Trend in mortality from a recent measles outbreak in Cameroon: a retrospective analysis of 223 measles cases in the Benakuma Health District

Measles is a highly contagious viral infection with high mortality in poorly vaccinated regions. We sought to establish the trend in mortality and the factors that favoured the recent measles outbreak that occurred in Benakuma, in the North west region of Cameroon from the 21/06/2015 to 26/09/2015.We carried out a retrospective register analysis of 223 measles cases. Time trends were established using the Mann-Kendall test while survival was assessed using the Kaplan-Meier survival analysis and log rank test for comparisons.We had a case fatality of 8.5% and the mortality decreased significantly (p = 0.01) after the following public health interventions were instituted: community sensitisation and education; outbreak response immunisation and the use of a clinician in controlling the outbreak. Furthermore, the number of cases (p < 0.01) and the duration from onset of illness to consultation at a health facility (p < 0.01) decreased significantly after the institution of the aforementioned interventions. Also, survival during the outbreak was better in females (p = 0.02) and in those treated in health facilities (p < 0.01).The poor vaccination status in Benakuma coupled with negative cultural beliefs; poor socioeconomic and environmental factors and inadequate public health policies predisposed the region to a measles outbreak and favoured the spread of the virus. Public health policies should be revisited, modified and intensified to scale up vaccination coverage in measles endemic zones in Cameroon to help eliminate the disease and facilitate the overall attainment of the Sustainable Development Goals

Rates of HBV, HCV, HDV and HIV type 1 among pregnant women and HIV type 1 drug resistance-associated mutations in breastfeeding women on antiretroviral therapy

Abstract Background HBV, HCV, HDV and HIV are blood borne and can be transmitted from mother-to-child. Reports of HBV infection rates show up to 11.9% in Cameroon while for HCV, the rate is less than 2%. More so, as pregnant women get enrolled in the HIV PMTCT Programme and stay in the care continuum, selection of HIV-1 drug resistant strains is evident. We sought to determine the seroprevalence of HBV, HCV, HDV and HIV among pregnant women, assess their knowledge, attitudes and practices on transmission and prevention of HBV infection, and determine HIV drug resistance profile of breastfeeding women. Methods A serosurvey of HBV, HCV, HDV and HIV was carried out among 1005 pregnant women in Yaounde, Cameroon. In 40 HIV-infected breastfeeding women enrolled in the PMTCT Programme, HIV-1 genotypes and HIV-1 resistance to NRTIs, NNRTIs and PIs, were determined by phylogeny and the Stanford University HIV Drug Resistance interpretation tool, respectively. Results Among the pregnant women, the rates of HIV-1, HBV, HCV and HDV infections were 8.5, 6.4, 0.8 and 4.0%, respectively. About 5.9% of the women knew their HBV status before pregnancy unlike 63.7% who knew their HIV status. Although 83.3% reported that vaccination against HBV infection is a method of prevention, and 47.1% knew that HBV could be transmitted from mother-to-child, only 2.5% had received the Hepatitis B vaccine. Of the 40 women on antiretroviral therapy (ART), 9 had at least one major resistance-associated mutation (RAM, 22.5%) to NRTI, NNRTI or PI. Of these M184 V (12.5%), K70R (10.0%), K103 N (12.5%), Y181C (10.0%), M46 L (2.5%) and L90 M (2.5%) were most frequently identified, suggesting resistance to lamivudine, nevirapine, efavirenz and zidovudine. Eighty four percent were infected with HIV-1 recombinant strains with CRF02_AG predominating (50%). Conclusions The rates of HBV and HIV-1 infections point to the need for early diagnosis of these viruses during pregnancy and referral to care services in order to minimize the risk of MTCT. Furthermore, our results would be useful for evaluating the HIV PMTCT Programme and Treatment Guidelines for Cameroon