RESUMEN
To alleviate the insufficient number of experienced medical teams invited to and accepting to monitor the effectiveness of drugs prescribed to patients with a diagnosis of uncomplicated malaria and to insure the surveillance of the susceptibility of P. falciparum to current antimalarials used in Madagascar, there is a need to draw a feasible study protocol carefully discussed with them. We carried out a preliminary study in two rural areas and assessed the efficacy of sulfadoxine-pyrimethamine (SP) for curing uncomplicated P. falciparum malaria, with a simplified protocol based on the principle of observational study. A single dose of SP was given on day 0 with paracetamol. The persons to whom the drugs were administered accepted two other interventions of one member of the medical teams on day 14 and day 28. Nineteen patients, 3-63 years old, fulfilled the follow-up. The efficacy of this combination was noted for the 19 persons. Our results show that P. falciparum strains are susceptible to SP. Since SP will be used in intermittent preventive treatment in pregnant women in Madagascar, one way to delay the occurrence of SP resistant parasites will be (a) to avoid massive use of SP for the non pregnant persons and (b) to monitor susceptibility of P. falciparum to SP as part of pilot studies using standard WHO protocol (which is not really easy for most of the peripheral health facilities--with the follow-up procedures with clinical examination and parasitological control at Days 0, 1, 2, 3, 7, 14, 21 and 28), and routinely with simplified protocol such as the analytical observational study illustrated in this present study. Limit and advantage of observational study are discussed.
Asunto(s)
Antimaláricos/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Adolescente , Adulto , Niño , Preescolar , Clima , Esquema de Medicación , Combinación de Medicamentos , Monitoreo de Drogas , Resistencia a Medicamentos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Madagascar/epidemiología , Malaria Falciparum/epidemiología , Malaria Falciparum/parasitología , Masculino , Persona de Mediana Edad , Observación , Pruebas de Sensibilidad Parasitaria , Proyectos de Investigación , Características de la Residencia/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Resultado del TratamientoRESUMEN
The first case of plague was introduced in Madagascar in 1898 in the east coast by way of boat from India. In 1921, plague reach the highlands and a large epidemic over the next twenty years. Until the beginning of the 80's, only of few case were identified, notified mostly in rural setting. However gradually it has re-emerged as a public health problem. Urban plague is located in the city of Antananarivo (resurgence in 1978 after 28 years of apparent silence) and in Mahajanga port (resurgence in 1991 after 63 years of silence). The reactivation of the Plague National Control Program from 1994 will allow better surveillance. The aim of this analysis is to update the epidemiological data on human plague in Madagascar based on reported cases obtained from the Central Lab of the Pasteur Institute of Madagascar from 1980 to 2001 (16,928 suspected cases of which 3,500 are likely positives or confirmed positives). The Plague season runs from October to March on the central highlands and July to November on the north-western coast. Sex-ratio male/female is 1.3/1, and the age-group of 5 to 25 years is more affected. The case fatality rate was 40% in the beginning of the 1980's, and decreased to 20% by the end of the 1990's. The percentage of case with pulmonary plague decrease from 15% to less than 5%. However, geographical extension is demonstrated: 4 districts in 1980, 30 districts in 1999 and 21 districts in 2001. In 2002, the diffusion of a new rapid test (reagent strip) in the primary health centres (CSB) in 42 endemic districts may help to decrease the morbidity and the letality due to plague and improve its control at the national level.
Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Peste/epidemiología , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Notificación de Enfermedades , Femenino , Humanos , Incidencia , Madagascar/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad , Peste/diagnóstico , Peste/prevención & control , Vigilancia de la Población , Tiras Reactivas , Salud Rural/estadística & datos numéricos , Estaciones del Año , Distribución por Sexo , Salud Urbana/estadística & datos numéricosRESUMEN
La peste est entrée à Madagascar en 1898, à partir du port de Toamasina, suite à l'escale d'un bâteau venant d'Inde. En 1921, elle arrive à Antananarivo et s'étend sur les Hautes Terres Centrales en y provoquant des épidémies sans précédent pendant près de 20 ans. Jusqu'au début des années 1980, elle a persisté à bas bruit surtout en milieu rural, avant de connaître une reviviscence au point de constituer un problème de santé publique de nos jours. La peste urbaine existe surtout dans la ville d'Antananarivo (réémergence en 1978 après 28 ans de silence apparent) et dans le port de Mahajanga (réémergence en 1991 après 63 ans de silence apparent). La re-dynamisation du programme national de lutte contre la peste, à partir de 1994, a permis une meilleure surveillance de la maladie. Cette analyse a pour objectif une actualisation des données épidémiologiques de la peste humaine à Madagascar, à partir des cas déclarés (16 928 cas suspects dont 3 500 confirmés ou probables) obtenus au Laboratoire Central à l'Institut Pasteur de Madagascar de 1980 à 2001. La saison pesteuse sur les hautes terres se situe d'octobre à mars et celle de la ville de Mahajanga de juillet à novembre. Le sex-ratio homme/femme est de 1,3/1, la tranche d'âge la plus touchée est celle des sujets âgés de 5 à 25 ans. Le taux de létalité de 40% au début des années 1980 a diminué à 20% vers la fin des années 1990, le pourcentage de formes pulmonaires est passé de 15% à moins de 5%, indiquant une amélioration de la prise en charge des cas. Par contre, on a assisté à une extension géographique de l'endémie pesteuse dans le pays : 4 districts confirmés en 1980, un pic de 30 districts en 1999 et 21 districts en 2001. En 2002, la diffusion d'un nouveau test de diagnostic rapide de la peste (bandelettes), dans les centres de santé de base des 42 districts endémiques, devrait contribuer à diminuer la morbidité et la létalité due à la peste, et améliorer sa surveillance au niveau national
Asunto(s)
Madagascar , Peste/diagnóstico , Peste/epidemiología , Peste/prevención & controlRESUMEN
Human cases of plague, which had virtually disappeared in Madagascar after the 1930s, reappeared in 1990 with more than 200 confirmed or presumptive cases reported each year since. In the port of Mahajanga, plague has been reintroduced, and epidemics occur every year. In Antananarivo, the capital, the number of new cases has increased, and many rodents are infected with Yersinia pestis. Despite surveillance for the sensitivity of Y. pestis and fleas to drugs and insecticides and control measures to prevent the spread of sporadic cases, the elimination of plague has been difficult because the host and reservoir of the bacillus, Rattus rattus, is both a domestic and a sylvatic rat.
Asunto(s)
Peste/epidemiología , Animales , Control de Enfermedades Transmisibles , Humanos , Madagascar/epidemiología , Peste/prevención & control , RatasRESUMEN
La peste est aujourd'hui considérée par l'OMS comme une maladie résurgente dans le monde. A Madagascar, on assiste à sa recrudescence : 150 à 250 cas par an sont notifiés confirmés ou probables. La peste sévit surtout sur les Hauts-Plateaux où 32 Services de Santé de District sont concernés. Parmi eux, le district d'Antananarivo-ville où 23 cas contrôlés ont été recensés en 1996. Sur les côtes, la maladie a réapparu en 1991, dans la ville portuaire de Mahajanga après 63 années de silence apparent; entre 1991 et 1997, 3 épidémies sont survenues : 180 cas ont été confirmés ou probables de peste. A Antananarivo, la surveillance de la population murine a montré une circulation intense du bacille pesteux. Fait préoccupant, les puces vectrices, Xenopsylla cheopis, récoltées des rats capturés ont montré une résistance aux principales familles d'insecticides dont les pyréthrinoïdes. Cette situation alarmante exige un système d'alerte et de riposte. La mise à disposition d'un test de diagnostic simple, très rapide et sûr aux services sanitaires périphériques devrait améliorer les mesures de riposte devant un cas confirmé de peste
Asunto(s)
Madagascar , Peste/epidemiología , Peste/prevención & control , RecurrenciaRESUMEN
After briefly reviewing the history and epidemiological cycle of the plague in Madagascar, we report a detailed analysis of 5,927 suspected cases of plague observed from 1989 to 1995 (average of 846 cases per year). Of those, 1,337 individuals (average of 191 cases per year) were confirmed (by isolation of Yersinia pestis) or indicated to be probable for plague (by positive smears). Since 1994, we observed an increasing number of confirmed and probable cases (252 cases in 1995). Most of the cases occurred between October and April in the central highlands, inside a geographical triangle limited by Alaotra lake, Itasy lake and the city of Fianarantsoa. Two exceptional epidemics occurred in the harbor of Majunga in 1991 and 1995. The bubonic plague was the most frequent clinical from (91.3%), with primarily an inguinal localization (67.8%). The mean case fatality rate was 19% of the confirmed or probable cases (14.8% for the bubonic form and 57.1% for the pneumonic form). The bubonic plague was significantly more frequent between the ages of 5 and 14 years, as compared to the general population, while the pneumonic plague was more frequent over 15 years of age. Males were more effected by the bubonic form, as the sex ratio (m:f) was 1.3. The national control program for plague is being strengthened to improve 1) the patient's early diagnosis and care system; 2) the measures for the prevention of epidemics; 3) the epidemiological surveillance; and 4) the studies on the biology of the plague vectors, rodents and fleas, and the agent, bacilli, in Madagascar.