Tag Archives: Neglected Tropical Diseases

Marie Anne and the WHO investigate Cholera in Sierra Leone

I believe accurate reporting of infectious diseases, including diarrhoeal diseases, to be a significant issue of consideration in both developed and developing nations.  Accurate reporting by the individual, as well as by medical and government institutions, is imperative for analysis of infectious disease epidemiology. With accurate reporting, especially of cholera cases and cholera typing, appropriate therapeutic and preventative measures can be put in place. 

Here, Marie Anne Chattaway, a microbiologist from the UK, describes her experiences working with the WHO in Sierra Leone establishing an Enteric Bacteria Laboratory in Sierra Leone.  Their goal was to aid cholera diagnosis and reporting in this region.  I can’t thank Marie Anne (marie.chattaway@hpa.org.uk) enough for sharing her project.  I wish her and the taskforce every success in the future.

Thank you to Marie Anne, WHO and Sierra Leone.      


Marie Anne and Cholera in Sierra Leone


Picture 1: Map of Sierra Leone

I first became interested in developing countries when I started to volunteer for JIDC (The Journal of Infection in Developing Countries) a couple of years ago as a scientific editor and reviewer where the focus was mentoring scientists to publish their research in a scientific journal. I have been working with enteric pathogens for over five years at the Health Protection Agency of the UK and now realise just how much of an impact bacterial enteric infection has in developing countries. Until now, I had only managed to help from the UK, but the outbreak in Sierra Leone provided me with an opportunity to really use my microbiological skills where it was needed the most.

Cholera outbreak in Sierra Leone

Sierra Leone (Picture 1) has recently battled its worst cholera outbreak in 15 years. In

Picture 2: Crowded housing at risk of cholera

Picture 2: Crowded housing at risk of cholera

July and August 2012, the epidemic rapidly spread to all but one of Sierra Leone’s 13 districts. With a combination of crowded housing (Picture 2), unsafe water supplies, poor sanitation and the rainy season ahead, intervention was paramount. On 16 August 2012, the Sierra Leone government declared the outbreak to be a public health emergency, and established the Presidential Taskforce on Cholera. As of 2 October 2012, there had been 20,736 cases, including 280 deaths (case fatality rate or CFR=1.35%). The western area of the country where the capital city of Freetown is located was the most affected area with more than 50% of total cases. Initial training and some supplies were provided to the Central Public Health Reference Laboratory (CPHRL), Lakka and Connaught Hospital, in Freetown by the World Health Organization (WHO) and International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B).  The Global Outbreak Alert Response Network (GOARN) later requested a microbiologist to further evaluate laboratory facilities and provide technical advice and assistance to strengthen laboratory services for detection of cholera cases, capacity for confirmation by laboratory identification and for conducting differential diagnosis for main enteric pathogens (e.g., Vibrio cholera, Shigella, Salmonella, E. coli). The Health Protection Agency (HPA), UK, sent a microbiologist from the Gastrointestinal Bacteria Reference Unit (GBRU) to undertake this task from 10 October to 8 November 2012.

Travel to Freetown

The HPA was already involved with the cholera outbreak with a focus on epidemiology and case management; Sarika Desai and William Welfare from the HPA had already been deployed as WHO consultants. The specific request for a microbiologist to go to Sierra Leone for the month came later and though I had volunteered to go, in the end I had only 24 hours’ notice that I was on the flight the next day and that urgent supplies were needed. Needless to say, my two large suitcases were filled with consumables as well as clothes, a ridiculous amount of a range of pharmaceutical products (which I did end up using – unfortunately), and insect repellent (the insects still got me, though). I’m not sure what part of the journey was the worst: the bad turbulence on the plane with the woman behind me screaming; the small speedboat trip across the sea in the pitch black;  the jolting of the spine across the dirt tracks in the jeep;, or the sickness on arriving when adapting to the humidity and heat (as you know, we English are used to the cold). Either way, I did make it in one piece and was so happy that I didn’t crash in the plane and impressed by the stunning views (Picture 3) that actually I didn’t mind the bumpy roads.

Picture 3: One of the many stunning views in Freetown

Picture 3: One of the many stunning views in Freetown

Assessment of the laboratory

I was fortunate that there was a dedicated laboratory which had been selected to develop testing based at the Central Public Health Reference Laboratory (CPHRL) in Lakka. It was an hour away from the WHO office. Prior to intervention the department was faced with challenges of the lack of supplies, shortage of available trained staff, poor processing systems, and inadequate Health and Safety protocols in the enteric bacteria section of the CPHRL. The icddr-b had done a fantastic emergency response but further work was now required to establish and maintain an enteric bacteria laboratory in Sierra Leone.

Establishing an Enteric Bacteria Laboratory in Sierra Leone

Before training could even begin, a supplies stock system with the support of the WHO, HPA, CDC and Ministry of Health and Sanitation (MoHS) was set up to receive the required equipment and supplies. Molly Freemen from the Enteric Diseases Laboratory Branch of the CDC joined me for 11 days and the collaboration of all these organisations enabled the success of this mission. Intense training of multiple staff was necessary to maintain function after I left and the staff worked incredibly hard, even coming in at weekends and public holidays. A quality accredited process was set up, including the design of request forms for necessary information, the development of protocols for taking samples, receiving and logging the samples into CPHRL, and testing and recording results on the enteric result database for reporting (Picture 4). A surveillance link was also set up

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

so that regular weekly reporting of confirmed enteric pathogens is fed back. The two weeks of practical (Picture 5) and theoretical training was followed by intense three-day theory and practical competency testing. Staff were then certificated in “Isolation and identification of Vibrio cholerae, Salmonella typhi, non-typhoida, lSalmonella, Shigella sp. and E. coli O157” and “Health and Safety and Quality Systems in the enteric bacteria laboratory” (Picture 6).

Picture 6: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Picture 5: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Challenges and future Work

To sustain the new laboratory service, there is still much work to be done.  The supply system must be managed to ensure stock is available when needed.  Regular testing at the laboratory and reporting of results are essential for monitoring the cholera situation in the country. The biggest challenge will be the organisation and implementation of regular sample collection and transport to CPHRL.  Without regular samples from the districts, the testing competency and surveillance cannot be maintained. The impact of this part of the international response has been considerable; there is now a system for detecting and confirming cholera and other enteric pathogens within Sierra Leone.  If this laboratory component of surveillance is sustained it will lead to a better understanding of the incidence of cholera in the country and provide earlier recognition should the infection become epidemic again, thus enabling a rapid response.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Would I recommend this experience

Absolutely! It was an amazing experience, from networking and collaborating on an international scale with the most amazing and interesting people to experiencing the culture. I felt a real sense of achievement seeing how I can personally make a difference. It is hard work, working long hours with little breaks in sometimes difficult conditions, but the end result was worth any hardship. My favourite challenge was when I first opened the incubator to find lots of small ants favouring the Trypticase Soy agarplates. At first I didn’t think much of it, but when I looked at the plates carefully I saw tiny ant footsteps left by the insects that had walked on a cholera plate just after it had been inoculated. The ants had walked across the plate, dragging the bacteria with it (Picture 7). It is possible that perhaps there is a vector influence with the spread of some diseases that we wouldn’t normally consider!

By Marie Anne Chattaway

**Pictures taken by Marie Anne Chattaway, HPA.

Picture 8: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

Picture 7: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).


Filed under Countries, Infectious Disease, Postcards, Sierra Leone, Vibrio cholera

Goodbye 2011 and Hello New Science Year 2012: JIDC Postcards 2011- a Wrap-up

Good Bye 2011.  Hello New Science Year! Its 2012!  I hope everyone had a fabulous 2011 and rang in 2012 with a (big) bang!

There is so much a new year brings, especially in science. A new year with many possibilities. New conferences to attend (yeah!). Papers to publish. Exciting projects to start.  And new posts to write for the JIDC Blog!

To move forward in a guided direction I often feel we need to review the past.  What conferences were attended?  Were they beneficial? What papers were we able to publish last year? Were they well received? What are the stages of the current projects? Are they close to a publication? Are they close to completion?

And here at the JIDC Blog, what were the posts on the Blog over the last year?  Were they helpful to readers and authors? Did they promote scientific discussion? Were the Blog and the Blog Posts a good resource for research information? – This was my main goal when starting the JIDC Blog.  My hope was that the Blog would be useful to JIDC readers and authors alike as an information resource as well as a point for discussions.  I also hoped that it would be a valuable tool for non-JIDC members and help educate new people about JIDC.

So shall we review?

There is a blog tradition that I have only just learned about.  The tradition is that the first post of the New Year should be a listing of all the first sentences from the first post of every month from the previous year.

Below is a listing of all of the first Posts of every month in 2011 and the first sentences from each.  I have also added my personal notes from each post.

Here we go…

June 2011 — JIDC Postcards: The JIDC Blog

Hi, and welcome to JIDC’s blog. 

I was sooo excited…and nervous to introduce the Blog to the JIDC community and the world.  Would anyone read it? Would anyone like it?  Would it be a Blog that we could be proud of? Only you can answer these questions for me. 


July 2011 – Olga:  From Mozambique to Brazil

A Challenge!! An Opportunity!!

My name is Olga André Chichava, and I’m a young biologist fromMozambique!

I absolutely loved this post from Olga. Her story gave an incredible view into the life of a research student who is also a mother.  I was inspired to see her courage to move to a foreign country and her drive to build her masters project.   She shared her passion for research as well as life with us. This post was featured on the headlines of Microbiology Daily, I was so proud. Also, this post is the most popular post on the Blog.


August 2011 – Milliedes in Kashmir,India

Insects have been found in Marrhama, a village in Blok Trehgam in the District of Kupwara Jammu and Kashmir, India. The main water source used for drinking purposes is badly affected by the insects.

This post from Dr. Kadri highlighted problems that affect regional areas which can easily go unnoticed to the rest of the world.  I am so glad that he shared this experience so that more people can be aware of such difficulties that face communities. This is the second most popular post of all time on the Blog and I am happy that it has reached so many people!


September 2011 – The First Annual Conference on Drug Therapy in TB Infection

The Africa Health Research Organization, AHRO, presents the International Conference on Drug Therapy in TB Infection

What: First International Conference on Drug Therapy in TB Infection
When: 6-7 January 2012
Where: Edinburgh Scotland
Who: Presented by AHRO,Africa Health Research Organization

It was great to post about this conference.  Since the conference was just completed, I hope that everything went well and it was a successful event.  Also, I would love to hear a roundup of the conference by anyone who attended.  Please contact me if you are interested in writing a Blog Post describing this meeting.


October 2011 – And the winner is…! JIDC Open Access Week#4

And the winner is….I just couldn’t help it.  I have enjoyed Open Access Week and the JIDC T-shirt give-away that I could not just draw only 1 name.  So I picked 6!

Ooooo this was an exciting one.  I was incredibly happy to share JIDC and the JIDC T-shirts with readers and authors! If you are a winner and you haven’t contacted me and would still like at T-shirt, please let me know.


November 2011 – Publishing a Scientific Article in JIDC

How do I publish a scientific paper?…This question is asked by all young scientists. 

How do you write a scientific paper? There are so many directions one can take when putting their research together. I hope this helped authors organize themselves when preparing manuscripts for JIDC.  In addition to this Post, if you have other specific questions about writing a paper or you have a particular writing topic you would like to see a post about, please don’t hesitate to let me know.  I am currently preparing a post how I write a scientific paper to share with you.


December 2011 – ReR – MedToday!

Memento te hominem esse. – Remember that you are human.

What an important point that is! Remember you are human. We are all vulnerable and delicate aren’t we? I am so happy to have posted the special work of ReR-MedToday! The importance of support during times of ill health can’t be overstated. I am sure the families touched by this organization are forever grateful.


Thats a Wrap! 

So that’s the JIDC Blog for 2011.  I hope 2012 brings just as fabulous Posts and discussions as 2011 did.

I would like to thank everyone who contributed to the Posts and Discussion of the 2011 JIDC Blog!  In no particular order, BIG THANKS to:

IRIN and Jane Summ

Olga Andre Chichava

Prof. Jorg Heukelbach

Anna Carolina Ritter

Laboratory of Food Microbiology of the ICTA/UFRGS

Federal University of Rio Grande do Sul

Dr. Vinod Singh


David Dorherty

Joanne Wong

Dr. S.M. Kadri

Open Access and Open Access Week



Donna Okubo

Dr. Amber Farooqui

Jain et al., JIDC 2011

Dr. Abubaker Yaro

Annals of Tropical Medicine and Public Health

1st International Conference on Drug Therapy in TB Infection

The Grandest Challenge

Dr. Abdallah S. Daar

Dr. Peter A. Singer

Sun et al., JIDC 2011

Amedei et al., JIDC 2011

Elios et al., JIDC 2011

Jeff Coombs

Tracy Zao

Ashish Chandra Shrestha

Sara Norris

Christopher Logue

Sunita Pareek

Marie Anne Chattaway

Chimwemwe Mandalasi

Jane-Francis Akoachere

University of Buea, Cameroon

Nikki Kelvin

Tribaldos et al., JIDC 2011

Dr. Lorelei Silverman

Dr. Rosalind Silverman

Models of Human Diseases


University Hospital of Hue, Vietnam

University of Sassari

Dr. Le Van An

Dr. Tran

Prof. Piero Cappuccinelli

Remi Eryk Raitza



Drake Current

Current Family

Dr. Myo Nyein Aung

School of Tropical Medicine, Mahidol University, Bangkok

And a spceial thanks to Prof. Salvatore Rubino for his support of the Blog!

Reflecting on the 2011 Blog has shown me I have lots more science to cover! It has also spiked my curiosity.  What was your favorite Post of 2011?  What about your Favorite JIDC Postcard? Was there a topic that you enjoyed reading about or a Postcard that you could identify with? Let me know. I love to hear from you!


Filed under Amber, Countries, Editor's Pick, Environmental Issues, JIDC News, Open Access, People, Postcards, Science Thoughts, Science Tools, Scientific Writing, Wrap-Up

Olga: From Mozambique to Brazil!


I am sooooooo excited to share this Postcard from Olga Andre Chichava.  Her post made me laugh, cry and most importantly think!  Olga is a science mom from Mozambique who studied Leprosy in Brazil.  Her post encompasses the vision of the JIDC Postcard and I am proud to have her on the Blog.  There is no doubt Olga has a bright future ahead of her!   




 A Challenge!! An Opportunity!!

My name is Olga André Chichava, and I’m a young biologist from Mozambique!

It has always been my dream to study abroad, to know how others do research and then hopefully help to improve the Health Sector back in my home country.

The opportunity arose in February 2009, when I was awarded a Brazilian Government “PEC-PG” scholarship (CNPq) and was accepted at the Public Health Master program at Ceará Federal University (Fortaleza, Brazil) under the supervision of Prof. Jörg Heukelbach.

The decision to go to Fortaleza was not easy, since I had a 3-year-old daughter and my husband was also abroad, enrolled in a PhD program in Japan. After a lot of discussions, we came to the agreement of leaving our daughter with my parents in Mozambique and took all provisions so she could have a “normal life” (expect our warm love and affection) while we both were abroad.

Upon choosing the hard way, and despite the semester starting at the end of that same month, a painful two-month waiting period followed, because the travel expenses, which were to be provided by my government, were still not available. I lost several classes and was informed that the ticket had been purchased, just a day before my departure on March 17, 2009!

In Brazil, I was welcomed by nice people but also with a long bureaucratic process regarding my student registration, which had to be done while attending classes and trying to recover the lost credits. This ended up adding further complications and delays in receiving my scholarship funds. So I had to live for several months without any funds. But Brazilians helped me a lot so that I was able to conclude all mandatory lectures and get the credit points.

I then joined the research team of the MAPATOPI project, an interdisciplinary approach to improve the leprosy control program in Brazil, coordinated by Prof. Heukelbach.

Leprosy is an infecto-contagious disease with a chronic evolution and high infectivity, though low pathogenicity, caused by the intracellular and acid-resistant bacteria Mycobacterium leprae (Fogos AR et al., 2000). The transmission occurs to people who have been in contact with a sick, non-medicated person; its immunogenic power is responsible for the high incapacitating potential of the illness.

Foot lesion, rural Lizarda, Tocantins State – 2009 Photo by Kathrin Hafner

Despite numerous efforts and advances to control leprosy in the world, the disease is still a serious public health’s problem in Brazil and several other countries (Galvao et al., 2008; Goulart IMB et al., 2002; ). Until 2007, Mozambique was the nation with the highest prevalence rate in Africa (Griffiths S & Ready N 2001;  Honrado ER et al., 2008). According to the World Health Organization (WHO), the annual detection rate of leprosy in the endemic regions has considerably declined since 2002, and the number of new cases as of 2008 was about 249.000, confirming that the disease hasn’t been yet eliminated from the Asian, South American and African continents (El Hassan LA et al., 2002; Heijnders ML 2004).



So, I found it interesting to join this team of professionals and took up the challenge of researching not just about this contagious disease, but to also excel myself in epidemiology investigation, so needed to contain many other diseases back home.

Interviewing a patient in his house, rural Miracema, Tocantins State – 2009. Photo taken by Friederike Walter

The study was conducted in 78 municipalities in Tocantins State, Central Brazil, a leprosy endemic area. Tocantins is the State with the highest leprosy annual detection rate (about 88.5 new cases per 100.000 population/year) (Kerr-pontes LR et al., 2006). So this was a real exciting challenge! We visited all these 78 districts and included all leprosy patients from these districts in the study. The field work was done in four months, in which we conducted scheduled interviews with patients usually in the local Health Centers, in both periods of the day. However, on several occasions we had to go after the patients because they did not show up, either because they lived far away, were at work, or their health condition was too poor. This situation was common in the rural areas and an extra effort was put in place to reduce the non-participation bias (Chalise SC 2005). The daily number of interviews ranged from 12 to 25, and we included a total of about 1,000 individuals with leprosy in the study.

Conducting an interview at the local Health Center, Miracema City, Tocantins State – 2009. Photo taken by Friederike Walter



My task was to identify risk factors for defaulting multidrug therapy that usually lasts 6-12 months. I have perceived that adherence to therapy is a result of a complex interaction between different socio-cultural, service-related, drug-related and economical factors (Aagard-Hansen et al., 2010; Altice FL & Friedland G 1998; Coebergh JA & Buddingh H 2004; Fogos AR et al., 2000; Ignotti E et al., 2001; Kar S et al., 2010; Nsagha DS et al., 2009; Natal S et al., 1999; Trindade LC et al., 2009). Intermittent problems of drug supply need to be resolved and many people complained of problems swallowing the drugs; thus producers should consider oral drug formulations that may be more easily accepted by patients (Chichava OA et al., 2011; Rao PS 2008). I have seen how complex public health interventions can be, and that an integrated approach is needed to further improve adherence and other aspects of leprosy control, such as early diagnosis. Improved adherence to treatment will further improve the leprosy control programs and in addition minimize the risk of possibly upcoming drug resistance. I am happy that I could contribute to the control of such an interesting disease and I learned a lot about epidemiological studies, not only in theory, but also in practice. I defended my Master’s thesis in less than two years, and the results of my study were published in two scientific journals: “Reasons for interrupting Multidrug Therapy against Leprosy: The patient’s point of view; Lepr Rev (2011) 82, 78-79” (Chichava OA et al., 2011) and “Interruption and Defaulting of Multidrug Therapy against Leprosy: Population-Based Study in Brazil’s Savannah Region; PLoS Negl Trop Dis (2011) 5(5): 1031” (Heukelbach J et al., 2011).



I am currently living with my lovely daughter and husband in Japan for the remainder of his PhD course, while we repair our broken family links and boost ourselves for the service of our country, starting probably mid next year!

Thank you very much for allowing me to share my little story with all of you in this blog.

Warm regards

Olga André Chichava 


Olga Andre Chichava was born in Maputo, Mozambique, and is 35 years old.  She attended primary school at “Escola Primaria 7 de Setembro”, junior high-school at “Escola Secundaria Josina Machel”, high-school at “Escola Secundaria Francisco Manyanga” and college at “Universidade Eduardo Mondlane”, all in Mozambique’s capital city Maputo. After college she worked at the private clinical laboratory “LAC-Laboratorio de Analises Clinicas”, before studying in Brazil.


AAGARD-HANSEN, J. H.; NOMBELA, N. & ALVAR, J. Population movement: a key factor in the epidemiology of neglected tropical diseases. Tropical Medicine and International Health, 15(11): 1281-1288, 2010.

ALTICE, F. L. & FRIEDLAND, G. H. The era of adherence to HIV therapy. Annals of Internal Medicine, 129(6): 503-505, 1998.

CHALISE, S. C. Leprosy disease in Nepal: Knowledge and non-compliance of patients. Journal of Nepal Medical Association 44(158): 39-43, 2005.

CHICHAVA, O. A.; ARIZA, L.; OLIVEIRA, A. R.; FERREIRA, A. C.; MARQUES  DA SILVA, L. F.; BARBOSA, J. C.; RAMOS JR., A. N.; HEUKELBACH, J. Reasons for interrupting multidrug therapy against leprosy: the patients’ point of view. Leprosy Review, 82, 78-79, 2011.

COEBERGH, J. A. & BUDDINGH, H. Non-adherence to leprosy treatment in Western Sudan; the people behind the numbers. Leprosy Review, 75(4): 404, 2004.

EL HASSAN, L. A.; KHALIL, E. A. & EL-HASSAN, A. M. Socio-cultural aspects of leprosy among the Masalit and Hawsa tribes in the Sudan. Leprosy Review, 73(1): 20-28, 2002.

FOGOS, A. R.; OLIVEIRA, E. R. A. & GARCIA, M. L. T. Análise dos motivos para abandono do tratamento – o caso dos pacientes hansenianos da Unidade de Saúde em Carapina/ES. Hansenologia Internationalis, 25(2): 147-156, 2000.

GALVÃO, P. R. S.; FERREIRA, A. T.; MACIEL, M. D. G. G.; ALMEIDA, R. P.; HINDERS, D.; SCHREUDER, P. A.; KERR-PONTES, L. R. An evaluation of the SINAN health information system as used by the Hansen’s disease control programme, Pernambuco State, Brazil. Leprosy Review, 79(2): 171-182, 2008.

GOULART, I. M. B.; ARBEX, M. H. C.; RODRIGUES, M. S.;GADIA, R., Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um centro de saúde da Universidade Federal de Uberlândia. Revista da Sociedade Brasileira de Medicina Tropical, 35(5):453-460, 2002.

GRIFFITHS, S. & READY, N. Defaulting patterns in a provincial leprosy control programme in Northern Mozambique. Leprosy Review, 72(2): 199-205, 2001.

HONRADO, E. R.; TALLO, V.; BALIS, C. A.; CHAN, G. P.; CHO, S. N. Noncompliance with the World Health Organization multidrug therapy among leprosy patients in Cebu, Philipines: Its causes and implications on the leprosy control program. Dermatologic Clinics, 26(74): 221-229, 2008.

HEIJNDERS, M. L. An exploration of the views of people with in Nepal concerning the quality of leprosy services and their impact on adherence behavior. Leprosy Review, 75(4): 338-347 2004.

HEUKELBACH, J.; CHICHAVA, O. A.; OLIVEIRA, A. R.; HAFNER, K.; WALTER, F.; MORAIS DE ALENCAR, C. H.; RAMOS JR., A. N.; FERREIRA, A. C.; ARIZA, L. Interrupting and defaulting of multidrug therapy against leprosy: Population-Based study in Brazil’s Savannah Region. Neglected Tropical Diseases, 5(5), e 1031, 2011.

IGNOTTI, E.; ANDRADE, V. L. G.; SABROSA, P. C.; ARAÚJO, A. J. G. Estudo da adesão ao tratamento da hanseníase no município de Duque de Caxias – Rio de Janiero. Abandonos ou abandonados? Hansenologia Internationalis, 26(1): 23-30, 2001.

KAR, S.; PAL, R. & BHARATI, D. R. Understanding non-compiance with WHO-multidrug therapy among leprosy patients in Assam, India. Jornal of Neurosciences in Rural Practice, 1(1): 9-13, 2010.

KERR-PONTES, L. R.; BARRETO, M. L.; EVANGELISTA, C. M.; RODRIGUES, L.C.; HEUKELBACH, J.; FELDMEIER, H. Socioeconomic, environmental, and behavioural risk factors for leprosy in Northeast Brazil: results of a case-control study. International Journal of Epidemiology, 35(4): 994-1000, 2006.

KUMAR, R. B. C.; SINGHASIVANON, P.; MEHAISAVARIYA, P.; KAEWKUNGWAL, J.; SHERCHAND, J. B.; PEERAPAKORN, S.; MAHOTARN, K. Gender differences in epidemiological factors associated with treatment completion status of leprosy patients in the most hyperendemic district of Nepal. Southeast Asian Journal of Tropical Medicine and Public Health, 35(2): 334-339, 2004.

LOCKWOOD, D. & SUNEETHA, S. Leprosy: too complex a disease for a simple elimination paradigm. Bulletin of the World Health Organization, 83(3): 230-235, 2005.

NSAGHA, D. S.; BAMGBOYE, E. A. & OYEDIRAN, A. B. O. O. Operational barrier to the implementation of multidrug therapy and leprosy elimination in cameroon. Indian Journal Dermatol Venereol Leprol, 75 (5): 469-475, 2009.

NATAL, S.; VALENTE, J.; GERHARDIT, G.; PENNA, M.L. Modelo de predição para o abandono do tratamento da tuberculose pulmonar. Boletim de Pneumologia Sanitária, 7(1): 65-78, 1999.

RAO, P. S. A study on non adherence to MDT among leprosy patients. Indian journal leprosy, 80: 149-154, 2008.

TRINDADE, L. C.; ZAMORA, A. R. N.; MENDES, M. S.; CAMPOS, G. P.; AQUINO, J. A. P.; CANTÍDIO, M. M.; HEUKELBACH, J. Fatores associados ao abandono do tratamento da hanseníase em João Pessoa, Estado de Paraíba. Cadernos Saúde Coletiva, 17(1): 51-65, 2009.


Filed under Infectious Disease, Leprosy, Mozambique, Postcards

Outbreaks: Chikungunya outbreak in the Republic of Congo

JIDC Outbreaks

JIDC is introducing a new section of our Blog, Outbreaks.  Outbreaks will report on current infectious outbreaks worldwide and will include a summary of scientific information and /or epidemiology concerning the pathogen.  If you have an outbreak to report or a summary you would like to see posted, please contact me at akelvin@jidc.org

Outbreak:  Chikungunya Outbreak in the Republic of Congo

Chikungunya fever is a crippling disease caused by an arthropod-borne virus (arbovirus) transmitted to humans through mosquitoes.  Although Chikungunya virus is not often associated with mortality, the effects of virus outbreaks are often devastating, causing significant economic loss.  The recent outbreak of Chikungunya fever in the Republic of Congo has reported thousands of people affected. 


Outbreak of Chikungunya in the Republic of Congo

It was reported by IRIN, the UN’s humanitarian news and analysis service, on June 15th, 2011 that a large outbreak of possible Chikungunya fever (CHIKF) is affecting the Republic of Congo (http://www.irinnews.org/Report.aspx?ReportID=92989)[1]. In Brazzaville, the Republic of Congo’s largest city, an estimated 1,000 cases of CHIKF is suspected since the beginning of June.  CHIKF in humans is caused by infection of the chikungunya virus (CHIKV) which is transmitted by mosquitoes to people (arbovirus)[2].  Testing of patients who presented with CHIKF symptoms in the Republic of Congo have resulted positive for the CHIKV. 

IRIN reported “More than 900 people are showing symptoms of chikungunya, which is transmitted by mosquito,” Director-General of Health Alexis Elira Dokekias told a news conference on 14 June. 

By the end of June (June 28, 2011) an IRIN representative reported there were approximately 8,000 CHIKF affected people with no associated deaths. 

Although historically CHIKV is found in tropical regions of the globe, outbreaks have been reported in temperate regions suggesting the expanding tropism of the virus.


JIDC has published 3 articles on CHIKV that can be found Open Access on the JIDC website:

  1.  A Review of Chikungunya by Cavrini F. et al., JIDC 2009 entitled Chikungunya:  an emerging and spreading arthropod-borne viral disease [2].
  2. Antiviral therapy for Chikungunya by Ravichandran R. and Manian M. JIDC 2008 entitled Ribavirin therapy for Chikungunya arthritis [3].
  3. A Case Report of Chikungunya in India by Kumari R. et al., JIDC 2010 entitled The first Chikungunya case from Sonipat district near the national capital city of Delhi, India[4].


CHIKF not only a disease of the tropics

Historically CHIKV was only found in tropical regions.  In 2007, an outbreak of CHIKV occurred in Emilia Romagna region of Northern Italy.  The Italian outbreak of CHIKV spread through communities surrounding the city of Ravenna during August to October 2007 and also involved the major Italian city of Bologna [5,6].  In Italy, 254 people were determined to be infected with CHIKV which was transmitted by Ae. albopictus mosquito. The mosquito has been found in the Emilia Romagna region since 1990 [7–9].  The virus was brought to the Emilia Romagna region by a traveller returning from a CHIKV affected country.  The virus was of the Central/East African virus genotype [7,8].  Genomic sequencing showed that the amino acids sequence included a substitution mutation in the E1 envelope protein (E1-A226V) [10] which is important for viral entry into host cells.  This mutation was acquired during the large 2005-2006 Indian Ocean CHIKV outbreak and enabled the virus to infect the Ae. albopictus mosquito where previously it only infected the Ae. aegyptii [11].  Importantly, from this outbreak, it was shown that temperate regions are also susceptible to the CHIKV infections and not only tropical regions.  

CHIKV Outbreak in Emilia Romagna region of Northern Italy. Cavrini F. et al., JIDC 2009


History of CHIKV

Interestingly, CHIKV has been shown to infect and be transmitted by 2 species of mosquitoes:  Ae. aegyptii and Ae. albopictus mosquitoes.  Chikungunya was identified in East Africa in the early 1950s and since then has caused epidemics in continental Africa, the Indian Ocean region, and countries of Southeast Asia such as India where there has been an estimated 1.39 million cases (since 2006) [4,12–15] .  The only reported outbreak outside of these areas was in Italy in the Emilia Romagna region in 2007.  Small non-epidemic imported cases have been reported in other regions such as North America, France and Japan which were caused by travellers returning from affected areas [16–18]. 

The epidemic which occurred on La Reunion Island, Indian Ocean in 2005-2006 was a devastating CHIKV outbreak where over one-third of the population was affected [19].  During this outbreak, the CHIKV acquired a genetic mutation permiting the Ae. albopictus mosquito to carry the CHIKV.  Previously CHIKV only circulated in Ae. aegyptii mosquitoes [19,20].  CHIKV is now of global health concern since expansion of mosquito vectors has created potential for the Chikungunya virus to spread to temperate areas as Ae. albopitcus inhabits regions in North America and Europe [21,22].     

CHIKV Clinical Manifestations

The defining symptom of CHIKF is severe joint pain and as the severe joint pain increases the patient often takes a bent posture.  Chikungunya, a word originating from the Tanzanian and Mozambique region meaning that which bends up, describes this distorted posture[20].  Other symptoms of CHIKF include sudden appearance of high fever, rash, headache, nausea, vomiting, myalgia and arthalgia or severe joint pain.  Symptoms start 4 to 7 days following infection which defines the acute phase of CHIKF.  Importantly, the acute phase lasts approximately 2 weeks, joint pain can persist for months or years following initial infection [6,7,23]. 

CHIKV Immune Response and Treatments

Currently, the immune response for CHIKV infection remains largely uninvestigated and there is no specific treatment available.  Reported in 2010, Ravichandran R. and Manian M. investigated the use of the antiviral agent ribavirin in patients suffering from severe joint pain attributed to CHIKV infection [3].  The ribavirin treated patients had a faster resolution of joint pain and joint inflammation compared to a control patient group.     

Cytokines have also been investigated as possible therapeutic drug targets and or biomarkers for CHIKF [24,25].  Importantly, Cytokines are immune mediators that direct immune responses during infection.  Ng and colleagues found that IL-1b, IL-6 and RANTES were correlated with severe acute phase CHIKF during the Singapore 2007 CHIKV outbreak [25].  Recently it was reported the acute phase of CHIKV infection is characterized by a strong innate immune response leading to CD8 T cell adaptive immunity[26]. It is clear that the immune response toward CHIKV needs to be further investigation and the cytokine signatures validated as possible biomarkers and/or drug targets for CHIKF.

Chikungunya Virus Phylogenetics

Chikungunya virus (CHIKV) is a single-stranded positive-sense RNA virus where there are three genotypes transmitted by mosquitoes.  The virus is of the Alphavirus genus in the Togaviridae family [21,23]. 

 Thanks to the IRIN!


Do you have questions?  Or would you like to report and outbreak in your area?  Please contact JIDC and let us know!  akelvin@jidc.org


Reference List


        1.    2011 June) IRIN. http://www.irinnews.org/Report.aspx?ReportID=92989.

        2.    Cavrini F, Gaibani P, Pierro AM, Rossini G, Landini MP, Sambri V (2009) Chikungunya: an emerging and spreading arthropod-borne viral disease. J Infect Dev Ctries 3: 744-752.

        3.    Ravichandran R, Manian M (2008) Ribavirin therapy for Chikungunya arthritis. J Infect Dev Ctries 2: 140-142.

        4.    Kumari R, Nand P, Mittal V, Lal S, Saxena VK (2010) The first Chikungunya case from Sonipat district near the national capital city of Delhi, India. J Infect Dev Ctries 4: 262-263.

        5.    Seyler T, Rizzo C, Finarelli AC, Po C, Alessio P, Sambri V, Ciofi Degli Atti ML, Salmaso S (2008) Autochthonous chikungunya virus transmission may have occurred in Bologna, Italy, during the summer 2007 outbreak. Euro Surveill 13.

        6.    Liumbruno GM, Calteri D, Petropulacos K, Mattivi A, Po C, Macini P, Tomasini I, Zucchelli P, Silvestri AR, Sambri V, Pupella S, Catalano L, Piccinini V, Calizzani G, Grazzini G (2008) The Chikungunya epidemic in Italy and its repercussion on the blood system. Blood Transfus 6: 199-210.

        7.    Sambri V, Cavrini F, Rossini G, Pierro A, Landini MP (2008) The 2007 epidemic outbreak of Chikungunya virus infection in the Romagna region of Italy: a new perspective for the possible diffusion of tropical diseases in temperate areas? New Microbiol 31: 303-304.

        8.    Bonilauri P, Bellini R, Calzolari M, Angelini R, Venturi L, Fallacara F, Cordioli P, Angelini P, Venturelli C, Merialdi G, Dottori M (2008) Chikungunya virus in Aedes albopictus, Italy. Emerg Infect Dis 14: 852-854.

        9.    Charrel RN, de L, X (2008) Chikungunya virus in north-eastern Italy: a consequence of seasonal synchronicity. Euro Surveill 13.

      10.    Bordi L, Carletti F, Castilletti C, Chiappini R, Sambri V, Cavrini F, Ippolito G, Di CA, Capobianchi MR (2008) Presence of the A226V mutation in autochthonous and imported Italian chikungunya virus strains. Clin Infect Dis 47: 428-429. 10.1086/589925 [doi].

      11.    Tsetsarkin KA, Vanlandingham DL, McGee CE, Higgs S (2007) A single mutation in chikungunya virus affects vector specificity and epidemic potential. PLoS Pathog 3: e201. 07-PLPA-RA-0664 [pii];10.1371/journal.ppat.0030201 [doi].

      12.    Demanou M, Antonio-Nkondjio C, Ngapana E, Rousset D, Paupy C, Manuguerra JC, Zeller H (2010) Chikungunya outbreak in a rural area of Western Cameroon in 2006: A retrospective serological and entomological survey. BMC Res Notes 3: 128. 1756-0500-3-128 [pii];10.1186/1756-0500-3-128 [doi].

      13.    Niyas KP, Abraham R, Unnikrishnan RN, Mathew T, Nair S, Manakkadan A, Issac A, Sreekumar E (2010) Molecular characterization of Chikungunya virus isolates from clinical samples and adult Aedes albopictus mosquitoes emerged from larvae from Kerala, South India. Virol J 7: 189. 1743-422X-7-189 [pii];10.1186/1743-422X-7-189 [doi].

      14.    Santhosh SR, Dash PK, Parida M, Khan M, Rao PV (2009) Appearance of E1: A226V mutant Chikungunya virus in Coastal Karnataka, India during 2008 outbreak. Virol J 6: 172. 1743-422X-6-172 [pii];10.1186/1743-422X-6-172 [doi].

      15.    2011) NVBDCP (2007).  Chikungunya fever situation in the country during 2006. http://nvbdcp.gov.in/Chikun-cases.html.

      16.    Parola P, de L, X, Jourdan J, Rovery C, Vaillant V, Minodier P, Brouqui P, Flahault A, Raoult D, Charrel RN (2006) Novel chikungunya virus variant in travelers returning from Indian Ocean islands. Emerg Infect Dis 12: 1493-1499.

      17.    Gibney KB, Fischer M, Prince HE, Kramer LD, St GK, Kosoy OL, Laven JJ, Staples JE (2011) Chikungunya fever in the United States: a fifteen year review of cases. Clin Infect Dis 52: e121-e126. ciq214 [pii];10.1093/cid/ciq214 [doi].

      18.    Mizuno Y, Kato Y, Takeshita N, Ujiie M, Kobayashi T, Kanagawa S, Kudo K, Lim CK, Takasaki T (2010) Clinical and radiological features of imported chikungunya fever in Japan: a study of six cases at the National Center for Global Health and Medicine. J Infect Chemother . 10.1007/s10156-010-0124-y [doi].

      19.    Schuffenecker I, Iteman I, Michault A, Murri S, Frangeul L, Vaney MC, Lavenir R, Pardigon N, Reynes JM, Pettinelli F, Biscornet L, Diancourt L, Michel S, Duquerroy S, Guigon G, Frenkiel MP, Brehin AC, Cubito N, Despres P, Kunst F, Rey FA, Zeller H, Brisse S (2006) Genome microevolution of chikungunya viruses causing the Indian Ocean outbreak. PLoS Med 3: e263. 06-PLME-RA-0242R1 [pii];10.1371/journal.pmed.0030263 [doi].

      20.    Thiboutot MM, Kannan S, Kawalekar OU, Shedlock DJ, Khan AS, Sarangan G, Srikanth P, Weiner DB, Muthumani K (2010) Chikungunya: a potentially emerging epidemic? PLoS Negl Trop Dis 4: e623. 10.1371/journal.pntd.0000623 [doi].

      21.    Sudeep AB, Parashar D (2008) Chikungunya: an overview. J Biosci 33: 443-449.

      22.    De L, X, Leroy E, Charrel RN, Ttsetsarkin K, Higgs S, Gould EA (2008) Chikungunya virus adapts to tiger mosquito via evolutionary convergence: a sign of things to come? Virol J 5: 33. 1743-422X-5-33 [pii];10.1186/1743-422X-5-33 [doi].

      23.    Cavrini F, Gaibani P, Pierro AM, Rossini G, Landini MP, Sambri V (2009) Chikungunya: an emerging and spreading arthropod-borne viral disease. J Infect Dev Ctries 3: 744-752.

      24.    Chirathaworn C, Rianthavorn P, Wuttirattanakowit N, Poovorawan Y (2010) Serum IL-18 and IL-18BP levels in patients with Chikungunya virus infection. Viral Immunol 23: 113-117. 10.1089/vim.2009.0077 [doi].

      25.    Ng LF, Chow A, Sun YJ, Kwek DJ, Lim PL, Dimatatac F, Ng LC, Ooi EE, Choo KH, Her Z, Kourilsky P, Leo YS (2009) IL-1beta, IL-6, and RANTES as biomarkers of Chikungunya severity. PLoS One 4: e4261. 10.1371/journal.pone.0004261 [doi].

      26.    Wauquier N, Becquart P, Nkoghe D, Padilla C, Ndjoyi-Mbiguino A, Leroy EM (2011) The acute phase of chikungunya virus infection in humans is associated with strong innate immunity and T CD8 cell activation. J Infect Dis 204: 115-123. jiq006 [pii];10.1093/infdis/jiq006 [doi].

1 Comment

Filed under Chikungunya, Chikungunya, Infectious Disease, JIDC News, Outbreaks, Uncategorized