The Ministry of Public Health (MOPH) of Cameroon reported in mid-February cases of acute fever and rash syndrome of unknown etiology being reported from the Far North and North regions of the country.
The major clinical manifestations of the illness included skin rash, persistent fever, malnutrition, anemia, hepato-splenomegaly and adenopathy. Laboratory results by the Centre Pasteur of Cameroon in Yaoundé have since shown this illnesses were due to cutaneous leishmaniasis.
Retrospective investigation indicated that 48 cases with similar clinical features including 17 deaths (case fatality rate of 35.4%) had been registered between January 2016 and 24 March 2017.
These cases originated from six health districts (Bourha, Mokolo, Mogode, Hina, Maroua 3 and Soulede Roua) in the Far North region of Cameroon, and Mayo-Oulo district in the North region, the same areas where humanitarian crisis is occurring.
Thirty six of the 48 cases investigated had no established epidemiological links, negating contact contagion as a mode of transmission. Six cases are currently hospitalized in Mokolo district hospital.
Leishmaniasis is caused by the protozoan Leishmania parasites that are transmitted through the bites of infected female sandflies. The disease is associated with malnutrition, population displacement, poor housing, a weak immune system, and poverty. These factors are prevalent in the Far North and North regions of the country, in addition to availability of the vectors.
The outbreak of leishmaniasis in the far north and north of Cameroon has been going on insidiously since January 2017 or beyond. Detection and confirmation of the outbreak took several weeks due to a number of factors, including weak surveillance system especially for a neglected tropical diseases like leishmaniasis, inadequate laboratory diagnostic capacity and functional specimen transportation system, shortage of essential medicines and supplies for case management, limited numbers of trained health workers, etc. Some parts of the affected areas are also experiencing insecurity, with poor communication network to the rest of the country and limited coverage and accessibility to health services.
The Ministry of Public Health has rallied several partners to mount an effective response to this outbreak. In the bid to address some of the existing challenges, WHO is shipping pentavalent antimonials, paromomycin, rapid diagnostic tests and supplies for leishmaniasis testing and case management from its emergency stocks to Cameroon. A neglected tropical diseases (NTD) case management expert will be deployed from WHO headquarters to work closely with the Ministry of Public Health.
Cutaneous leishmaniasis was first described in Cameroon in 1930, with the first case reported from Mokolo in 1972. Between January 2007 and June 2009, 147 cases were reported from Mokolo, 60% of the affected people were under 15 years of age. Visceral leishmaniasis has also been reported in the north of the country, with the first case confirmed in 1986. Under reporting of the disease is thought to be substantial in the country.
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