Publications by authors named "Eric Adehossi"

29 Publications

  • Page 1 of 1

Immunogenicity of an oral rotavirus vaccine administered with prenatal nutritional support in Niger: A cluster randomized clinical trial.

PLoS Med 2021 Aug 10;18(8):e1003720. Epub 2021 Aug 10.

Department of Research, Epicentre, Paris, France.

Background: Nutritional status may play a role in infant immune development. To identify potential boosters of immunogenicity in low-income countries where oral vaccine efficacy is low, we tested the effect of prenatal nutritional supplementation on immune response to 3 doses of a live oral rotavirus vaccine.

Methods And Findings: We nested a cluster randomized trial within a double-blind, placebo-controlled randomized efficacy trial to assess the effect of 3 prenatal nutritional supplements (lipid-based nutrient supplement [LNS], multiple micronutrient supplement [MMS], or iron-folic acid [IFA]) on infant immune response (n = 53 villages and 1,525 infants with valid serology results: 794 in the vaccine group and 731 in the placebo group). From September 2015 to February 2017, participating women received prenatal nutrient supplement during pregnancy. Eligible infants were then randomized to receive 3 doses of an oral rotavirus vaccine or placebo at 6-8 weeks of age (mean age: 6.3 weeks, 50% female). Infant sera (pre-Dose 1 and 28 days post-Dose 3) were analyzed for anti-rotavirus immunoglobulin A (IgA) using enzyme-linked immunosorbent assay (ELISA). The primary immunogenicity end point, seroconversion defined as ≥3-fold increase in IgA, was compared in vaccinated infants among the 3 supplement groups and between vaccine/placebo groups using mixed model analysis of variance procedures. Seroconversion did not differ by supplementation group (41.1% (94/229) with LNS vs. 39.1% (102/261) with multiple micronutrients (MMN) vs. 38.8% (118/304) with IFA, p = 0.91). Overall, 39.6% (n = 314/794) of infants who received vaccine seroconverted, compared to 29.0% (n = 212/731) of infants who received placebo (relative risk [RR]: 1.36; 95% confidence interval [CI]: 1.18, 1.57, p < 0.001). This study was conducted in a high rotavirus transmission setting. Study limitations include the absence of an immune correlate of protection for rotavirus vaccines, with the implications of using serum anti-rotavirus IgA for the assessment of immunogenicity and efficacy in low-income countries unclear.

Conclusions: This study showed no effect of the type of prenatal nutrient supplementation on immune response in this setting. Immune response varied depending on previous exposure to rotavirus, suggesting that alternative delivery modalities and schedules may be considered to improve vaccine performance in high transmission settings.

Trial Registration: ClinicalTrials.gov NCT02145000.
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http://dx.doi.org/10.1371/journal.pmed.1003720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354620PMC
August 2021

Rotavirus vaccine efficacy up to 2 years of age and against diverse circulating rotavirus strains in Niger: Extended follow-up of a randomized controlled trial.

PLoS Med 2021 Jul 2;18(7):e1003655. Epub 2021 Jul 2.

Department of Research, Epicentre, Paris, France.

Background: Rotavirus vaccination is recommended in all countries to reduce the burden of diarrhea-related morbidity and mortality in children. In resource-limited settings, rotavirus vaccination in the national immunization program has important cost implications, and evidence for protection beyond the first year of life and against the evolving variety of rotavirus strains is important. We assessed the extended and strain-specific vaccine efficacy of a heat-stable, affordable oral rotavirus vaccine (Rotasiil, Serum Institute of India, Pune, India) against severe rotavirus gastroenteritis (SRVGE) among healthy infants in Niger.

Methods And Findings: From August 2014 to November 2015, infants were randomized in a 1:1 ratio to receive 3 doses of Rotasiil or placebo at approximately 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and graded using the Vesikari score. The primary endpoint was vaccine efficacy of 3 doses of vaccine versus placebo against a first episode of laboratory-confirmed SRVGE (Vesikari score ≥ 11) from 28 days after dose 3, as previously reported. At the time of the primary analysis, median age was 9.8 months. In the present paper, analyses of extended efficacy were undertaken for 3 periods (28 days after dose 3 to 1 year of age, 1 to 2 years of age, and the combined period 28 days after dose 3 to 2 years of age) and by individual rotavirus G type. Among the 3,508 infants included in the per-protocol efficacy analysis (mean age at first dose 6.5 weeks; 49% male), the vaccine provided significant protection against SRVGE through the first year of life (3.96 and 9.98 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 60.3%, 95% CI 43.6% to 72.1%) and over the entire efficacy follow-up period up to 2 years of age (2.13 and 4.69 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 54.7%, 95% CI 38.1% to 66.8%), but the difference was not statistically significant in the second year of life. Up to 2 years of age, rotavirus vaccination prevented 2.56 episodes of SRVGE per 100 child-years. Estimates of efficacy against SRVGE by individual rotavirus genotype were consistent with the overall protective efficacy. Study limitations include limited generalizability to settings with administration of oral polio virus due to low concomitant administration, limited power to assess vaccine efficacy in the second year of life owing to a low number of events among older children, potential bias due to censoring of placebo children at the time of study vaccine receipt, and suboptimal adapted severity scoring based on the Vesikari score, which was designed for use in settings with high parental literacy.

Conclusions: Rotasiil provided protection against SRVGE in infants through an extended follow-up period of approximately 2 years. Protection was significant in the first year of life, when the disease burden and risk of death are highest, and against a changing pattern of rotavirus strains during the 2-year efficacy period. Rotavirus vaccines that are safe, effective, and protective against multiple strains represent the best hope for preventing the severe consequences of rotavirus infection, especially in resource-limited settings, where access to care may be limited. Studies such as this provide valuable information for the planning of national immunization programs and future vaccine development.

Trial Registration: ClinicalTrials.gov NCT02145000.
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http://dx.doi.org/10.1371/journal.pmed.1003655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8253401PMC
July 2021

Laboratory organisation and management of SARS-CoV-2 infection in Niger, West Africa.

Afr J Lab Med 2020 21;9(1):1308. Epub 2020 Dec 21.

Faculté des Sciences de la Santé, Université Abdou Moumouni, Niamey, Niger.

Background: As the coronavirus disease 2019 (COVID-19) pandemic unfolds, laboratory services have been identified as key to its containment. This article outlines the laboratory organisation and management and control interventions in Niger.

Intervention: The capitol city of Niger, Niamey, adopted a 'National COVID-19 Emergency Preparedness and Response Plan' to strengthen the preparedness of the country for the detection of severe acute respiratory syndrome coronavirus-2. Laboratory training and diagnostic capacity building were supported by existing active clinical and research laboratories for more rapid and practicable responses. The National Reference Laboratory for Respiratory Viruses located at the was designated as the reference centre for COVID-19 testing. The national plan for COVID-19 testing is being gradually adopted in other regions of the country in response to the rapidly evolving COVID-19 emergency and to ensure a more rapid turn-around time.

Lessons Learnt: After the decentralisation of COVID-19 testing to other regions of the country, turn-around times were reduced from 48-72 h to 12-24 h. Reducing turn-around times allowed Niger to reduce the length of patients' stays in hospitals and isolation facilities. Shortages in testing capacity must be anticipated and addressed. In an effort to reduce risk of shortages and increase availability of reagents and consumables, Niamey diversified real-time reverse transcriptase-polymerase chain reaction kits for severe acute respiratory syndrome coronavirus-2 detection.

Recommendations: Continued investment in training programmes and laboratory strategy is needed in order to strengthen Niger's laboratory capacity against the outbreak.
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http://dx.doi.org/10.4102/ajlm.v9i1.1308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756896PMC
December 2020

A Fatal Case of COVID-19 in an Infant with Severe Acute Malnutrition Admitted to a Paediatric Ward in Niger.

Case Rep Pediatr 2020 24;2020:8847415. Epub 2020 Sep 24.

Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger.

While there have been very few fatal cases, SARS-CoV-2 has been reported in paediatric patients. This study aims to describe a fatal case of COVID-19 in a child with severe acute malnutrition. The eight-month-old child presented with fever, diarrhoea, and difficulty in breathing. The mother of the child had fever and shortness of breath four weeks before she died. Physical examination revealed lethargy, dehydration, and severe weight loss with a weight of 5 kg at a height of 78 cm tall. The weight-for-height index was less than three -scores, which corresponds to severe acute malnutrition. The pulmonary examination revealed moderate respiratory distress, and the chest X-ray presented features suggestive of pneumonia in the right lung area. In the context of the COVID-19 outbreak in Niger and the circumstances of the mother's death, a nasal swab was taken for laboratory confirmation. Treatment provided to the child included intranasal oxygen, antibiotics, and a dietary program with therapeutic milk. The child died 48 hours after his admission. The history of contact with a SARS-CoV-2 suspect or positive patient should lead to screening for infection by using RT-PCR. It is important to investigate malnutrition as a potential risk factor for severe SARS-CoV-2 infection and resultant mortality.
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http://dx.doi.org/10.1155/2020/8847415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520010PMC
September 2020

A Report of Four Cases of Blackwater Fever after Quinine Treatment at Zinder National Hospital, Niger Republic.

Case Rep Infect Dis 2019 25;2019:2346087. Epub 2019 Aug 25.

Faculty of Health Sciences, University of Niamey, Niamey, Niger.

Background: Blackwater fever (BWF) is a rare but serious complication of malaria that is a consequence of antimalarial treatment. Its prevalence seems to have increased. Its diagnosis is based on clinical symptoms and urine color. We report on 4 BWF cases admitted to the infectious diseases department of Zinder National Hospital.

Results: Four patients were hospitalized in September 2017 for a hepatorenal syndrome of jaundice, port wine-colored urine, renal failure, and hepatic cytolysis following antimalarial treatment with quinine salts. Quinine treatment was stopped and treatment was continued with injectable artemether. Three patients underwent extra-renal purification. Their evolution was favorable. One patient died less than 24 hours after admission.

Conclusion: A rare and severe complication, blackwater fever must be considered for patients under antimalarial treatment who present with jaundice, abdominal pain, and acute renal insufficiency with port wine-colored urine. Rapid diagnosis and management in an intensive care unit are crucial for improving the prognosis.
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http://dx.doi.org/10.1155/2019/2346087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732635PMC
August 2019

[Epidemiological, clinical and evolutionary profile of patients with tuberculosis at the Regional Hospital of Maradi, Republic of the Niger].

Pan Afr Med J 2019 17;33:120. Epub 2019 Jun 17.

Service de Médecine Interne, Hôpital Général de Référence Niamey, Faculté des Sciences de la Santé de l'UAM de Niamey, Niamey, Niger.

Introduction: This study aimed to describe the epidemiological, clinical and evolutionary profile of patients treated for tuberculosis at the Regional Hospital of Maradi.

Methods: We conducted a retrospective, descriptive and analytical study of data from the medical records of patients treated for tuberculosis from 1 January 2015 to 31 December 2017.

Results: A total of 595 patients were followed (406 men, 68.24%, and 189 women, 31.76%) with a prevalence of 27,71%. The average age of patients was 42.3 ranging from 13 months to 85 years; 70.5% of these patients were from urban areas. Merchants represented 36.9% of the cases. Bacterial test was positive in 64.7% of cases. Functional signs included: coughing (99.5%), fever (79.5%), and chest pain. Pulmonary tuberculosis represented 78.7% of cases. Therapy was effective in 81.28% of cases. HIV prevalence was 13.6%, lethality 10.42% (40.4% of patients died from TB/HIV co-infection).

Conclusion: Tuberculosis is a scourge in low-income countries, with 10.42% of deaths. HIV/AIDS infection has negatively contributed to these deaths during the study period. The search for comorbidities in any patient with tuberculosis should be systematic in order to improve their global management.
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http://dx.doi.org/10.11604/pamj.2019.33.120.17715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6711699PMC
September 2019

Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial.

PLoS Med 2018 06 26;15(6):e1002593. Epub 2018 Jun 26.

Epicentre, Paris, France.

Background: Antibiotic prophylaxis for contacts of meningitis cases is not recommended during outbreaks in the African meningitis belt. We assessed the effectiveness of single-dose oral ciprofloxacin administered to household contacts and in village-wide distributions on the overall attack rate (AR) in an outbreak of meningococcal meningitis.

Methods And Findings: In this 3-arm, open-label, cluster-randomized trial during a meningococcal meningitis outbreak in Madarounfa District, Niger, villages notifying a suspected case were randomly assigned (1:1:1) to standard care (the control arm), single-dose oral ciprofloxacin for household contacts within 24 hours of case notification, or village-wide distribution of ciprofloxacin within 72 hours of first case notification. The primary outcome was the overall AR of suspected meningitis after inclusion. A random sample of 20 participating villages was enrolled to document any changes in fecal carriage prevalence of ciprofloxacin-resistant and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae before and after the intervention. Between April 22 and May 18, 2017, 49 villages were included: 17 to the control arm, 17 to household prophylaxis, and 15 to village-wide prophylaxis. A total of 248 cases were notified in the study after the index cases. The AR was 451 per 100,000 persons in the control arm, 386 per 100,000 persons in the household prophylaxis arm (t test versus control p = 0.68), and 190 per 100,000 persons in the village-wide prophylaxis arm (t test versus control p = 0.032). The adjusted AR ratio between the household prophylaxis arm and the control arm was 0.94 (95% CI 0.52-1.73, p = 0.85), and the adjusted AR ratio between the village-wide prophylaxis arm and the control arm was 0.40 (95% CI 0.19‒0.87, p = 0.022). No adverse events were notified. Baseline carriage prevalence of ciprofloxacin-resistant Enterobacteriaceae was 95% and of ESBL-producing Enterobacteriaceae was >90%, and did not change post-intervention. One limitation of the study was the small number of cerebrospinal fluid samples sent for confirmatory testing.

Conclusions: Village-wide distribution of single-dose oral ciprofloxacin within 72 hours of case notification reduced overall meningitis AR. Distributions of ciprofloxacin could be an effective tool in future meningitis outbreak responses, but further studies investigating length of protection, effectiveness in urban settings, and potential impact on antimicrobial resistance patterns should be carried out.

Trial Registration: ClinicalTrials.gov NCT02724046.
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http://dx.doi.org/10.1371/journal.pmed.1002593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019097PMC
June 2018

Efficacy of a Low-Cost, Heat-Stable Oral Rotavirus Vaccine in Niger.

N Engl J Med 2017 03;376(12):1121-1130

From the Department of Research, Epicentre, Paris (S.I., C.L., R.F.G.); the Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (S.I.); Epicentre (O.G., A.M.S., N.S.-M.), National Hospital (E.A.), and University of Niamey (A.D.), Niamey, Niger; BioStat Consulting, Jasper, GA (B.D.P.); Laboratory of Specialized Clinical Studies, Cincinnati Children's Hospital Medical Center, Cincinnati (M.M.M., N.M.); and Médecins sans Frontières Operational Center, Geneva (B.J.).

Background: Each year, rotavirus gastroenteritis is responsible for about 37% of deaths from diarrhea among children younger than 5 years of age worldwide, with a disproportionate effect in sub-Saharan Africa.

Methods: We conducted a randomized, placebo-controlled trial in Niger to evaluate the efficacy of a live, oral bovine rotavirus pentavalent vaccine (BRV-PV, Serum Institute of India) to prevent severe rotavirus gastroenteritis. Healthy infants received three doses of the vaccine or placebo at 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and were graded on the basis of the score on the Vesikari scale (which ranges from 0 to 20, with higher scores indicating more severe disease). The primary end point was the efficacy of three doses of vaccine as compared with placebo against a first episode of laboratory-confirmed severe rotavirus gastroenteritis (Vesikari score, ≥11) beginning 28 days after dose 3.

Results: Among the 3508 infants who were included in the per-protocol efficacy analysis, there were 31 cases of severe rotavirus gastroenteritis in the vaccine group and 87 cases in the placebo group (2.14 and 6.44 cases per 100 person-years, respectively), for a vaccine efficacy of 66.7% (95% confidence interval [CI], 49.9 to 77.9). Similar efficacy was seen in the intention-to-treat analyses, which showed a vaccine efficacy of 69.1% (95% CI, 55.0 to 78.7). There was no significant between-group difference in the risk of adverse events, which were reported in 68.7% of the infants in the vaccine group and in 67.2% of those in the placebo group, or in the risk of serious adverse events (in 8.3% in the vaccine group and in 9.1% in the placebo group); there were 27 deaths in the vaccine group and 22 in the placebo group. None of the infants had confirmed intussusception.

Conclusions: Three doses of BRV-PV, an oral rotavirus vaccine, had an efficacy of 66.7% against severe rotavirus gastroenteritis among infants in Niger. (Funded by Médecins sans Frontières Operational Center and the Kavli Foundation; ClinicalTrials.gov number, NCT02145000 .).
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http://dx.doi.org/10.1056/NEJMoa1609462DOI Listing
March 2017

High efficacy of first-line ART in a West African cohort, assessed by dried blood spot virological and pharmacological measurements.

J Antimicrob Chemother 2016 11 20;71(11):3222-3227. Epub 2016 Jul 20.

Laboratoire de Virologie-INSERM U941, Hôpital Saint Louis-APHP, Université Paris Diderot, Paris, France.

Objectives: The objectives of this study were to determine the rate of viral success in HIV-infected patients on first-line ART by the assessment of dried blood spot (DBS) viral load (VL) and to assess the performance of DBS sampling for VL measurement, genotypic resistance and antiretroviral concentration determinations.

Methods: HIV-infected patients treated for >1 year with first-line ART in Niamey, Niger were included. VL based on nucleic acid sequence-based amplification (NASBA) assay (limit of quantification <800 copies/mL) was measured on DBS capillary samples. Resistance genotype was assessed for all detectable VLs (limit of detection >100 copies/mL); antiretroviral concentrations were interpreted using standard plasma cut-offs after extrapolation of blood to plasma results. Median (IQR) results are presented.

Results: Two hundred and eighteen patients (61% women), aged 41 (34-46) years, with 138 (56-235) CD4 cells/mm at baseline were included. After 4 (2-6) years of follow-up under therapy, CD4 gain was +197 (98-372) cells/mm; 81% had VL <800 copies/mL. Antiretroviral concentrations were adequate in 87% of patients and nevirapine/efavirenz concentrations were related to viral success (P < 0.001). DBS genotypic resistance amplification succeeded in 71% of failing patients: NRTI drug resistance mutations were identified in 73% including resistance to lamivudine/emtricitabine (67%), abacavir (30%) and tenofovir (21%); and NNRTI drug resistance mutations were identified in 82% including resistance to rilpivirine (39%) and etravirine (15%).

Conclusions: This study demonstrated a good response after 4 years of first-line ART in Niger. Adherence was high, according to antiretroviral concentrations, and the majority of failures were explained by selection of drug resistance mutations detected in the DBS genotype. Using DBS might improve the assessment of ART failure in HIV-infected patients in low-income countries.
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http://dx.doi.org/10.1093/jac/dkw286DOI Listing
November 2016

Molecular characterization of hepatitis B virus from chronically-infected patients in Niamey, Niger.

Int J Infect Dis 2016 Apr 16;45:18-23. Epub 2016 Feb 16.

Aix-Marseille University, URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, 27 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France; IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, 264 rue Saint-Pierre 13385, Marseille CEDEX 05, France. Electronic address:

Objectives: In Niger, 65% of hepatocarcinoma and 75% of cirrhosis cases were due to hepatitis B virus (HBV). We studied the genotypic characteristics of HBsAg in chronically HBV-infected patients in Niamey.

Methods: We studied prospectively HBV genotypic patterns among hospitalized patients with HBV infection in the National Hospital of Niamey, Niger. Patients were screened for hepatitis B surface antigen (HBsAg) and HBV genotyping was performed on the HBsAg-positive patients.

Results: In this study, we have confirmed the predominance of the HBV genotype E (HBV-E) in Niger and have identified 2 recombinant forms including HBV-E/D and HBV-A3/E reported previously among blood donors in Niger and Ghana, respectively. Amino acid substitutions found in HBV sequences obtained here included P120T, S143L, G145A and A194T. These substitutions were characterized as being associated with modified antigenicity and, notably, with impaired serological detection of HBsAg, while the A194T variant was found to have a controversial role in reduced susceptibility to tenofovir.

Conclusions: We have identified two recombinant HBV forms and rare genotypic patterns in Niger that may affect hepatitis B surface antigen antigenicity, and improve current knowledge of epidemiological, clinical and virological patterns of hepatitis B in this country.
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http://dx.doi.org/10.1016/j.ijid.2016.02.009DOI Listing
April 2016

Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children.

N Engl J Med 2016 Feb;374(5):444-53

From the Department of Research, Epicentre (S.I., C.L., F.B., S.G., R.F.G.), and Médecins sans Frontières Operational Center Paris (M.S.), Paris; the Departments of Nutrition (S.I.) and Global Health and Population (S.I., N.L.), Harvard T.H. Chan School of Public Health, Boston; and the Ministry of Health (N.O.), Forum Santé Niger (S.H.), and National Hospital (E.A.), Niamey, and UNICEF, Maradi (H.H.) - all in Niger.

Background: High-quality evidence supporting a community-based treatment protocol for children with severe acute malnutrition, including routine antibiotic use at admission to a nutritional treatment program, remains limited. In view of the costs and consequences of emerging resistance associated with routine antibiotic use, more evidence is required to support this practice.

Methods: In a double-blind, placebo-controlled trial in Niger, we randomly assigned children who were 6 to 59 months of age and had uncomplicated severe acute malnutrition to receive amoxicillin or placebo for 7 days. The primary outcome was nutritional recovery at or before week 8.

Results: A total of 2412 children underwent randomization, and 2399 children were included in the analysis. Nutritional recovery occurred in 65.9% of children in the amoxicillin group (790 of 1199) and in 62.7% of children in the placebo group (752 of 1200). There was no significant difference in the likelihood of nutritional recovery (risk ratio for amoxicillin vs. placebo, 1.05; 95% confidence interval [CI], 0.99 to 1.12; P=0.10). In secondary analyses, amoxicillin decreased the risk of transfer to inpatient care by 14% (26.4% in the amoxicillin group vs. 30.7% in the placebo group; risk ratio, 0.86; 95% CI, 0.76 to 0.98; P=0.02).

Conclusions: We found no benefit of routine antibiotic use with respect to nutritional recovery from uncomplicated severe acute malnutrition in Niger. In regions with adequate infrastructure for surveillance and management of complications, health care facilities could consider eliminating the routine use of antibiotics in protocols for the treatment of uncomplicated severe acute malnutrition. (Funded by Médecins sans Frontières Operational Center Paris; ClinicalTrials.gov number, NCT01613547.).
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http://dx.doi.org/10.1056/NEJMoa1507024DOI Listing
February 2016

[First documented cases of systemic lupus erythematosus in Niger].

Tunis Med 2015 Jul;93(7):470-3

Objective: We describe in this first series of lupus documented in Niger, the epidemiological, diagnostic, therapeutic and prognostic aspects.

Method: This is a prospective study in internal medicine at the National Hospital of Niamey during 10 years. ACR criteria were used as diagnostic criteria.

Results: We identified only 9 cases with a frequency of 0.05 % (7 women, 2 men) with a mean age of 36.7 years [range, (26, 48)]. Frequent manifestations were prolonged fever (8 cases), malar rash (6 cases), arthritis (6 cases), alopecia (5 cases), discoid lupus (3 cases), haematological disorders (7 cases), serositis (4 cases) and renal failure (4 cases). All patients had at least 4 ACR criteria with an average of 6.11 criteria. ANA were positive in 8 patients with an average of 1/568, 68 [extremes (1/1280-1/160)]. The most commonly molecules used were Prednisone, Azathioprine and Hydroxychloroquine. The Mycofénolate Mofétil, Cyclophosphamide and Rituximab were used in a single patient. The outcome was favorable in 8 patients and we deplore the death of one patient.

Conclusion: Under diagnosis would be the basis of the low prevalence of lupus in Niger. Diagnostic means are necessary for epidemiological studies in order to have more representative data.
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July 2015

[Comparison of the therapeutic efficiency and of the tolerance of the artemether-lumefantrine and artesunate-amodiaquine combination in Niger].

Mali Med 2016 ;31(1):1-7

Faculté des Sciences de la Santé. UAM. BP: 10.896. Niamey-Niger.

Malaria is a major public health problem in Niger. The Global Fund to fight AIDS, Tuberculosis, and Malaria launched, in 2011, an initiative entitled "Affordable Medicines Facility - Malaria" or AMFm which aims to make artemisinin-based combination therapies (ACT) more available, more accessible and to eliminate the development of artemisinin resistance. It is in this context that we have conducted a randomized comparative double open-arm study of the efficacy and safety of artemether-lumefantrine (AL) and artesunate-amodiaquine (AM) in Gaya.

The objective of the study is to evaluate and then to compare the efficiency and tolerance to these two combinations. The study was modeled with the WHO 2003, 28 days protocol.

370 febrile patients were examined. 159 patients were included, where 79 (49.4%) were put in the AL arm and 81 (50.6%) were placed in the AM arm. The adequate clinical and parasitological response was 94.8% and 97.1% respectively for AL and AM. There was no statistical significant difference in efficiency between the two therapies . This difference in adverse effects was not statistically significant . Artemether-lumefantrine and artesunate-amodiaquine are two combinations with comparable efficacies and safety.
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January 2016

Prevalence of Bordetella infection in a hospital setting in niamey, niger.

J Trop Pediatr 2014 Jun 14;60(3):223-30. Epub 2014 Feb 14.

Epicentre, Paris, France.

Bordetella pertussis still poses an important health threat in developing countries. In Niger, notified pertussis cases are few despite the low diphtheria-tetanus-pertussis/pentavalent vaccine coverage. We aimed to estimate the prevalence of B. pertussis in children aged <5 years consulting at a pediatric ward. A 5-month study in 2011 recruited 342 children with respiratory symptoms at the National Hospital of Niamey. Nasopharyngeal aspirates were tested by culture and real-time polymerase chain reaction. Overall, 34 (11.2%) of the 305 available nasopharyngeal aspirates tested by real-time polymerase chain reaction were positive for a Bordetella spp., with an estimated prevalence of 8.2 cases per 1000 children aged <5. None was notified to the surveillance network. A single specimen was positive on culture. This study, the first to provide laboratory-confirmed data on pertussis in Niger, highlights the need to sensitize health care personnel to actively notify clinical cases and to integrate laboratory diagnosis in the existing surveillance system.
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http://dx.doi.org/10.1093/tropej/fmu001DOI Listing
June 2014

Is universal HBV vaccination of healthcare workers a relevant strategy in developing endemic countries? The case of a university hospital in Niger.

PLoS One 2012 7;7(9):e44442. Epub 2012 Sep 7.

Groupe d'Etude sur le Risque d'Exposition des Soignants Aux Agents Infectieux, Faculté de Médecine Paris VII - Bichat, Paris, France.

Background: Exposure to hepatitis B virus (HBV) remains a serious risk to healthcare workers (HCWs) in endemic developing countries owing to the strong prevalence of HBV in the general and hospital populations, and to the high rate of occupational blood exposure. Routine HBV vaccination programs targeted to high-risk groups and especially to HCWs are generally considered as a key element of prevention strategies. However, the high rate of natural immunization among adults in such countries where most infections occur perinatally or during early childhood must be taken into account.

Methodology/principal Findings: We conducted a cross sectional study in 207 personnel of 4 occupational groups (medical, paramedical, cleaning staff, and administrative) in Niamey's National Hospital, Niger, in order to assess the prevalence of HBV markers, to evaluate susceptibility to HBV infection, and to identify personnel who might benefit from vaccination. The proportion of those who declared a history of occupational blood exposure ranged from 18.9% in the administrative staff to 46.9% in paramedical staff. Only 7.2% had a history of vaccination against HBV with at least 3 injections. Ninety two percent were anti-HBc positive. When we focused on170 HCWs, only 12 (7.1%) showed no biological HBV contact. Twenty six were HBsAg positive (15,3%; 95% confidence interval: 9.9%-20.7%) of whom 8 (32%) had a viral load >2000 IU/ml.

Conclusions/significance: The very small proportion of HCWs susceptible to HBV infection in our study and other studies suggests that in a global approach to prevent occupational infection by bloodborne pathogens, a universal hepatitis B vaccination of HCWs is not priority in these settings. The greatest impact on the risk will most likely be achieved by focusing efforts on primary prevention strategies to reduce occupational blood exposure. HBV screening in HCWs and treatment of those with chronic HBV infection should be however considered.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0044442PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436880PMC
March 2013

Rabies exposure in international travelers: do we miss the target?

Int J Infect Dis 2010 Mar 12;14(3):e243-6. Epub 2009 Aug 12.

Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Chemin des Bourrelys, 13915 Marseille, Cedex 20, France.

Background: Little data exist about the spatial distribution of the risk for travelers of being injured by a potentially rabid animal.

Methods: Over the last 14 years, animal-associated injuries in 424 international travelers presenting to a travel medicine clinic in Marseille, southern France, were investigated.

Results: The majority of cases were reported from North Africa (41.5%) and Asia (22.2%). Most countries where at-risk injuries occurred (Algeria, Morocco, Tunisia, Thailand, and Turkey) were those for which travelers do not usually seek advice at a specialized travel clinic, because these countries are not at risk for specific travel-associated diseases like malaria or yellow fever. The probability of travelers being attacked by each animal species varied significantly according to the destination country. Dogs were more frequently involved in Algeria, cats in Tunisia and the Middle East, and non-human primates in sub-Saharan Africa, Madagascar, and Asia.

Conclusions: We suggest that rabies pre-exposure vaccination should be offered to individuals traveling regularly to North Africa to visit their relatives and who are at high risk of exposure to potentially rabid animal attacks. Pre-travel advice when addressing rabies prevention should consider the specific epidemiology of animal-related injuries in the traveled country, as well as the traveler's characteristics. Travelers should be advised about which species of animal are potentially aggressive in their destination country so that they can more easily avoid risk-contacts.
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http://dx.doi.org/10.1016/j.ijid.2009.05.009DOI Listing
March 2010

A woman with a skin lesion. Myiasis.

Clin Infect Dis 2009 Jun;48(11):1584, 1628-9

Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Assistance Publique Hôpitaux de Marsaille, Marseille, France.

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http://dx.doi.org/10.1086/598972DOI Listing
June 2009

Mycobacterium marinum infection.

BMJ Case Rep 2009 21;2009. Epub 2009 Jun 21.

Hopital de la Conception, 257 bd Baille, Marseille, 13005, France.

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http://dx.doi.org/10.1136/bcr.12.2008.1311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3027957PMC
July 2011

Mefloquine versus 3-day oral quinine-clindamycin in uncomplicated imported falciparum malaria.

Travel Med Infect Dis 2007 Sep 20;5(5):306-9. Epub 2007 Aug 20.

Laboratoire de Parasitologie et Mycologie, IFR 48, Faculté de Médecine, 27 Bd. Jean Moulin, 13385 Marseille Cedex 5, France.

In this open randomized trial comparing 3-day oral quinine-clindamycin versus standard mefloquine regimen for uncomplicated imported falciparum malaria, mefloquine treatment was associated with a higher risk of discontinuation of the treatment (RR=1.8, 95% CI [1.1-2.8]) related to mainly mild gastrointestinal adverse drug events. The poor tolerability of mefloquine sets a question mark against its use in outpatients.
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http://dx.doi.org/10.1016/j.tmaid.2007.07.001DOI Listing
September 2007

Molecular study of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon intestinalis among human immunodeficiency virus-infected patients from two geographical areas: Niamey, Niger, and Hanoi, Vietnam.

J Clin Microbiol 2007 Sep 18;45(9):2999-3002. Epub 2007 Jul 18.

Laboratory of Parasitology and Mycology, Nantes University Hospital, Nantes, France.

Microsporidiosis cases due to Enterocytozoon bieneusi and Encephalitozoon intestinalis are emerging opportunistic infections associated with a wide range of clinical syndromes in humans. The aim of this study was to specify microsporidial epidemiology in two different geographical areas. From November 2004 to August 2005, 228 and 42 stool samples were collected in Niamey, Niger, and Hanoi, Vietnam, respectively. Screening for microsporidia was performed using UV-light microscopy. Detection was confirmed by molecular biology using two methods specific for E. bieneusi and E. intestinalis. All samples positive for E. bieneusi were subjected to genotyping. In this study, we found high prevalences of microsporidiosis among human immunodeficiency virus-infected patients, 10.5% and 9.5%, respectively, in Niamey and Hanoi. These levels of prevalence are similar to those recorded in European countries before highly active antiretroviral therapy was introduced. In the samples positive for E. bieneusi, we found seven distinct genotypes, including two genotypes not previously described. The E. bieneusi genotype distributions in the two geographical areas suggest different routes of infection transmission, person-to-person in Niger and zoonotic in Vietnam.
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http://dx.doi.org/10.1128/JCM.00684-07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2045311PMC
September 2007

Field-based evidence for the linkage of pfcrt and pfdhfr drug-resistant malaria genotypes and clinical profiles of severe malaria in Niger.

Microbes Infect 2007 Apr 20;9(5):599-604. Epub 2007 Feb 20.

Department of Parasitology, CERMES, Boulevard de la Nation, BP 10887, Niamey, Niger.

Drug resistance has been shown to increase malaria mortality and morbidity in both community- and hospital-based studies. We investigated the association between two Plasmodium falciparum drug resistance-related molecular markers and clinical profiles of severe malaria in children hospitalised in Niger. PCR-RFLP analysis showed that the codon 108 mutation of the pfdhfr gene was positively linked to severe malarial anaemia. These findings are consistent with persistent parasite infection leading to unbalanced anaemia in young children. No significant relationship was found between the molecular markers and hypoglycaemia or hyperparasitaemia. Conversely, the pfcrt T76 mutation was found to be negatively associated with cerebral malaria and neurological symptoms, such as convulsions and coma. These results have implications for the strain-specific virulence hypothesis and for parasite fitness and evolution. Our findings are discussed in regard to the local malaria transmission level.
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http://dx.doi.org/10.1016/j.micinf.2007.02.003DOI Listing
April 2007

Genetic diversity and structure of African Plasmodium falciparum populations in urban and rural areas.

Am J Trop Med Hyg 2006 Jun;74(6):953-9

Institut de Médecine Tropicale du Service de Santé des Armées, Unité de Recherche en Biologie et Epidémiologie Parasitaire, Marseille, France.

The genetic variability and population structure of Plasmodium falciparum are key factors in malaria control strategies. Studies have suggested no P. falciparum population structure although linkage disequilibrium was observed in some African areas. We have assessed length polymorphism at 6-22 microsatellites in four urban and rural sites (Djibouti, Dakar, Niamey, and Zouan-Hounien, n = 240 blood samples). Results have shown a P. falciparum population structure in Africa (Fst = 0.17-0.24), lower genetic diversity in Djibouti (He = 0.53) than in the other sites (He = 0.73-0.76), and 3) significant linkage disequilibrium in Djibouti. These results could be related to geographic isolation and low flow of parasites between sites. They also suggest a potential effect of rural suburbs to generate genetic diversity in towns. This could affect the dispersal of selected drug resistance and should be considered when adapting urban malaria control strategies.
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June 2006

Epidemiological, clinical and biological features of malaria among children in Niamey, Niger.

Malar J 2005 Feb 9;4:10. Epub 2005 Feb 9.

Laboratory of Medical Biology, National Hospital of Niamey, Niamey, Niger.

Background: Malaria takes a heavy toll in Niger, one of the world's poorest countries. Previous evaluations conducted in the context of the strategy for the Integrated Management of Childhood Illness, showed that 84% of severe malaria cases and 64 % of ordinary cases are not correctly managed. The aim of this survey was to describe epidemiological, clinical and biological features of malaria among <5 year-old children in the paediatric department of the National Hospital of Niamey, Niger's main referral hospital.

Methods: The study was performed in 2003 during the rainy season from July 25th to October 25th. Microscopic diagnosis of malaria, complete blood cell counts and measurement of glycaemia were performed in compliance with the routine procedure of the laboratory. Epidemiological data was collected through interviews with mothers.

Results: 256 children aged 3-60 months were included in the study. Anthropometrics and epidemiological data were typical of a very underprivileged population: 58% of the children were suffering from malnutrition and all were from poor families. Diagnosis of malaria was confirmed by microscopy in 52% of the cases. Clinical symptoms upon admission were non-specific, but there was a significant combination between a positive thick blood smear and neurological symptoms, and between a positive thick blood smear and splenomegaly. Thrombopaenia was also statistically more frequent among confirmed cases of malaria. The prevalence of severe malaria was 86%, including cases of severe anaemia among < 2 year-old children and neurological forms after 2 years of age. Overall mortality was 20% among confirmed cases and 21% among severe cases.

Conclusions: The study confirmed that malaria was a major burden for the National Hospital of Niamey. Children hospitalized for malaria had an underprivileged background. Two distinctive features were the prevalence of severe malaria and a high mortality rate. Medical and non-medical underlying factors which may explain such a situation are discussed.
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http://dx.doi.org/10.1186/1475-2875-4-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC549526PMC
February 2005

Schistosomal appendicitis.

Lancet Infect Dis 2004 Aug;4(8):498

Service des Maladies Infectieuses et Tropicales, CHU Nord, Marseille, France.

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http://dx.doi.org/10.1016/S1473-3099(04)01104-1DOI Listing
August 2004

Febrile Broca's aphasia: a rare presentation of typhoid fever.

J Travel Med 2003 May-Jun;10(3):192-3

Service des Maladies Infectieuses et Tropicales, Hôpital Nord, Marseille, France.

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http://dx.doi.org/10.2310/7060.2003.35773DOI Listing
September 2003
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