Cameroon: Country Profile
The Republic of Cameroon is a country in western/central Africa with a population of over 25 million people. Cameroon has a large livestock sector and much of the population is involved in small-scale agriculture. The National Program for the Prevention and Control of Emerging and Re-emerging Zoonoses (PNPLZER), a “One Health” platform, was set up in 2014 to respond to the impact of zoonotic diseases on public health. In 2016, Cameroon identified five priority zoonotic diseases (PZDs) after the 2014-2016 Ebola epidemic in West Africa. By 2020 the list had grown to 10 diseases: Rabies, Anthrax, Highly Pathogenic Avian Influenza (HPAI), Ebola/Marburg, Bovine Tuberculosis, Salmonellosis, Lassa Fever, Trypanosomiasis, Monkeypox and Brucellosis. One Health partners work under the national program for the prevention and control of zoonotic diseases, and there is a national preparedness strategy in place for future public health emergencies.
Priority Zoonotic Diseases
Anthrax is a bacterial infection that typically affects animals and can pass from animals and animal products to humans, with limited human-to-human transmission. In endemic settings, anthrax affects primarily cattle, goats, sheeps and the spores can remain in soil for years. It can spread to humans through open wounds on the skin, ingestion, or inhaling the spores. Before 2015, sporadic cases of anthrax have been reported in domestic animals in the North, Far-North and Adamaoua regions only. However, in 2015, a case report describes the first outbreak of anthrax on a cattle farm in Bangangte, in the West Region of Cameroon, where cases of sudden mortalities were reported. Four animals (4%) died out of a 100. This was later found out to be anthrax. In the first half of 2020, four (04) cases of anthrax were reported in cattle in the Northwest Region of Cameroon.
Avian influenza is an infection by an influenza virus that can affect almost all species of birds, wild or domestic. It can be highly contagious, especially in chickens and turkeys, and can lead to extremely high mortality, especially in factory farms. The avian influenza virus sometimes infects other animal species, including pigs. Two strains have been reported in Cameroon: the first (H5N1) in both the 2006 and 2016-2017 HPAI outbreaks, and the second (H5N8, clade 188.8.131.52) in the 2016-2017 epidemic. In early 2022, there was an outbreak of highly pathogenic avian influenza (H5N1) which led to thousands of poultry deaths through the virus or culling. To date, a series of avian influenza cases have been reported among domestic birds especially in the west region of Cameroon, and 217 samples of suspected human influenza cases have been received at the national public health laboratory, Centre Pasteur du Cameroun (CPC). Of these, 32 (14.7%) were positive (2 H1N1; 30 H3N2).
Bovine tuberculosis is caused by the bacterial species Mycobacterium bovis and causes bovine tuberculosis in farm animals (and tuberculosis in other wild animals). In 2016, according to WHO estimates, 147,000 new cases of zoonotic TB were reported in humans, including 12,500 deaths. The M. bovis strains circulating in animals, the extent of zoonotic TB due to M. bovis as well as M. bovis maintenance hosts, and the role that they play are unknown in Cameroon. In 2019 however, out of 15 samples suspected of tuberculosis, 11 were confirmed. About 18,318.05 kg of bovine meat were seized for tuberculosis, representing more than 40 million FCFA in 2019. The prevalence of bovine tuberculosis in the slaughterhouses of Yaoundé and Douala was 1.03% in 2011.
Brucellosis is a bacterial infection with a global incidence of about 500,000 cases per year worldwide and a prevalence of more than 10 cases per 100,000 population in some countries. Humans become infected through contact with sick animals, ingestion of fresh unpasteurized or unboiled milk, or fresh cheese. Brucellosis has a significant impact on the health and productivity of livestock, thus greatly reducing their economic value and work performance. Bovine brucellosis is widely endemic in Cameroon and prevalence rates in the range of 3–31% in cattle at individual levels and 16.2–35.0% at herd levels have been reported. In 2014, the prevalence of 6.5 to 12.5% in Cameroon in cattle depending on the region and the season have been reported. In a study in 2018, it was revealed that brucella infection is an important public health problem among abattoir personnel and pregnant women living in Ngaoundéré Cameroon.
Ebola Virus Disease: Ebola is an infection caused by a virus of the filovirus family. Humans are contaminated either by direct contact with infected bats (a rare event), or by handling infected animals found dead or sick in forests (a more frequent event). Human-to-human transmission is also possible and occurs through direct contact with the blood, secretions, organs or biological fluids of infected individuals. There have been no cases of EVD reported in Cameroon but given its evolving situation, there is a considerable risk that cases will appear in currently unaffected countries.
Lassa fever is a serious disease transmitted by contact with secretions (urine, feces, blood) of infected mice and rats. It iis manifested by fever, muscle pain, generalized weakness, diarrhea. There have been no cases of Lassa fever reported in Cameroon but given its re-emergence in neighboring Nigeria, there is a considerable risk that cases will appear in currently unaffected countries.
Monkeypox is a viral disease that primarily affects animals such as rodents or non-human primates but can be transmitted to humans. The disease is transmitted through respiratory droplets, close contact with lesions or bodily fluids, or contaminated materials and causes a variety of symptoms including fever and rash. In the same family as smallpox, smallpox vaccines offer some protection against monkeypox. In 2016, at the Mefou and Afamba primate sanctuary, 3 cases were reported out of 300 exposed chimpanzees. In Cameroon, there were no human cases of monkeypox reported since 1989 until April-May 2018, in which a total of 16 confirmed and suspected cases in humans (one confirmed and 15 suspected cases) were reported to the Directorate of Control of Epidemic and Pandemic diseases (DLMEP). Recently in 2022, six health districts (Ayos, Djoungolo, Odza, Benakuma, Kumba and Konye) in three regions (Center, North West and South West) have registered 34 suspected cases, seven (7) of which were confirmed and two (2) dead.
Rabies remains a widespread disease worldwide, responsible for tens of thousands of deaths each year. It is most often transmitted by dogs. In Côte d’Ivoire, rabies is endemic. Despite the existence of an effective post-exposure prophylaxis, it remains a concern. According to epidemiological surveillance data, approximately 11,000 people are exposed to rabies risk each year. Children are the most affected group. Animal and human rabies have been notifiable diseases in Cameroon since 2000. Rabies control legislation also requires vaccination of pet dogs and cats and requires that owners of biting animals are recorded in each district. Although rabies control efforts, such as yearly reduced-price pet vaccination events, radio information campaigns, and dog culling, exist in Cameroon, the impacts of these programs are unknown. However, 15 cases of animal rabies were confirmed in 2019, 19 cases confirmed in 2018, 18 cases confirmed in 2017.
Salmonellosis is an infection caused by the bacteria salmonella which typically spreads through contaminated food or contact with infected animals such as poultry, swine, cattle, rodents, or reptiles. Salmonellosis causes diarrhea, fever, and vomiting and is typically more severe in children or the elderly. Little is known about the burden, transmission or its risk factors of Salmonellosis in most parts of Cameroon. In a study carried out in Buea Health District in Cameroon, of 385 patients enrolled, 105 were diagnosed of salmonellosis giving an overall prevalence 27.3.
Trypanosomiasis is caused by parasites and is spread through tsetse flies. Depending on the form, it may cause a chronic or acute infection leading to consequences on the central nervous system. There are several endemic zones in Cameroon, the most active of which are Fontem and Bafia. Risk is found in Bafia (Mbam Division, Centre Region) and Fontem/Mamfe (Manyu/Fontem Division, South West Region). Mbam Division reports the most cases of this disease. Potential areas for recurrence include Far-North region bordering Chad and East Region bordering the Nola area of the Central African Republic.
Find more information in the Landscape Analysis of PZDs in Cameroon.
One Health Landscape
The stakeholders involved in zoonotic disease control in Cameroon with national coverage are primarily in the public sector, such as the ministries of Public Health (MINSANTE), Ministry of Environment, Nature Protection and Sustainable Development (MINEPDED), Minister of Forestry and Wildlife (MINFOF) and Ministry of Livestock, Fisheries and Animal Industries (MINEPIA). There are, however, the presence of international organizations and livestock and farmers associations that have local coverages in their respective communities. They engage in preventive and curative activities for both animals and humans, targeting different persons depending on the focus of the stakeholders.
Find more information in the landscape analysis of PZDs in Cameroon.
Summary of existing Breakthrough ACTION research
In early 2022, the National Program for the Prevention and Control of Emerging and Re-emerging Zoonotic Diseases (PNPLZER), with support from Breakthrough ACTION, conducted a qualitative study to identify and understand the individual and social determinants of high-risk behaviors that drive PZD transmission in Cameroon. The study also explored potential methods of prevention and response among high-risk groups. Data were collected in three sites (Guider, Tonga, and Godji) through focus group discussions, individual interviews, and non-participant observations with people who come into contact with both domestic and wild animals as well as animal and human health professionals and media personnel. Overall, the team conducted 6 interviews, 8 focus groups, and 5 observations per site involving 222 total individuals. Findings suggested several risk behaviors on the part of all target categories (cattle farmers, veterinarians, butchers, human and animal health workers, the general population, etc.), even though they may or may not perceive the risk of their behavior. These risky behaviors are felt at all levels, particularly in knowledge, hygiene, interaction with animals and consumption of animal products. With respect to the risk behaviors, the team identified socio-cultural, economic, and individual determinants. Socio-cultural norms, beliefs and practices and the lack of knowledge of the population in general and of livestock farmers in particular constitute a first factor limiting the adoption of certain risk behaviors, notably: the failure to use protective measures in interactions with animals to avoid the risk of contamination; lack of hand washing with soap in certain circumstances, notably after helping an animal give birth, after touching the blood of animals, after touching sick animals, or before and after milking the cow; not disinfecting pens with disinfectant; eating the meat of sick or dead animals; not vaccinating dogs; and consumption of unboiled milk. On the other hand, the lack of financial resources (i.e. economic factors) explained certain structural and individual risk behaviors. These include: selling sick animals or their meat; eating the meat of sick or dead animals; not using veterinarians in case of need; self-medication in terms of animal and human health. The study also identified reliable information sources at the community level. These include: health workers; religious leaders; the community radio; and community leaders. The local population believe any information emanating from these sources are very reliable and they are most likely to live by it.
All of these risk behaviors were found across the three research sites in the three agro-ecologic zones studied.
Read more from the Resultats-Enquete-2022APR20.
Case study on SBC response
Upon completion of the landscape analysis, a documented list of stakeholders at all administrative levels and their domain of intervention now exist. This has been very useful to the PNPLZER as it currently facilitates harmonious and coordinated actions in the “One Health” Approach and the prevention and fight against zoonotic diseases in Cameroon.
After completion of the qualitative studies, a knowledge sharing seminar was organized with various stakeholders to present and deliberate on the results. These results were used to guide the RCCE strategies, SOPs, and protocols that are now being finalized. With the recent outbreak of Mpox in three regions of the country and thanks to the results of these studies, targeted interventions and messages targeting specific group of persons in the concerned agro-ecologic zones have been developed to inform and modify susceptible practices in the target population. These messages will be disseminated using recommended channels of communication as revealed by the studies.
From April 3 to 7, 2023, the zoonosis program, with technical and financial support from Breakthrough ACTION, developed a behavioral profile and a guide to essential awareness messages specific to Cameroon’s five agro-ecological zones. The source document was the result of a qualitative study entitled “Social, cultural and individual determinants of risk, prevention and response behaviors related to priority zoonotic diseases in Cameroon.” Participants developed the message guides using findings from the study about knowledge and risk perception toward zoonotic diseases, while behavioral profiles were developed using the behaviors and practices that expose people to risk of zoonotic diseases explored by the study. This behavioral profile and the message guide are currently being finalized and will serve as strategic documents for the zoonosis program, once finalized.