Project funding: no specific funding
[Photo credit: Courtesy from Serge Mazamay]

Project funding: no specific funding (former funding: CNES 2016-2019)
[Photo credit: extracted from Tine et al. 2018]

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004  and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However,  for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly  developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent  epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000–2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to  identify spatial clusters of cases. Both using conventional statistics and the Cleveland’s algorithm for decomposition  into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae,Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of  DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Background: Acute Respiratory Infections (ARI) are common causes of febrile illnesses in many settings in Senegal. These infections are usually managed presumptively due to lack of appropriate diagnostic tools. This situation, can lead to poor management of febrile illness or antibiotic misuse. In addition, there are limited data on the spectrum of pathogens commonly responsible for these ARI. This study was conducted to explore the pathogens community among patients with acute respiratory infection in a rural area in Senegal. Methods: A cross sectional study was conducted from August to December 2015. Children and adult patients attending Keur Socé health post for signs suggestive of acute respiratory infection were enrolled after providing inform consent. Eligible participants were recruited using a consecutive sampling method. Paired nose and throat swabs were collected for pathogen detection. Samples were processed using a multiplex PCR designed to identify 21 pathogens including both virus and bacteria. Results: Two hundred and fifty patients participated in the study. Samples positivity rate was evaluated at 95.2% (238/250). Streptococcus pneumoniae was the predominant pathogen (74%) and was present in all months and all age-groups, followed by Staphylococcus aureus (28,8%) and rhinovirus (28,4%). Respiratory syncytial virus (RSV) was detected only among children under 5 years old in August and September while coronavirus was present in all age groups, during the months of October and December. Conclusion: This pilot study revealed a diversity of pathogens over the time and across all age groups, highlighting the need for further exploration. A pathogen community approach including both virus and bacteria at a larger scale becomes crucial for a better understanding of transmission dynamics at population level in order to help shape ARI control strategies.

In recent years, the ecology and evolution of infectious diseases has been studied extensively and new approaches to the study of host-pathogen interactions continue to emerge. At the same time, pathogen control in low-income countries has tended to remain largely informed by classical epidemiology, where the objective is to treat as many people as possible, despite recent research suggesting new opportunities for improved disease control in the context of limited economic resources. The need to integrate the scientific developments in the ecology and evolution of infectious diseases with public health strategy in low-income countries is now more important than ever. This novel text uniquely incorporates the latest research in ecology and evolutionary biology into the discussion of public health issues in low-income countries. It brings together an international team of experts from both universities and health NGOs to provide an up-to-date, authoritative, and challenging review of the ecology and evolution of infectious diseases, focusing on low-income countries for effective public health applications and outcomes. It discusses a range of public health threats including malaria, TB, HIV, measles, Ebola, tuberculosis, influenza and meningitis among others.