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Background: Febrile jaundice is a common indicator of certain infectious diseases, including hepatitis E. In Cameroon, the yellow fever virus is the only pathogen that is monitored in patients who present with this symptom. However, more than 90% of the samples received as part of this surveillance are negative for yellow fever. This study aimed to describe the prevalence and hepatitis E virus (HEV) genotype among yellow fever-negative patients in the Far North and West regions of Cameroon. Methods: In a cross-sectional study, yellow fever surveillance-negative samples collected between January 2021 and January 2023 were retrospectively analyzed. Anti-HEV IgM and IgG antibodies were tested using commercially available ELISA kits. Anti-HEV IgM and/or IgG positive samples were tested for HEV RNA by real-time RT-PCR, followed by nested RT-PCR, sequencing and phylogenetic analysis. Results: Overall, 121 of the 543 samples (22.3%, 95% CI: 19.0% - 26.0%) were positive for at least one anti-HEV marker. Amongst these, 8.1% (44/543) were positive for anti-HEV IgM, 5.9% (32/543) for anti-HEV IgG, and 8.3% (45/544) for both markers. A total of 15.2% (12/79) samples were positive for HEV RNA real-time RT-PCR and 8 samples were positive for HEV RNA by nested RT-PCR. Phylogenetic analysis showed that the retrieved sequences clustered within HEV genotypes/subtypes 1/1e, 3/3f and 4/4b. Conclusion: Our results showed that HEV is one of the causes of acute febrile jaundice in patients enrolled in the yellow fever surveillance program in two regions of Cameroon. We described the circulation of three HEV genotypes, including two zoonotic genotypes. Further studies will be important to elucidate the transmission routes of these zoonotic HEV genotypes to humans in Cameroon. [ABSTRACT FROM AUTHOR]

Acute febrile illness is a common problem managed by clinicians and health systems globally, particularly in the Tropics. In many regions, malaria is a leading and potentially deadly cause of fever; however, myriad alternative etiologies exist. Identifying the cause of fever allows optimal management, but this depends on many factors including thorough knowledge of circulating infections. Arboviruses such as dengue (DENV) cause fever and may be underdiagnosed in sub-Saharan Africa where malaria is a major focus. We examined cases of fever in western Cameroon that tested negative for malaria and found 13.5% (13/96) were due to DENV, with 75% (9/12) of these being DENV serotype 2 infections. Two complete DENV2 genomes were obtained and clustered closely to recent isolates from Senegal and Burkina Faso. The seroprevalence of DENV in this region was 24.8% (96/387). Neutralizing antibodies to DENV2 were detected in all (15/15) seropositive samples tested. Chikungunya (CHIKV) is an arthritogenic alphavirus that is transmitted by Aedes mosquitoes, the same principal vector as DENV. The seroprevalence for CHIKV was 15.7% (67/427); however, CHIKV did not cause a single case of fever in the 96 subjects tested. Of note, being seropositive for one arbovirus was associated with being seropositive for the other (Χ2 = 16.8, p<0.001). Taken together, these data indicate that Aedes-transmitted arboviruses are endemic in western Cameroon and are likely a common but underappreciated cause of febrile illness. This work supports the need for additional study of arboviruses in sub-Saharan Africa and efforts to improve diagnostic capacity, surveillance systems, and arbovirus prevention strategies. Author summary: Acute illness with fever is common but can be challenging for clinicians to manage, particularly in resource-limited settings. In sub-Saharan Africa, malaria is a major cause of fever, but other causes of fever are poorly documented or monitored, which impairs optimal medical care to patients and implementation of public health interventions to control leading causes of disease. Viruses transmitted by mosquitoes are a prevalent and expanding problem throughout the tropics and beyond; however, there is concern that these infections frequently go undetected in sub-Saharan Africa. We discovered a previously unrecognized outbreak of dengue virus in western Cameroon by testing remnant samples from over 400 patients that presented with fever. Our results indicate that dengue has circulated in this region for decades with little recognition. This study adds important information about causes of fever in sub-Saharan Africa and advocates for increasing investment in surveillance systems and prevention strategies for mosquito-borne viruses. [ABSTRACT FROM AUTHOR]

Introduction: Arboviral diseases including dengue are increasingly spreading in the tropical/subtropical world including Africa. Updated knowledge on the distribution and abundance of the major vectors Aedes aegypti and Aedes albopictus constitutes crucial surveillance action to prepare African countries such as Cameroon for potential arbovirus outbreaks. Here, we present a nationwide survey in Cameroon to assess the current geographical distribution and prevalence of both vectors including a genetic diversity profiling of Ae. albopictus (invasive species) using mitochondrial DNA. Methods: Immature stages of Aedes were collected between March and August 2017 in 29 localities across Cameroon following north-south and east-west transects. Larvae and pupae were collected from several containers in each location, reared to adult and morphologically identified. Genetic diversity of Ae. albopictus from 16 locations were analysed using Cytochrome Oxidase I gene (COI). Results: In total, 30,381 immature stages of Aedes with an average of 646.40±414.21 per location were identified across the country comprising 69.3% of Ae. albopictus and 30.7% of Ae. aegypti. Analysis revealed that Ae. aegypti is still distributed nation widely whereas Ae. albopictus is limited to the southern part, around 6°4’N. However, Ae. albopictus is the most prevalent species in all southern locations where both species are sympatric except in Douala where Ae. aegypti is predominant. This suggests that factors such as climate, vegetation, and building density impact the distribution of both species in Cameroon. Mitochondrial DNA analysis revealed a low genetic diversity in Ae. albopictus populations with a major common haplotype resulting in low haplotype diversity ranging from 0.13 to 0.65 and 0.35 for the total sample. Similarly, low nucleotide diversity was also reported varying from 0.0000 to 0.0017 with an overall index of 0.0008. This low genetic polymorphism is consistent with the recent introduction of Ae. albopictus in Cameroon. Conclusion: This updated distribution of arbovirus vectors across Cameroon will help in planning vector control programme against possible outbreak of arbovirus related diseases in the country. [ABSTRACT FROM AUTHOR]