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.
Boris Tchakounte Youngui, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Emilienne Epée, National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon.
Tatiana Djikeussi, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Joseph Fokam, Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management, Messa, Yaoundé, Cameroon.
André P. Goura, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Loic Feuzeu, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Muhamed Awulo Mbunka, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Pallavi Dani, FIND, Geneva, Switzerland.
Shannon Viana, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Anne Hoppe, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Yap Boum, National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon.
Rhoderick Machekano, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Laura Guay, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Anne-Cecile Zoung-Kanyi Bissek, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.
John Ditekemena, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Appolinaire Tiam, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Alain G. Etoundi, National Public Health Emergency Operations Coordination Centre, Ministry of Public Health, Yaoundé, Cameroon.
Patrice Tchendjou, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.
Michelle M. Gill, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon, and Washington, District of Columbia.

Document Type

Journal Article

Publication Date

4-1-2025

Journal

The American journal of tropical medicine and hygiene

Volume

112

Issue

4_Suppl

DOI

10.4269/ajtmh.23-0898

Abstract

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.

Department

Epidemiology

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