tetano
Editor, Senior Moderator
Clin Infect Dis
. 2025 Jul 22;80(Supplement_1):S16-S28.
doi: 10.1093/cid/ciaf041. COVID-19 Surveillance in Madagascar and Urban Burkina Faso: Addressing Underreporting of Disease Burden Through Integrative Analysis of Diverse Data Streams
Njariharinjakamampionona Rakotozandrindrainy[SUP] 1 [/SUP], Sophie S Y Kang[SUP] 2 [/SUP], Lady R Wandji Nana[SUP] 3 [/SUP], Jonathan D Sugimoto[SUP] 2 4 [/SUP], Yi-Ting Wang[SUP] 2 [/SUP], Ndrainaharimira Rakotozandrindrainy[SUP] 1 [/SUP], Tsiriniaina Jean Luco Razafindrabe[SUP] 1 [/SUP], Tiana Mirana Raminosoa[SUP] 1 [/SUP], Sye Lim Hong[SUP] 2 [/SUP], Mathilde Razafindrakalia[SUP] 1 [/SUP], Gabriel Nyirenda[SUP] 1 2 [/SUP], Tabea Binger[SUP] 2 [/SUP], Ellen E Higginson[SUP] 5 6 [/SUP], Hyon Jin Jeon[SUP] 1 2 6 [/SUP], Namgay Wangmo[SUP] 2 [/SUP], Gbènonminvo E Cakpo[SUP] 3 [/SUP], YoungAe You[SUP] 2 [/SUP], Birkneh Tilahun Tadesse[SUP] 2 7 8 [/SUP], Abdramane Bassiahi Soura[SUP] 3 [/SUP], Raphaël Rakotozandrindrainy[SUP] 1 [/SUP], Florian Marks[SUP] 1 2 6 7 9 [/SUP]
Affiliations
Background: Coronavirus disease 2019 (COVID-19) caused substantial disease and death worldwide since December 2019, but the burden was lower in Africa than in high-income countries. To address potential underreporting, we modeled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease burden in Burkina Faso and Madagascar.
Methods: Prospectively enrolled patients who presented with fever at sentinel healthcare facilities were assessed for active SARS-CoV-2 infection. Household members of SARS-CoV-2-infected patients were prospectively followed for confirmed SARS-CoV-2 infection. Archived serum specimens that spanned the pandemic onset in Madagascar to the start of prospective surveillance were tested for anti-SARS-CoV-2 immunoglobulins. Data from these multiple sources contributed to an integrated analysis to calibrate an epidemiologic mass action model.
Results: COVID-19 accounted for a substantial fraction of healthcare-ascertained febrile illness in both Burkina Faso and Madagascar, with symptom profiles consistent with those previously reported. SARS-CoV-2 vaccination coverage was very low in Burkina Faso and unavailable in Madagascar. The household secondary attack rate was 28% (95% confidence intervals [CI], 22%-35%] in Madagascar and 31% (95% CI: 9%-68%) in Burkina Faso, indicating substantial transmission of the disease within households in both locations. Model simulations estimated that the actual number of SARS-CoV-2 infections was at least nine times higher than the reported number of febrile COVID-19 cases.
Conclusions: Africa has faced persistent challenges due to underinvestment in vaccination programs and disease surveillance programs. There was substantial underreporting of COVID-19 cases during the pandemic in both countries. Our findings call for improving systems and resources in disease surveillance during epidemic and interepidemic periods in these countries.
Keywords: Burkina Faso; COVID-19; Madagascar; serosurveillance.
. 2025 Jul 22;80(Supplement_1):S16-S28.
doi: 10.1093/cid/ciaf041. COVID-19 Surveillance in Madagascar and Urban Burkina Faso: Addressing Underreporting of Disease Burden Through Integrative Analysis of Diverse Data Streams
Njariharinjakamampionona Rakotozandrindrainy[SUP] 1 [/SUP], Sophie S Y Kang[SUP] 2 [/SUP], Lady R Wandji Nana[SUP] 3 [/SUP], Jonathan D Sugimoto[SUP] 2 4 [/SUP], Yi-Ting Wang[SUP] 2 [/SUP], Ndrainaharimira Rakotozandrindrainy[SUP] 1 [/SUP], Tsiriniaina Jean Luco Razafindrabe[SUP] 1 [/SUP], Tiana Mirana Raminosoa[SUP] 1 [/SUP], Sye Lim Hong[SUP] 2 [/SUP], Mathilde Razafindrakalia[SUP] 1 [/SUP], Gabriel Nyirenda[SUP] 1 2 [/SUP], Tabea Binger[SUP] 2 [/SUP], Ellen E Higginson[SUP] 5 6 [/SUP], Hyon Jin Jeon[SUP] 1 2 6 [/SUP], Namgay Wangmo[SUP] 2 [/SUP], Gbènonminvo E Cakpo[SUP] 3 [/SUP], YoungAe You[SUP] 2 [/SUP], Birkneh Tilahun Tadesse[SUP] 2 7 8 [/SUP], Abdramane Bassiahi Soura[SUP] 3 [/SUP], Raphaël Rakotozandrindrainy[SUP] 1 [/SUP], Florian Marks[SUP] 1 2 6 7 9 [/SUP]
Affiliations
- PMID: 40694513
- DOI: 10.1093/cid/ciaf041
Background: Coronavirus disease 2019 (COVID-19) caused substantial disease and death worldwide since December 2019, but the burden was lower in Africa than in high-income countries. To address potential underreporting, we modeled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease burden in Burkina Faso and Madagascar.
Methods: Prospectively enrolled patients who presented with fever at sentinel healthcare facilities were assessed for active SARS-CoV-2 infection. Household members of SARS-CoV-2-infected patients were prospectively followed for confirmed SARS-CoV-2 infection. Archived serum specimens that spanned the pandemic onset in Madagascar to the start of prospective surveillance were tested for anti-SARS-CoV-2 immunoglobulins. Data from these multiple sources contributed to an integrated analysis to calibrate an epidemiologic mass action model.
Results: COVID-19 accounted for a substantial fraction of healthcare-ascertained febrile illness in both Burkina Faso and Madagascar, with symptom profiles consistent with those previously reported. SARS-CoV-2 vaccination coverage was very low in Burkina Faso and unavailable in Madagascar. The household secondary attack rate was 28% (95% confidence intervals [CI], 22%-35%] in Madagascar and 31% (95% CI: 9%-68%) in Burkina Faso, indicating substantial transmission of the disease within households in both locations. Model simulations estimated that the actual number of SARS-CoV-2 infections was at least nine times higher than the reported number of febrile COVID-19 cases.
Conclusions: Africa has faced persistent challenges due to underinvestment in vaccination programs and disease surveillance programs. There was substantial underreporting of COVID-19 cases during the pandemic in both countries. Our findings call for improving systems and resources in disease surveillance during epidemic and interepidemic periods in these countries.
Keywords: Burkina Faso; COVID-19; Madagascar; serosurveillance.