COVID-19 surveillance in Madagascar and Urban Burkina Faso: addressing underreporting of disease burden through integrative analysis of diverse data streams
Coronavirus disease 2019 (COVID-19) caused substantial disease and death worldwide since December 2019, but the burden was lower in Africa than in high-income countries. To address potential underreporting, we modeled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease...
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
15 June 2025
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| In: |
Clinical infectious diseases
Year: 2025, Volume: 80, Pages: S16-S28 |
| ISSN: | 1537-6591 |
| DOI: | 10.1093/cid/ciaf041 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1093/cid/ciaf041 Verlag, kostenfrei, Volltext: https://academic.oup.com/cid/article/80/Supplement_1/S16/8210482 
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| Author Notes: | Njariharinjakamampionona Rakotozandrindrainy, Sophie S.Y. Kang, Lady R. Wandji Nana, Jonathan D. Sugimoto, Yi-Ting Wang, Ndrainaharimira Rakotozandrindrainy, Tsiriniaina Jean Luco Razafindrabe, Tiana Mirana Raminosoa, Sye Lim Hong, Mathilde Razafindrakalia, Gabriel Nyirenda, Tabea Binger, Ellen E. Higginson, Hyon Jin Jeon, Namgay Wangmo, Gbènonminvo E. Cakpo, YoungAe You, Birkneh Tilahun Tadesse, Abdramane Bassiahi Soura, Raphaël Rakotozandrindrainy, and Florian Marks |
| Summary: | Coronavirus disease 2019 (COVID-19) caused substantial disease and death worldwide since December 2019, but the burden was lower in Africa than in high-income countries. To address potential underreporting, we modeled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and disease burden in Burkina Faso and Madagascar.Prospectively enrolled patients who presented with fever at sentinel healthcare facilities were assessed for active SARS-CoV-2 infection. Household members of SARS-CoV-2-infected patients were prospectively followed for confirmed SARS-CoV-2 infection. Archived serum specimens that spanned the pandemic onset in Madagascar to the start of prospective surveillance were tested for anti-SARS-CoV-2 immunoglobulins. Data from these multiple sources contributed to an integrated analysis to calibrate an epidemiologic mass action model.COVID-19 accounted for a substantial fraction of healthcare-ascertained febrile illness in both Burkina Faso and Madagascar, with symptom profiles consistent with those previously reported. SARS-CoV-2 vaccination coverage was very low in Burkina Faso and unavailable in Madagascar. The household secondary attack rate was 28% (95% confidence intervals [CI], 22%-35%] in Madagascar and 31% (95% CI: 9%-68%) in Burkina Faso, indicating substantial transmission of the disease within households in both locations. Model simulations estimated that the actual number of SARS-CoV-2 infections was at least nine times higher than the reported number of febrile COVID-19 cases.Africa has faced persistent challenges due to underinvestment in vaccination programs and disease surveillance programs. There was substantial underreporting of COVID-19 cases during the pandemic in both countries. Our findings call for improving systems and resources in disease surveillance during epidemic and interepidemic periods in these countries. |
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| Item Description: | Gesehen am 12.12.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1537-6591 |
| DOI: | 10.1093/cid/ciaf041 |