Emergence of Buruli Ulcer Disease in the Daloa Region of Cote D'Ivoire

Barbara J. MarstonChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Mamadou O. DialloChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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C. Robert Horsburgh JrChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Idrissa DiomandeChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Mathieu Z. SakiChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Jean-Marie KangaChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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G'Bery PatriceChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Harvey B. LipmanChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Stephen M. OstroffChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Robert C. GoodChildhood and Respiratory Diseases Branch and Biostatistics and Information Management Branch, Division of Bacterial and Mycotic Diseases, and Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Projet Retro-CI, Secteur Sante Rurale, Ministere de la Sante et de la Protection Sociale, Service Dermatologie, University of Treichville, Atlanta, Georgia

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Recent reports have suggested increases in Buruli ulcer (BU), an infection caused by Mycobacterium ulcerans in west Africa. In 1991, we conducted surveillance for BU in a rural area of Cote d'Ivoire and identified 312 cases of active or healed ulceration. A case-control study was then performed to investigate risk factors for this infection. The rate of illness did not appear to differ between males and females (5.2% versus 7.5%; P = 0.11). The highest rate of illness was seen in the 10–14-year-old age group (143 cases per 1,000 population). New cases increased more than three-fold between 1987 and 1991, and local prevalence of BU was as high as 16.3%. Twenty-six percent of persons with healed ulcers had chronic functional disability. Participation in farming activities near the main river in the region was identified in the case-control study as a risk factor for infection (odds ratio [OR] for each 10-min decrease in walking distance between the fields and the river = 1.52, 95% confidence interval [CI] 1.01, 2.28, P = 0.046). Wearing long pants was protective (OR 0.20, 95% CI 0.06, 0.62, P < 0.005). We conclude that the incidence of BU is increasing rapidly in Cote d'Ivoire. Specific causes of this increase were not identified, but wearing protective clothing appeared to decrease the risk of disease.

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