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McNamara BJ, Blasdell KR, Yerramilli A, Smith IL, Clayton SL, Dunn M, Tay EL, Gibney KB, Waidyatillake NT, Hussain MA, Muleme M, O'Brien DP, Athan E. Comprehensive Case-Control Study of Protective and Risk Factors for Buruli Ulcer, Southeastern Australia. Emerg Infect Dis 2023; 29:2032-2043. [PMID: 37735741 PMCID: PMC10521623 DOI: 10.3201/eid2910.230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
To examine protective and risk factors for Buruli ulcer (BU), we conducted a case-control study of 245 adult BU cases and 481 postcode-matched controls across BU-endemic areas of Victoria, Australia. We calculated age- and sex-adjusted odds ratios for socio-environmental, host, and behavioral factors associated with BU by using conditional logistic regression. Odds of BU were >2-fold for persons with diabetes mellitus and persons working outdoors who had soil contact in BU-endemic areas (compared with indoor work) but were lower among persons who had bacillus Calmette-Guérin vaccinations. BU was associated with increasing numbers of possums and with ponds and bore water use at residences. Using insect repellent, covering arms and legs outdoors, and immediately washing wounds were protective; undertaking multiple protective behaviors was associated with the lowest odds of BU. Skin hygiene/protection behaviors and previous bacillus Calmette-Guérin vaccination might provide protection against BU in BU-endemic areas.
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Linking the Mycobacterium ulcerans environment to Buruli ulcer disease: Progress and challenges. One Health 2021; 13:100311. [PMID: 34485670 PMCID: PMC8403752 DOI: 10.1016/j.onehlt.2021.100311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022] Open
Abstract
Buruli ulcer (BU), the second most common mycobacterial disease in West Africa, is a necrotizing skin disease that can lead to high morbidity in affected patients. The disease is caused by Mycobacterium ulcerans (MU), whose major virulence factor is mycolactone. Although early infection can be treated with antibiotics, an effective preventative strategy is challenging due to unknown reservoir(s) and unresolved mode(s) of transmission. Further, disease occurrence in remote locations with limited access to health facilities further complicates disease burden and associated costs. We discuss here MU transmission hypotheses and investigations into environmental reservoirs and discuss successes and challenges of studying MU and Buruli ulcer across human, animal, and environmental interfaces. We argue that a One Health approach is needed to advance the understanding of MU transmission and designing management scenarios that prevent and respond to epidemics. Although previous work has provided significant insights into risk factors, epidemiology and clinical perspectives of disease, understanding the bacterial ecology, environmental niches and role of mycolactone in natural environments and during infection of the human host remains equally important to better understanding and preventing this mysterious disease.
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Simpson H, Tabah EN, Phillips RO, Frimpong M, Maman I, Ampadu E, Timothy J, Saunderson P, Pullan RL, Cano J. Mapping suitability for Buruli ulcer at fine spatial scales across Africa: A modelling study. PLoS Negl Trop Dis 2021; 15:e0009157. [PMID: 33657104 PMCID: PMC7959670 DOI: 10.1371/journal.pntd.0009157] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/15/2021] [Accepted: 01/17/2021] [Indexed: 12/14/2022] Open
Abstract
Buruli ulcer (BU) is a disabling and stigmatising neglected tropical disease (NTD). Its distribution and burden are unknown because of underdiagnosis and underreporting. It is caused by Mycobacterium ulcerans, an environmental pathogen whose environmental niche and transmission routes are not fully understood. The main control strategy is active surveillance to promote early treatment and thus limit morbidity, but these activities are mostly restricted to well-known endemic areas. A better understanding of environmental suitability for the bacterium and disease could inform targeted surveillance, and advance understanding of the ecology and burden of BU. We used previously compiled point-level datasets of BU and M. ulcerans occurrence, evidence for BU occurrence within national and sub-national areas, and a suite of relevant environmental covariates in a distribution modelling framework. We fitted relationships between BU and M. ulcerans occurrence and environmental predictors by applying regression and machine learning based algorithms, combined in an ensemble model to characterise the optimal ecological niche for the disease and bacterium across Africa at a resolution of 5km x 5km. Proximity to waterbodies was the strongest predictor of suitability for BU, followed potential evapotranspiration. The strongest predictors of suitability for M. ulcerans were deforestation and potential evapotranspiration. We identified patchy foci of suitability throughout West and Central Africa, including areas with no previous evidence of the disease. Predicted suitability for M. ulcerans was wider but overlapping with that of BU. The estimated population living in areas predicted suitable for the bacterium and disease was 46.1 million. These maps could be used to inform burden estimations and case searches which would generate a more complete understanding of the spatial distribution of BU in Africa, and may guide control programmes to identify cases beyond the well-known endemic areas.
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Affiliation(s)
- Hope Simpson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Earnest Njih Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Cameroon
| | - Richard O. Phillips
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Frimpong
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Issaka Maman
- National Reference Laboratory for Buruli Ulcer Disease in Togo, Ecole Supérieure des Techniques Biologiques et Alimentaires (ESTBA), Laboratoire des Sciences Biologiques et des Substances Bioactives, Université de Lomé, Lomé, Togo
| | - Edwin Ampadu
- National Buruli Ulcer Control Program, Ghana Health Service, Accra, Ghana
| | - Joseph Timothy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul Saunderson
- Accelerating Integrated Management (AIM) Initiative, Accra, Ghana
| | - Rachel L. Pullan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Omansen TF, Erbowor-Becksen A, Yotsu R, van der Werf TS, Tiendrebeogo A, Grout L, Asiedu K. Global Epidemiology of Buruli Ulcer, 2010-2017, and Analysis of 2014 WHO Programmatic Targets. Emerg Infect Dis 2020; 25:2183-2190. [PMID: 31742506 PMCID: PMC6874257 DOI: 10.3201/eid2512.190427] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Buruli ulcer is a neglected tropical disease caused by Myocobacterium ulcerans; it manifests as a skin lesion, nodule, or ulcer that can be extensive and disabling. To assess the global burden and the progress on disease control, we analyzed epidemiologic data reported by countries to the World Health Organization during 2010–2017. During this period, 23,206 cases of Buruli ulcer were reported. Globally, cases declined to 2,217 in 2017, but local epidemics seem to arise, such as in Australia and Liberia. In 2013, the World Health Organization formulated 4 programmatic targets for Buruli ulcer that addressed PCR confirmation, occurrence of category III (extensive) lesions and ulcerative lesions, and movement limitation caused by the disease. In 2014, only the movement limitation goal was met, and in 2019, none are met, on a global average. Our findings support discussion on future Buruli ulcer policy and post-2020 programmatic targets.
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Coates SJ, Enbiale W, Davis MDP, Andersen LK. The effects of climate change on human health in Africa, a dermatologic perspective: a report from the International Society of Dermatology Climate Change Committee. Int J Dermatol 2020; 59:265-278. [PMID: 31970754 DOI: 10.1111/ijd.14759] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022]
Abstract
Throughout much of the African continent, healthcare systems are already strained in their efforts to meet the needs of a growing population using limited resources. Climate change threatens to undermine many of the public health gains that have been made in this region in the last several decades via multiple mechanisms, including malnutrition secondary to drought-induced food insecurity, mass human displacement from newly uninhabitable areas, exacerbation of environmentally sensitive chronic diseases, and enhanced viability of pathogenic microbes and their vectors. We reviewed the literature describing the various direct and indirect effects of climate change on diseases with cutaneous manifestations in Africa. We included non-communicable diseases such as malignancies (non-melanoma skin cancers), inflammatory dermatoses (i.e. photosensitive dermatoses, atopic dermatitis), and trauma (skin injury), as well as communicable diseases and neglected tropical diseases. Physicians should be aware of the ways in which climate change threatens human health in low- and middle-income countries in general, and particularly in countries throughout Africa, the world's lowest-income and second most populous continent.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, The University of California San Francisco, San Francisco, CA, USA
| | | | - Mark D P Davis
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Louise K Andersen
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus, Denmark
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Combe M, Gozlan RE, Jagadesh S, Velvin CJ, Ruffine R, Demar MP, Couppié P, Djossou F, Nacher M, Epelboin L. Comparison of Mycobacterium ulcerans (Buruli ulcer) and Leptospira sp. (Leptospirosis) dynamics in urban and rural settings. PLoS Negl Trop Dis 2019; 13:e0007074. [PMID: 30615683 PMCID: PMC6336349 DOI: 10.1371/journal.pntd.0007074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/17/2019] [Accepted: 12/13/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Zoonotic pathogens respond to changes in host range and/or pathogen, vector and host ecology. Environmental changes (biodiversity, habitat changes, variability in climate), even at a local level, lead to variability in environmental pathogen dynamics and can facilitate their transmission from natural reservoirs to new susceptible hosts. Whilst the environmental dynamics of aquatic bacteria are directly linked to seasonal changes of their habitat they also rely on the ecological processes underpining their transmission. However data allowing the comparison of these ecological processes are lacking. Here we compared the environmental dynamics of generalist and vector-borne aquatic bacterial pathogens in the same unit of time and space, and across rural and urban habitats in French Guiana (South America). PRINCIPAL FINDINGS Using Leptospira sp. and Mycobacterium ulcerans we performed an environmental survey that allowed the detection of both pathogens in urban vs. rural areas, and during rainy vs. dry weather conditions. All samples were subjected to qPCR amplifications of LipL32 (Leptospira sp.) and IS2404 and KR (M. ulcerans) genetic markers. We found (i) a greater presence of M. ulcerans in rural areas compared with Leptospira sp., (ii) that modified urban environments were more favourable to the establishment of both pathogens, (iii) that Leptospira sp. presence was enhanced during the rainy season and M. ulcerans during the dry period, and (iv) differences in the spatial distribution of both bacteria across urban sites, probably due to the mode of dissemination of each pathogen in the environment. CONCLUSIONS We propose that in French Guiana simplified and modified urban ecosystems might favour leptospirosis and Buruli ulcer emergence and transmission. Moreover, disease risk was also constrained by seasonality. We suggest that the prevention of aquatic bacterial disease emergence in impoverished urban areas of developing countries would benefit from seasonal diseases targeted surveys, which would maximise limited budgets from cash-strapped health agencies.
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Affiliation(s)
- Marine Combe
- ISEM UMR226, Université de Montpellier, CNRS, IRD, EPHE, Montpellier, France
| | | | - Soushieta Jagadesh
- ISEM UMR226, Université de Montpellier, CNRS, IRD, EPHE, Montpellier, France
| | | | - Rolland Ruffine
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, Centre IRD de Cayenne, Guyane française
| | - Magalie Pierre Demar
- Equipe EA 3593, Ecosystèmes amazoniens et pathologie tropicale, Université de la Guyane, Cayenne, Guyane française
- Laboratoire hospitalo-universitaire de parasitologie mycologie, Centre hospitalier Andrée Rosemon, Guyane française
| | - Pierre Couppié
- Equipe EA 3593, Ecosystèmes amazoniens et pathologie tropicale, Université de la Guyane, Cayenne, Guyane française
- Service de Dermatologie, Cayenne Hospital, rue des Flamboyant, Cayenne, French Guiana, France
| | - Felix Djossou
- Equipe EA 3593, Ecosystèmes amazoniens et pathologie tropicale, Université de la Guyane, Cayenne, Guyane française
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, av des Flamboyants, Guyane française
| | - Mathieu Nacher
- Centre d’investigation clinique (CIC Inserm 1424), Centre hospitalier Andrée Rosemon, Guyane française
| | - Loïc Epelboin
- Equipe EA 3593, Ecosystèmes amazoniens et pathologie tropicale, Université de la Guyane, Cayenne, Guyane française
- Unité des maladies infectieuses et tropicales, Centre hospitalier Andrée Rosemon, av des Flamboyants, Guyane française
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Abstract
Mycobacterium ulcerans is recognised as the third most common mycobacterial infection worldwide. It causes necrotising infections of skin and soft tissue and is classified as a neglected tropical disease by the World Health Organization (WHO). However, despite extensive research, the environmental reservoir of the organism and mode of transmission of the infection to humans remain unknown. This limits the ability to design and implement public health interventions to effectively and consistently prevent the spread and reduce the incidence of this disease. In recent years, the epidemiology of the disease has changed. In most endemic regions of the world, the number of cases reported to the WHO are reducing, with a 64% reduction in cases reported worldwide in the last 9 years. Conversely, in a smaller number of countries including Australia and Nigeria, reported cases are increasing at a rapid rate, new endemic areas continue to appear, and in Australia cases are becoming more severe. The reasons for this changing epidemiology are unknown. We review the epidemiology of M. ulcerans disease worldwide, and document recent changes. We also outline and discuss the current state of knowledge on the ecology of M. ulcerans, possible transmission mechanisms to humans and what may be enabling the spread of M. ulcerans into new endemic areas.
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Yerramilli A, Tay EL, Stewardson AJ, Fyfe J, O’Brien DP, Johnson PDR. The association of rainfall and Buruli ulcer in southeastern Australia. PLoS Negl Trop Dis 2018; 12:e0006757. [PMID: 30222751 PMCID: PMC6160213 DOI: 10.1371/journal.pntd.0006757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/27/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background Buruli ulcer has been increasing in incidence in southeastern Australia with unclear transmission mechanisms. We aimed to investigate the link between rainfall and case numbers in two endemic areas of the state of Victoria; the Bellarine and Mornington Peninsulas. Methodology We created yearly and monthly graphs comparing rainfall with local Buruli ulcer incidence for the period 2004–2016 by endemic region and then considered a range of time lag intervals of 0–24 months to investigate patterns of correlation. Conclusions Optimal positive correlation for the Bellarine Peninsula occurred with a 12-month prior rainfall lag, however, no significant correlation was observed on the Mornington Peninsula for any time lag. These results provide an update in evidence to further explore transmission mechanisms which may differ between these geographically proximate endemic regions. Buruli ulcer, a mycobacterial infection resulting in destructive soft tissue lesions, has been increasing in incidence in southeastern Australia over recent years. Exact transmission mechanisms and therefore preventative measures remain unclear. We aimed to investigate a possible link between Buruli ulcer and rainfall for two major endemic areas of the state of Victoria; the Bellarine and Mornington Peninsulas. Our results demonstrate a positive correlation with rainfall on the Bellarine Peninsula with a prior rainfall lag of 12 months but no correlation on the Mornington Peninsula. Established time-frames such as the incubation period and average delay to diagnosis (due to slow and often asymptomatic progression of the disease) make up a total of at least 5–6 months. On the Bellarine Peninsula, there appears to be another 5–6 months of unaccounted time from rainfall to transmission of the pathogen. This provides a basis to explore previously proposed transmission mechanisms which, based on the discrepancy noted with rainfall correlation, may differ between endemic regions.
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Affiliation(s)
- Arvind Yerramilli
- University of Melbourne, Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine and Infectious Diseases, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- * E-mail: (AY); (PDRJ)
| | - Ee Laine Tay
- Health Protection Branch, Department of Health & Human Services, Melbourne, Victoria, Australia
| | - Andrew J. Stewardson
- Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Janet Fyfe
- Victorian Infectious Diseases References Laboratory, Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Daniel P. O’Brien
- Department of Medicine and Infectious Diseases, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Paul D. R. Johnson
- University of Melbourne, Department of Medicine, Austin Health, Heidelberg, Victoria, Australia
- Infectious Diseases Department, Austin Health, Heidelberg, Victoria, Australia
- * E-mail: (AY); (PDRJ)
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Cano J, Rodríguez A, Simpson H, Tabah EN, Gómez JF, Pullan RL. Modelling the spatial distribution of aquatic insects (Order Hemiptera) potentially involved in the transmission of Mycobacterium ulcerans in Africa. Parasit Vectors 2018; 11:501. [PMID: 30189883 PMCID: PMC6127916 DOI: 10.1186/s13071-018-3066-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Biting aquatic insects belonging to the order Hemiptera have been suggested as potential vectors of Mycobacterium ulcerans in endemic areas for Buruli ulcer (BU). If this is the case, these insects would be expected to co-exist with M. ulcerans in the same geographical areas. Here, we studied the geographical distribution of six aquatic Hemiptera families that are thought to be vectors of M. ulcerans and explored their potential geographical overlapping with communities reporting BU cases in endemic countries. Methods We have developed ensemble ecological models of predicted distribution for six families of the Hemiptera (Naucoridae, Belostomatidae, Notonectidae, Nepidae, Corixidae and Gerridae) applying a robust modelling framework over a collection of recorded presences and a suite of environmental and topographical factors. Ecological niche factor analysis (ENFA) was first used to identify factors that best described the ecological niches for each hemipteran family. Finally, we explored the potential geographical co-occurrence of these insects and BU in two endemic countries, Cameroon and Ghana. Results Species of the families Naucoridae and Belostomatidae, according to our models, are widely distributed across Africa, although absent from drier and hotter areas. The other two families of biting Hemiptera, the Notonectidae and Nepidae, would have a more restricted distribution, being more predominant in western and southern Africa. All these four families of biting water bugs are widely distributed across coastal areas of West Africa. They would thrive in areas where annual mean temperature varies between 15–22 °C, with moderate annual precipitation (i.e. 350–1000 mm/annual) and near to water courses. Species of all hemipteran families show preference for human-made environments such as agricultural landscapes and urbanized areas. Finally, our analysis suggests that M. ulcerans and species of these aquatic insects might coexist in the same ecological niches, although there would be variation in species diversity between BU endemic areas. Conclusions Our findings predict the geographical co-existence of some species of aquatic hemipteran families and BU. Considering the existing biological evidence that points to some of these aquatic insects as potential phoretic vectors of M. ulcerans, its presence in BU endemic areas should be considered a risk factor. The ecological models here presented may be helpful to inform future environmental based models intended to delineate the potential geographical distribution of BU in the African region. Electronic supplementary material The online version of this article (10.1186/s13071-018-3066-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jorge Cano
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
| | - Antonio Rodríguez
- Department of Horticulture, Botany and Landscaping, School of Agriculture, Food and Forestry Science and Engineering, University of Lleida, Lleida, Spain
| | - Hope Simpson
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Earnest N Tabah
- National Yaws, Leishmaniasis, Leprosy and Buruli ulcer Control Programme, Ministry of Public Health, Yaounde, Cameroon
| | - Jose F Gómez
- Department of Biodiversity, Ecology & Evolution, Complutense University, Madrid, Spain
| | - Rachel L Pullan
- Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Buruli Ulcer, a Prototype for Ecosystem-Related Infection, Caused by Mycobacterium ulcerans. Clin Microbiol Rev 2017; 31:31/1/e00045-17. [PMID: 29237707 DOI: 10.1128/cmr.00045-17] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Buruli ulcer is a noncontagious disabling cutaneous and subcutaneous mycobacteriosis reported by 33 countries in Africa, Asia, Oceania, and South America. The causative agent, Mycobacterium ulcerans, derives from Mycobacterium marinum by genomic reduction and acquisition of a plasmid-borne, nonribosomal cytotoxin mycolactone, the major virulence factor. M. ulcerans-specific sequences have been readily detected in aquatic environments in food chains involving small mammals. Skin contamination combined with any type of puncture, including insect bites, is the most plausible route of transmission, and skin temperature of <30°C significantly correlates with the topography of lesions. After 30 years of emergence and increasing prevalence between 1970 and 2010, mainly in Africa, factors related to ongoing decreasing prevalence in the same countries remain unexplained. Rapid diagnosis, including laboratory confirmation at the point of care, is mandatory in order to reduce delays in effective treatment. Parenteral and potentially toxic streptomycin-rifampin is to be replaced by oral clarithromycin or fluoroquinolone combined with rifampin. In the absence of proven effective primary prevention, avoiding skin contamination by means of clothing can be implemented in areas of endemicity. Buruli ulcer is a prototype of ecosystem pathology, illustrating the impact of human activities on the environment as a source for emerging tropical infectious diseases.
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Aboagye SY, Ampah KA, Ross A, Asare P, Otchere ID, Fyfe J, Yeboah-Manu D. Seasonal Pattern of Mycobacterium ulcerans, the Causative Agent of Buruli Ulcer, in the Environment in Ghana. MICROBIAL ECOLOGY 2017; 74:350-361. [PMID: 28238016 PMCID: PMC5496970 DOI: 10.1007/s00248-017-0946-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/31/2017] [Indexed: 06/06/2023]
Abstract
This study aimed to contribute to the understanding of Mycobacterium ulcerans (MU) ecology by analysing both clinical and environmental samples collected from ten communities along two major river basins (Offin and Densu) associated with Buruli ulcer (BU) at different seasons. We collected clinical samples from presumptive BU cases and environmental samples from ten communities. Following DNA extraction, clinical samples were confirmed by IS2404 PCR and environmental samples were confirmed by targeting MU-specific genes, IS2404, IS2606 and the ketoreductase (KR) using real-time PCR. Environmental samples were first analysed for IS2404; after which, IS2404-positive samples were multiplexed for the IS2606 and KR gene. Our findings indicate an overall decline in BU incidence along both river basins, although incidence at Densu outweighs that of Offin. Overall, 1600 environmental samples were screened along Densu (434, 27 %) and Offin (1166, 73 %) and MU was detected in 139 (9 %) of the combined samples. The positivity of MU along the Densu River basin was 89/434 (20.5 %), whilst that of the Offin River basin was 50/1166 (4.3 %). The DNA was detected mainly in snails (5/6, 83 %), moss (8/40, 20 %), soil (55/586, 9 %) and vegetation (55/675, 8 %). The proportion of MU positive samples recorded was higher during the months with higher rainfall levels (126/1175, 11 %) than during the dry season months (13/425, 3 %). This study indicates for the first time that there is a seasonal pattern in the presence of MU in the environment, which may be related to recent rainfall or water in the soil.
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Affiliation(s)
- Samuel Yaw Aboagye
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Accra, Ghana
- Institute of Environmental and Sanitation Studies, University of Ghana, Accra, Ghana
| | - Kobina Assan Ampah
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Accra, Ghana
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Prince Asare
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Accra, Ghana
| | - Isaac Darko Otchere
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Accra, Ghana
| | - Janet Fyfe
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia
| | - Dorothy Yeboah-Manu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581, Legon, Accra, Ghana.
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Douine M, Gozlan R, Nacher M, Dufour J, Reynaud Y, Elguero E, Combe M, Velvin CJ, Chevillon C, Berlioz-Arthaud A, Labbé S, Sainte-Marie D, Guégan JF, Pradinaud R, Couppié P. Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969-2013: an epidemiological study. Lancet Planet Health 2017; 1:e65-e73. [PMID: 29851583 DOI: 10.1016/s2542-5196(17)30009-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013. METHODS Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years. FINDINGS 245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100 000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100 000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections. INTERPRETATION The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care. FUNDING Agence Nationale de la Recherche.
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Affiliation(s)
- Maylis Douine
- Centre d'Investigation Clinique, Institut National de la Santé et de la Recherche Médicale 1424, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana
| | - Rodolphe Gozlan
- Institut de Recherche pour le Développement Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques, Université Pierre et Marie Curie, Muséum National d'Histoire Naturelle, Paris, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique, Institut National de la Santé et de la Recherche Médicale 1424, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana
| | - Julie Dufour
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana
| | - Yann Reynaud
- Institut Pasteur de la Guadeloupe, Tuberculosis and Mycobacteria Unit, Morne Jolivière, Les Abymes, Guadeloupe, France
| | - Eric Elguero
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Marine Combe
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Camilla J Velvin
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Christine Chevillon
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Alain Berlioz-Arthaud
- Institut Pasteur de la Guyane, Laboratoire de Biologie Médicale, Cayenne, French Guiana
| | - Sylvain Labbé
- Service D'Anatomie-Pathologique, Cayenne Hospital, Cayenne, French Guiana
| | | | - Jean-François Guégan
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France; Future Earth United Nations International Programme, OneHealth Research Initiative, Montréal, QC, Canada
| | - Roger Pradinaud
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana
| | - Pierre Couppié
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana.
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O'Brien DP. Unlocking of the secrets of Mycobacterium ulcerans disease transmission. Lancet Planet Health 2017; 1:e52-e53. [PMID: 29851578 DOI: 10.1016/s2542-5196(17)30026-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Daniel Patrick O'Brien
- Barwon Health, Department of Infectious Diseases, Geelong, VIC 3220, Australia; Department of Medicine and Infectious Diseases, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia; Manson Unit, Médecins Sans Frontières, London, UK.
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15
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Combe M, Velvin CJ, Morris A, Garchitorena A, Carolan K, Sanhueza D, Roche B, Couppié P, Guégan JF, Gozlan RE. Global and local environmental changes as drivers of Buruli ulcer emergence. Emerg Microbes Infect 2017; 6:e21. [PMID: 28442755 PMCID: PMC5457673 DOI: 10.1038/emi.2017.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 11/21/2022]
Abstract
Many emerging infectious diseases are caused by generalist pathogens that infect and transmit via multiple host species with multiple dissemination routes, thus confounding the understanding of pathogen transmission pathways from wildlife reservoirs to humans. The emergence of these pathogens in human populations has frequently been associated with global changes, such as socio-economic, climate or biodiversity modifications, by allowing generalist pathogens to invade and persist in new ecological niches, infect new host species, and thus change the nature of transmission pathways. Using the case of Buruli ulcer disease, we review how land-use changes, climatic patterns and biodiversity alterations contribute to disease emergence in many parts of the world. Here we clearly show that Mycobacterium ulcerans is an environmental pathogen characterized by multi-host transmission dynamics and that its infectious pathways to humans rely on the local effects of global environmental changes. We show that the interplay between habitat changes (for example, deforestation and agricultural land-use changes) and climatic patterns (for example, rainfall events), applied in a local context, can lead to abiotic environmental changes and functional changes in local biodiversity that favor the pathogen's prevalence in the environment and may explain disease emergence.
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Affiliation(s)
- Marine Combe
- Centre IRD de Montpellier, Département Santé, UMR MIVEGEC IRD-CNRS-Université de Montpellier, 34394 Montpellier, France
| | - Camilla Jensen Velvin
- Centre IRD de Montpellier, Département Santé, UMR MIVEGEC IRD-CNRS-Université de Montpellier, 34394 Montpellier, France
| | - Aaron Morris
- The Royal Veterinary College, Department of Production and Population Health, The Royal Veterinary College, Hawkshead Lane North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - Andres Garchitorena
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- PIVOT, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Kevin Carolan
- Computational & Systems Biology, Rothamsted Research, Harpenden AL5 2JQ, UK
| | - Daniel Sanhueza
- Centre IRD de Montpellier, Département Santé, UMR MIVEGEC IRD-CNRS-Université de Montpellier, 34394 Montpellier, France
| | - Benjamin Roche
- UMMISCO, Département Sociétés et Mondialisation, UMI IRD-UPMC 209, 93143 Bondy, France
| | - Pierre Couppié
- Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, 97306 Cayenne, French Guiana, France
- Service de Dermatologie, Cayenne Hospital, rue des Flamboyant, BP 6006, 97306 Cayenne, French Guiana, France
| | - Jean-François Guégan
- Centre IRD de Montpellier, Département Santé, UMR MIVEGEC IRD-CNRS-Université de Montpellier, 34394 Montpellier, France
- Future Earth International Programme, OneHealth Global Research Project, Future Earth Montréal Hub, Montréal, QC H3H 2L3, Canada
| | - Rodolphe Elie Gozlan
- Institut de Recherche pour le Développement, Département Ecologie, Biodiversité et Fonctionnement des Ecosystemes Continentaux, UMR BOREA IRD 207, CNRS 7208, MNHN, UPMC, Muséum National d'Histoire Naturelle, 75231 Paris, France
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16
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Tobias NJ, Ammisah NA, Ahortor EK, Wallace JR, Ablordey A, Stinear TP. Snapshot fecal survey of domestic animals in rural Ghana for Mycobacterium ulcerans. PeerJ 2016; 4:e2065. [PMID: 27280071 PMCID: PMC4893338 DOI: 10.7717/peerj.2065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022] Open
Abstract
Identifying the source reservoirs of Mycobacterium ulcerans is key to understanding the mode of transmission of this pathogen and controlling the spread of Buruli ulcer (BU). In Australia, the native possum can harbor M. ulcerans in its gastrointestinal tract and shed high concentrations of the bacteria in its feces. To date, an analogous animal reservoir in Africa has not been identified. Here we tested the hypothesis that common domestic animals in BU endemic villages of Ghana are reservoir species analogous to the Australian possum. Using linear-transects at 10-meter intervals, we performed systematic fecal surveys across four BU endemic villages and one non-endemic village in the Asante Akim North District of Ghana. One hundred and eighty fecal specimens from a single survey event were collected and analyzed by qPCR for the M. ulcerans diagnostic DNA targets IS2404 and KR-B. Positive and negative controls performed as expected but all 180 test samples were negative. This structured snapshot survey suggests that common domestic animals living in and around humans do not shed M. ulcerans in their feces. We conclude that, unlike the Australian native possum, domestic animals in rural Ghana are unlikely to be major reservoirs of M. ulcerans.
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Affiliation(s)
- Nicholas J Tobias
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity , Melbourne , Australia
| | - Nana Ama Ammisah
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana , Legon , Ghana
| | - Evans K Ahortor
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana; School of Pharmacy & Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - John R Wallace
- Department of Biology, Millersville University of Pennsylvania , Millersville, PA , United States
| | - Anthony Ablordey
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana , Legon , Ghana
| | - Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity , Melbourne , Australia
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17
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Tian RBD, Niamké S, Tissot-Dupont H, Drancourt M. Detection of Mycobacterium ulcerans DNA in the Environment, Ivory Coast. PLoS One 2016; 11:e0151567. [PMID: 26982581 PMCID: PMC4794205 DOI: 10.1371/journal.pone.0151567] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Ivory Coast is a West African country with the highest reported cases of Buruli ulcer, a disabling subcutaneous infection due to Mycobacterium ulcerans. However, the prevalence of environmental M. ulcerans is poorly known in this country. Methods We collected 496 environmental specimens consisting of soil (n = 100), stagnant water (n = 200), plants (n = 100) and animal feces (n = 96) in Ivory Coast over five months in the dry and wet seasons in regions which are free of Buruli ulcer (control group A; 250 specimens) and in regions where the Buruli ulcer is endemic (group B; 246 specimens). After appropriate total DNA extraction incorporating an internal control, the M. ulcerans IS2404 and KR-B gene were amplified by real-time PCR in samples. In parallel, a calibration curve was done for M. ulcerans Agy99 IS2404 and KR-B gene. Results Of 460 samples free of PCR inhibition, a positive real-time PCR detection of insertion sequence IS2404 and KR-B gene was observed in 1/230 specimens in control group A versus 9/230 specimens in group B (P = 0.02; Fisher exact test). Positive specimens comprised seven stagnant water specimens, two feces specimens confirmed to be of Thryonomys swinderianus (agouti) origin by real-time PCR of the cytb gene; and one soil specimen. Extrapolation from the calibration curves indicated low inoculums ranging from 1 to 102 mycobacteria/mL. Conclusion This study confirms the presence of M. ulcerans in the watery environment surrounding patients with Buruli ulcer in Ivory Coast. It suggests that the agouti, which is in close contacts with populations, could play a role in the environmental cycle of M. ulcerans, as previously suggested for the closely related possums in Australia.
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Affiliation(s)
- Roger Bi Diangoné Tian
- Aix Marseille Université, URMITE, UMR, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
- Laboratoire de biotechnologies, UFR Biosciences, Université Félix Houphouet Boigny Abidjan, Côte d’Ivoire
| | - Sébastian Niamké
- Laboratoire de biotechnologies, UFR Biosciences, Université Félix Houphouet Boigny Abidjan, Côte d’Ivoire
| | - Hervé Tissot-Dupont
- Aix Marseille Université, URMITE, UMR, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
| | - Michel Drancourt
- Aix Marseille Université, URMITE, UMR, CNRS 7278, IRD 198, INSERM 1095, Faculté de Médecine, Marseille, France
- * E-mail:
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Garchitorena A, Ngonghala CN, Texier G, Landier J, Eyangoh S, Bonds MH, Guégan JF, Roche B. Environmental transmission of Mycobacterium ulcerans drives dynamics of Buruli ulcer in endemic regions of Cameroon. Sci Rep 2015; 5:18055. [PMID: 26658922 PMCID: PMC4676024 DOI: 10.1038/srep18055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022] Open
Abstract
Buruli Ulcer is a devastating skin disease caused by the pathogen Mycobacterium ulcerans. Emergence and distribution of Buruli ulcer cases is clearly linked to aquatic ecosystems, but the specific route of transmission of M. ulcerans to humans remains unclear. Relying on the most detailed field data in space and time on M. ulcerans and Buruli ulcer available today, we assess the relative contribution of two potential transmission routes--environmental and water bug transmission--to the dynamics of Buruli ulcer in two endemic regions of Cameroon. The temporal dynamics of Buruli ulcer incidence are explained by estimating rates of different routes of transmission in mathematical models. Independently, we also estimate statistical models of the different transmission pathways on the spatial distribution of Buruli ulcer. The results of these two independent approaches are corroborative and suggest that environmental transmission pathways explain the temporal and spatial patterns of Buruli ulcer in our endemic areas better than the water bug transmission.
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Affiliation(s)
- Andrés Garchitorena
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Calistus N. Ngonghala
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Gaëtan Texier
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- UMR 912 - SESSTIM - INSERM/IRD/Aix-Marseille Université Faculté de Médecine, Marseille, France
| | - Jordi Landier
- Service d'épidémiologie et de santé publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
- Unité d’Epidémiologie de Maladies Emergentes, Institut Pasteur, Paris, France
| | - Sara Eyangoh
- Laboratoire de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroun
| | - Matthew H. Bonds
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Earth System Science, Stanford University, Stanford, CA 94305, USA
| | - Jean-François Guégan
- UMR MIVEGEC 5290 CNRS - IRD - Université de Montpellier, Montpellier, France
- Ecole des Hautes Etudes en Santé Publique, Rennes, France
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