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African swine fever (ASF) is a haemorrhagic contagious pig disease generally causing high mortality. ASF is enzootic in Madagascar with outbreaks reported each year. An ASF outbreak occurred in May 2015 in the municipality of Imerintsiatosika in Madagascar. We investigated the outbreak to describe it and to identify risk factors in order to propose control measures, and to document evidence of an ASF outbreak in an enzootic country. We took biological samples from very sick and dying pigs, sold by the farmer to the butcher, for PCR analysis. An active search for all possible farm-cases was carried out. A definition of suspected farm-case was established and we implemented a descriptive survey and a retrospective cohort study. Laboratory results confirmed ASF virus infection. Suspected farm-cases represented 81 farms out of 922. Out of 3081 pigs of infected farms, 44% (95% CI: 42–46%) were sick, of which 47% were sold or slaughtered. Case fatality was 60% (95% CI: 56–63%) while 21% (95% CI: 19–24%) of the diseased pigs recovered. The outbreak duration was nine months and half of the infected farms' pig population remained after the outbreak. Compared to the exotic breed, local pigs had twice the risk of infection. It is the first detailed report of an ASF outbreak in an enzootic situation. The disease still has a large impact with 50% animals lost. However, the case fatality is lower than expected that suggests the possibility of resistance and subclinical cases. Proximity to road and increased number of farms are risk factors so biosecurity measures are needed. Further studies are needed to understand why pigs of local breed are more affected. Finally, an acceptable alternative to the sale of sick animals should be found as this currently is the breeders' means to reducing economic loss.

Introduction: following the 2005-6 chikungunya outbreak, a project to strengthen regional Public Health preparedness in the Indian Ocean was implemented. It includes the Comoros, Madagascar, Mauritius, Reunion (France) and Seychelles. A Field Epidemiology Training Programme (FETP-OI) was started in 2011 to develop a pool of well-trained intervention epidemiologists. Methods: the FETP-OI consists of two years of supervised, learning-by-doing, on-the-job training at national sites involved in disease surveillance and response. It includes work placements at the Madagascar Pasteur Institute and the French regional epidemiology unit in Reunion and up to three training courses per year. Training objectives include epidemiological surveillance, outbreak investigations, research studies, scientific communication and transfer of competencies. Results: in four years, two cohorts of in total 15 fellows originating from four countries followed the FETP-OI. They led 42 surveillance projects (71% routine management, 14% evaluations, 12% setup, 3% other) and investigated 36 outbreak alerts, 58% of them in Madagascar; most investigations (72%) concerned foodborne pathogens, plague or malaria. Fellows performed 18 studies (44% descriptive analyses, 22%disease risk factors, and 34% on other subjects), and presented results during regional and international conferences through 26 oral and 15 poster presentations. Four articles were published in regional Public Health bulletins and several scientific manuscripts are in process. Conclusion: the FETP-OI has created a regional force of intervention consisting of field epidemiologists and trained supervisors using the same technical language and epidemiological methods. The third cohort is now ongoing. Technically and financially sustainable FETP-OI projects help addressing public health priorities of the Indian Ocean.

In 2005, a Chikungunya epidemic hit tens of thousands of people in the Indian Ocean region. This event revealed that health information sharing within the Indian Ocean Commission (IOC) countries (Comoros, Madagascar, Mauritius, France/Reunion and Seychelles) was critical. At the same time, zoonoses like Rift Valley fever and other animal diseases with high economic impact like Peste des petits ruminants burst out endangering food security in the region. Methods: To support the control of these emerging infectious diseases, two regional surveillance networks (human and animal), operational since 2009, were merged in 2013 into a unique “SEGA One health” network. It aims at strengthening surveillance systems at national and regional level, improving response to health risks and building capacity. This network is coordinated by a unit based at the IOC and involves focal points from human and animal health ministries, laboratories and research institutions. The network activities include health events monitoring through regular conference calls and meetings, web-surveillance, support for national surveillance systems and outbreak investigations, arboviruses quality control program for laboratories, training program and “one health” surveillance programs at national and regional level.Results: A weekly epidemiological bulletin is widely distributed (240 issues since 2009), twenty outbreaks have been investigated since 2013 (plague, dengue, Rift valley fever⋯). Eight national surveillance systems have been strengthened with an emphasis on information and communication technologies and specific “One health” programs have been initiated such as cysticercosis in Madagascar, leptospirosis in Seychelles, antibiotic-resistance and insecticide-resistance monitoring programmes at regional level. Another originality of this network is its close interactions with researchers through regular workshops and research studies. Priorities are defined by health managers and research result