Conference Material > Abstract
Sun C
Epicentre Scientific Day Paris 2019. 2019 June 13
This study of HCV prevalence in adults in Cambodia shows higher seropositivity with older age, poverty, lower education levels, and past routine medical interventions.
BACKGROUND
Despite a dramatic reduction of HCV drug costs and proven, simplified models of care, many countries lack accurate prevalence estimates to scale up HCV services.
METHODS
We conducted a cross-sectional, multi-stage cluster design survey of HCV sero-prevalence in adults ≥18 years old, with an oversampling of the population ≥45 years. 147 clusters of 25 households were randomly selected in two sets (set 1=24 clusters, ≥18-year-old respondents; set 2=123 clusters, exclusively ≥45-year-old respondents). A multivariate analysis assessed risk factors for sero positivity among participants aged ≥45. The study was conducted in rural Moung Ruessei Health Operational District, Battambang Province, in Western Cambodia.
RESULTS
A total of 5 103 individuals and 3 616 households participated in the survey. The overall seroprevalence for the entire adult population aged ≥18 years was 2.61% (CI95% 2.25-2.96), with 5.10% (CI95% 4.55-5.65) for adults aged ≥45, and 0.58% (CI95% 0.27-0.89) for adults 18-44. Viraemic prevalence for these same populations was 1.87% (CI95% 1.62-2.14), 3.62% (CI95% 3.22-4.01), and 0.47% (CI95% 0.17 - 0.76), respectively. Men were more likely to be positive both serologically and by viral load; considering the population aged ≥18, the serological prevalence for men was 3.03 (CI95% 2.54 - 3.52), and 2.27 (CI95% 1.87 - 2.66) for women. Risk factors identified for the population ≥45 years included: more advanced age, lower education level, membership in an ID poor card program, injection for medical use or surgery before 1990, blood donation or transfusion before 1980 and having ever had dental or gum treatment.
CONCLUSIONS
This study provides the first large-scale prevalence data on HCV infection in the general adult population of three rural districts of Cambodia and clarifies several important infection trends: for adults ≥45 years, sero-positivity was more likely with increased age, poverty, a low level of education, and past routine medical interventions (especially prior to 1990 and 1980).
BACKGROUND
Despite a dramatic reduction of HCV drug costs and proven, simplified models of care, many countries lack accurate prevalence estimates to scale up HCV services.
METHODS
We conducted a cross-sectional, multi-stage cluster design survey of HCV sero-prevalence in adults ≥18 years old, with an oversampling of the population ≥45 years. 147 clusters of 25 households were randomly selected in two sets (set 1=24 clusters, ≥18-year-old respondents; set 2=123 clusters, exclusively ≥45-year-old respondents). A multivariate analysis assessed risk factors for sero positivity among participants aged ≥45. The study was conducted in rural Moung Ruessei Health Operational District, Battambang Province, in Western Cambodia.
RESULTS
A total of 5 103 individuals and 3 616 households participated in the survey. The overall seroprevalence for the entire adult population aged ≥18 years was 2.61% (CI95% 2.25-2.96), with 5.10% (CI95% 4.55-5.65) for adults aged ≥45, and 0.58% (CI95% 0.27-0.89) for adults 18-44. Viraemic prevalence for these same populations was 1.87% (CI95% 1.62-2.14), 3.62% (CI95% 3.22-4.01), and 0.47% (CI95% 0.17 - 0.76), respectively. Men were more likely to be positive both serologically and by viral load; considering the population aged ≥18, the serological prevalence for men was 3.03 (CI95% 2.54 - 3.52), and 2.27 (CI95% 1.87 - 2.66) for women. Risk factors identified for the population ≥45 years included: more advanced age, lower education level, membership in an ID poor card program, injection for medical use or surgery before 1990, blood donation or transfusion before 1980 and having ever had dental or gum treatment.
CONCLUSIONS
This study provides the first large-scale prevalence data on HCV infection in the general adult population of three rural districts of Cambodia and clarifies several important infection trends: for adults ≥45 years, sero-positivity was more likely with increased age, poverty, a low level of education, and past routine medical interventions (especially prior to 1990 and 1980).
Conference Material > Video
Luquero FJ
Epicentre Scientific Day Paris 2019. 2019 June 13
Conference Material > Video
Dousset JP
Epicentre Scientific Day Paris 2019. 2019 June 13
Conference Material > Video
Sun C
Epicentre Scientific Day Paris 2019. 2019 June 13
Conference Material > Abstract
Dousset JP
Epicentre Scientific Day Paris 2019. 2019 June 13
The screening strategies and simplified model of care implemented by the MSF HCV-project in Phnom Penh and in a rural district bring critical evidence tools for designing national programs in affected countries.
Approximately 1.1% of the world population, and 1.6 % of the population (257 000 people) in Cambodia, are estimated to be chronically infected with Hepatitis C virus (HCV), with the rate in Cambodia being the second highest in the Western Pacific Region. In 2016, MSF and the Cambodian Ministry of Health launched an HCV project at Preah Kossamak Hospital in Phnom Penh.
As part of this project, MSF implemented a simplified model of care (MoC) for HCV, with Gene-Xpert for point of care viral load testing and Sofosbuvir/Daclatasvir as the pan-genotype treatment regimen. This simplified MoC resulted in a 97% success rate (n = 10 000). With no reduction in the treatment safety or effectiveness, the MoC reduced the number of patient visits, the time between diagnosis and initiation of direct-acting antivirals (DAA). This increase in efficiency resulted in more patients initiating DAA and an overall reduction in staffing and cost requirements.
The simplified MoC was then adapted to a rural setting, where sero-diagnosis and follow up care were conducted by nursing staff at
health centers, while viral load testing and DAA initiation were managed by physicians at a referral hospital.
In 2018, Epicentre/MSF conducted an HCV prevalence survey of the adult population in Moung Russei district, identifying very low population awareness of HCV and an overall adult seroprevalence of 2.6%, with seroprevalence twice higher (5.1%) among adults aged ≥ 45 years. These results allowed MSF to incorporate active case finding among older adults and to better understand the limitations of passive screening.
Supported by the findings of the MSF HCV-project, the Cambodian Ministry of Health will develop a national strategic plan for HCV for 2019. Together with the simplified MoC – capable of decentralization and complemented by targeted screening strategies – this is a promising next step to accelerate HCV elimination in Cambodia.
KEY MESSAGE: The screening strategies and simplified model of care implemented by the MSF HCV-project in Phnom Penh and in a rural district bring critical evidence tools for designing national programs in affected countries.
Approximately 1.1% of the world population, and 1.6 % of the population (257 000 people) in Cambodia, are estimated to be chronically infected with Hepatitis C virus (HCV), with the rate in Cambodia being the second highest in the Western Pacific Region. In 2016, MSF and the Cambodian Ministry of Health launched an HCV project at Preah Kossamak Hospital in Phnom Penh.
As part of this project, MSF implemented a simplified model of care (MoC) for HCV, with Gene-Xpert for point of care viral load testing and Sofosbuvir/Daclatasvir as the pan-genotype treatment regimen. This simplified MoC resulted in a 97% success rate (n = 10 000). With no reduction in the treatment safety or effectiveness, the MoC reduced the number of patient visits, the time between diagnosis and initiation of direct-acting antivirals (DAA). This increase in efficiency resulted in more patients initiating DAA and an overall reduction in staffing and cost requirements.
The simplified MoC was then adapted to a rural setting, where sero-diagnosis and follow up care were conducted by nursing staff at
health centers, while viral load testing and DAA initiation were managed by physicians at a referral hospital.
In 2018, Epicentre/MSF conducted an HCV prevalence survey of the adult population in Moung Russei district, identifying very low population awareness of HCV and an overall adult seroprevalence of 2.6%, with seroprevalence twice higher (5.1%) among adults aged ≥ 45 years. These results allowed MSF to incorporate active case finding among older adults and to better understand the limitations of passive screening.
Supported by the findings of the MSF HCV-project, the Cambodian Ministry of Health will develop a national strategic plan for HCV for 2019. Together with the simplified MoC – capable of decentralization and complemented by targeted screening strategies – this is a promising next step to accelerate HCV elimination in Cambodia.
KEY MESSAGE: The screening strategies and simplified model of care implemented by the MSF HCV-project in Phnom Penh and in a rural district bring critical evidence tools for designing national programs in affected countries.
Conference Material > Abstract
Luquero FJ
Epicentre Scientific Day Paris 2019. 2019 June 13
This combined epidemiological and genomic analysis shows that the ongoing cholera epidemic in Yemen is part of a larger regional outbreak that started in East Africa in 2013-2014, and reinforces the importance of detecting the emergence of new lineages earlier.
INTRODUCTION
Between 2013 and 2016, Kenya reported 19,192 cholera cases and 156 cholera deaths to the World Health Organization. The majority of these cases and deaths were reported in 2015, when a countrywide outbreak spread to 22 out of 47 counties. In 2016, a massive cholera outbreak started in Yemen affecting almost all districts in the country. Here we explore the epidemiological relatedness of these events.
METHODS
We investigated the phylogeny of Vibrio cholerae isolates from Yemen and recent isolates from neighboring regions. Overall the analysis was conducted from 116 genomic sequences (42 from Yemen), which were placed within the phylogenetic context of the seventh V. cholerae pandemic. The sequencing and analysis were carried out in collaboration with Institute Pasteur and Sanger Institute. We also described the epidemiology of cholera in Yemen and the neighboring countries.
RESULTS
The isolates from Yemen were collected during the two waves of the epidemic—the first between 28 September 2016 and 23 April 2017 with 25,839 suspected cases and the second beginning on 24 April 2017 with more than 1 million suspected cases—are V. cholerae serotype Ogawa isolates from a single sub-lineage of the seventh pandemic V. cholerae O1 El Tor lineage. This sub-lineage originated from South Asia and caused outbreaks in East Africa between 2013 and 2016 before appearing in Yemen.
CONCLUSION
The outbreaks in Kenya and Yemen are part of a larger regional outbreak, which has affected several hundreds of thousand people and caused thousands of related deaths. These findings highlight the importance of considering both the regional nature of cholera epidemics and the need
to nationally control spread to protect local and neighboring populations. They also show that the systematic integration of genomic analysis in the
surveillance of cholera could help to identify new lineages at the beginning of outbreaks and should help to trigger intensified control measures.
INTRODUCTION
Between 2013 and 2016, Kenya reported 19,192 cholera cases and 156 cholera deaths to the World Health Organization. The majority of these cases and deaths were reported in 2015, when a countrywide outbreak spread to 22 out of 47 counties. In 2016, a massive cholera outbreak started in Yemen affecting almost all districts in the country. Here we explore the epidemiological relatedness of these events.
METHODS
We investigated the phylogeny of Vibrio cholerae isolates from Yemen and recent isolates from neighboring regions. Overall the analysis was conducted from 116 genomic sequences (42 from Yemen), which were placed within the phylogenetic context of the seventh V. cholerae pandemic. The sequencing and analysis were carried out in collaboration with Institute Pasteur and Sanger Institute. We also described the epidemiology of cholera in Yemen and the neighboring countries.
RESULTS
The isolates from Yemen were collected during the two waves of the epidemic—the first between 28 September 2016 and 23 April 2017 with 25,839 suspected cases and the second beginning on 24 April 2017 with more than 1 million suspected cases—are V. cholerae serotype Ogawa isolates from a single sub-lineage of the seventh pandemic V. cholerae O1 El Tor lineage. This sub-lineage originated from South Asia and caused outbreaks in East Africa between 2013 and 2016 before appearing in Yemen.
CONCLUSION
The outbreaks in Kenya and Yemen are part of a larger regional outbreak, which has affected several hundreds of thousand people and caused thousands of related deaths. These findings highlight the importance of considering both the regional nature of cholera epidemics and the need
to nationally control spread to protect local and neighboring populations. They also show that the systematic integration of genomic analysis in the
surveillance of cholera could help to identify new lineages at the beginning of outbreaks and should help to trigger intensified control measures.