Data from: Impact of the Ebola outbreak on Trypanosoma brucei gambiense infection medical activities in coastal Guinea, 2014-2015: a retrospective analysis from the Guinean national Human African Trypanosomiasis control program

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.背景：2014—2015年埃博拉疫情重创几内亚。博法（Boffa）、杜布雷卡（Dubreka）和福雷卡里亚（Forecariah）沿海区县作为非洲人类锥虫病（Human African Trypanosomiasis，HAT）的三大主要流行区，受疫情影响尤为严重。本研究旨在评估此次疫情对锥虫病筛查与诊疗工作的影响。 研究方法与主要结果：本研究使用几内亚锥虫病防控项目于2012—2015年间收集的现有数据。我们按月统计了四类人群的相关数据：(1) 主动筛查人数；(2) 被动筛查人数；(3) 接受锥虫病治疗的人数；(4) 接受治疗后随访的人数。我们基于现有数据，对比了埃博拉疫情暴发前（2012年2月—2013年12月）与暴发期间（2014年1月—2015年10月）的临床数据、治疗特征及伤残调整寿命年（Disability Adjusted Life-Years，DALYs）。 在几内亚官方报告首例埃博拉病例前的2012年2月—2013年12月间，累计主动筛查32221人；而埃博拉疫情暴发期间，所有主动筛查活动均被迫中止。2014年初，随着锥虫病被动监测系统的强化与扩容，月度被动筛查人数从2014年4月的7人增至9月的286人；随后该数字急剧下滑，至2015年1月降至180人，2015年3月后则完全停止。共计213名患者启动锥虫病治疗：其中72%（154例）在埃博拉疫情前接受治疗，28%（59例）在疫情暴发期间启动治疗。疫情期间启动治疗的患者均通过被动筛查发现，且疾病分期更晚：96%的患者确诊为第2期锥虫病，而疫情前该比例仅为55%（p<0.0001）。治疗后3个月与6个月的随访依从率分别从疫情前的44%、16%降至疫情期间的10%（p<0.0001）与3%（p=0.017）。埃博拉疫情前的伤残调整寿命年估算值为48.7（95%置信区间：46.7—51.5）；假设漏报的锥虫病病例病死率分别为2%、5%与10%，则疫情期间的伤残调整寿命年分别升至168.7（162.7—174.7）、284.9（277.1—292.8）与466.3（455.7—477.0）。 结论与意义：2014—2015年埃博拉疫情对几内亚锥虫病筛查工作造成了深远影响。主动筛查活动全面中止。疫情期间被动筛查规模大幅下滑，但由于缺乏疫情前的对应数据，无法与疫情前的筛查趋势进行对比。疫情期间确诊为晚期锥虫病的患者数量较少，随访留存率也有所降低。埃博拉疫情期间新确诊的锥虫病病例数下降，并非源于锥虫病发病率的降低。尽管我们无法直接证实这一点，但该现象更可能源于筛查工作受阻，以及民众对后续确诊与诊疗服务的畏惧心理。在后埃博拉疫情时代，需强化项目监测、优化防控策略，并可持续投入财政与人力资源，以减轻几内亚的锥虫病负担。