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Molecular epidemiology of HIV type 1 subtypes in equatorial guinea.

Equatorial Guinea is endemic for HIV-1. This country borders to the north with Cameroon, where different subtypes belonging to group M, as well as group O strains, are circulating simultaneously. To assess the molecular epidemiology of HIV-1 in Equatorial Guinea we analyzed 76 plasma samples collected throughout 1999 from seropositive individuals. Phylogenetic analysis of the gp41 region revealed that 53 were of subtype A, with 64% of these sequences clustering with CRF02_AG reference strains; 11 were of subtype C; 4 were of subtype D; 2 (closely related to subtype F2) were of subtype F; 3 were of subtype G, two of them forming a separate cluster with the recombinant circulating forms CRF06_cpx; 1 was of subtype H; and 2 were unclassifiable. Although subtype A is predominant, the presence of 14% of subtype C is also noteworthy. This work represents the first HIV-1 subtype distribution study in Equatorial Guinea.

Base Sequence↗

Endemic human paragonimiasis in Equatorial Guinea. Detection of the existence of endemic human paragonimiasis in Equatorial Guinea as a result of an integrated sanitary programme.

Between February and April 1990 the first five cases of human paragonimiasis, tentatively due to Paragonimus africanus, have been detected in Equatorial Guinea, thanks to the normal activities of the National Schistosomiasis Project and its coordination with the National Tuberculosis Project.

Equatorial Guinea↗

[Epidemiology of human trypanosomiasis in the Luba focus, in Equatorial Guinea].

In Equatorial Guinea, the human trypanosomiasis, after an intensive surveillance beginning in the 30's, seemed to be controlled by the end of the 60's. A lack of surveillance provoked a surge of different foci, confirmed in 1982 by the spontaneous presentations of sick in the hospitals of the old foci. These processes have been observed in the Luba focus (ex San Carlos) on the island of Bioko (ex Fernando Poo). The situation was grave in 1985 and a survey was organized by the "Centro de Control de la Tripanosomiasis" (Ministerio de Sanidad de Guinea Ecuatorial--Agencia Española de Cooperación Internacional) to delimit the focus, to evaluate the presence of the disease in the different villages, to know the characteristics and the distribution of the vector, and evaluate the impact of the mono-pyramidal trap as the method of anti-vectorial control. The results have been obtained and presented in the conclusion.

Age Factors↗

[Underdevelopment and role of health assistance. The case of Equatorial Guinea].

The health-care problems of Equatorial Guinea and its health-care resources are analyzed to put them into the context of aid to developing nations, and to especially consider, the impact of Spanish Technological Cooperation, in particular. The parallel between goals of economic development and the development of health-care is so great in Equatorial Guinea that not even the structural change programs patronized by the International Monetary Fund have any effect on health-care expenses. The considerable uncertainty regarding the most suitable development strategy for Equatorial Guinea makes investments in human resources (health-care, education and self-sufficiency in food production) one of the most indisputable measures taken. The role of foreign aid, specifically that of Spain in Equatorial Guinea, has been considerable and is bound to increase, as it contributes effectively to development and can result in external benefits for the donor country.

Delivery of Health Care↗

Envelope sequence variability and serologic characterization of HIV type 1 group O isolates from equatorial guinea.

Four sera from Equatorial Guinea (EG) suspected to contain antibody against HIV-1 group O-related viruses were identified on the basis of unusual and differential serologic reactivity in selected commercial assays and Western blot. Degenerate primers, designed from HIV-1 group O published sequences, were used to PCR amplify envelope (env) gene sequences from the suspect EG sera. A complete envelope gene sequence from each serum was determined from the overlapping env gene fragments. Analysis (PHYLIP package of programs) of Env amino acid sequences (translated from nucleotide sequences) indicated that the amino acid sequences obtained from EG sera clustered more closely with HIV Env sequences of group O compared to group M. The amino acid sequences at the octameric tip of the V3 loop were either RIGPLAWY (one isolate), RIGPMAWY (two isolates), or GLGPLAVY (one isolate). The V3 tip tetrameric sequence GPLA is represented only once in the 1995 HIV (Los Alamos) database, but was present in two of our group O-related EG samples. The gp41 immunodominant regions (IDR) protein sequences were identical for sequences from three of the sera, RLLALETLIQNQQLLNLWGCKGR(K)L(I)VCYTSVK(T)W, whereas sequence from the fourth serum contained three changes as noted in parentheses. IDR sequences derived from EG sera were unique compared to those reported for other HIV-1 group O isolate ANT70, VAU, or MVP5180. Antibody in each EG serum directed against the IDR could be detected using synthetic peptides comprising sequences from the ANT70 or MVP5180 IDRs, but were most reactive against the sequences derived from the samples themselves. Little or no serologic reactivity was detected when EG sera were reacted against peptides comprising the IDR of HIV-1 group M (subtype B consensus) or HIV-2 (consensus).

Amino Acid Sequence↗

Semi-nested, multiplex polymerase chain reaction for detection of human malaria parasites and evidence of Plasmodium vivax infection in Equatorial Guinea.

A semi-nested, multiplex polymerase chain reaction (PCR) based on the amplification of the sequences of the 18S small subunit ribosomal RNA (ssrRNA) gene was tested in a field trial in Equatorial Guinea (a hyperendemic focus of malaria in west central Africa). The method uses a primary PCR amplification reaction with a universal reverse primer and two forward primers specific for the genus Plasmodium and to mammals (the mammalian-specific primer was included as a positive control to distinguish uninfected cases from inhibition of the PCR). The second amplification is carried out with the same Plasmodium genus-specific forward primer and four specific reverse primers for each human Plasmodium species. The PCR amplified products are differentiated by fragment size after electrophoresis on a 2% agarose gel. Four villages from three regions of the island of Bioko (Equatorial Guinea) and two suspected Plasmodium vivax-P. ovale infections from the hospital of Malabo were tested by microscopy and PCR. The PCR method showed greater sensitivity and specificity than microscopic examination and confirmed the existence of a focus of P. vivax infections in Equatorial Guinea suspected by microscopic examination. It also provided evidence of several mixed infections, mainly P. falciparum and P. malariae, the two predominant species causing malaria in Equatorial Guinea.

Animals↗

In vitro susceptibility of Plasmodium falciparum to chloroquine, amodiaquine, quinine, mefloquine, and sulfadoxine/pyrimethamine in Equatorial Guinea.

Between March 1990 and June 1992, a study was carried out in Equatorial Guinea on the in vitro response of Plasmodium falciparum to different antimalarial drugs. Field work for the study was conducted both in the country's island region as well as on the mainland, and resistant isolates were found to exhibit interregional differences. On the island of Bioko, 204 tests were performed with 16% (11 of 69) resistant to chloroquine, 9% (4 of 46) resistant to quinine, 14% (6 of 43) resistant to a combination of sulfadoxine/pyrimethamine, and 6.5% (3 of 46) resistant to amodiaquine. In the mainland area of Bata, the same antimalarial drugs and mefloquine were tested with the following results: 9% (5 of 58) resistant to chloroquine; 2% (1 of 58) resistant to amodiaquine, and 3% (2 of 58) resistant to a combination of sulfadoxine/pyrimethamine. No isolates resistant to quinine or mefloquine were found. Effective concentrations (EC50, EC90, and EC99) and regression lines (log dose/response) for each antimalarial drug were calculated to establish a surveillance system for antimalarial drug chemosensitivity in Equatorial Guinea. Finally, 12 isolates from 12 patients previously treated with chloroquine were studied to compare both tests (in vivo-in vitro) and obtain a correlation between the RII and RIII types of in vivo and in vitro resistances. No correlation for the RI type was found between the two methods.

Amodiaquine↗

Resistance of Plasmodium falciparum to antimalarial drugs in Equatorial Guinea.

One hundred and sixty-six children from Equatorial Guinea, all under 10 years of age and with acute uncomplicated falciparum malaria, were randomly allocated to four groups and treated with one of the following regimens: chloroquine or amodiaquine (25 mg base/kg body weight over 3 days), quinine (8 mg/kg every 8 h for 3 or 5 days), and sulphadoxine-pyrimethamine (25-1.25 mg/kg, in one dose). The parasite clearance rates up to day 14 were 28% with chloroquine, 74% with amodiaquine, and 95% with quinine or sulphadoxine-pyrimethamine. The times required to clear asexual blood forms of Plasmodium falciparum in sensitive cases were 64, 70, 73 and 65 h, respectively. Although quinine and sulphadoxine-pyrimethamine are equally effective, quinine is recommended for treatment of multidrug-resistant malaria in paediatric patients, essentially because of the risk of serious reactions to sulpha drugs. Health providers are, however, encouraged to keep supplies of sulphadoxine-pyrimethamine as an option and to refer patients quickly, if required.

Amodiaquine↗

Strong association between HLA-Cw*0706 and HLA-B*44032 in the Bubi population from Equatorial Guinea.

Unrelated Bubi, native to the island of Bioko (Equatorial Guinea), were previously typed by low-resolution polymerase chain reaction using sequence-specific primers (PCR-SSP) and serology for HLA-A, -B and -C. HLA-B*44 was found frequently and associated with Cw*07. We have studied the HLA subtypes of 20 B*44pos/Cw*07pos Bubi individuals. HLA-B and -C were typed by sequencing exons 2 and 3. To distinguish the alleles Cw*1701/02/03, Cw*07011/012/06 and Cw*1801/02 additional sequencing of exon 1 or 5 was performed. All 20 B*44pos/Cw*07pos individuals of the Bubi population were typed Cw*0706 positive. Nineteen of them carried the B*44032 allele and one B*4407. In addition, 19 B*44neg/ Cw*07pos Bubi individuals were typed for HLA-C and none of them proved Cw*0706 positive. To determine whether the association between Cw*0706 and B*44032 was limited to the Bubi, 19 individuals from Dutch Caucasian families were typed in which B44 and Cw7 segregated on one haplotype. None of these individuals showed the presence of B*44032 or Cw*0706. The haplotypes found in the Dutch Caucasians were B*4402-Cw*0704, B*44031-Cw*07011 and B*44031-Cw*0702. The present observation indicates a strong association between B*44032 and Cw*0706 in the Bubi population.

Alleles↗

Seroprevalence of hepatitis B and C, and human immunodeficiency type 1 viruses in a rural population from the Republic of Equatorial Guinea.

The seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus type 1 (HIV-1) markers was evaluated in a group of 2042 subjects from a rural area in the Republic of Equatorial Guinea, to obtain a better understanding of the transmission patterns of these viruses. Antibodies to HIV-1 were detected in 12 subjects (0.6%); the seroprevalence did not differ significantly by age or gender. Overall seroprevalence for HCV was 1.7% (in patients aged > 40 years, 5.6%). Hepatitis B surface antigen was detected in 8.8% of subjects, with the higher seroprevalence in children aged < or = 18 years of 13.4% contrasting with the higher seroprevalence of HCV in older subjects of the Equatoguinean studied population. These results indicate differences in the distribution of the viruses and, probably, different routes of transmission. The study demonstrates the existence of a high HBV carrier rate in children, concluding that hepatitis B vaccine should be incorporated into the Expanded Programme on Vaccination in Equatorial Guinea.

Adolescent↗

Prevalence of intestinal parasite infections with special reference to Entamoeba histolytica on the island of Bioko (Equatorial Guinea).

The prevalence of intestinal parasitic infections was assessed (1993 through 1995) among two different groups of persons on the island of Bioko, Equatorial Guinea. In the first group, parasitologic examinations were performed on stool specimens from a household-based sample of 557 dwellers from the rural area of the island. In the second group, 1,633 inpatients and outpatients at the General Hospital of Malabo (the capital of the country) were studied. All age groups were represented in both groups. The average prevalence of the most common protozoan and helminthic intestinal infections in rural and urban areas, respectively, was as follows: Entamoeba histolytica/E. dispar (14.9% and 32.7%, respectively), Giardia lamblia (7.2% and 8.6%), Ascaris lumbricoides (45.8% and 31.4%), and Trichuris trichiura (25.7% and 36.4%). Seventy-nine sera from patients with amebic liver abscess (suspected by ultrasonography) were studied by an immunohemagglutination assay, with 44 (56%) showing anti-E. histolytica titers > or = 1:32. Of these 79 sera, 71 were studied by an enzyme immunoassay, 86% of which were positive with titers > or = 1:64. This study showed that parasitic infections in Equatorial Guinea represent a major health problem.

Animals↗

[Has the focus of human African trypanosomiasis in Luba, Equatorial Guinea been eradicated?].

Human African trypanosomiasis was considered a major public health problem in Luba, Equatorial Guinea in 1985. Because of the lack of qualified personnel, the emergency response consisted of a simple control strategy based on serological screening without parasitological confirmation and staging by lumbar puncture. This strategy was highly effective since the outbreak seems to have stopped. The authors discuss implications of this strategy which raises the risk of misdiagnosis and unwarranted treatment of trypanosomiasis. Other points of discussion in this article include the concept of sterilization of the disease area and need for continued low-grade surveillance.

Disease Outbreaks↗

Malaria vectors in Bioko Island (Equatorial Guinea): PCR determination of the members of Anopheles gambiae Giles complex (Diptera: Culicidae) and pyrethroid knockdown resistance (kdr) in An. gambiae sensu stricto.

Anopheles gambiae sensu lato Giles, 1902 and Anophelesfunestus Giles, 1900 are the main malaria vectors on the island of Bioko (Equatorial Guinea). This study was carried out to determine: a) members of the An. gambiae complex that may be present on the island of Bioko and, b) the sensitivity of An. gambiae sensu stricto to pyrethroids. The analysis by PCR detected the presence of An. gambiae s.s. as the major vector of the complex and the "forest chromosomal form" was demonstrated by cytogenetic analysis. The presence of Anopheles melas in the southwest, north and southeast of the island justifies its study as a vector. The molecular characterization of pyrethroid knockdown resistance (kdr) showed that the populations of An. gambiae s.s. were sensitive and no mutations were found. This fact justifies the implementation on a large scale of pyrethroid-impregnated bednets within the framework of the Malaria Control Program of Equatorial Guinea.

Animals↗

An epidemiological study of malaria in Bioko and Annobón islands (Equatorial Guinea).

A seroparasitological study of malaria was carried out in two of the more important islands of Equatorial Guinea, Bioko (ex Fernando Poo) and Annobón. The study involved a randomly-chosen population of children aged from two to nine years. In Bioko 1130 children were chosen from 29 of the 51 villages on the island; in Annobón 185 children were chosen from the capital town, where all the population lived. Indirect immunofluorescence tests (IFAT) showed a prevalence of malaria infection of 29.8% in Bioko and 55.7% in Annobón. The parasitic prevalence (malaria index) was 26.6% and 55.1% respectively, and the splenic index was 57.0% and 54.6% respectively. The results indicate that this is an area of stable hyperendemic malaria, which may benefit from an antimalarial programme.

Age Factors↗

Distribution of the Simulium damnosum complex on Bioko island, Equatorial Guinea, and the potential for onchocerciasis elimination by vector eradication.

Onchocerciasis is endemic on the island of Bioko, Equatorial Guinea, where it is transmitted by the 'Bioko form' of the Simulium damnosum complex, a cytospecies unique to the island. To determine the distribution of vector breeding, three dry season and two wet season expeditions were made in 1989, 1996 and 1997, and 226 of the island's 247 rivers (91.5%) were visited. Of these 226 rivers, 130 (58%) were flowing during the dry season, forty-five (20%) supported aquatic stages of Simuliidae of any species and twenty-five (11%) contained larvae or pupae of the S. damnosum complex. The twenty-one rivers not prospected were in the mountainous south of the island, where an additional seventeen rivers were reached but not satisfactorily prospected. Of these thirty-eight rivers, twenty-nine were considered highly likely to support vector breeding, bringing the total number of rivers which could harbour the vector during the dry season to fifty-four (21.9% of the island's total). Breeding was believed to be limited to river stretches below 1000 m altitude, and during the dry season the total length of those stretches which could support breeding on Bioko was estimated to be 1020 km. A combination of factors, including low river discharges during the dry season, the relatively low water temperature on Bioko, the suitability of limited stretches of most rivers as vector breeding sites and the close proximity of many rivers within a small geographical area, render the vector vulnerable to eradication by aerial treatment of rivers with insecticide. The isolation of the Bioko form of the S. damnosum complex suggests that reinvasion following treatment would be unlikely, and eradication of the vector might be achieved by a dry season larviciding programme in one or two years.

Altitude↗

African trypanosomiasis and S. intercalatum infection in Equatorial Guinea: comparative epidemiology and feasibility of integrated control.

The integration of schistosomiasis control with the activities of different endemic disease control or health programmes has been endorsed by a WHO Expert Committee on the Control of Schistosomiasis (WHO 1985). Endemic countries face increasing economic and manpower constraints which limit the coverage and effectiveness of control activities. Integration would be expected to optimize available resources for control. The feasibility of integration can be assessed by a comparative evaluation of: the epidemiology and distribution of the health problems; the techniques and methodology of control; and the requirements for maintenance and their relative health importance. This report presents a preliminary assessment of trypanosomiasis and schistosomiasis in Equatorial Guinea. The background and implementation of the operational national trypanosomiasis control programme are summarized. Population-based epidemiological investigations undertaken by the staff of the trypanosomiasis control programme are reported from a rural village and an urban suburb of Bata, Equatorial Guinea. The distribution and morbidity of S. intercalatum are compared, the public health importance of S. intercalatum is reviewed and the feasibility of integration of control of trypanosomiasis and schistosomiasis are assessed.

Adolescent↗

HLA class I and class II allele distribution in the Bubi population from the island of Bioko (Equatorial Guinea).

We determined the HLA frequency distribution in a sample of 100 Bubi individuals born on the island of Bioko (Equatorial Guinea). HLA-A, -B and -C typing was performed by serology and PCR-SSP. DRB1/3/4/5, DQB1 and DQA1 alleles were determined by PCR-SSOP. The HLA allele distribution of this population group resembles those found in other Bantu-speaking groups; however, the higher frequency of A30, A32, B44, DRB1*1301 in the Bubi with respect to other Bantu groups and the absence of DR4 deserve special mention. The cloning and sequencing of class I and II genes in this population allowed the description of five new allelic variants: B*4407, Cw*0706, Cw*1801, Cw*1802 and DQB1*0612 and five confirmatory sequences: B*3910, B*5703, B*8101, Cw*1203 and Cw*1701. The following new HLA-C,B haplotypes have been found in Bubi: Cw*08-B*57, Cw*18-B*57, Cw*0302-B*53, Cw*07-B*53 and Cw*1601-B*63. The most frequent seven-locus haplotype is: A*30-Cw*17-B*42-DRB1*1102-DRB3*0202-DQA1*05-DQB1 *0301. In terms of genetic distance, the Bubi are closer to other Bantu groups than to West African populations.

Alleles↗