Date: Fri 26 Oct 2018
Source: PLoS Negl Trop Dis 2018;12:e0006750 [edited]

Wanji S, Chounna Ndongmo WP, Fombad FF, et al. Impact of repeated annual community-directed treatment with ivermectin on loiasis parasitological indicators in Cameroon: implications for onchocerciasis and lymphatic filariasis elimination in areas co-endemic with _Loa loa_ in Africa. PLoS Negl Trop Dis 2018;12:e0006750.

Loiasis is a filarial infection endemic in the rainforest zone of west and central Africa, particularly in Cameroon, Gabon, Republic of Congo, and Democratic Republic of the Congo. Repeated treatments with ivermectin have been delivered using the annual community-directed treatment with ivermectin (CDTI) approach for several years to control onchocerciasis in some _Loa loa_ and _Onchocerca volvulus_ co-endemic areas. The impact of CDTI on loiasis parasitological indicators is not known. Therefore, we designed this cross-sectional study to explore the effects of several rounds of CDTI on parasitological indicators of loiasis.

Methodology/principal findings
The study was conducted in the East, Northwest, and Southwest 2 CDTI projects of Cameroon. Individuals who consented to participate were interviewed for ivermectin treatment history and enrolled for parasitological screening using thick smears. Ivermectin treatment history was correlated with loiasis prevalence/intensity. A total of 3684 individuals were recruited from 36 communities of the 3 CDTI projects, and 900 individuals were from 9 villages in a non-CDTI district. In the East, loiasis prevalence was 29.3% (range, 24.2% to 34.6%) in the non-CDTI district but 16.0% (3.3% to 26.6%) in the CDTI district with 10 ivermectin rounds (there were no baseline data for the latter).

In the Northwest and Southwest 2 districts, reductions from 30.5% to 17.9% (after 9 ivermectin rounds) and from 8.1% to 7.8% (not significantly different after 14 rounds) were registered post-CDTI, respectively. Similar trends in infection intensity were observed in all sites. There was a negative relationship between adherence to ivermectin treatment and prevalence/intensity of infection in all sites. None of the children (ages 10 to 14 years) examined in the East CDTI project harboured high (8000 to 30,000 mf/mL) or very high (more than 30,000 mf/mL) microfilarial loads. Individuals who had taken more than 5 ivermectin treatments were 2.1 times more likely to present with no microfilaraemia than those with fewer treatments.

In areas where onchocerciasis and loiasis are co-endemic, CDTI reduces the number of and microfilaraemia in _L. loa_-infected individuals, and this, in turn, will help to prevent non-neurological and neurological complications post-ivermectin treatment among CDTI adherents.
[Onchocerciasis (African River blindness) is a neglected tropical disease, but the invasive nematode _Loa loa_ is not on the list. The study clearly demonstrates that scheduled regular ivermectin against onchocerciasis also reduced the nematode burden of _L. loa_.

_L. loa_, the African eye worm, is a nematode transmitted by tabanid flies (Order: Diptera; Family: Tabanidae) of the genus _Chrysops_. _L. loa_ may cause skin oedema (Calabar swellings) and may occasionally invade the eye. As far as it is known, there is no animal reservoir. - ProMED Mod.EP]

[HealthMap/ProMED map:
Cameroon: <>]
Date: Sat, 6 Oct 2018 04:59:35 +0200
By Gregory WALTON

Buea, Cameroon, Oct 6, 2018 (AFP) - "For the peak season I would have about 280 persons climbing Mount Cameroon," said John Ngomba, a tour guide in the town of Buea, which has been at the forefront of Cameroon's anglophone separatist insurgency.   "But now there are no tourists coming. It's really crazy. The reason tourists are not coming is because of the crisis."

Since an independence declaration a year ago, Buea -- once a tourist hotspot -- has suffered near-daily clashes and visitors have all but disappeared.   The violence has claimed the lives of at least 420 civilians, 175 members of the security forces and an unknown number of separatists, according to the International Crisis Group think-tank.   "Sometimes I would receive 600 Germans a year. They would come through the cruise ships. I could have about 30 to 50 tourists a week who came to visit," said Ngomba in his hut in the town's Bismarck Fountain gardens.

Cameroon was once a German colony but was divided between Britain and France after World War I -- a separation that lies at the heart of the current conflict.   France's colony won independence in 1960, becoming Cameroon, and in 1961 the British-ruled Southern Cameroons was merged into it, giving the new state English-speaking majorities in the northwest and southwest.   "I am a father of five children. How am I living with them? It's impossible," said Ngomba, who has appealed for help from the German embassy, which assists with the upkeep of the garden containing a bust of Bismarck.

- Empty hotels -
"The fountain is not even working," he said, looking out over the restive town below and the former German governor's residence, which is now an army base.   But Ngomba insisted that the foothills above Buea remained safe.   "If the tourists arrive and get to this point, they are safe," he said.   "I tell people: after the election, things will be OK," he added of polls due on unday at which President Paul Biya will seek a seventh term.

But several countries including Germany, Britain, Canada and the United States have issued security advisories to their citizens about the anglophone regions.   "We used to have customers coming from many countries -- America, Europe, Nigeria," said Janet Nkowo, 30, a receptionist at the Eta Palace Hotel in downtown Buea.   "I think it's because of the crisis. The difference is really clear," she said.   "We have one-quarter of what we had, I don't know how the director does it. I think things will hopefully get better on Sunday."

Most of Buea's hotels are sitting empty, the majority of shops are shuttered and only a handful of students queued up at the town's university to register for the new academic term.   A total of 246,000 people have fled their homes in the southwest region that includes Buea -- and 25,000 have left the country altogether for Nigeria, according to UN figures.

At the town's weekly market, one of the few retail outlets still functioning, many stalls sat empty.   A man in a white vest shouted "French bastards" at passers-by, in French.   "Maybe if voting passes well, they will come back," said Fidelis Kum, a stallholder selling hair extensions, as customers haggled over live chickens nearby and women sat shelling snails.
Date: Sun 15 Jul 2018 6:49 PM WAT
Source: The Sun Daily [edited]

The health ministry said 6 people have died in Cameroon from a cholera outbreak that has infected 43 people since May 2018. "Cases of cholera were documented since May 2018 in 4 districts in northern regions," health minister Andre Mama Fouda said in a statement sent late [Sat 14 Jul 2018]. He said one case of the disease had been found in the capital Yaounde. "From the moment the 1st cases were documented in the northern region, every measure was taken to contain the epidemic," Fouda said.

Cholera is caused by a bacterium transmitted through contaminated food or drinking water. It causes acute diarrhoea, with children particularly at risk. In 2010, an outbreak of the disease killed more than 750 people across Cameroon.
Date: Sun, 15 Jul 2018 12:20:59 +0200

Douala, July 15, 2018 (AFP) - Six people have died in Cameroon from a cholera outbreak that has infected 43 people since May, the health ministry said.    "Cases of cholera were documented since May 2018 in four districts in northern regions," health minister Andre Mama Fouda said in a statement sent late Saturday.   He said one case of the disease had been found in the capital Yaoundé.   "From the moment the first cases were documented in the northern region, every measure was taken to contain the epidemic," Fouda said.   Cholera is caused by a bacterium transmitted through contaminated food or drinking water. It causes acute diarrhoea, with children particularly at risk.    In 2010, an outbreak of the disease killed more than 750 people across Cameroon.
Date: Fri 1 Jun 2018
Source: Relief Web [edited]

The outbreak of monkeypox in Cameroon continues, with new areas being affected. Since our last report on 18 May 2018 (Weekly Bulletin 20), 9 additional cases have been reported, bringing the cumulative total to 16, including one confirmed case as of 30 May 2018. No deaths have so far been reported. The ages of the affected people range from one month to 58 years, with a median age of 13 years, and the gender distribution is proportionate.

In addition to the 2 initial health districts, 3 others from 3 different regions have been affected, namely: Njikwa (7 cases) in the North-west Region; Akwaya (6) in the South-west Region; Biyem-Assi (1) in the Central Region; Bertoua (1) in the Eastern Region; and Fotokol (1) in the Far-North Region.

The outbreak of monkeypox in Cameroon was confirmed by the Centre Pasteur du Cameroun (CPC) on 14 May 2018 when one of 2 specimens (obtained from the initial cases) tested positive for orthopoxvirus/monkeypox virus by real-time polymerase chain reaction. The confirmed case is a 20 year old male with clinical symptoms of fever, generalized vesiculo-pustular rash and enlarged lymph nodes. Samples from 11 suspected cases have been collected and tested at the CPC. The event was initially reported to the Ministry of Health by Bjikwa health authorities on 30 Apr 2018 when the 1st 2 suspected cases were detected. The Ministry of Health formally notified WHO of the event on 15 May 2018, following laboratory confirmation.

Public health actions
On 15 May 2018, the Ministry of Health activated an Incident Management System in response to the outbreak, with support from WHO.
- An action plan has been developed for the interventions, and the needs of the different pillars of the response (coordination, operations, logistics, and communication) have been articulated.
- Active surveillance has been enhanced in the whole country, including case investigation of suspected cases and alerts.
- Training of healthcare workers on using personal protective equipment and advocating proper hand hygiene have been conducted. Information related to isolation of cases, symptomatic case management, and handwashing technique have been shared.
- A communication plan has been developed, and risk communication materials have been disseminated to increase public awareness and precautionary measures to prevent monkeypox transmission.
- On 22 May 2018, the Regional Centre for Epidemics Prevention and Control (CERPLE) organised a coordination meeting attended by the Njikwa Health District team, WHO, UNICEF, and other stakeholders.

Situation interpretation
The outbreak of monkeypox continues in Cameroon, with 5 of the 10 regions in the country reporting at least one suspected case. The cases are being reported from remote rural areas where occupational activities such as farming and hunting are increasing animal-human interaction. The detection of additional cases in the other regions could be due to enhanced surveillance following confirmation of the outbreak.

The resurgence of monkeypox in Cameroon underscores the need to maintain a high level of vigilance and raise awareness of the disease among the local population. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising public awareness of the risk factors, such as close contact with wildlife including rodents, and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical. People infected with monkeypox should be isolated, and infection prevention and control measures should be observed in healthcare facilities caring for infected patients. Close physical contact with persons infected with monkeypox should be limited, and protective equipment such as gloves, face masks and gowns should be worn when taking care of ill people in any setting. Regular hand washing should be carried out after caring for or visiting sick people.
[The previous ProMED-mail post on monkeypox cases in Cameroon did not provide numbers of cases (see ProMED-mail. Monkeypox - Africa (09): Cameroon Monkeypox virus is widespread in central and west Africa, and sporadic human cases occur there. A report earlier this year [2018] in MMWR stated that: "Since 2016, monkeypox cases have been reported and confirmed from Central African Republic (19 cases), DRC (more than 1000 reported per year), Liberia (2), Nigeria (more than 80), Republic of the Congo (88), and Sierra Leone (1) (table); an outbreak in captive chimpanzees occurred in Cameroon. With 80 confirmed cases, Nigeria is currently experiencing the largest documented outbreak of human monkeypox in West Africa this year (2018). The emergence of cases is a concern for global health security;" (see Monkeypox - Africa (04) This report does not mention human cases in Cameroon, but the cases in chimpanzees in that country indicate that the virus is present.

The main reservoirs of monkeypox virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp; an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals in order to halt MPX virus exposure will be culturally and economically difficult, so continued occasional occurrence of cases can be expected.

Durski KN, McCollum AM, Nakazawa Y, et al. Emergence of monkeypox -- West and Central Africa, 1970-2017. MMWR Morb Mortal Wkly Rep 2018; 67(10):306-10. - ProMED Mod.TY]

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