Burundi: strengthening the laboratory pillar in the mpox response

21 November 2024

Bujumbura - The biomedical laboratory is a critical component of outbreak response efforts. In Burundi, it serves as a cornerstone in addressing the current mpox outbreak. When the outbreak was declared on 25 July, the country faced a shortage of qualified staff to manage the laboratory pillar effectively. As of 17 November, Burundi is the second most affected country in the African Region, with 2003 confirmed mpox cases.

"Only two of us work here as laboratory technicians and we collect at least 10 samples a day. We used to be called up even in the middle of the night," says Thierry Nzeyimana, a medical laboratory technologist at Kamenge Hospital in Bujumbura, the district worst affected by the outbreak in the country. "The shortage of three-layer packaging equipment made it difficult to handle and transfer samples to the national laboratory. It was very hard, but our lives and those of our fellow citizens are at stake."

After assessing the situation, health authorities with support from World Health Organization (WHO), took steps to strengthen the laboratory pillar. WHO provided diagnostic supplies and facilitated the deployment of a mobile laboratory to bring screening services closer to the population, ensuring early detection of cases.

In Bujumbura Nord District, which accounts for over 40% of all reported cases and continues to experience active community transmission, WHO pre-empted a testing kit shortage by ensuring the timely delivery of essential supplies. This swift action was critical in slowing transmission in high-risk areas and sustaining mpox screening efforts. It also ensured the rapid delivery of laboratory results, aiding the response in Bujumbura Nord.

Additionally, over 120 laboratory technicians, including Thierry, have been trained in sampling and analysis techniques. "The training has enabled me to better manage samples during this mpox outbreak, and we have also received essential equipment, such as a sequencer, for rapid diagnostic tests," he says.

The training focused on sampling techniques and secure handling of samples. "The training of the laboratory technicians has been invaluable in decentralizing screening to the district level and involving the decentralized level in the management of the outbreak. Indeed, the trained laboratory technicians are now responsible for collecting the samples, which are then sent to the national reference laboratory for analysis", explains Dr Parfait Shingiro, Head of the Health Information and Communication Department of Burundi's Public Health Emergency Operations Centre (COUSP).

Rapid case detection enables early initiation of life-saving treatment. "The illness developed quickly, with no headaches or fever. A rash appeared on my face, hands and feet. As I had no other symptoms, I waited a couple of days to see if the rash would go away on its own; on the contrary, it spread even more. I then went to the hospital in the northern district," says Egide Bitangimana, aged 32 years, a shopkeeper in Bujumbura.

"I was swabbed, then confined until the result was available. And when the result came back positive, I wasn't afraid, because I knew the disease could be cured. I was in hospital for two weeks and the nursing staff took good care of me until I recovered."

To ensure rapid results, WHO equipped the national laboratory with GeneXpert cartridges, reducing the turnaround time from 24 hours to 1 hour.

Isolation areas and specialized centers have been established to provide patients with free medical care and nutritional support. Efforts are being intensified to end the mpox outbreak in Burundi. The health authorities, with the support of partners, are implementing a multipronged strategy that has limited the outbreak to only one recorded death so far.

This success is the result of concerted efforts, in particular the strengthening of the essential response pillars: case management, surveillance, active case finding, training of front-line responders, risk communication and community engagement, and rapid diagnosis.

"We will continue to build the capacity of front-line responders, be they district medical officers, laboratory technicians or members of rapid response teams (RRTs)," says Dr Issa Diallo, health emergency officer and incident manager for mpox at the WHO Country Office in Burundi. "Their role in the mpox response is crucial, and the training also prepares them to deal with other outbreaks."

With the training they have received, laboratory technicians fully understand their critical role in the country's response strategy. "We're an essential link in the response chain," says laboratory technician Thierry Nzeyimana. "Thanks to WHO training, I am able to contribute effectively to the mpox outbreak response, and I feel ready to face any other health crisis that may occur."

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