Impact of the Ebola outbreak on Trypanosoma brucei gambiense infection medical activities in coastal Guinea, 2014-2015: A retrospective analysis from the Guinean national Human African Trypanosomiasis control program

Abstract

BackgroundThe 2014–2015 Ebola outbreak massively hit Guinea. The coastal districts of Boffa, Dubreka and Forecariah, three major foci of Human African Trypanosomiasis (HAT), were particularly affected. We aimed to assess the impact of this epidemic on sleeping sickness screening and caring activities.Methodology/Principal findingsWe used preexisting data from the Guinean sleeping sickness control program, collected between 2012 and 2015. We described monthly: the number of persons (i) screened actively; (ii) or passively; (iii) treated for HAT; (iv) attending post-treatment follow-up visits. We compared clinical data, treatment characteristics and Disability Adjusted Life-Years (DALYs) before (February 2012 to December 2013) and during (January 2014 to October 2015) the Ebola outbreak period according to available data. Whereas 32,221 persons were actively screened from February 2012 to December 2013, before the official declaration of the first Ebola case in Guinea, no active screening campaigns could be performed during the Ebola outbreak. Following the reinforcement and extension of HAT passive surveillance system early in 2014, the number of persons tested passively by month increased from 7 to 286 between April and September 2014 and then abruptly decreased to 180 until January 2015 and to none after March 2015. 213 patients initiated HAT treatment, 154 (72%) before Ebola and 59 (28%) during the Ebola outbreak. Those initiating HAT therapy during Ebola outbreak were recruited through passive screening and diagnosed at a later stage 2 of the disease (96% vs. 55% before Ebola, p<0.0001). The proportion of patients attending the 3 months and 6 months post-treatment follow-up visits decreased from 44% to 10% (p <0.0001) and from 16% to 3% (p = 0.017) respectively. The DALYs generated before the Ebola outbreak were estimated to 48.7 (46.7–51.5) and increased up to 168.7 (162.7–174.7), 284.9 (277.1–292.8) and 466.3 (455.7–477.0) during Ebola assuming case fatality rates of 2%, 5% and 10% respectively among under-reported HAT cases.Conclusions/SignificanceThe 2014–2015 Ebola outbreak deeply impacted HAT screening activities in Guinea. Active screening campaigns were stopped. Passive screening dramatically decreased during the Ebola period, but trends could not be compared with pre-Ebola period (data not available). Few patients were diagnosed with more advanced HAT during the Ebola period and retention rates in follow-up were lowered. The drop in newly diagnosed HAT cases during Ebola epidemic is unlikely due to a fall in HAT incidence. Even if we were unable to demonstrate it directly, it is much more probably the consequence of hampered screening activities and of the fear of the population on subsequent confirmation and linkage to care. Reinforced program monitoring, alternative control strategies and sustainable financial and human resources allocation are mandatory during post Ebola period to reduce HAT burden in Guinea.

Trypa-NO! contributes to the elimination of gambiense human African trypanosomiasis by combining tsetse control with “screen, diagnose and treat” using innovative tools and strategies

“…In Guinea, vector control, initially implemented from 2012 in part of the Boffa focus, was extended to all 3 active foci, with up to 20,000 Tiny Targets deployed each year. This has contributed to a sharp decrease in disease incidence and PLOS NEGLECTED TROPICAL DISEASES played a critical role in combating an upsurge of g-HAT cases that occurred (2016 to 2017) after the Ebola crisis [22].…”

Ebola outbreak brings to light an unforeseen impact of tsetse control on sleeping sickness transmission in Guinea

“…HAT control was deeply hampered as no active screenings could be led during this period. Passive detection with rapid tests in health centers was organized early in 2014, but was efficient only for several months 8 and Dubreka, located a 100 km from Boffa, became rapidly the only functional site for diagnosis and treatment of HAT in Guinea. Remarkably, vector control initiated on the Eastern bank of the Rio Pongo River in the Boffa focus, could be maintained throughout the ebola period.…”

The complex health seeking pathway of a human African trypanosomiasis patient in Côte d’Ivoire underlines the need of setting up passive surveillance systems

“…To detect additional cases as early as possible, passive surveillance should therefore be accompanied by adapted reactive active screening strategies, such as reactive door to door screening, [ 4 ], spatial tracking [ 26 ], follow-up of seropositive subjects [ 47 , 48 , 49 , 50 ] or identification of villages at risk [ 51 ]. It is also essential to inform the health personnel that, even if HAT prevalence has decreased, the disease still exists and carries a risk to re-emerge [ 52 ]. Health personnel needs to be trained continuously and must receive the means to diagnose the disease.…”