Investigation of an Outbreak of Dengue Virus Serotype 1 in a Rural Area of Kribi, South Cameroon: A Cross-Sectional Study

Molecular surveillance for dengue serotypes among the population living in Moyen-Ogooué province, Gabon; evidence of the presence of dengue serotype 1

BACKGROUND

Despite dengue virus (DENV) outbreak in Gabon a decade ago, less is known on the potential circulation of DENV serotypes in the country. Previous studies conducted in some areas of the country, are limited to hospital-based surveys which reported the presence of some cases of serotype 2 and 3 seven years ago and more recently the serotype 1. As further investigation, we extend the survey to the community of Moyen Ogooué region with the aim to assess the presence of the dengue virus serotypes, additionally to characterize chikungunya (CHIKV) infection and describe the symptomatology associated with infections.

METHOD

A cross-sectional survey was conducted from April 2020 to March 2021. The study included participants of both sexes and any age one year and above, with fever or history of fever in the past seven days until blood collection. Eligible volunteers were clinically examined, and blood sample was collected for the detection of DENV and CHIKV using RT-qPCR. Positive samples were selected for the target sequencing.

RESULTS

A total of 579 volunteers were included. Their mean age (SD) was 20 (20) years with 55% of them being female. Four cases of DENV infection were diagnosed giving a prevalence of 0.7% (95%CI: 0.2-1.8) in our cohort while no case of CHIKV was detected. The common symptoms and signs presented by the DENV cases included fatigue, arthralgia myalgia, cough, and loss of appetite. DENV-1was the only virus detected by RT-qPCR.

CONCLUSION

Our results confirm the presence of active dengue infection in the region, particularly DENV-1, and could suggest the decline of DENV-2 and DENV-3. Continuous surveillance remains paramount to comprehensively describe the extent of dengue serotypes distribution in the Moyen-Ogooué region of Gabon.

Mosquito-Borne Arboviruses Occurrence and Distribution in the Last Three Decades in Central Africa: A Systematic Literature Review

Arboviruses represent a real public health problem globally and in the Central African subregion in particular, which represents a high-risk zone for the emergence and re-emergence of arbovirus outbreaks. Furthermore, an updated review on the current arbovirus burden and associated mosquito vectors is lacking for this region. To contribute to filling this knowledge gap, the current study was designed with the following objectives: (i) to systematically review data on the occurrence and distribution of arboviruses and mosquito fauna; and (ii) to identify potential spillover mosquito species in the Central African region in the last 30 years. A web search enabled the documentation of 2454 articles from different online databases. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) and the quality of reporting of meta-analyses (QUORUM) steps for a systematic review enabled the selection of 164 articles that fulfilled our selection criteria. Of the six arboviruses (dengue virus (DENV), chikungunya virus (CHIKV), yellow fever virus (YFV), Zika virus (ZIKV), Rift Valley fever virus (RVFV), and West Nile virus (WNV)) of public health concern studied, the most frequently reported were chikungunya and dengue. The entomological records showed >248 species of mosquitoes regrouped under 15 genera, with Anopheles (n = 100 species), Culex (n = 56 species), and Aedes (n = 52 species) having high species diversity. Three genera were rarely represented, with only one species included, namely, Orthopodomyia, Lutzia, and Verrallina, but individuals of the genera Toxorhinchites and Finlayas were not identified at the species level. We found that two Aedes species (Ae. aegypti and Ae. albopictus) colonised the same microhabitat and were involved in major epidemics of the six medically important arboviruses, and other less-frequently identified mosquito genera consisted of competent species and were associated with outbreaks of medical and zoonotic arboviruses. The present study reveals a high species richness of competent mosquito vectors that could lead to the spillover of medically important arboviruses in the region. Although epidemiological studies were found, they were not regularly documented, and this also applies to vector competence and transmission studies. Future studies will consider unpublished information in dissertations and technical reports from different countries to allow their information to be more consistent. A regional project, entitled "Ecology of Arboviruses" (EcoVir), is underway in three countries (Gabon, Benin, and Cote d'Ivoire) to generate a more comprehensive epidemiological and entomological data on this topic.

Whole genome sequencing of outbreak strains from 2017 to 2018 reveals an endemic clade of dengue 1 virus in Cameroon

Dengue fever is expanding as a global public health threat including countries within Africa. For the past few decades, Cameroon has experienced sporadic cases of arboviral infections including dengue fever. Here, we conducted genomic analyses to investigate the origin and phylogenetic profile of Cameroon DENV-1 outbreak strains and predict the impact of emerging therapeutics on these strains. Bayesian and maximum-likelihood phylogenetic inference approaches were employed in virus evolutionary analyses. An in silico analysis was performed to assess the divergence in immunotherapeutic and vaccine targets in the new genomes. Six complete DENV-1 genomes were generated from 50 samples that met a clinical definition for DENV infection. Phylogenetic analyses revealed that the strains from the current study belong to a sub-lineage of DENV-1 genotype V and form a monophyletic taxon with a 2012 strain from Gabon. The most recent common ancestor (TMRCA) of the Cameroon and Gabon strains was estimated to have existed around 2008. Comparing our sequences to the vaccine strains, 19 and 15 amino acid (aa) substitutions were observed in the immuno-protective prM-E protein segments of the Dengvaxia® and TetraVax-DV-TV003 vaccines, respectively. Epitope mapping revealed mismatches in aa residues at positions E155 and E161 located in the epitope of the human anti-DENV-1 monoclonal antibody HMAb 1F4. The new DENV strains constitute a conserved genomic pool of viruses endemic to the Central African region that needs prospective monitoring to track local viral evolution. Further work is needed to ascertain the performance of emerging therapeutics in DENV strains from the African region.

Arboviruses as an unappreciated cause of non-malarial acute febrile illness in the Dschang Health District of western Cameroon

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.

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.

Assessment of Dengue and Chikungunya Infections among Febrile Patients Visiting Four Healthcare Centres in Yaoundé and Dizangué, Cameroon

Dengue and chikungunya are now widely distributed in Cameroon, but there is still not enough information on their prevalence in different epidemiological settings. This study was undertaken to assess the prevalence of dengue and chikungunya in both urban and rural settings in Cameroon using three diagnostic tools. From December 2019 to September 2021, willing febrile (temperature >38 °C) outpatients visiting four healthcare facilities in the cities of Yaoundé and Dizangué were screened for dengue, and chikungunya. Clinical features of patient were recorded in a form, and their blood samples were analysed using real-time reverse transcriptase-polymerase chain reaction (rtRT-PCR), rapid diagnostic tests (RDTs) and enzyme-linked immuno-sorbent assays (ELISA). Odds ratios were used to determine the level of association between socio-demographic factors, clinical features, and infection status. The Kappa coefficient permitted to assess the level of agreement between RDTs and ELISA. Overall, 301 febrile patients were recruited in the study: 198 in Yaoundé and 103 in Dizangué. The prevalence of infection varied with the diagnostic tool used. For dengue diagnostics, 110 patients were positive to rtRT-PCR: 90 (45.45%) in Yaoundé, and 20 (19.42%) in Dizangué. The prevalence of dengue IgM using ELISA varied from 22.3% in Dizangué to 30.8% in Yaoundé. Dengue IgM rate using RDTs was 7.6% in Yaoundé and 3.9% in Dizangué. For chikungunya, one (0.5%) patient (Yaoundé, suburb) was positive to rtRT-PCR. The prevalence of chikungunya IgM according to ELISA varied from 18.4% in Dizangué to 21.7% in Yaoundé, while it was 4.5% in Yaoundé and 12.6% in Dizangué with RDTs. Only abdominal and retro-orbital pains were significantly associated with acute dengue infection. All four dengue serotypes were recorded, with a predominance of DENV-3 (35.45%) and DENV-4 (25.45%). Rapid Diagnostic Tests for either chikungunya or dengue displayed very poor sensitivity. This study further confirms the high endemicity of both dengue and chikungunya in Yaoundé and Dizangué. These data stress the need for active surveillance and the implementation of vector control measures to prevent the occurrence of outbreaks across the country.

Aedes Mosquito Surveillance Using Ovitraps, Sweep Nets, and Biogent Traps in the City of Yaoundé, Cameroon

Arbovirus diseases represent a significant public health problem in Cameroon and vector surveillance is a key component of prevention strategies. However, there is still not enough evidence of the efficacy of different sampling methods used to monitor Aedes mosquito population dynamic in different epidemiological settings. The present study provides data on the evaluation of ovitraps and different adult sampling methods in the city of Yaoundé and its close vicinity. Entomological surveys were carried out from February 2020 to March 2021 in two urban (Obili, Mvan), two peri-urban (Simbock, Ahala), and two rural (Lendom, Elig-essomballa) sites in the city of Yaoundé. The efficacy of three sampling methods, namely ovitraps, Biogent Sentinel trap, and sweep nets, was evaluated. Different ovitrap indices were used to assess the infestation levels across study sites; a general linear model was used to determine if there are statistical differences between positive ovitraps across ecological zones. A total of 16,264 Aedes mosquitoes were collected during entomological surveys. Ovitraps provided the highest mosquito abundance (15,323; 91.14%) and the highest species diversity. Of the five Aedes species collected, Aedes albopictus (59.74%) was the most commonly recorded in both urban and rural settings. Different Aedes species were collected in the same ovitrap. The ovitrap positivity index was high in all sites and varied from 58.3% in Obili in the urban area to 86.08% in Lendom in the rural area. The egg density index varied from 6.42 in Mvan (urban site) to 13.70 in Lendom (rural area). Adult sampling methods recorded mostly Aedes albopictus. The present study supports high infestation of Aedes species in the city of Yaoundé. Ovitraps were highly efficient in detecting Aedes distribution across study sites. The situation calls for regular surveillance and control of Aedes population to prevent sudden occurrence of outbreaks.

Global prevalence of dengue and chikungunya coinfection: A systematic review and meta-analysis of 43,341 participants

Dengue and chikungunya virus are important arboviruses of public health concern. In the past decades, they have accounted for numerous outbreaks of dengue and chikungunya in different parts of the world. Several cases of concurrent infection of dengue and chikungunya have been documented. However, the true burden of this concurrent infection is unknown. Here, a systematic review and meta-analysis of published data on the prevalence of dengue and chikungunya coinfection in the human population was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Six electronic databases (Web of science, Embase, PubMed, ScienceDirect, Scopus, and Google Scholar) were searched without year or language restrictions for relevant studies. The study protocol was registered with PROSPERO (CRD42020175344). Eighty-three studies involving a total of 43,341 participants were included. The random-effects model was employed to calculate the summary estimates. A pooled global prevalence of 2.5% (95% CI: 1.8-3.4) was obtained for dengue and chikungunya coinfection. Males and females appear to be coinfected at a fairly similar rate. Among the regions, Asia accounted for the highest prevalence (3.3%, 95% CI: 2.3-4.6) while North America was the least (0.8%, 95% CI: 0.3-2.4). The prevalence estimates varied across different countries. A much higher prevalence rates were obtained for Colombia (37.4%, 95% CI: 9.1-78.1), Madagascar (18.2%, 95% CI: 10.1-30.6), Laos (12.5%, 95% CI: 5.3-26.7), Maldives (4.5%, 95% CI: 1.5-13.0) and Thailand (3.7%, 95% CI: 0.4-26.3). This first extensive systematic review and meta-analysis reveals dengue and chikungunya coinfection as a global problem worthy of consideration. It is therefore pertinent that both infections be assessed during diagnosis, mosquito vector control practices be implemented, and vaccine development strides be supported globally.

Dengue and Chikungunya virus circulation in Cameroon and Gabon: molecular evidence among symptomatic individuals

We report the molecular evidence of dengue virus (DENV) and chikungunya virus (CHIKV) infection in symptomatic individuals in Cameroon and Gabon, respectively. Arthropod-borne viruses (arboviruses) are distributed in the tropical or subtropical regions, with DENV having the highest burden. The morbidity and mortality related to arboviral diseases raise the concern of timely and efficient surveillance and care. Our aim was to assess the circulation of arboviruses [DENV, CHIKV, Zika virus (ZIKV)] among febrile patients in Dschang (West Cameroon) and Kyé-ossi (South Cameroon, border with Gabon and Equatorial Guinea). Dried blood spots were collected from 601 consenting febrile patients, and 194 Plasmodium spp.-negative samples were tested for the molecular detection of cases of DENV, CHIKV and ZIKV infection. Overall, no case of ZIKV infection was found, whereas one case of DENV infection and one case of CHIKV infection were detected in Dschang and Kyé-ossi, respectively, with the CHIKV-infected patient being resident in Gabon. Our findings suggest the need to establish an active surveillance of arbovirus transmission in Cameroon and bordering countries.

Sustained circulation of yellow fever virus in Cameroon: an analysis of laboratory surveillance data, 2010-2020

BACKGROUND

The re-emergence of yellow fever poses a serious public health risk to unimmunized communities in the tropical regions of Africa and South America and unvaccinated travelers visiting these regions. This risk is further accentuated by the likely spread of the virus to areas with potential for yellow fever transmission such as in Asia, Europe, and North America. To mitigate this risk, surveillance of yellow fever is pivotal. We performed an analysis of laboratory-based surveillance of yellow fever suspected cases in Cameroon during 2010-2020 to characterize the epidemiology of yellow fever cases and define health districts at high risk.

METHOD

We reviewed IgM capture ELISA and plaque reduction neutralization test (PRNT) test results of all suspected yellow fever patients analyzed at Centre Pasteur of Cameroon, the national yellow fever testing laboratory, during 2010-2020.

RESULTS

Of the 20,261 yellow fever suspected patient's samples that were tested, yellow fever IgM antibodies were detected in 360 patients representing an annual average of 33 cases/year. A major increase in YF IgM positive cases was observed in 2015 and in 2016 followed by a decrease in cases to below pre-2015 levels. The majority of the 2015 cases occurred during the latter part of the year while those in 2016, occurred between February and May. This trend may be due to an increase in transmission that began in late 2015 and continued to early 2016 or due to two separate transmission events. In 2016, where the highest number of cases were detected, 60 health districts in the 10 regions of Cameroon were affected with the Littoral, Northwest and, Far North regions being the most affected. After 2016, the number of detected yellow fever IgM positive cases dropped.

CONCLUSION

Our study shows that yellow fever transmission continues to persist and seems to be occurring all over Cameroon with all 10 regions under surveillance reporting a case. Preventive measures such as mass vaccination campaigns and routine childhood immunizations are urgently needed to increase population immunity. The diagnostic limitations in our analysis highlight the need to strengthen laboratory capacity and improve case investigations.

Uncovering the Burden of Dengue in Africa: Considerations on Magnitude, Misdiagnosis, and Ancestry

Dengue is a re-emerging neglected disease of major public health importance. This review highlights important considerations for dengue disease in Africa, including epidemiology and underestimation of disease burden in African countries, issues with malaria misdiagnosis and co-infections, and potential evidence of genetic protection from severe dengue disease in populations of African descent. The findings indicate that dengue virus prevalence in African countries and populations may be more widespread than reported data suggests, and that the Aedes mosquito vectors appear to be increasing in dissemination and number. Changes in climate, population, and plastic pollution are expected to worsen the dengue situation in Africa. Dengue misdiagnosis is also a problem in Africa, especially due to the typical non-specific clinical presentation of dengue leading to misdiagnosis as malaria. Finally, research suggests that a protective genetic component against severe dengue exists in African descent populations, but further studies should be conducted to strengthen this association in various populations, taking into consideration socioeconomic factors that may contribute to these findings. The main takeaway is that Africa should not be overlooked when it comes to dengue, and more attention and resources should be devoted to this disease in Africa.

Concurrent circulation of dengue serotype 1, 2 and 3 among acute febrile patients in Cameroon

Acute febrile patients presenting at hospitals in Douala, Cameroon between July and December 2020, were screened for dengue infections using real time RT-PCR on fragments of the 5’ and 3’ UTR genomic regions. In total, 12.8% (41/320) of cases examined were positive for dengue. Dengue virus 3 (DENV-3) was the most common serotype found (68.3%), followed by DENV-2 (19.5%) and DENV-1 (4.9%). Co-infections of DENV-3 and DENV-2 were found in 3 cases. Jaundice and headache were the most frequent clinical signs associated with infection and 56% (23/41) of the cases were co-infections with malaria. Phylogenetic analysis of the envelope gene identified DENV-1 as belonging to genotype V, DENV-2 to genotype II and DENV-3 to genotype III. The simultaneous occurrence of three serotypes in Douala reveals dengue as a serious public health threat for Cameroon and highlights the need for further epidemiological studies in the major cities of this region.

Acute febrile patients presenting at hospitals in Douala, Cameroon between July and December 2020, were screened for dengue infections by Polymerase chain reaction. In total, 12.8% (41/320) of cases examined were infected by dengue virus. Dengue virus 3 (DENV-3) was the most common serotype found (68.3%), followed by DENV-2 (19.5%) and DENV-1 (4.9%). Co-infections of DENV-3 and DENV-2 were found in 3 cases. Jaundice and headache were the most frequent clinical signs associated with infection and 56% (23/41) of the cases were co-infections with malaria. The simultaneous occurrence of three serotypes in Douala reveals dengue as a serious public health threat for Cameroon and highlights the need for further epidemiological studies in the major cities of this region.

An update on the mosquito fauna and mosquito-borne diseases distribution in Cameroon

The expansion of mosquito-borne diseases such as dengue, yellow fever, and chikungunya in the past 15 years has ignited the need for active surveillance of common and neglected mosquito-borne infectious diseases. The surveillance should be designed to detect diseases and to provide relevant field-based data for developing and implementing effective control measures to prevent outbreaks before significant public health consequences can occur. Mosquitoes are important vectors of human and animal pathogens, and knowledge on their biodiversity and distribution in the Afrotropical region is needed for the development of evidence-based vector control strategies. Following a comprehensive literature search, an inventory of the diversity and distribution of mosquitoes as well as the different mosquito-borne diseases found in Cameroon was made. A total of 290 publications/reports and the mosquito catalogue website were consulted for the review. To date, about 307 species, four subspecies and one putative new species of Culicidae, comprising 60 species and one putative new species of Anopheles, 67 species and two subspecies of Culex, 77 species and one subspecies of Aedes, 31 species and one subspecies of Eretmapodites, two Mansonia, eight Coquillettidia, and 62 species with unknown medical and veterinary importance (Toxorhynchites, Uranotaenia, Mimomyia, Malaya, Hodgesia, Ficalbia, Orthopodomyia, Aedeomyia, and Culiseta and Lutzia) have been collected in Cameroon. Multiple mosquito species implicated in the transmission of pathogens within Anopheles, Culex, Aedes, Eretmapodites, Mansonia, and Coquillettidia have been reported in Cameroon. Furthermore, the presence of 26 human and zoonotic arboviral diseases, one helminthic disease, and two protozoal diseases has been reported. Information on the bionomics, taxonomy, and distribution of mosquito species will be useful for the development of integrated vector management programmes for the surveillance and elimination of mosquito-borne diseases in Cameroon.

Chikungunya viruses containing the A226V mutation detected retrospectively in Cameroon form a new geographical subclade

BACKGROUND

Chikungunya virus (CHIKV) is a re-emerging arbovirus associated with sporadic outbreaks in Cameroon since 2006. Viral whole genomes were generated to analyze the origins of evolutionary lineages, the potential of emergence/re-emergence, and to infer transmission dynamics of recent Cameroon CHIKV outbreak strains.

METHODS

Samples collected between 2016 and 2019 during CHIKV outbreaks in Cameroon were screened for CHIKV using reverse transcription PCR (RT-PCR), followed by whole genome sequencing of positive samples.

RESULTS

Three coding-complete CHIKV genomes were obtained from samples, which belong to an emerging sub-lineage of the East/Central/South African genotype and formed a monophyletic taxon with previous Central African strains. This clade, which we have named the new Central African clade, appears to be evolving at 3.0 × 10^-4 nucleotide substitutions per site per year (95% highest posterior density (HPD) interval of 1.94 × 10^-4 to 4.1 × 10^-4). Notably, mutations in the envelope proteins (E1-A226V, E2-L210Q, and E2-I211T), which are known to enhance CHIKV adaptability and infectious potential in Aedes albopictus, were present in all strains and mapped to established high-density Ae. albopictus populations.

CONCLUSIONS

These new CHIKV strains constitute a conserved genomic pool of an emerging sub-lineage, reflecting a putative vector host adaptation to Ae. albopictus, which has practically displaced Aedes aegypti from select regions of Cameroon.

Aedes Mosquito Distribution along a Transect from Rural to Urban Settings in Yaoundé, Cameroon

INTRODUCTION

The surveillance of mosquito vectors is important for the control of arboviruses diseases worldwide. Detailed information on the bionomics and distribution of their main vectors, Aedes aegypti and Aedes albopictus, is essential for assessing disease transmission risk and for better planning of control interventions.

METHODS

Entomological surveys were carried out from November 2019 to November 2020 in six localities of Yaoundé city following a transect from urban to rural settings: two urban (Obili, Mvan), two peri-urban (Simbock, Ahala) and two rural areas (Lendom, Elig-essomballa)-during rainy and dry seasons. All water containers were inspected. Aedes mosquito abundance, species distribution and seasonal distribution patterns were compared using generalized linear models. Stegomyia indexes were estimated to determine the risk of arbovirus transmission.

RESULTS

A total of 6332 mosquitoes larvae were collected (2342 in urban areas, 1694 in peri-urban areas and 2296 in rural sites). Aedes species recorded included Ae. albopictus, Ae. aegytpi, Ae. simpsoni and Aedes spp. High mosquito abundance was registered in the rainy season (4706) compared to the dry season (1626) (p < 0.0001). Ae. albopictus was the most abundant Aedes species in urban (96.89%) and peri-urban (95.09%) sites whereas Ae. aegypti was more prevalent in rural sites (68.56%) (p < 0.0001). Both species were found together in 71 larval habitats. Ae. albopictus was mostly found in discarded tires (42.51%), whereas Ae. aegypti was more prevalent in plastic containers used for storing water (65.87%). The majority of Aedes mosquitoes' breeding places were situated close to human dwellings (0-10 m).

CONCLUSION

Uncontrolled urbanization seems to greatly favour the presence of Aedes mosquito species around human dwellings in Yaoundé. Controlling Aedes mosquito distribution is becoming urgent to reduce the risk of arbovirus outbreaks in the city of Yaoundé.

Investigation of dengue-malaria coinfection among febrile patients consulting at Ngaoundere Regional Hospital, Cameroon

This study aimed at evaluating the seroprevalence of dengue among malarious patients consulting at the Ngaoundere Regional Hospital. During 2 months and a half, 174 participants were recruited and their blood samples were screened for Plasmodium spp and then for Dengue virus (DENV) infection using rapid diagnostic tests. Also, hematological asparameters were measured using a hematology autoanalyzer. Among patients tested, 134 (77.01%) were malaria-positive, and 12/134 (8.95%) were coinfected. In this population, 8/12 (66.67%) were only anti-DENV IgM-positive, 3/12 (25%) were both NS1 and anti-DENV IgM positive, and 1/12 (8.33%) were anti-DENV IgG-positive. Furthermore, women were more affected (58.3%) than men (41.7%). The most affected age groups were young people aged less than or equal to 15 years (33.3%) and adults aged between 30 and 45 years (33.3%). A significant association (p < .05; odds ratio [OR] = 5.16) was found between the age range (30-45) and dengue-malaria coinfection. Similarly, we noted a significant association between the coinfection, and joint pain (p < .05; OR = 6.15), fatigue (p < .01; OR = 5.74), and chills (p < .05; OR = 0). Analysis of hematologic parameters showed a significant decrease (p < .001) in platelets in coinfected patients compared with monoinfected patients. In conclusion, dengue-malaria coinfection is a reality in Ngaoundere city and associated with the appearance of clinical features which predict the disease severity.

Analyses of Insecticide Resistance Genes in Aedes aegypti and Aedes albopictus Mosquito Populations from Cameroon

The emergence of insecticide resistance in Aedes mosquitoes could pose major challenges for arboviral-borne disease control. In this paper, insecticide susceptibility level and resistance mechanisms were assessed in Aedes aegypti (Linnaeus, 1762) and Aedes albopictus (Skuse, 1894) from urban settings of Cameroon. The F1 progeny of Aedes aegypti and Aedes albopictus collected in Douala, Yaoundé and Dschang from August to December 2020 was tested using WHO tube assays with four insecticides: deltamethrin 0.05%, permethrin 0.75%, DDT 4% and bendiocarb 0.1%. TaqMan, qPCR and RT-qPCR assays were used to detect kdr mutations and the expression profiles of eight detoxification genes. Aedes aegypti mosquitoes from Douala were found to be resistant to DDT, permethrin and deltamethrin. Three kdr mutations, F1534C, V1016G and V1016I were detected in Aedes aegypti populations from Douala and Dschang. The kdr allele F1534C was predominant (90%) in Aedes aegypti and was detected for the first time in Aedes albopictus (2.08%). P450s genes, Cyp9J28 (2.23-7.03 folds), Cyp9M6 (1.49-2.59 folds), Cyp9J32 (1.29-3.75 folds) and GSTD4 (1.34-55.3 folds) were found overexpressed in the Douala and Yaoundé Aedes aegypti populations. The emergence of insecticide resistance in Aedes aegypti and Aedes albopictus calls for alternative strategies towards the control and prevention of arboviral vector-borne diseases in Cameroon.

First detection of F1534C knockdown resistance mutation in Aedes aegypti (Diptera: Culicidae) from Cameroon

Background

Aedes borne viral diseases, notably dengue, are increasingly reported in Cameroon with Aedes aegypti being a major vector. Data on insecticide resistance of this vector and underlying mechanisms needed for outbreak preparedness remain scarce in Cameroon. Here, we present the nationwide distribution of insecticide resistance in Ae. aegypti and investigate the potential resistance mechanisms involved.

Methods

Immature stages of Ae. aegypti were collected between March and July 2017 in 13 locations across Cameroon and reared until G1/G2/G3 generation. Larval, adult bioassays, and piperonyl butoxide (PBO) synergist assays were carried out according to World Health Organization guidelines. F1534C mutation was genotyped using allele specific polymerase chain reaction in field collected adults (Go) and the polymorphism of the sodium channel gene was assessed. The χ² test was used to compare the mortality rate between bioassays with insecticides only and bioassays after preexposure to PBO synergist.

Results

Larval bioassay revealed that all the three populations tested with temephos were susceptible. Adult bioassays showed a good level of susceptibility toward both pyrethroids tested, 0.25% permethrin and 0.05% deltamethrin, with six out of 10 populations susceptible. However, two populations (Douala and Edéa) were resistant (deltamethrin [73.2–92.5% mortality], permethrin [2.6–76.3% mortality]). The resistance to 4% dichlorodiphenyltrichloroethane was observed in four out of 10 populations tested (16.8–87.1% mortality). Resistance was also reported to carbamates including 0.1% propoxur (60.8–87.1% mortality) and to 0.1% bendiocarb (82.9% mortality). All populations tested were fully susceptible to 1% fenitrothion. A partial recovery of susceptibility was observed in the pyrethroid resistant population of Douala after pre-exposed to PBO suggesting the implication of cytochrome P450 monoxygenases permethrin resistance. Genotyping and sequencing detected the F1534C kdr mutation in the two pyrethroid resistant locations of Edéa and Douala, with allelic frequency of 3.3% and 33.3% respectively. However, the high genetic diversity of the sodium channel gene supports the recent introduction of this mutation in Cameroon.

Conclusions

This study revealed the contrasting resistance profiles to insecticides of Ae. aegypti populations in Cameroon suggesting that, instead of a unique nationwide control approach, a regionally adapted strategy will be needed to control this vector. The localised distribution of the F1534C kdr mutation supports this region-specific control strategy.

Dengue virus serological markers among potential blood donors: an evidence of asymptomatic dengue virus transmission in Cameroon

Introduction

the risk of dengue virus or its antibodies which can be transmitted through blood transfusion by asymptomatic individuals infected, has been a major concern all over the world. Dengue is an endemic disease in sub-Saharan Africa, particularly in Cameroon. The purpose of this study is to determine the frequency of dengue virus (DENV) infection among potential blood donors at Yaounde Jamot Hospital.

Methods

serum samples were collected from 310 potential adult blood donors aged 18-57 years, who signed a written informed consent and completed the questionnaire between March 2019 and August 2019. This serum is used to screen for the presence of serological markers of DENV infection (NS1, IgM and IgG) using immunochromatographic tests (Zhuhai Encode Medical Engineering Co., Ltd, China). IgM/IgG positive samples were confirmed by enzyme-linked immunosorbent assays (ELISA).

Results

the overall prevalence was 24.8% among potential blood donors were subdivided as follows: 4.5% (14/310), 12.3% (38/310) and 6.1% (19/310) showed mono-positivity to DENV-NS1 antigen, anti-DENV IgM and anti-DENV IgG antibodies respectively. 1.9% (6/310) of potential blood donors showed dual positivity to anti-DENV IgM antibodies and anti-DENV IgG antibodies. The presence of DENV-NS1 antigen show asymptomatic viremia of dengue at the time of donation, while the presence of IgG antibodies reflects the high endemicity of dengue disease in the city of Yaoundé.

Conclusion

these findings demonstrate the high level of risk of the DENV transmission among potential blood donors to needy recipients, underscoring the importance of establishing dengue fever blood screening in different services and blood collection units in Cameroon to improve safety transfusion and control the dissemination of the DENV.

Patterns of Ecological Adaptation of Aedes aegypti and Aedes albopictus and Stegomyia Indices Highlight the Potential Risk of Arbovirus Transmission in Yaoundé, the Capital City of Cameroon

The dynamic of arbovirus vectors such as Aedes aegypti and Ae. albopictus remains poorly understood in large cities in central Africa. Here, we compared the larval ecology, geographical distribution and degree of infestation of Ae. aegypti and Ae. albopictus in Yaoundé, the capital city of Cameroon, and estimated their Stegomyia indices revealing a significant potential risk of arbovirus transmission. An entomological survey was conducted in April-May 2018 in a cluster of houses randomly selected. Each selected house was inspected, the number of inhabitants was recorded, and potential and positive containers for Aedes were characterized. Stegomyia and pupae-based indices were estimated. Overall, 447 houses and 954 containers were inspected comprising 10,801 immature stages of Aedes with 84.95% of Ae. albopictus and 15.05% of Ae. aegypti. Both species bred mainly in discarded tanks and used tyres, associated with turbid water and the presence of plant debris inside containers. Aedes albopictus was the most prevalent species in almost all neighbourhoods. The house index, Breteau index, and container index were higher for Ae. albopictus (38.26%, 71.81%, and 29.61%) compared to those of Ae. aegypti (25.73%, 40.93%, and 16.88%). These indices are high compared to the thresholds established by Pan American Health Organization and World Health Organization, which suggests a high potential risk of arbovirus transmission.

Nationwide profiling of insecticide resistance in Aedes albopictus (Diptera: Culicidae) in Cameroon

The Asian mosquito, Aedes albopictus (Skuse), is an invasive mosquito which has become one of the most important vectors of dengue, Zika, and chikungunya viruses worldwide. This species was reported for the first time in Cameroon in early 2000s and became the dominant Aedes species in the urban areas in the southern part of Cameroon but remain poorly characterized. Here, we assessed the susceptibility profile of A. albopictus collected throughout Cameroon and investigated the potential resistance mechanisms involved. Immature stages of A. albopictus were collected between March and July 2017 in 15 locations across Cameroon and reared until G1/G2 generation. Larval, adult bioassays, and synergists [piperonyl butoxide (PBO) and diethyl maleate (DEM)] assays were carried out according to WHO recommendations. F1534C mutation was genotyped in field collected adults (Go) using allele specific PCR. All tested populations were susceptible to both larvicides, temephos and Bacillus thuringiensis israelensis (Bti), after larval bioassays. Adult bioassays revealed a high level of resistance of A. albopictus to 4% DDT with mortality rates ranging from 12.42% in Bafang to 75.04% in Kumba. The resistance was reported also in 0.05% deltamethrin, 0.25% permethrin, and 0.1% propoxur in some locations. A loss of susceptibility to 0.1% bendiocarb was found in one of three populations analysed. A full susceptibility to 1% fenitrothion were observed across the country. A full recovery or partial of susceptibility was observed in A. albopictus when pre-exposed to PBO or DEM and then to DDT and permethrin, respectively. The F1534C kdr mutation was not detected in A. albopictus. This study showed that the susceptibility profile of A. albopictus to insecticide vary according to the sampling location and insecticides used. These findings are useful to planning vector control program against arbovirus vectors in Cameroon and can be used as baseline data for further researches.

Contrasting resistance patterns to type I and II pyrethroids in two major arbovirus vectors Aedes aegypti and Aedes albopictus in the Republic of the Congo, Central Africa

BACKGROUND

In the Republic of Congo, with two massive outbreaks of chikungunya observed this decade, little is known about the insecticide resistance profile of the two major arbovirus vectors Aedes aegypti and Aedes albopictus. Here, we established the resistance profile of both species to insecticides and explored the resistance mechanisms to help Congo to better prepare for future outbreaks.

METHODS

Immature stages of Ae. aegypti and Ae. albopictus were sampled in May 2017 in eight cities of the Republic of the Congo and reared to adult stage. Larval and adult bioassays, and synergist (piperonyl butoxide [PBO]) assays were carried out according to WHO guidelines. F1534C mutation was genotyped in field collected adults in both species and the polymorphism of the sodium channel gene assessed in Ae. aegypti.

RESULTS

All tested populations were susceptible to temephos after larval bioassays. A high resistance level was observed to 4% DDT in both species countrywide (21.9-88.3% mortality). All but one population (Ae. aegypti from Ngo) exhibited resistance to type I pyrethroid, permethrin, but showed a full susceptibility to type II pyrethroid (deltamethrin) in almost all locations. Resistance was also reported to 1% propoxur in Ae. aegypti likewise in two Ae. albopictus populations (Owando and Ouesso), and the remaining were fully susceptible. All populations of both species were fully susceptible to 1% fenitrothion. A full recovery of susceptibility was observed in Ae. aegypti and Ae. albopictus when pre-exposed to PBO and then to propoxur and permethrin respectively. The F1534C kdr mutation was not detected in either species. The high genetic variability of the portion of sodium channel spanning the F1534C in Ae. aegypti further supported that knockdown resistance probably play no role in the permethrin resistance.

CONCLUSIONS

Our study showed that both Aedes species were susceptible to organophosphates (temephos and fenitrothion), while for other insecticide classes tested the profile of resistance vary according to the population origin. These findings could help to implement better and efficient strategies to control these species in the Congo in the advent of future arbovirus outbreaks.

Evidence of Low-Level Dengue Virus Circulation in the South Region of Cameroon in 2018

Dengue fever is an understudied disease in many parts of Africa and little is known about its prevalence in Cameroon. We tested blood from 629 individuals from the South Region of Cameroon, collected over the course of one year, for flavivirus RNA using conventional broad range PCR. Flavivirus RNA corresponding to dengue virus (DENV) serotype 1 was identified in two individuals who were also diagnosed with malaria. This finding confirms previous reports that indicate the presence of low-level circulation of DENV in Cameroon and supports the concern that dengue fever may be underdiagnosed due to more prevalent diseases that have similar symptomology and insufficient diagnostic capacity.

Risk of dengue in Central Africa: Vector competence studies with Aedes aegypti and Aedes albopictus (Diptera: Culicidae) populations and dengue 2 virus

Introduction

Dengue is the most important mosquito-borne diseases worldwide but was considered scarce in West-Central Africa. During the last decade, dengue outbreaks have increasingly been reported in urban foci in this region suggesting major epidemiological changes. However, in Central Africa where both vectors, Aedes aegypti and Aedes albopictus are well established, the role of each species in dengue transmission remains poorly investigated.

Methodology/Principal findings

Field-collected strains of Ae. aegypti and Ae. albopictus from different ecological settings in Central Africa were experimentally challenged with dengue 2 virus (DENV-2). Mosquitoes were analysed at 14- and 21-days post-infection. Analysis provide evidence that both Ae. aegypti and Ae. albopictus in Central Africa were able to transmit dengue virus with Ae. aegypti exhibiting a higher transmission rate. Unexpectedly, two Ae. aegypti populations from Bénoué and Maroua, in northern Cameroon, were not able to transmit DENV-2.

Conclusions/Significance

We conclude that both Ae. aegypti and Ae. albopictus are susceptible to DENV-2 and may intervene as active dengue vectors. These findings highlight the urgent need to plan a vector surveillance program and control methods against dengue vectors in Central Africa in order to prevent future outbreaks.

Dengue virus (DENV) is a flavivirus mainly transmitted to humans through the bite of infected mosquitoes notably Aedes aegypti and Aedes albopictus. In Central Africa where both vectors, Ae. aegypti and Ae. albopictus are well established, the role of each species in dengue transmission remains poorly investigated. Here, we assessed the vector competence of Ae. aegypti and Ae. albopictus collected in different ecological settings in Central Africa to transmit dengue 2 virus (DENV-2). We provide evidence that both Ae. aegypti and Ae. albopictus in Central Africa were able to transmit dengue virus with Ae. aegypti exhibiting a higher transmission rate. These findings could increase the risk of dengue outbreak in the region and emphasize the need for a comprehensive vector surveillance program to prevent and preparedness for an intervention in case of outbreaks.