BackgroundIllegal gold miners in French Guiana, a French overseas territory (‘département’) located in Amazonia, often carry malaria parasites (up to 46.8%). While the Guiana Shield Region aims at malaria elimination, the high prevalence of Plasmodium in this hard-to-reach population in conjunction with frequent incorrect use of artemisinin-based anti-malarials could favour the emergence of resistant parasites. Due to geographical and regulatory issues in French Guiana, usual malaria control strategies cannot be implemented in this particular context. Therefore, new strategies targeting this specific population in the forest are required.MethodsNumerous discussions among health institutions and scientific partners from French Guiana, Brazil and Suriname have led to an innovative project based on the distribution of kits for self-diagnosis and self-treatment of Plasmodium infections. The kit-distribution will be implemented at “resting sites”, which are areas across the border of French Guiana regularly frequented by gold miners. The main objective is to increase the appropriate use and complete malaria treatment after a positive malaria diagnosis with a rapid test, which will be evaluated with before-and-after cross-sectional studies. Monitoring indicators will be collected from health mediators at the time of kit distribution and during subsequent visits, and from illegal gold miners themselves, through a smartphone application. The project funding is multisource, including Ministries of Health of the three countries, WHO/PAHO, and the European Union.ResultsThis project will start in April 2018 as a 18 month pilot study led by the Clinical Investigation Centre of Cayenne. Results should be available at the end of 2019.DiscussionThis innovative approach may have several limitations which should be taken into account, as potential side effects, kit misuse or resale, declarative main criteria, or no Plasmodium vivax curative treatment. Close monitoring is thus needed.ConclusionsThis project may be the best available solution to a specific and important public health challenge in the Guiana Shield. If the use of self-diagnosis and self-treatment approach is effective, this strategy could be sustained by health institutions in the region.
T he Republic of Djibouti, bordered by Eritrea, Ethiopia, and Somalia, is a semiarid country in the Horn of Africa. The population comprises <900,000 persons, 70% of whom live in Djibouti, the capital city. Before 2013, malaria was hypoendemic to the country, with low levels of transmission in periruban and rural areas during December-May. Localized outbreaks occurred regularly, possibly caused by migration from surrounding countries. Most cases were caused by infection with Plasmodium falciparum (>80%) or P. vivax. Before 2013, researchers considered the Anopheles arabiensis mosquito to be the primary vector (1).The incidence of malaria had drastically decreased in the country since 2008; by 2012, this transmission level was compatible with preelimination goals (2,3). In 2013, an autochthonous outbreak of malaria occurred in Djibouti; fi eld entomologic investigations identifi ed An. stephensi mosquitoes as a new malaria vector (4). This species, a known vector of urban malaria in India and the Arabian Peninsula, has changed the epidemiologic profi le of malaria in Djibouti (5). In 2018, malaria incidence increased to 25,319 confi rmed cases (64% caused by P. falciparum and 36% by P. vivax) and >100,000 suspected cases (Appendix Figure 1, https://wwwnc.cdc.gov/EID/ article/27/6/20-4557-App1.pdf).The French Armed Forces (FAF) have served in Djibouti for decades. Service members and their families (≈2,700 persons) live in the capital. Despite malaria prevention and treatment measures described elsewhere (6), an outbreak among French military personnel occurred in February 2019; failure of early artemisinin combined therapy was documented in 1 patient. The StudyWe collated FAF epidemiologic surveillance data on malaria cases among service members in Djibouti during 1993Djibouti during -2019; the 2019 data included cases among family members. We defi ned a malaria case as an illness resulting in a positive result on a rapid diagnostic test or thin blood smear.We conducted the fi eld investigation in the capital during February 28-March 22, 2019. We obtained a dried blood spot on fi lter paper from each patient and stored the samples in a sealed plastic pouch until processing. We extracted DNA from the samples and
We conducted this study to describe the dynamics of the acquisition of respiratory pathogens, their potential interactions and risk factors for possible lower respiratory tract infection symptoms (LRTI) among French pilgrims during the 2018 Hajj. Each participant underwent four successive systematic nasopharyngeal swabs before and during their stay in Saudi Arabia. Carriage of the main respiratory pathogens was assessed by PCR. 121 pilgrims were included and 93.4% reported respiratory symptoms during the study period. The acquisition of rhinovirus, coronaviruses and Staphylococcus aureus occurred soon after arrival in Saudi Arabia and rates decreased gradually after days 5 and 6. In contrast, Streptococcus pneumoniae and Klebsiella pneumoniae carriage increased progressively until the end of the stay in Saudi Arabia. Haemophilus influenzae and Moraxella catarrhalis carriage increased starting around days 12 and 13, following an initial clearance. Influenza viruses were rarely isolated. We observed an independent positive mutual association between S. aureus and rhinovirus carriage and between H. influenzae and M. catarrhalis carriage. Dual carriage of H. influenzae and M. catarrhalis was strongly associated with S. pneumoniae carriage (OR = 6.22). Finally, our model showed that M. catarrhalis carriage was negatively associated with K. pneumoniae carriage. Chronic respiratory disease was associated with symptoms of LRTI. K. pneumoniae, M. catarrhalis-S. aureus and H. influenzae-rhinovirus dual carriage was associated with LRTI symptoms. Our data suggest that RTIs at the Hajj are a result of complex interactions between a number of respiratory viruses and bacteria.
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