Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

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Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 8—August 2015

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Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012

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• The Study
• Conclusions
• Suggested Citation

Figures

• Figure 1
• Figure 2

Technical Appendicies

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Jordi Landier , Guillaume Constantin de Magny, Andres Garchitorena, Jean-François Guégan, Jean Gaudart, Laurent Marsollier, Philippe Le Gall, Tamara Giles-Vernick, Sara Eyangoh, Arnaud Fontanet, and Gaëtan Texier

Author affiliations: Institut Pasteur, Paris, France (J. Landier, T. Giles-Vernick, A. Fontanet); Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroon (J. Landier, S. Eyangoh, G. Texier);UMR MIVEGEC, Montpellier, France (G. Constantin de Magny, A. Garchitorena, J.-F. Guégan); Ecole des Hautes Etudes en Santé Publique, Rennes, France (A. Garchitorena, J.-F. Guégan); UMR912-SESSTIM, Marseille, France (J. Gaudart, G. Texier); INSERM and CHU et Université d’Angers, Angers, France (L. Marsollier); Institut de Recherche pour le Développement, Gif sur Yvette, France (P. Le Gall); Université Paris-Sud 11, Orsay, France. (P. Le Gall); Chaire Santé et Développement, Conservatoire National des Arts et Métiers, Paris (A. Fontanet)

Suggested citation for this article

Abstract

To determine when risk for Buruli ulcer is highest, we examined seasonal patterns in a highly disease-endemic area of Cameroon during 2002–2012. Cases peaked in March, suggesting that risk is highest during the high rainy season. During and after this season, populations should increase protective behaviors, and case detection efforts should be intensified.

Buruli ulcer (BU) is a severe infection caused by Mycobacterium ulcerans. Most affected are rural populations living in tropical areas with abundant wetlands (1). BU causes extensive, damaging skin lesions and often results in severe disabilities. Of the 4,000 cases reported to the World Health Organization by 14 countries in 2011, >95% originated in African countries around the Gulf of Guinea (2).

Much remains unknown about the mode of M. ulcerans transmission and the epidemiology of BU (1). Specifically, although the spatial distribution of BU in several settings has been addressed (3,4), most studies have examined only temporal variations of BU incidence in terms of yearly trends (5). Several observational studies have reported seasonal changes in the monthly number of cases and have hypothesized that cases are linked with rainfall variation (6–8). One spatiotemporal study in Australia showed that BU incidence was associated with rainfall variability with a 5-month lag and with total rainfall with a 19-month lag (4). However, none of these studies provided quantitative evidence of seasonal changes in BU incidence and their relationship with seasonal environmental changes. Indeed, a formal demonstration of such evidence requires a sufficiently long time series, large numbers of cases from a defined source population, and use of signal analysis techniques adapted to the constraints of BU disease surveillance and environmental data (9) (Technical Appendix[PDF - 691 KB - 7 pages]). Therefore, we investigated the seasonality of BU case incidence during 2002–2012 in Akonolinga District, located in the highly BU-endemic region of the Nyong River valley in Centre Region, Cameroon.

Dr. Landier specializes in infectious diseases epidemiology. While working on his PhD degree at the Institut Pasteur in Paris, he focused on BU epidemiology and M. ulcerans transmission in Central Africa.

Acknowledgment

We thank the staff of the Akonolinga district hospital, who provided diagnoses and delivered treatment to BU patients, and the staff of the Service de Mycobactériologie at Centre Pasteur du Cameroun, who provided laboratory confirmation of diagnoses.

References

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2. World Health Organization. Summary data. WHO meeting on Buruli ulcer control and research, 2013 Mar 25–27; Geneva; 2012 [cited 2013 Dec 12]. http://www.who.int/buruli/Summary_data_and_new_target_2013.pdf
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13. Pouillot R, Matias G, Wondje CM, Portaels F, Valin N, Ngos F, Risk factors for Buruli ulcer: a case control study in Cameroon. PLoS Negl Trop Dis.2007;1:e101. DOIPubMed
14. Garchitorena A, Roche B, Kamgang R, Ossomba J, Babonneau J, Landier J, Mycobacterium ulcerans ecological dynamics and its association with freshwater ecosystems and aquatic communities: results from a 12-month environmental survey in Cameroon. PLoS Negl Trop Dis. 2014;8:e2879.PLoS Negl Trop Dis. 2014;8:e2879 .DOIPubMed
15. Giles-Vernick T, Owona-Ntsama J, Landier J, Eyangoh S. The puzzle of Buruli ulcer transmission, ethno-ecological history and the end of “love” in the Akonolinga district, Cameroon. Soc Sci Med. 2015;129:20–7. DOIPubMed

Figures

• Figure 1. Wavelet analysis of Buruli ulcer (BU) case series and Nyong River flow, January 2002–December 2010. A, B) The color gradient indicates how well the wavelet of a given period...
• Figure 2. Schematic representation of the seasonal changes and possible links between the environment, Mycobacterium ulcerans presence, human exposure, and Buruli ulcer (BU) incidence in the Akonolinga district and the Nyong...

Technical Appendix

• . Additional materials, methods, and results for analysis of seasonal patterns of Buruli ulcer incidence, central Africa, 2002–2012.  691 KB

Suggested citation for this article: Landier J, Constantin de Magny G, Garchitorena A, Guégan J-F, Gaudart J, Marsollier L, et al. Seasonal patterns of Buruli ulcer incidence, central Africa, 2002–2012. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/eid2108.141336

DOI: 10.3201/eid2108.141336