Emerging infectious diseases (EIDs) are more than ever a global health issue and knowledge of their clinical and biological presentation is essential to optimize management, in terms of supportive care, specific treatment ...
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Emerging infectious diseases (EIDs) are more than ever a global health issue and knowledge of their clinical and biological presentation is essential to optimize management, in terms of supportive care, specific treatment and epidemic control, for example through vaccination. The challenge is particularly important on the African continent, where diseases regularly emerge and where the impact on vulnerable populations is major. Operational research is one of the tools for improving knowledge about these diseases and their management. For example, three diseases have emerged in sub-Saharan Africa and worldwide in recent years: Lassa fever, Ebola Virus Disease (EVD) and Covid-19. Lassa fever has a seasonal epidemic pattern, mainly in Nigeria, but knowledge of the disease is still incomplete. Moreover, the recommended treatment, ribavirin, does not seem to be sufficiently effective in managing patients. Since the major epidemic of 2014-2016, EVD has been occurring in epidemic waves in West and Central Africa, through animal transmission or relapse in a survivor. Despite the discovery of a specific treatment, many questions remain, particularly around supportive care and prevention of infection in contacts. Finally, the Covid-19 pandemic that has severely affected the entire planet for more than 2 years has specific implications on the African continent that need to be explored. Thanks to an unprecedented collaboration between an international medical NGO, ALIMA, and a clinical research team, the IDLIC team of the Inserm 1219 unit / PACCI, ANRS site in Côte d'Ivoire, several clinical research projects on EVDs have been set up in sub-Saharan Africa over the last 5 years. In this thesis, we will present some of the studies that have been carried out during this collaboration, on the 3 diseases mentioned above. This is a publication thesis, in which 4 publications and their perspectives will be presented. The LASCOPE (published in Lancet Global Health), EVISTA (under review in e-clinical Medicine) and COVISTA (published in The International Journal of Infectious Disease) studies are prospective cohorts describing the clinical and biological presentation and standard of care of patients with Lassa fever in Nigeria, EVD in the Democratic Republic of the Congo (DRC) and Covid-19 in Guinea and Burkina Faso, respectively. The fourth publication concerns a pilot study conducted in the DRC to assess the feasibility of post-exposure prophylaxis (PEP) with monoclonal antibodies in high-risk contacts of EVD (published in The International Journal of Infectious Disease). The perspectives of this thesis are multiple. Concerning Lassa fever, the main challenge is currently to identify a specific treatment that is effective and accessible in West African countries. To this end, a phase 2-3 adaptive trial is being set up in several West African countries. To combat the spread of EVD, a reflection on the available options in terms of PEP is underway at the international level. Finally, on Covid-19, therapeutic and vaccine trials are ongoing in sub-Saharan Africa.
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