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Re: Influenza in Africa Should Not Be Ignored, Researchers Urge
Maria Yazdanbakhsh<sup>1</sup><sup>*</sup>, Peter G. Kremsner<sup>2</sup><sup>,</sup><sup>3</sup>
1 Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands, 2 Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon, 3 Institute for Tropical Medicine, University of T?bingen, T?bingen, Germany
snip
Clinically, influenza is not distinguishable from most other infectious diseases with fever in the tropics. In this context malaria is of particular interest when considering the African continent. In tropical Africa, malaria is an important infectious disease and is still thought to be the main cause of febrile episodes in children. However, the threshold of clinical manifestation of malaria is strongly influenced by the endemicity of Plasmodium falciparum infection in an area: in very low transmission areas, any microscopically detectable parasitemia would indicate malaria, whereas in regions of high transmission, a certain parasitemia needs to be reached to lead to malaria at least from 5 years of age on. Recent, mainly unpublished observations show that there is a considerable drop in malaria incidence [15] and in P. falciparum prevalence rate [16] in some African countries. Despite this reduction, the old habit of treating every child with fever with antimalarials continues. As fever due to many infectious diseases wanes after a few days without treatment, the belief that medical staff are successfully treating malaria cases lingers on.
A recent study in Lambarene, Gabon, illustrates the extent of the problem and the unresolved conundrum. In and around Lambarene all febrile children are still treated with antimalarials, mainly amodiaquine-artesunate [17]. In a study of 1,000 consecutive children presenting with fever at our research center in Lambarene, the results from the thick blood smears indicated that only about 5% had malaria. Recent serological tests have shown that parts of the febrile illnesses in Lambarene are due not only to influenza, but also to dengue fever, chikungunya disease, and streptococcal pneumonia [18]. In addition, in Tanzania where malaria is considered to be highly endemic, D'Acremont and coworkers refer to recent data indicating that only 10%?40% of under-5-year-old patients with fever have malarial parasites in rural areas [19]. Thus, in Lambarene and perhaps elsewhere in Africa, the majority of febrile cases may be unnecessarily exposed to antimalarial drugs, with the well-recognized negative consequences.
Maria Yazdanbakhsh<sup>1</sup><sup>*</sup>, Peter G. Kremsner<sup>2</sup><sup>,</sup><sup>3</sup>
1 Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands, 2 Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon, 3 Institute for Tropical Medicine, University of T?bingen, T?bingen, Germany
snip
Clinically, influenza is not distinguishable from most other infectious diseases with fever in the tropics. In this context malaria is of particular interest when considering the African continent. In tropical Africa, malaria is an important infectious disease and is still thought to be the main cause of febrile episodes in children. However, the threshold of clinical manifestation of malaria is strongly influenced by the endemicity of Plasmodium falciparum infection in an area: in very low transmission areas, any microscopically detectable parasitemia would indicate malaria, whereas in regions of high transmission, a certain parasitemia needs to be reached to lead to malaria at least from 5 years of age on. Recent, mainly unpublished observations show that there is a considerable drop in malaria incidence [15] and in P. falciparum prevalence rate [16] in some African countries. Despite this reduction, the old habit of treating every child with fever with antimalarials continues. As fever due to many infectious diseases wanes after a few days without treatment, the belief that medical staff are successfully treating malaria cases lingers on.
A recent study in Lambarene, Gabon, illustrates the extent of the problem and the unresolved conundrum. In and around Lambarene all febrile children are still treated with antimalarials, mainly amodiaquine-artesunate [17]. In a study of 1,000 consecutive children presenting with fever at our research center in Lambarene, the results from the thick blood smears indicated that only about 5% had malaria. Recent serological tests have shown that parts of the febrile illnesses in Lambarene are due not only to influenza, but also to dengue fever, chikungunya disease, and streptococcal pneumonia [18]. In addition, in Tanzania where malaria is considered to be highly endemic, D'Acremont and coworkers refer to recent data indicating that only 10%?40% of under-5-year-old patients with fever have malarial parasites in rural areas [19]. Thus, in Lambarene and perhaps elsewhere in Africa, the majority of febrile cases may be unnecessarily exposed to antimalarial drugs, with the well-recognized negative consequences.