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Benhammou D, Chippaux JP, Ntone R, Madec Y, Amta P, Noel G, Karl FN, Perilhou A, Matchim L, Sanchez M, Ndifon M, Clauteaux P, Eteki L, Boum Y, Nkwescheu AS, Taieb F. Snakebites in Cameroon: Tolerance of a Snake Antivenom (Inoserp™ PAN-AFRICA) in Africa in Real-Life Conditions. Toxins (Basel) 2024; 16:165. [PMID: 38668590 PMCID: PMC11053651 DOI: 10.3390/toxins16040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 04/29/2024] Open
Abstract
Snakebite envenomation (SBE) is a public health issue in sub-Saharan countries. Antivenom is the only etiological treatment. Excellent tolerance is essential in managing SBE successfully. This study aimed to evaluate tolerance of InoserpTM PAN-AFRICA (IPA). It was conducted on fourteen sites across Cameroon. IPA was administered intravenously and repeated at the same dose every two hours if needed. Early and late tolerance was assessed by the onset of clinical signs within two hours and at a visit two weeks or more after the first IPA administration, respectively. Over 20 months, 447 patients presenting with a snakebite were included. One dose of IPA was administered to 361 patients and repeated at least once in 106 patients. No significant difference was shown between the proportion of adverse events in patients who received IPA (266/361, 73.7%) and those who did not (69/85, 81.2%) (p = 0.95). Adverse reactions, probably attributable to IPA, were identified in four (1.1%) patients, including one severe (angioedema) and three mild. All these reactions resolved favorably. None of the serious adverse events observed in twelve patients were attributed to IPA. No signs of late intolerance were observed in 302 patients. Tolerance appears to be satisfactory. The availability of effective and well-tolerated antivenoms would reduce the duration of treatment and prevent most disabilities and/or deaths.
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Affiliation(s)
- David Benhammou
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris Cité University, F-75015 Paris, France; (D.B.)
| | - Jean-Philippe Chippaux
- MERIT Unit, Institut de Recherche pour le Développement, Paris Cité University, F-75006 Paris, France
| | - Rodrigue Ntone
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris Cité University, F-75015 Paris, France; (D.B.)
| | - Pierre Amta
- Tokombere Hospital, Tokombere, Mora BP 74, Cameroon;
| | - Gaëlle Noel
- Institut Pasteur, Translational Research Center, Paris Cité University, F-75015 Paris, France; (G.N.); (P.C.)
| | - Fai Njuwa Karl
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Anaïs Perilhou
- Institut Pasteur, Clinical Research Coordination Center, Paris Cité University, F-75015 Paris, France;
| | - Lucrece Matchim
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Marie Sanchez
- Institut Pasteur, Data Management Core Facility, Paris Cité University, F-75015 Paris, France;
| | - Mark Ndifon
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Pedro Clauteaux
- Institut Pasteur, Translational Research Center, Paris Cité University, F-75015 Paris, France; (G.N.); (P.C.)
| | - Lucrèce Eteki
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
| | - Yap Boum
- Epicentre Yaounde, Yaounde BP 12069, Cameroon; (R.N.); (F.N.K.); (L.M.); (M.N.); (L.E.)
- Institut Pasteur de Bangui, Bangui BP 923, Central African Republic
- Faculté de Médecine et de Sciences Biomédicales, Yaounde I University, Yaounde BP 1364, Cameroon
| | | | - Fabien Taieb
- Institut Pasteur Medical Center, Paris Cité University, F-75015 Paris, France
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Chippaux JP, Ntone R, Benhammou D, Madec Y, Noël G, Perilhou A, Karl F, Amta P, Sanchez M, Matchim L, Clauteaux P, Eteki L, Ndifon M, Boum Y, Nkwescheu AS, Taieb F. Real life condition evaluation of Inoserp PAN-AFRICA antivenom effectiveness in Cameroon. PLoS Negl Trop Dis 2023; 17:e0011707. [PMID: 37939111 PMCID: PMC10659212 DOI: 10.1371/journal.pntd.0011707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 11/20/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Snakebites is a serious public health issue but remains a neglected tropical disease. Data on antivenom effectiveness are urgently needed in Africa. We assessed effectiveness of Inoserp PAN-AFRICA (IPA), the recommended antivenom available in Cameroon. METHODOLOGY/PRINCIPAL FINDINGS We enrolled 447 patients presenting with snakebite in 14 health facilities across Cameroon. At presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. We administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. We renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. We defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. Medium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. After hospital discharge, a home visit was planned to assess long-term outcomes. Between October 2019 and May 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. The median [IQR] age was 25 [14-40]. Envenomation was diagnosed in 369 (82.6%) participants. The antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. Among these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. Two hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. Complete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. Sequelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection. CONCLUSIONS/SIGNIFICANCE We confirmed good effectiveness of the IPA and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. Sequential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom. TRIAL REGISTRATION NCT03326492.
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Affiliation(s)
- Jean-Philippe Chippaux
- Université Paris Cité, Institut de Recherche pour le développement, MERIT, Paris, France
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | - David Benhammou
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Yoann Madec
- Institut Pasteur, Université Paris Cité, Emerging Diseases Epidemiology unit, Paris, France
| | - Gaëlle Noël
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Anais Perilhou
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | - Fai Karl
- Epicentre Yaoundé, Yaoundé, Cameroon
| | | | - Marie Sanchez
- Institut Pasteur, Université Paris Cité, Data management core facility, Paris, France
| | | | - Pedro Clauteaux
- Institut Pasteur, Université Paris Cité, Centre de Recherche Translationnelle, Paris, France
| | | | | | - Yap Boum
- Epicentre Yaoundé, Yaoundé, Cameroon
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Fai KN, Corine TM, Bebell LM, Mboringong AB, Nguimbis EBPT, Nsaibirni R, Mbarga NF, Eteki L, Nikolay B, Essomba RG, Ndifon M, Ntone R, Hamadou A, Matchim L, Tchiasso D, Abah Abah AS, Essaka R, Peppa S, Crescence F, Ouamba JP, Koku MT, Mandeng N, Fanne M, Eyangoh S, Mballa GAE, Esso L, Epée E, Njouom R, Okomo Assoumou MC, Boum Y. Serologic response to SARS-CoV-2 in an African population. Sci Afr 2021; 12:e00802. [PMID: 34095639 PMCID: PMC8164732 DOI: 10.1016/j.sciaf.2021.e00802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/15/2021] [Accepted: 05/02/2021] [Indexed: 01/04/2023] Open
Abstract
Official case counts suggest Africa has not seen the expected burden of COVID-19 as predicted by international health agencies, and the proportion of asymptomatic patients, disease severity, and mortality burden differ significantly in Africa from what has been observed elsewhere. Testing for SARS-CoV-2 was extremely limited early in the pandemic and likely led to under-reporting of cases leaving important gaps in our understanding of transmission and disease characteristics in the African context. SARS-CoV-2 antibody prevalence and serologic response data could help quantify the burden of COVID-19 disease in Africa to address this knowledge gap and guide future outbreak response, adapted to the local context. However, such data are widely lacking in Africa. We conducted a cross-sectional seroprevalence survey among 1,192 individuals seeking COVID-19 screening and testing in central Cameroon using the Innovita antibody-based rapid diagnostic. Overall immunoglobulin prevalence was 32%, IgM prevalence was 20%, and IgG prevalence was 24%. IgM positivity gradually increased, peaking around symptom day 20. IgG positivity was similar, gradually increasing over the first 10 days of symptoms, then increasing rapidly to 30 days and beyond. These findings highlight the importance of diagnostic testing and asymptomatic SARS-CoV-2 transmission in Cameroon, which likely resulted in artificially low case counts. Rapid antibody tests are a useful diagnostic modality for seroprevalence surveys and infection diagnosis starting 5-7 days after symptom onset. These results represent the first step towards better understanding the SARS-CoV-2 immunological response in African populations.
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Affiliation(s)
| | | | - Lisa M Bebell
- Massachussetts General Hospital, Boston, United States
| | | | | | | | | | | | | | - Rene Ghislain Essomba
- National Public Health Laboratory, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon
| | | | | | - Achta Hamadou
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
| | | | | | | | | | - Solange Peppa
- National Public Health Laboratory, Yaoundé, Cameroon
| | | | | | | | - Nadia Mandeng
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
| | - Mahamat Fanne
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
| | | | | | - Linda Esso
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
| | - Emilienne Epée
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
| | | | - Marie-Claire Okomo Assoumou
- National Public Health Laboratory, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Public Health Emergency Operation Center, Ministry of Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon
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