Résumé
Background: The 2014–2015 Ebola outbreak massively hit Guinea. The coastal
districts of Boffa, Dubreka and Forecariah, three major foci of Human
African Trypanosomiasis (HAT), were particularly affected. We aimed to
assess the impact of this epidemic on sleeping sickness screening and
caring activities. Methodology/Principal findings: We used preexisting
data from the Guinean sleeping sickness control program, collected between
2012 and 2015. We described monthly: the number of persons (i) screened
actively; (ii) or passively; (iii) treated for HAT; (iv) attending
post-treatment follow-up visits. We compared clinical data, treatment
characteristics and Disability Adjusted Life-Years (DALYs) before
(February 2012 to December 2013) and during (January 2014 to October 2015)
the Ebola outbreak period according to available data. Whereas 32,221
persons were actively screened from February 2012 to December 2013, before
the official declaration of the first Ebola case in Guinea, no active
screening campaigns could be performed during the Ebola outbreak.
Following the reinforcement and extension of HAT passive surveillance
system early in 2014, the number of persons tested passively by month
increased from 7 to 286 between April and September 2014 and then abruptly
decreased to 180 until January 2015 and to none after March 2015. 213
patients initiated HAT treatment, 154 (72%) before Ebola and 59 (28%)
during the Ebola outbreak. Those initiating HAT therapy during Ebola
outbreak were recruited through passive screening and diagnosed at a later
stage 2 of the disease (96% vs. 55% before Ebola, p<0.0001). The
proportion of patients attending the 3 months and 6 months post-treatment
follow-up visits decreased from 44% to 10% (p <0.0001) and from 16%
to 3% (p = 0.017) respectively. The DALYs generated before the Ebola
outbreak were estimated to 48.7 (46.7–51.5) and increased up to 168.7
(162.7–174.7), 284.9 (277.1–292.8) and 466.3 (455.7–477.0) during Ebola
assuming case fatality rates of 2%, 5% and 10% respectively among
under-reported HAT cases. Conclusions/Significance: The 2014–2015 Ebola
outbreak deeply impacted HAT screening activities in Guinea. Active
screening campaigns were stopped. Passive screening dramatically decreased
during the Ebola period, but trends could not be compared with pre-Ebola
period (data not available). Few patients were diagnosed with more
advanced HAT during the Ebola period and retention rates in follow-up were
lowered. The drop in newly diagnosed HAT cases during Ebola epidemic is
unlikely due to a fall in HAT incidence. Even if we were unable to
demonstrate it directly, it is much more probably the consequence of
hampered screening activities and of the fear of the population on
subsequent confirmation and linkage to care. Reinforced program
monitoring, alternative control strategies and sustainable financial and
human resources allocation are mandatory during post Ebola period to
reduce HAT burden in Guinea.