3099(22)00810-6
Three years since proving effective for Ebola virus disease in a clinical trial, two breakthrough treatments are registered and stockpiled in the USA but still not registered and generally available in the countries most affected by this deadly infection of epidemic potential. Analysing the reasons for this, we see a fragmentation of the research and development value chain, with different stakeholders taking on different steps of the research and development process, without the public health-focused leadership needed to ensure the end goal of equitable access in countries where Ebola virus disease is prevalent. Current financial incentives for companies to overcome market failures and engage in epidemic-prone diseases are geared towards registration and stockpiling in the USA, without responsibility to provide access where and when needed. Ebola virus disease is the case in point, but not unique—a situation seen again for mpox and likely to occur again for other epidemics primarily affecting disempowered communities. Stronger leadership in African countries will help drive drug development efforts for diseases that primarily affect their communities, and ensure all partners align with and commit to an end-to-end approach to pharmaceutical development and manufacturing that puts equitable access when and where needed at its core.
Journal Article > ResearchFull Text
Toxins. 2024 March 22; Volume 16 (Issue 4); 165.; DOI:10.3390/toxins16040165
Benhammou D, Chippaux JP, Ntone R, Madec Y, Amta P, et al.
Toxins. 2024 March 22; Volume 16 (Issue 4); 165.; DOI:10.3390/toxins16040165
Snakebite envenomation (SBE) is a public health issue in sub-Saharan countries. Antivenom is the only etiological treatment. Excellent tolerance is essential in managing SBE successfully. This study aimed to evaluate tolerance of InoserpTM PAN-AFRICA (IPA). It was conducted on fourteen sites across Cameroon. IPA was administered intravenously and repeated at the same dose every two hours if needed. Early and late tolerance was assessed by the onset of clinical signs within two hours and at a visit two weeks or more after the first IPA administration, respectively. Over 20 months, 447 patients presenting with a snakebite were included. One dose of IPA was administered to 361 patients and repeated at least once in 106 patients. No significant difference was shown between the proportion of adverse events in patients who received IPA (266/361, 73.7%) and those who did not (69/85, 81.2%) (p = 0.95). Adverse reactions, probably attributable to IPA, were identified in four (1.1%) patients, including one severe (angioedema) and three mild. All these reactions resolved favorably. None of the serious adverse events observed in twelve patients were attributed to IPA. No signs of late intolerance were observed in 302 patients. Tolerance appears to be satisfactory. The availability of effective and well-tolerated antivenoms would reduce the duration of treatment and prevent most disabilities and/or deaths.
Conference Material > Poster
Eyong J, Fai KN, Nikolay B, Gignoux EM, Nsaibirini R, et al.
Epicentre Scientific Day 2024. 2024 May 23
Français
Journal Article > LetterFull Text
Lancet Infect Dis. 2023 April 1; Volume 23 (Issue 4); 407-408.; DOI:10.1016/S1473-3099(23)00127-5
Torreele E, Boum Y, Adjaho I, Alé FGB, Issoufou SH, et al.
Lancet Infect Dis. 2023 April 1; Volume 23 (Issue 4); 407-408.; DOI:10.1016/S1473-3099(23)00127-5
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2023 November 8; Volume 17 (Issue 11); e0011707.; DOI:10.1371/journal.pntd.0011707
Chippaux JP, Ntone R, Benhammou D, Madec Y, Noël G, et al.
PLoS Negl Trop Dis. 2023 November 8; Volume 17 (Issue 11); e0011707.; DOI:10.1371/journal.pntd.0011707
BACKGROUND
Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon.
METHODOLOGY/PRINCIPAL FINDINGS
We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes.
Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14–40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection.
CONCLUSIONS/SIGNIFICANCE
We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom.
Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon.
METHODOLOGY/PRINCIPAL FINDINGS
We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes.
Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14–40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection.
CONCLUSIONS/SIGNIFICANCE
We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom.