Search

Reports on concerns regarding changes in the epidemiology of infectious diseases. Possible adverse effect on budget plans of public health authorities; Spread of diseases in Djibouti in East Africa; Poverty as a cause of emergence and recurrence of diseases.

From October 1991 to February 1992, an outbreak of acute fever (in which thick blood films were negative for malaria) spread rapidly in the city of Djibouti, Djibouti Republic, affecting all age groups and both nationals and foreigners. The estimated number of cases was 12,000. The clinical features were consistent with a non-haemorrhagic dengue-like illness. Serum samples from 91 patients were analysed serologically for flavivirus infection (dengue 1-4, West Nile, yellow fever, Zika, Banzi, and Uganda-S), and virus isolation was attempted. Twelve strains of dengue 2 virus were isolated. Dengue infection was confirmed by a 4-fold or greater rise in immunoglobulin (Ig) G antibody in paired serum specimens, the presence of IgM antibody, or isolation of the virus. Overall, 46 of the suspected cases (51%) were confirmed virologically or had serological evidence of a recent flavivirus infection. Statistical analysis showed that the presence of a rash was the best predictor of flavivirus seropositivity. In November 1992, Aedes aegypti was widespread and abundant in several districts of Djibouti city. A serological study of serum samples collected from Djiboutian military personnel 5 months before the epidemic showed that only 15/177 (8.5%) had flavivirus antibodies. These findings, together with a negative serosurvey for dengue serotypes 1-4 and yellow fever virus performed in 1987, support the conclusion that dengue 2 virus has only recently been introduced to Djibouti.

The first evidence of HIV infection in Djibouti, East Africa, was found in the spring of 1986; the first case of acquired immunodeficiency syndrome (AIDS) was diagnosed in March 1988; and, as of the end of 1991, 104 cases of AIDS had been reported. HIV-1 infection was predominant. Previously published results of four serosurveys carried out in October 87, June 1998, February 1990, and from January 1991 to April 1991 among high risk groups are presented and compared. The subjects included street girls, bar hostesses, and male STD patients. HIV-1 infection was demonstrated in 1991 among 36.0% of street girls, 15.3% of bar hostesses and 10.4% of male STD patients. Three sera were positive for both HIV-1 and HIV-2 antibodies. The prevalence of HIV-1 infection among street girls in Djibouti did not increase between February 1990 and January 1991 while the prevalence of HIV infection among male STD patients rose almost five-fold during the same period. HIV prevalence in bar hostesses showed a steady growth. Epidemiology of HIV infection among prostitutes is complex as theses populations have a rapid turn-over. HIV prevalence data and predominance of Ethiopian nationality among prostitutes suggest importation of HIV from Ethiopia via the prostitutes and their clients. These results are reviewed and compared with data from Ethiopia and Somalia.

In order to determine the prevalence of deficient activity of the enzyme glucose-6-phosphate dehydrogenase (G-6-PD) among the inhabitants of the east African Republic of Djibouti, we analyzed by the methaemoglobin reduction test the blood of 170 Djiboutian males, 81 Afars and 89 Somalis. Eight subjects were found to be G-6-PD deficient, 1 Afar and 7 Somalis (1.2% versus 8%; P = 0.02). We conclude that in Djibouti, health care providers should consider the presence of potential G-6-PD deficiency in their patients, especially in males of the Somali ethnic group. Indeed, many medications are contraindicated in the G-6-PD deficient subjects, and primaquine and pyrimethamine-sulfadoxine (FANSIDAR) have to be considered dangerous anti-malarial drugs for Somali males as long as their level of G-6-PD activity has not been determined. Since in Djibouti many acute falciparum cases are presenting with severe icteric anaemia, we hypothesize that some of these haemolytic anaemias might not be caused by the parasitic infection alone, but that some malaria patients might become aggravated through the administration of haemolytic drugs in case they are G-6-PD deficient. Finally, we propose that our study should be expanded to include the systematic determination of the variants of the enzyme in all subjects found G-6-PD deficient, since the clinical manifestations of G-6-PD deficiency are directly related to the type of variant present.

To investigate the role of the Djibouti-Ethiopian railway as a potential vehicle for inter-regional spread of malaria vectors and malaria parasites, we performed a double-sided study, both entomological and parasitological, during November 1989, at the frontier post of Guelile where the trains from Ethiopia enter the Republic of Djibouti. No malaria-transmitting mosquitoes were collected either from the daily passenger train or from the weekly vegetables train. One hundred and five passengers entering Djibouti by train from Ethiopia had a thick film examined for malaria parasites. Five smears were positive for Plasmodium falciparum, among them two showed gametocytes. We conclude that the railway may be an effective route for the propagation of the human malaria parasite between Ethiopia and Djibouti. Indeed, passengers infected abroad could import plasmodia into Djibouti and thus become the index cases for local malaria outbreaks, in case the climatic and entomological prerequisites essential for sustaining malaria transmission are present.