Borreliosis, or relapsing fever, is a disease provoked by bacteria of the genus Borrelia. Two of these are encountered in tropical Africa: Borrelia crocidurae in the Sahara and Sahel, Borrelia duttoni in East Africa.
This infection causes recurrent fevers over a long period that can lead to severe meningoencephalitis and sometimes death. The human vector of Borrelia crocidurae in West Africa is the tick Ornithodoros sonrai, which lives in burrows of small wild rodents and is therefore in close contact with them. This disease was considered rare up to the end of the 1980s when a team of IRD researchers showed that in a rural area of the Dakar region tick-borne relapsing fever was the second most frequent reason for patients’ consultation at the local dispensary.
Since 1990, the IRD launched a comprehensive research programme on this disease, first in Senegal, then in the whole of West Africa. In Senegal, the investigation showed that the tick had colonized savannah and that the disease’s expansion was closely linked with the decrease in average rainfall since the long drought began in 1970. The advance of borreliosis prompted the research team to extend their epidemiological research and study the long-term trends, by 14 years of measurement of the infection’s incidence in a rural Senegalese community which was the subject of continuous demographic and health monitoring programme run jointly by the IRD, the Pasteur Institute and the University of Dakar.
The study was conducted from 1990 to 2003 on people in Dielmo, a village in the savannah in the Sine-Saloum region of Senegal, in order to determine the frequency and describe the clinical manifestations of malaria, tick-borne relapsing fever and other fevers not linked to these two diseases. The research team lived permanently in the village so that they could visit each inhabitant daily. Medical examinations and biological tests were systematically carried where someone had a fever or other symptoms that might signal the disease. The presence of Borrelia crocidurae was also tested in people without symptoms at least once a year. All rodent burrows near houses and inner yards of concession were counted and recorded. They were searched for ticks and the latter’s infection rate by the bacterium determined. Rodents and insectivores were captured in order to study the bacterial reservoir.
Over the period of study as a whole, an average 11 % of the population suffered from borreliosis each year, an exceptional incidence rate for a disease, whatever its cause. Only malaria, among the parasitic diseases and in any case to a lesser degree, and influenza, among viral diseases, are known to produce a comparable incidence level over such a long period. Tick-borne relapsing fever is the second cause of illness after malaria. All age groups were affected by it in the population studied.