Clinical Forms of Chikungunya in Gabon, 2010

Chikungunya fever (CHIK) is a disease caused by a virus transmitted to humans by infected mosquitos. The virus is responsible for multiple outbreaks in tropical and temperate areas worldwide, and is now a global concern. Clinical and biological features of the disease are poorly described, especially in Africa, where the disease is neglected because it is considered benign. During a recent CHIK outbreak that occurred in southeast Gabon, we prospectively studied clinical and biological features of 270 virologically confirmed cases. Fever and arthralgias were the predominant symptoms. Furthermore, variable and distinct clinical pictures including pure febrile, pure arthralgic and unusual forms (neither fever nor arthralgias) were detected. No severe forms or deaths were reported. These findings suggest that, during CHIK epidemics, some patients may not have classical symptoms (fever and arthralgias). Local surveillance is needed to detect any changes in the pathogenicity of this virus

No Clinical or Biological Difference between Chikungunya and Dengue Fever during the 2010 Gabonese Outbreak

Chikungunya (CHIKV) and Dengue (DENV) viruses, both arboviruses, have caused multiple outbreaks worldwide. Their clinical features are poorly described in Africa and there is no comparative study, although Chikungunya is considered as a dengue-like disease. We conducted a comparative study of clinical and biological data from CHIKV and DENV positive patients during the 2010 Gabonese outbreak. Patients consulting with general symptoms and having laboratory confirmation for CHIKV or DENV were included. Clinical and biological data were recorded. Statistical analyses were performed using Epi Info. A P value < 0.05 was considered significant. In all, 270 CHIKV+, 53 DENV+ and 20 co-infected patients were included in the study. Headaches, hemorrhage, leukopenia and lymphopenia were significantly (P respectively 0.01, 0.001, 0.02 and 0.001) more frequent in DENV+ patients than in CHIKV+. There was no additive effect of the two viruses. These clinical and hematological disorders are non specific and cannot assist for the differential diagnosis. These diseases are clinically indistinguishable, and need for laboratory confirmation

Map of Gabon, and location of the different Chikungunya outbreaks from 2007 to 2010.

<p>Map of Gabon, and location of the different Chikungunya outbreaks from 2007 to 2010.</p

Distribution of suspected and confirmed cases during the 2010 Chikungunya outbreak in south-east Gabon.

<p>Distribution of suspected and confirmed cases during the 2010 Chikungunya outbreak in south-east Gabon.</p

Location of arthralgias in CHIKV+ patients during the 2010 outbreak in Franceville, Gabon.

<p>Low Viral Load: <100 000 DNA cDNA genome equivalents/ml.</p><p>High Viral Load: ≥100 000 DNA cDNA genome equivalents/ml.</p

Sante Publique

Objectif : Le besoin de disposer d’un système d’information sanitaire efficient et fiable a motivé le Gabon, avec l’appui de la Banque mondiale, pour qu’il financer un projet visant à renforcer son système d’information sanitaire. En amont, un audit de ce système s’imposait pour rendre compte de la réalité des dispositifs et des outils existants. Méthode : Les informations ont été recueillies sur deux périodes allant respectivement de mai à septembre 2016 et d’avril à mai 2018 pour la seconde en utilisant des approches qualitative et quantitative. Dans ce cadre, ont été réalisés successivement des ateliers participatifs incluant des acteurs de santé au Gabon, une enquête menée auprès de professionnels de santé, une analyse des documents de référence relatifs à la politique de santé nationale et une analyse des forces, faiblesses, opportunités et menaces du système. Résultats : Au total, 171 professionnels de santé de santé ont participé aux différents ateliers, et 770 autres ont été interrogés parmi 150 structures de soins issues des 10 régions sanitaires du pays. Au terme de ce travail, des problèmes organisationnels et techniques ont été relevés au niveau du système d’information sanitaire du Gabon, notamment l’absence de cadre juridique définissant les rôles et responsabilités des différents acteurs du système, une faible pratique de la gestion des données, un système d’information en silo, plusieurs applications informatiques non interopérables et un taux de complétude faible, à 30 %. Parmi les 770 professionnels de santé enquêtés, 539 (70 %) étaient favorables à la mise en place d’un nouveau système d’information. Comme principaux acquis, nous avons noté l’existence d’un parc informatique et une couverture Internet acceptables, 31,5 % des structures de soins étant connectées via le câble. Conclusion : Ce travail apporte des éclaircissements sur le système d’information sanitaire existant et permet de mieux envisager la mise en œuvre du nouveau système.Objective: The need for an efficient and reliable health information system motivated Gabon, with the support of the World Bank, to finance a project to reinforce its health information system. An audit of this system was required to report on the reality of the existing system and tools. Methods: Over the course of two periods, May to September 2016 and April to May 2018, information was collected using both qualitative and quantitative approaches. In this framework, were carried out successively: participative workshops including health actors in Gabon, a survey of health care workers, an analysis of reference documents relating to national health policies, and an analysis of the strengths, weaknesses, opportunities, and threats to the system. Results: In total, 171 health care professionals participated in the different workshops, and 770 others were questioned among 150 health care establishments from 10 health care regions of the country. At the end of this research work, organizational and technical problems were noted at the level of the health information system of Gabon, notably the absence of a judicial framework defining the roles and responsibilities of the different actors of the system, weak data management, a stovepipe information system, several non-interoperable IT applications, and weak completeness rate, at 30%. Among the 770 health care professionals surveyed, 539 (70%) were favorable to a new information system. As for the main assets, we noted the existence of computing equipment and acceptable internet coverage, 31.5% of the health care establishments are connected via cable. Conclusion: This research sheds light on the existing health information system and should enable the implementation of a new system

Symptoms of patients with unusual forms.

<p>ND: Not done; Viral load of 1 corresponds to a positive PCR signal detected outside the standard linearity. Viral loads are expressed in cDNA genome equivalents/ml.</p