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Pasteur Institute of Bangui
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Resurgence of monkeypox cases in the Central African Republic: AFRIPOX is picking up the slack!
After two years of suspension of AFRIPOX missions due to the Covid 19 pandemic, Camille BESOMBES, infectious disease physician and researcher in epidemiology of emerging infectious diseases at the Institut Pasteur (Paris), was in Bangui to see the difficulties inherent in the field. In the company of Dr Festus Mbrenga, medical investigator at the Pasteur Institute in Bangui, they were able to carry out the clinical follow-up of a severe case of monkeypox which occurred in an 8-year-old child from the Lobaye region and currently hospitalized at the Complexe Pediatric University Hospital of Bangui. Camille BESOMBES answers a few questions….
Tell a bit about yourself, your work on monkeypox
I am an infectiologist and researcher in the epidemiology of emerging infectious diseases in the epidemiology of emerging diseases unit at the Institut Pasteur Paris, I have previously worked on other projects around bacterial antibiotic resistance, particularly in Haiti, or on vector-borne diseases in Bangladesh and finally on delta hepatitis in Cameroon.
After a meeting with Prof. Emmanuel Nakouné, director of the laboratory for viral haemorrhagic fevers, zoonoses and arboviruses at the Pasteur Institute in Bangui, 4 years ago, I decided to accompany him in his project proposal around the epidemiology of monkeypox in CAR. Together Prof. Emmanuel Nakouné and Prof. Arnaud Fontanet have set up a multidisciplinary project around a "One Health" approach to monkeypox, in order to develop a comprehensive understanding of this disease, which is very present in the CAR.
How is the Afripox project structured? What is the current research?
The AFRIPOX project is composed of 5 different complementary components, involving about twenty people between IP Paris, IP Bangui, National Museum of Natural History of Paris and the University of Aix Marseille, requiring significant circulation between the different disciplines:
• An epidemiological component based on national monitoring of monkeypox in the CAR, with a serological follow-up study between cases of monkeypox and negative controls from the same villages. The aim is to identify the risk factors at the origin of contamination by the monkeypox virus either of zoonotic origin (consumption, hunting, other contact with the environment?), or by human-to-human contamination (what types of contact between humans?), to clinically and epidemiologically characterize the disease.
• An anthropology section complements the contributions of epidemiology through surveys in the villages affected by epidemics, in order to better understand the representations associated with this disease in the population and ultimately to prevent contamination.
• A zoological component aims to identify the animal reservoir(s) of the monkeypox virus, by analyzing animals found around villages affected by human epidemics.
• An ecological component makes it possible to identify the ecological characteristics of the areas affected by epidemics in the CAR: deforestation, land use, rainfall, fire regime, seasonality, etc.
• A virological component consists of developing field diagnostic tests (making it possible to differentiate monkeypox from chickenpox in 1 hour in the field, as well as more specific serological tests to target a former contact with this virus. Finally, a strain sequencing component monkeypox viral strains makes it possible to characterize the origins of each strain responsible for an epidemic and to link the epidemics to each other according to genomic characteristics.
What is your last mission from February 21 to 25, 2022?
The purpose of this mission was to find the team after two years of suspension of missions due to the Covid 19 pandemic, to take stock of the work already accomplished since the official establishment of the project in September 2021 and to see the difficulties inherent in the field.
In the company of Dr Festus Mbrenga, medical investigator at the Pasteur Institute in Bangui, we were able to carry out the clinical follow-up of a severe case of monkeypox which occurred in an 8-year-old child currently hospitalized at the Pediatric University Hospital Complex in Bangui, originally from in the Lobaye region, the main region affected by monkeypox in the CAR.
We were also able to investigate a suspected case of monkeypox in a captive wild animal.
We would like to congratulate the entire local team for the work carried out on the project despite the difficult conditions with the sars cov2 epidemic.
What should we remember from monkeypox in the CAR? Can epidemics be controlled or prevented?
Monkeypox is a real public health problem in the CAR, probably still underestimated by the under-reporting of the number of cases. There has been a sharp increase in the number of human cases and epidemics in recent years, especially this year since September 2021.
Detecting epidemics as early as possible makes it possible to dispatch the WHO/Ministry of Health/ Institut Pasteur de Bangui in order to determine the origins of this epidemic and to contain it while providing the best clinical care for patients.
Ultimately, the risk factors highlighted by the project will make it possible to raise public awareness in order to limit their exposure and therefore the risk of disease.
What are the challenges of the Afripox project in CAR?
The challenge is to strengthen the national surveillance of this disease carried out by the Pasteur Institute in Bangui, which is the Regional Reference Center for monkeypox, while trying to better understand the risk factors for the transmission of monkeypox. from animal to human and between humans, as well as the ecological characteristics favoring epidemics. The ultimate goal is to diagnose epidemics more quickly in order to contain them and prevent the spread of the disease within the country and also to avoid the risk of international spread. Finally, the aim is to promote appropriate medical management of the disease by preventive or curative treatment of the associated complications (dehydration, superinfection of the skin, pulmonary infections,
The strengthening of collaboration between the teams of IP Paris and IP Bangui is an effect
Prospects?
Multidisciplinary anthropology-zoology-epidemiology missions are planned for the next few months in order to better understand this disease in the areas concerned and to extend national surveillance to areas such as the Dzangha Sangha.
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