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Implementing SARS-CoV-2 Testing during a Large-Scale Sporting Event in Africa: Lessons Learned from the Africa Football Cup of Nations Tournament in Cameroon

Boris K. Tchounga Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Boris Tchakounte Youngui Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Emilienne Epée National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon;
Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon;

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Tatiana Djikeussi Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Joseph Fokam Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Messa, Yaoundé, Cameroon;
Faculty of Health Sciences, University of Buea, Buea, Cameroon;

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André P. Goura Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Loic Feuzeu Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Muhamed Awulo Mbunka Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Pallavi Dani FIND, Geneva, Switzerland;

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Shannon Viana Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Anne Hoppe Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;
FIND, Geneva, Switzerland;

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Yap Boum National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon;
Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon;

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Rhoderick Machekano Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Laura Guay Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;
George Washington University, Milken Institute School of Public Health, Washington, District of Columbia;

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Anne-Cecile Zoung-Kanyi Bissek Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon;
Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon;

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John Ditekemena Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Appolinaire Tiam Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;
George Washington University, Milken Institute School of Public Health, Washington, District of Columbia;

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Alain G. Etoundi National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon;
Department of Disease, Epidemic and Pandemic Control, Ministry of Public Health, Yaoundé, Cameroon

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Patrice Tchendjou Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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Michelle M. Gill Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia;

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DOI:
https://doi.org/10.4269/ajtmh.23-0898
Volume/Issue:
Ahead of Print
Open access
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During the 33rd Africa Cup of Nations (AFCON) football tournament in Cameroon, organizers and health authorities required a negative SARS-CoV-2 test result <48 hours before entry and provided free SARS-CoV-2 testing and vaccination at stadium and fan zone entrances. We describe the outcomes and implementation of mandatory SARS-CoV-2 testing at fan zones during AFCON. All consenting fan zones attendees were administered an electronic questionnaire capturing exposure factors, COVID-19-like symptoms, and COVID-19 vaccination status, before being tested for SARS-CoV-2 using an antigen rapid diagnostic test (Ag-RDT). Participants testing positive were sampled for confirmatory real-time SARS-CoV-2 polymerase chain reaction (PCR) and sequencing for variant surveillance. The case detection rate was estimated using PCR-confirmed cases, and the challenges were summarized from staff discussions and project/study documentation. In total, 4,820 fan zone attendees (median [interquartile range] age 30 [24–38], 27.7% females) were tested for SARS-CoV-2, including 1,228 (25.5%) fully vaccinated. Of 4,820 participants, 148 (3.1%) had a positive Ag-RDT result, of whom 67 consented to PCR testing and 19 of 64 (29.7%) were confirmed PCR-positive. The case detection rate was 40.1 (95% CI: 24.2–62.7) per 10,000 attendees. The Omicron variant (B.1.1.529) was found in all 11 samples successfully sequenced. The implementation of mandatory SARS-CoV-2 Ag-RDT at fan zone entrances was challenged by high attendance volume just prior to matches, lobbying of economic stakeholders, and inconsistent quality assurance when using test kits. Despite the challenges encountered, implementing mandatory SARS-CoV-2 Ag-RDT at fan zones, was a unique opportunity for SARS-CoV-2 case identification and genomic surveillance.

Author Notes

Financial support: This project was supported by FIND through a grant from the German Federal Ministry of Economic Cooperation and Development (BMZ).

Disclosure: The study protocol was approved by the Cameroon National Ethics Committee for Research in Human Health (No. 2021/12/1412) and the Advarra Institutional Review Board (Pro00060355) in the United States.

Current contact information: Boris K. Tchounga, Boris Tchakounte Youngui, André P. Goura, Loic Feuzeu, and Patrice Tchendjou, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia, E-mails: btchounga@pedaids.org, btchakounte@pedaids.org, agoura@pedaids.org, lfeuzeu@pedaids.org, and ptchendjou@pedaids.org. Emilienne Epée, National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaounde, Cameroon, and Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon, E-mail: epeeemilienne@gmail.com. Tatiana Djikeussi and Muhamed Awulo Mbunka, Elizabeth Glaser Pediatric AIDS Foundation Cameroon, Douala, Cameroon, E-mails: tdjikeussi@pedaids.org and ambunka@pedaids.org. Joseph Fokam, Virology Laboratory, Chantal BIYA International Reference Centre, Yaoundé, Cameroon, E-mail: josephfokam@gmail.com. Pallavi Dani, Foundation for Innovative New Diagnostics, Geneva, Switzerland, E-mail: pallavi.dani@finddx.org. Shannon Viana, Rhoderick Machekano, Laura Guay, Appolinaire Tiam, and Michelle M. Gill, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, E-mails: shannonviana@gmail.com, rmachekano@pedaids.org, lguay@pedaids.org, atiam@pedaids.org, and mgill@pedaids.org. Anne Hoppe, Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland, E-mail: ahoppe@pedaids.org. Yap Boum, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon, E-mail: yap.boum2@pasteur-bangui.cf. Anne-Cecile Zoung-Kanyi Bissek, Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon, E-mail: annezkbissek@yahoo.fr. John Ditekemena, Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, Democratic Republic of the Congo, E-mail: jditekemena@pedaids.org. Alain G. Etoundi, Department of Disease, Epidemic and Pandemic Control, Ministry of Public Health, Yaoundé, Cameroon, E-mail: dretoundi@yahoo.fr.

Address correspondence to Boris K. Tchounga, Elizabeth Glaser Pediatric AIDS Foundation, P.O. Box 35 489, Bastos Yaoundé, Cameroon. E-mail: btchounga@pedaids.org
Copyright:
© The author(s) 2024
Received:
19 Dec 2023
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Accepted:
17 Aug 2024
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Published Online:
26 Nov 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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