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Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

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Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 8—August 2015


Seasonal Patterns of Buruli Ulcer Incidence, Central Africa, 2002–2012

Jordi LandierComments to Author , Guillaume Constantin de Magny, Andres Garchitorena, Jean-François Guégan, Jean Gaudart, Laurent Marsollier, Philippe Le Gall, Tamara Giles-Vernick, Sara Eyangoh, Arnaud Fontanet, and Gaëtan Texier
Author affiliations: Institut Pasteur, Paris, France (J. Landier, T. Giles-Vernick, A. Fontanet)Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaoundé, Cameroon (J. Landier, S. Eyangoh, G. Texier);UMR MIVEGEC, Montpellier, France (G. Constantin de Magny, A. Garchitorena, J.-F. Guégan)Ecole des Hautes Etudes en Santé Publique, Rennes, France (A. Garchitorena, J.-F. Guégan)UMR912-SESSTIM, Marseille, France (J. Gaudart, G. Texier)INSERM and CHU et Université d’Angers, Angers, France (L. Marsollier)Institut de Recherche pour le Développement, Gif sur Yvette, France (P. Le Gall)Université Paris-Sud 11, Orsay, France. (P. Le Gall)Chaire Santé et Développement, Conservatoire National des Arts et Métiers, Paris (A. Fontanet)


To determine when risk for Buruli ulcer is highest, we examined seasonal patterns in a highly disease-endemic area of Cameroon during 2002–2012. Cases peaked in March, suggesting that risk is highest during the high rainy season. During and after this season, populations should increase protective behaviors, and case detection efforts should be intensified.
Buruli ulcer (BU) is a severe infection caused by Mycobacterium ulcerans. Most affected are rural populations living in tropical areas with abundant wetlands (1). BU causes extensive, damaging skin lesions and often results in severe disabilities. Of the 4,000 cases reported to the World Health Organization by 14 countries in 2011, >95% originated in African countries around the Gulf of Guinea (2).
Much remains unknown about the mode of M. ulcerans transmission and the epidemiology of BU (1). Specifically, although the spatial distribution of BU in several settings has been addressed (3,4), most studies have examined only temporal variations of BU incidence in terms of yearly trends (5). Several observational studies have reported seasonal changes in the monthly number of cases and have hypothesized that cases are linked with rainfall variation (68). One spatiotemporal study in Australia showed that BU incidence was associated with rainfall variability with a 5-month lag and with total rainfall with a 19-month lag (4). However, none of these studies provided quantitative evidence of seasonal changes in BU incidence and their relationship with seasonal environmental changes. Indeed, a formal demonstration of such evidence requires a sufficiently long time series, large numbers of cases from a defined source population, and use of signal analysis techniques adapted to the constraints of BU disease surveillance and environmental data (9) (Technical Appendix[PDF - 691 KB - 7 pages]). Therefore, we investigated the seasonality of BU case incidence during 2002–2012 in Akonolinga District, located in the highly BU-endemic region of the Nyong River valley in Centre Region, Cameroon.
Dr. Landier specializes in infectious diseases epidemiology. While working on his PhD degree at the Institut Pasteur in Paris, he focused on BU epidemiology and M. ulcerans transmission in Central Africa.


We thank the staff of the Akonolinga district hospital, who provided diagnoses and delivered treatment to BU patients, and the staff of the Service de Mycobactériologie at Centre Pasteur du Cameroun, who provided laboratory confirmation of diagnoses.


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Technical Appendix

Suggested citation for this article: Landier J, Constantin de Magny G, Garchitorena A, Guégan J-F, Gaudart J, Marsollier L, et al. Seasonal patterns of Buruli ulcer incidence, central Africa, 2002–2012. Emerg Infect Dis. 2015 Aug [date cited].
DOI: 10.3201/eid2108.141336

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