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年埃博拉疫情严重冲击几内亚。博法（Boffa）、迪布雷卡（Dubreka）、福雷卡里亚（Forecariah）三个沿海区县，是人类非洲锥虫病（Human African Trypanosomiasis, HAT，俗称睡眠病）的主要流行区，此次疫情对该区域影响尤甚。本研究旨在评估此次埃博拉疫情对HAT筛查与诊疗活动的影响。

材料与方法/主要研究结果：本研究使用几内亚HAT防控项目2012—2015年收集的既往数据，按月统计四类人群指标：(i) 主动筛查人次；(ii) 被动筛查人次；(iii) 接受HAT治疗的患者数；(iv) 完成治疗后随访的患者数。基于现有数据，对比埃博拉疫情暴发前（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）。

2012年2月至2013年12月，即几内亚官方报告首例埃博拉病例前，累计完成主动筛查32221人次；但埃博拉疫情暴发期间，无法开展任何主动筛查活动。2014年初，HAT被动监测系统得到强化与拓展后，月度被动筛查人次从2014年4月的7例升至9月的286例，随后持续回落：至2015年1月降至180例，2015年3月后无新增被动筛查病例。本研究共计纳入213名启动HAT治疗的患者，其中154例（72%）为埃博拉疫情前确诊病例，59例（28%）为疫情期间确诊病例。疫情期间启动治疗的患者均通过被动筛查发现，且确诊时处于疾病第2期的较晚阶段（该比例达96%，而疫情前该比例为55%，p<0.0001）。完成治疗后3个月及6个月随访的患者占比分别从44%降至10%（p<0.0001）、从16%降至3%（p=0.017）。埃博拉暴发前的DALYs估算值为48.7（95%置信区间46.7—51.5）；假设漏报的HAT病例病死率分别为2%、5%、10%时，疫情期间的DALYs分别升至168.7（162.7—174.7）、284.9（277.1—292.8）及466.3（455.7—477.0）。

结论与意义：2014—2015年埃博拉疫情严重冲击了几内亚的HAT筛查工作。主动筛查活动全面暂停，被动筛查人次在疫情期间大幅下降，但由于缺乏疫情前的对应数据，无法直接对比疫情前后的被动筛查趋势。疫情期间确诊的HAT患者病情更晚，且随访留存率有所降低。埃博拉疫情期间新确诊HAT病例数下降，并非源于HAT发病率的降低。尽管本研究无法直接证实该推测，但该现象更可能是筛查工作受阻、民众对后续确诊及转诊诊疗存在恐惧共同导致的结果。埃博拉疫情结束后，需强化项目监测、优化防控策略，并落实可持续的财政与人力资源配置，以减轻几内亚的HAT疾病负担。