Minimally invasive sampling to identify leprosy patients with a high bacterial burden in the Union of the Comoros

The World Health Organization (WHO) endorsed diagnosis of leprosy (also known as Hansen’s disease) entirely based on clinical cardinal signs, without microbiological confirmation, which may lead to late or misdiagnosis. The use of slit skin smears is variable, but lacks sensitivity. In 2017–2018 during the ComLep study, on the island of Anjouan (Union of the Comoros; High priority country according to WHO, 310 patients were diagnosed with leprosy (paucibacillary = 159; multibacillary = 151), of whom 263 were sampled for a skin biopsy and fingerstick blood, and 260 for a minimally-invasive nasal swab. In 74.5% of all skin biopsies and in 15.4% of all nasal swabs, M. leprae DNA was detected. In 63.1% of fingerstick blood samples, M. leprae specific antibodies were detected with the quantitative αPGL-I test. Results show a strong correlation of αPGL-I IgM levels in fingerstick blood and RLEP-qPCR positivity of nasal swabs, with the M. leprae bacterial load measured by RLEP-qPCR of skin biopsies. Patients with a high bacterial load (≥50,000 bacilli in a skin biopsy) can be identified with combination of counting lesions and the αPGL-I test. To our knowledge, this is the first study that compared αPGL-I IgM levels in fingerstick blood with the bacterial load determined by RLEP-qPCR in skin biopsies of leprosy patients. The demonstrated potential of minimally invasive sampling such as fingerstick blood samples to identify high bacterial load persons likely to be accountable for the ongoing transmission, merits further evaluation in follow-up studies.

The Flotilla Incident from the Perspective of International Law and the Judicial Rights of the Victims

The Mavi Marmara flotilla, which sailed for a humanitarian mission and aimed to break the Israeli blockade to Gaza, was intercepted by the Israeli soldiers on high sea on 31st May 2010. In this raid, nine civilians have lost their lives on the spot and 55 others were wounded. States and their agents can be held accountable if they commit crimes. Therefore, the Mavi Marmara victims have the right to sue at national and international level the Israeli officers who took part in the operation. Some victims have filed criminal and civil cases before the Turkish courts against Israel and its officers. Besides these judicial cases brought before the national courts, a referral was also made by the Union of the Comoros, flag country of the Mavi Marmara vessel, to the International Criminal Court. Meanwhile, Turkey and Israel have signed a bilateral agreement for the compensation of the bereaved families. This compensation agreement clears Israel and its officers off all legal responsibilities arising from the flotilla incident before the Turkish courts. This bilateral agreement is a legal obstruction imposed to the victims in their quest of justice. The Turkish Court of Cassation, in its recent decisions, has requested the courts of first instance to take into consideration the provisions of the said agreement. Despite the above mentioned agreement, the victims shall have still the right to sue the Israeli officials responsible for the flotilla incident before national, foreign and international courts, on the grounds of crime against humanity, provided that the necessary requirements are fulfilled.

France's Approaches to Territorial Disputes Settlement

The article explores France's territorial disputes in Europe and beyond (in French overseas territories), as well as disputes settlement approaches adopted by Paris. The author outlines the historical background of the disputes and the motives of France to allocate significant funds in order to maintain high-cost overseas territories, some of them are disputed by regional countries. In Europe France relies on both bilateral mechanisms and EU instruments to settle disputes. The French territorial disagreements with other countries remain more acute overseas. Paris promotes a method of gradual settlement based on the idea that the joint development of disputed areas allows to mitigate contradictions and to create conditions for a long-term territorial settlement. The French overseas Department of Mayotte as a special territorial case is outlined. The Union of the Comoros claims are supported by the UN. The French rationale for retaining Mayotte as part of France despite the UN decision is based on the results of several referendums, when the island's residents voted for this idea.

Genetic diversity of Plasmodium falciparum in Grande Comore Island

Background Despite several control interventions resulting in a considerable decrease in malaria prevalence in the Union of the Comoros, the disease remains a public health problem with high transmission in Grand Comore compared to neighboring islands. In this country, only a few studies investigating the genetic diversity of Plasmodium falciparum have been performed so far. For this reason, this study aims to examine the genetic diversity of P. falciparum by studying samples collected in Grande Comore in 2012 and 2013, using merozoite surface protein 1 ( msp1 ), merozoite surface protein 2 ( msp2 ) and single nucleotide polymorphism (SNP) genetic markers. Methods A total of 151 positive rapid diagnostic test (RDT) samples from Grande Comore were used to extract parasite DNA. Allelic families K1, Mad20 and RO33 of the msp1 gene as well as allelic families IC3D7 and FC37 of the msp2 gene were determined by using nested PCR. Additionally, 50 out of 151 samples were genotyped to study 24 SNPs by using high resolution melting (HRM). Results Two allelic families were predominant, the K1 family of msp1 gene (55%) and the FC27 family of msp2 gene (47.4%). Among 50 samples genotyped for 24 SNPs, 42 (84%) yielded interpretable results. Out of these isolates, 36 (85%) were genetically unique and 6 (15%) grouped into two clusters. The genetic diversity of Plasmodium falciparum calculated from msp gene ( msp1 and msp 2) and SNPs was 0.82 and 0.6 respectively. Conclusion In summary, a large genetic diversity of P. falciparum was observed in Grande Comore. This may favor persistence of malaria, and might be one of the reasons for the high malaria transmission compared to neighboring islands. Further surveillance of P. falciparum isolates, mainly through environmental management / vector control, is warranted until complete elimination is attained.

Union of the Comoros

Selected Issues

Genetic diversity of Plasmodium falciparum in Grande Comore Island

Background Despite several control interventions resulting in a considerable decrease in malaria prevalence in the Union of the Comoros, the disease remains a public health problem with high transmission in Grand Comore compared to neighboring islands. In this country, only a few studies investigating the genetic diversity of Plasmodium falciparum have been performed so far. For this reason, this study aims to examine the genetic diversity of P. falciparum by studying samples collected in Grande Comore in 2012 and 2013, using merozoite surface protein 1 (msp1), merozoite surface protein 2 (msp2) and single nucleotide polymorphism (SNP) genetic markers.Methods A total of 151 positive rapid diagnostic test (RDT) samples from Grande Comore were used to extract parasite DNA. Allelic families K1, Mad20 and RO33 of the msp1 gene as well as allelic families IC3D7 and FC37 of the msp2 gene were determined by using nested PCR. Additionally, 50 out of 151 samples were genotyped to study 24 SNPs by using high resolution melting (HRM).Results Two allelic families were predominant, the K1 family of msp1 gene (55%) and the FC27 family of msp2 gene (47.4%). Among 50 samples genotyped for 24 SNPs, 42 (84%) yielded

Union of the Comoros

While the authorities have so far not reported any COVID-19 cases in Comoros, the pandemic’s economic impact is already being felt as remittances receipts have slowed, visitor arrivals have stopped, and liquidity pressures have developed in the banking sector. The authorities have taken measures such as school closings and travel bans and have taken initial steps to address bank liquidity strains.