EMERGENCE OF BURULI ULCER DISEASE IN THE DALOA REGION OF COTE-DIVOIRE

Recent reports have suggested increases in Buruli ulcer (BU), an infec tion caused by Mycobacterium ulcerans in west Africa. In 1991, we cond ucted surveillance for BU in a rural area of Cote d'Ivoire and identif ied 312 cases of active or healed ulceration. A case-control study was then performed to investigate risk factors for this infection. The ra te 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 1 0-14-year-old age group (143 cases per 1,000 population). New cases in creased more than three-fold between 1987 and 1991, and local prevalen ce of BU was as high as 16.3%. Twenty-six percent of persons with heal ed ulcers had chronic functional disability. Participation in farming activities near the main river in the region was identified in the cas e-control study as a risk factor for infection (odds ratio [OR] for ea ch 10-min decrease in walking distance between the fields and the rive r = 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'Ivo ire. Specific causes of this increase were not identified, but wearing protective clothing appeared to decrease the risk of disease.