Evaluation du système de surveillance épidémiologique de la méningite bactérienne dans la région des Savanes au Togo, 2016 – 2019: Evaluation of the epidemiological surveillance system for bacterial meningitis in the Savanes region of Togo, 2016 – 2019

Introduction: La surveillance cas par cas de la Méningite Bactérienne Aiguë (MBA) a démarré depuis 2014 dans la ré-gion des Savanes mais le niveau de sa performance est méconnu. L’objectif de cette étude était d’évaluer ce système de surveillance de 2016 à 2019. Méthodes: Il s’est agi d’une étude transversale qui a inclus tous les cas de MBA notifiés dans la région des Savanes entre la semaine 1 (S1) 2016 et S19 2019, 34 Formations Sanitaires (FS) périphériques, sept hôpitaux de districts (HD) et l’hôpital régional (CHR). Les données ont été collectées par interview, observation et examen de registres. Les directives éditées dans le guide « CDC-Atlanta 2001 », ont été utilisées pour dé-crire l’organisation, le fonctionnement et les attributs : utilité, simplicité, acceptabilité, flexibilité, représen-tativité, réactivité, qualité des données et Valeur Prédictive Positive (VPP). Résultats: Le système opérait avec trois mécanismes de transmission des données suivant le circuit : FS-Direction préfectorale-Direction régionale-Niveau central. Trois épidémies causées par Nm W en 2016 et 2017 et Nm C en 2019 ont été détectées. Le délai moyen de vaccination réactive était de cinq semaines. La promp-titude des rapports hebdomadaires, initialement à 100%, a régressé à moins de 60% après introduction de « Argus » et « District Health Information System, deuxième version (DHIS-2) ». Les prestataires avaient prélevé le LCR et rempli la fiche d’investigation dans 92,2% (141/153), IC 95% (86,7% - 95,9%) des cas. Dans la base de données, respectivement 24,6% (252/1024), IC 95% (22,2% - 27,3%) et 20,7% (212/1024), IC 95% (18,3% - 23,3%] des données manquaient pour les variables « Résultat final » et « Classification finale ». Les cas provenaient de tous les districts et représentaient toutes les tranches d’âge. La Valeur Pré-dictive Positive globale a varié de 42,1% (122/290), IC 95% (36,3% - 48,0%) en 2016 à 64,0% (48/75), IC 95% (52,1% - 74,8%) en 2019. Conclusion: Le système de surveillance de la MBA dans la région des Savanes était utile, acceptable et représentatif malgré certaines données manquantes. Il était complexe, non flexible et peu prompt pour la riposte vacci-nale. Il faudrait un mécanisme unique de transmission des données, pouvoir confirmer les cas dans les HD et auditer les données. Introduction: Case-by-case surveillance of Acute Bacterial Meningitis (ABM) started since 2014 in the Savannah region but the level of its performance is unknown. The objective of this study was to evaluate this surveillance system from 2016 to 2019. Methods: This was a cross-sectional study that included all cases of (ABM) notified in the Savanes region between week 1 (W1) 2016 and week19 2019, 34 peri-urban Health Formations (SFs), seven district hospitals (DHs) and the regional hospital (RHC). Data were collected by interview, observation and review of records. The guidelines published in the CDC-Atlanta 2001 guide were used to describe the organisation, functioning and attributes: utility, simplicity, acceptability, flexibility, representativeness, responsiveness, data quality and Positive Predictive Value (PPV). Results: The system operated with three data transmission mechanisms following the circuit: FS-Prefectural Directorate-Regional Directorate-Central level. Three epidemics caused by Nm W in 2016 and 2017 and Nm C in 2019 were detected. The average time for reactive vaccination was five weeks. The promptness of weekly reporting, initially 100%, decreased to less than 60% after the introduction of Argus and District Health Information System, version 2 (DHIS-2). Providers had collected CSF and completed the investigation form in 92.2% (141/153), 95% CI (86.7% - 95.9%) of cases. In the database, 24.6% (252/1024), 95% CI (22.2% - 27.3%) and 20.7% (212/1024), 95% CI (18.3% - 23.3%) of the data were missing for the variables "Final outcome" and "Final classification" respectively. The cases came from all districts and represented all age groups. The overall Positive Predictive Value ranged from 42.1% (122/290), 95% CI (36.3% - 48.0%) in 2016 to 64.0% (48/75), 95% CI (52.1% - 74.8%) in 2019. Conclusion: The surveillance system for MVA in the Savanes region was useful, acceptable and representative despite some missing data. It was complex, inflexible and not very prompt for the vaccine response. A single data transmission mechanism is needed, as well as the ability to confirm cases in HDs and audit data

Représentativité et réactivité du système de surveillance de la Fièvre Jaune au Togo, 2004-2014: Representativeness and responsiveness of the Yellow Fever surveillance system in Togo, 2004-2014

Introduction: Peu d’informations sont disponibles sur le système de surveillance de la fièvre jaune au Togo. L’objectif est d’évaluer la simplicité, la représentativité et la réactivité de ce système. Méthodes: Une étude transversale descriptive a été menée de 2015 à 2016 à l’Institut Na-tional d’Hygiène (INH) qui est le Laboratoire National de Référence (LNR) pour les maladies à po-tentiel épidémique du Togo. La base de données de 2004-2014 de la fièvre jaune- rougeole -rubéole du LNR et le guide de surveillance intégrée des maladies et riposte, le guide d’évaluation des systèmes de surveillance de Centers for Disease Control and Prevention (CDC) ont été utilisés. Les médianes, intervalles interquartiles et les proportions ont été calculés avec Epi Info 7 et Excel 2003. Résultats: Un cas suspect de fièvre jaune nécessite une confirmation biologique qui se fait à plusieurs niveaux. Le système est représentatif de tous les districts, toutes les années et de toutes les populations du Togo. Un total de 3054 de cas suspects a été notifié dont 32 cas probables et 12 cas confirmés, par-mi lesquels, 8 étaient des hommes. Environs 93,01 % (2833) des cas suspects ont été prélevés dans les 14 jours suivants le début des symp-tômes, 28,39% (866) des échantillons ont été acheminés dans les 72 heures et 77,95% des résultats rendus dans les 7 jours rendant le système peu réactif. Conclusion: Le système de surveillance de la fièvre jaune au Togo est représentatif, complexe et peu réactif. Il s’avère nécessaire de mettre en place un système de convoyage rapide des échantillons. Introduction: Little information is available on yellow fever surveillance system in Togo. The simplicity, representativeness and responsiveness of this system were assessed. Material and Methods: It was a descriptive cross-sectional study conducted from October 2015 to February 2016 at the Institut National d’Hygiène, the National Reference Laboratory (NRL) for epidemic prone diseases of Togo. We used the yellow fever-measles-rubella database, the integrated dis-ease surveillance and response guideline and the Centers for Disease Control and Prevention (CDC) guidelines for surveillance system evaluation. Medians, interquartile intervals and proportions were calculated and presented in tables and figures with Excel 2003 and Epi Info 7. Results: A yellow fever case must be confirmed at several reference levels making yellow fever surveillance complex. This surveillance system is representative of all districts, all years and all populations of Togo. A total of 3054 suspected cases were reported, including 32 probable cases and 12 confirmed cases. Of the confirmed cases, 08 were men. About 93.01% (2833) of the suspected cases samples were taken within 14 days after the symptoms onset, 28,39% (866) of samples were transported within 72 hours and 77, 95% of the results were available within 7 days, making the system unresponsive. Conclusion: The yellow fever surveillance system in Togo is representative, complex, and unresponsive due to the long delay in transporting samples to the NRL. A rapid sample conveying system is recommende

Implementation of a National Reference Laboratory for Buruli Ulcer Disease in Togo

Background: In a previous study PCR analysis of clinical samples from suspected cases of Buruli ulcer disease (BUD) from Togo and external quality assurance (EQA) for local microscopy were conducted at an external reference laboratory in Germany. The relatively poor performance of local microscopy as well as effort and time associated with shipment of PCR samples necessitated the implementation of stringent EQA measures and availability of local laboratory capacity. This study describes the approach to implementation of a national BUD reference laboratory in Togo. Methodology: Large scale outreach activities accompanied by regular training programs for health care professionals were conducted in the regions "Maritime'' and "Central,'' standard operating procedures defined all processes in participating laboratories (regional, national and external reference laboratories) as well as the interaction between laboratories and partners in the field. Microscopy was conducted at regional level and slides were subjected to EQA at national and external reference laboratories. For PCR analysis, sample pairs were collected and subjected to a dry-reagent-based IS2404-PCR (DRB-PCR) at national level and standard IS2404 PCR followed by IS2404 qPCR analysis of negative samples at the external reference laboratory. Principal Findings: The inter-laboratory concordance rates for microscopy ranged from 89% to 94%; overall, microscopy confirmed 50% of all suspected BUD cases. The inter-laboratory concordance rate for PCR was 96% with an overall PCR case confirmation rate of 78%. Compared to a previous study, the rate of BUD patients with non-ulcerative lesions increased from 37% to 50%, the mean duration of disease before clinical diagnosis decreased significantly from 182.6 to 82.1 days among patients with ulcerative lesions, and the percentage of category III lesions decreased from 30.3% to 19.2%. Conclusions: High inter-laboratory concordance rates as well as case confirmation rates of 50% (microscopy), 71% (PCR at national level), and 78% (including qPCR confirmation at external reference laboratory) suggest high standards of BUD diagnostics. The increase of non-ulcerative lesions, as well as the decrease in diagnostic delay and category III lesions, prove the effect of comprehensive EQA and training measures involving also procedures outside the laboratory

Augmentation de la résistance aux antibiotiques des Entérobactéries isolées à l’Institut National d’Hygiène de Lomé de 2010 à 2017: Increase in antibiotic resistance of Enterobacteriaceae isolated at the National Institute of Hygiene of Lomé from 2010 to 2017

Introduction: La résistance des Entérobactéries aux antibiotiques est un problème d’importance croissante en pratique médicale. L’objectif de cette étude était de déterminer le profil de résistance aux antibiotiques des Entérobactéries isolées à l’institut national d’hygiène (INH) de Lomé et d’analyser son évolution dans le temps. Méthodes: Il s’agissait d’une analyse rétrospective, sur une période de huit ans (2010-2017), portant sur l’ensemble des souches d’Entérobactéries isolées des prélèvements pathologiques analysés au laboratoire de bactériologie de l’INH. Résultats: Au total, 5910 Entérobactéries ont été isolées majoritairement des urines (59,59%), avec une prédominance d’Escherichia coli (63,93%) suivie de Klebsiella spp (22,86%). Entre 2010 et 2017, le taux de résistance des souches d’Escherichia coli a augmenté significativement de 18,69% à 39,26% (p< 0,0001) à la Ceftazidime ; de 1,68% à 40,22% à la Ceftriaxone (p< 0,0001) et de 42,37% à 63,23% (p< 0,0001) à la Ciprofloxacine. La résistance des souches de Klebsiella spp à la Ceftazidime a augmenté significativement de 25,26% à 42,54% (p< 0,0001) et celle à la Ceftriaxone de 2,17% à 41,79% (p< 0,0001) respectivement de 2010 à 2017. Conclusion: L’augmentation de la résistance des Entérobactéries aux antibiotiques et surtout l’évolution des résistances aux Céphalosporines de 3e Génération et aux Fluoroquinolones est un phénomène réel. Ceci exposera à des difficultés de prise en charge thérapeutique et nécessite la mise en place des dispositions idoines. Background: Antibiotic resistance in Enterobacteriaceae is a growing problem in medical practice. The objective of this study was to determine the antibiotic resistance profile of Enterobacteriaceae isolated at the National Institute of Hygiene (INH) of Lomé and to analyse its evolution over time. Method: This was a retrospective analysis, over a period of eight years (2010-2017), of all strains of Enterobacteriaceae isolated from pathological samples analysed in the bacteriology laboratory of the INH. Results: A total of 5910 Enterobacteriaceae were isolated mainly from urine (59.59%), with a predominance of Escherichia coli (63.93%) followed by Klebsiella spp (22.86%). Between 2010 and 2017, the resistance rate of Escherichia coli strains increased significantly from 18.69% to 39.26% (p<0.0001) to Ceftazidime; from 1.68% to 40.22% to Ceftriaxone (p<0.0001) and from 42.37% to 63.23% (p<0.0001) to Ciprofloxacin. Resistance of Klebsiella spp strains to Ceftazidime increased significantly from 25.26% to 42.54% (p< 0.0001) and to Ceftriaxone from 2.17% to 41.79% (p< 0.0001) respectively from 2010 to 2017. Conclusion: The increase in antibiotic resistance in Enterobacteriaceae and especially the evolution of resistance to 3rd generation cephalosporins and fluoroquinolones is a real phenomenon. This will lead to difficulties in therapeutic management and requires the implementation of appropriate measures

Effectiveness of Routine BCG Vaccination on Buruli Ulcer Disease: A Case-Control Study in the Democratic Republic of Congo, Ghana and Togo

Background: The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guerin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD. Methodology: The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors. Principal Findings: After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31),sex (p = 0.24),age (p = 0.96),and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions. Conclusions: In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD

Effectiveness of Routine BCG Vaccination on Buruli Ulcer Disease: A Case-Control Study in the Democratic Republic of Congo, Ghana and Togo

Background: The only available vaccine that could be potentially beneficial against mycobacterial diseases contains live attenuated bovine tuberculosis bacillus (Mycobacterium bovis) also called Bacillus Calmette-Guerin (BCG). Even though the BCG vaccine is still widely used, results on its effectiveness in preventing mycobacterial diseases are partially contradictory, especially regarding Buruli Ulcer Disease (BUD). The aim of this case-control study is to evaluate the possible protective effect of BCG vaccination on BUD. Methodology: The present study was performed in three different countries and sites where BUD is endemic: in the Democratic Republic of the Congo, Ghana, and Togo from 2010 through 2013. The large study population was comprised of 401 cases with laboratory confirmed BUD and 826 controls, mostly family members or neighbors. Principal Findings: After stratification by the three countries, two sexes and four age groups, no significant correlation was found between the presence of BCG scar and BUD status of individuals. Multivariate analysis has shown that the independent variables country (p = 0.31),sex (p = 0.24),age (p = 0.96),and presence of a BCG scar (p = 0.07) did not significantly influence the development of BUD category I or category II/III. Furthermore, the status of BCG vaccination was also not significantly related to duration of BUD or time to healing of lesions. Conclusions: In our study, we did not observe significant evidence of a protective effect of routine BCG vaccination on the risk of developing either BUD or severe forms of BUD. Since accurate data on BCG strains used in these three countries were not available, no final conclusion can be drawn on the effectiveness of BCG strain in protecting against BUD. As has been suggested for tuberculosis and leprosy, well-designed prospective studies on different existing BCG vaccine strains are needed also for BUD

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Prevalence of syphilis among female sex workers and their clients in Togo in 2011

Abstract Background During the last ten years, a resurgence of syphilis has occurred in many countries worldwide, including Togo. Previous studies have shown a wide range of syphilis infection among the female sex workers (FSWs), from 1.5 to 42.1%. In Togo, Key populations, including FSWs, are rarely involved in the sentinel surveillance programs to determine the prevalence of HIV and syphilis. The aim of this study was to determine the prevalence of syphilis among female sex workers (FSWs) and their clients in Togo. Methods We conducted a cross-sectional study in December 2011 targeting FSWs and their clients in Togo. Among participant who consented, we collected blood samples for syphilis and HIV testing. Results In total, 1,836 participants (1,106 FSWs and 730 clients) were included in the survey. Their mean age was 28.6 ± 9 years. The prevalence of syphilis was 2.2% (2.2% among FSWs compare to 2.3% among their clients, p = 0.82). This prevalence was higher among FSWs over 30 years old compare to those less than 30 years old (Odd Ratio (OR) =5.03; 95% CI [1.95-13.49]). Single FSWs were three times less likely to have syphilis than those living in couple or married (OR = 3.11; CI 95% [1.16-8.83]). Brothel based or declared FSWs were 4 times more likely to be infected by syphilis than secret ones (OR = 3.89; CI 95% [1.60-9.54]). Out of the 1,836 participants of the survey, 165 (8.9%) were HIV positive. Having syphilis was associated with HIV infection (OR = 3.41; IC 95% [1.53-7.41]). Conclusion This study showed that: i) the prevalence of syphilis among FSWs and their clients was high; ii) syphilis was significantly associated with HIV infection. It is necessary to increase awareness campaigns and emphasize on condom use among this key population group

Phytochemical Screening, Antimicrobial and Antioxidant Activities of Aloe buettneri, Mitracarpus scaber and Hannoa undulata used in Togolese Cosmetopoeia

Background: Aloe buettneri, Mitracarpus scaber and Hannoa undulata are three plants species used in the Togolese traditional medicine to cure dermatosis. This study aims at assessing their anti-oxidant and anti-microbial activities on acne-developing micro-organisms. Methods: Six micro-organisms including Cutibacterium acnes ATCC 6919, Pseudomonas aeruginosa ATCC 27853; Escherichia coli ATCC 25922; Klebsiella pneumoniae ATCC 700603; Staphylococcus aureus ATCC 29213; and Candida albicans ATCC 35659 were used. Inhibition diameter was assessed using the agar well diffusion method. Minimum inhibitory and minimum microbicidal concentrations have been achieved through the liquid dilution method. Anti-oxidant activities were evaluated by DPPH antiradical scaving and FRAP methods. Phytochemical screening was also realized. Results: All the microorganism’s strains tested, excepted Candida albicans and Escherichia coli, were susceptible to plants extracts at 250 mg/mL in the agar well diffusion assay with inhibition diameters ranging from 12.10 ± 0.07 to 18.20 ± 0.10 mm. The MICs values were comprised between 15.625 mg/mL and 62.5 mg/mL, when MMCs ranged from 31.25 to 125 mg/mL. At the concentration of 500 µg/mL, the scavenging properties on DPPH radicals were 49.20 ± 0.15% for H. undulata, 41.29 ± 0.51% for A. buettneri, 59.57 ± 0.41% for M. scaber and 87.22 ± 0.03% for Quercetin. For FRAP assay, the effective concentration (EC50) of A. buettneri, M. scaber and H. undulata extracts were 977.44 ± 1.13 µg/mL; 267.74 ± 10.13 µg/mL and, 272.54 ± 12.87 µg/mL respectively while quercetin presented the EC50 of 48.63 ± 2.00 µg/mL. The antimicrobial and antioxidant activities of these species might be required to the presence of polyphenols, tannins, flavonoids, triterpenes, saponoside and alkaloids identified by phytochemical screening. Conclusion: The three plants extracts are all potential natural antimicrobial and antioxidant candidates for treating acne vulgaris. Keywords: Aloe buettneri, Mitracarpus scaber, Hannoa undulata, antimicrobial activity, antioxidant activity, phytochemical screening, Acne vulgari