[Recent latent tuberculous infection (LTBI) in different sub-groups of contacts]. / L'infection tuberculeuse latente (ITL) récente chez les sujets contact.

Screening for latent tuberculous infection (LTBI) in contacts of identified cases of tuberculosis should be based on intention to treat. We know that only LTBI that is attributable to a recent transmission requires preventive treatment in immunocompetent adults. There is no current test that allows accurate dating of LTBI. The objective of this retrospective study with QuantiFERON-TB-Gold In-Tube (QFT) is to estimate the probability of recent LTBI in various groups of contacts. Among 2424 subjects included, 407 (17%) tests were positive; 129 (28%) within the family circle, 69 (19%) within the social environment, 153 (14%) among professional acquaintances and 56 (10%) within the school environment (respectively: OR=0.69 and P=0.04; OR=0.49 and P<0.001; OR=0.51 and P<0.001). After comparison with a basal rate of LTBI, professional and family contacts less than 40 years old, born in a country of incidence lower than 20, had a rate of recent LTBI between 15 and 40% and between 68 and 80%, respectively. For those born in a country of incidence greater than 20, we estimate the rate of recent LTBI between 6 and 18% for professional contacts and between 43 and 50% for family contacts. These results, although approximate and specific to Paris, are important for the clinician who has to decide on preventive treatment and for the public health specialist who has to identify groups of contacts. Finally, to limit the differences in rates of recent LTBI, it would probably be necessary to specify thresholds of accumulated contact time, according to the type of contact, before considering an individual as a contact.

Impact of a 14-year screening programme on tuberculosis transmission among the homeless in Paris.

OBJECTIVE: To evaluate the impact of an active case-finding programme on tuberculosis (TB) transmission in homeless shelters in Paris, France. DESIGN: Between 1994 and 1997, an active case-finding programme was implemented in homeless shelters using a mobile radiological screening unit, and continued from 1997 to 2007. During these periods, the strains isolated from TB cases diagnosed in the homeless were genotyped by restriction fragment length polymorphism analysis using the insertion sequence IS6110 as a probe. RESULTS: Between 1994 and 2007, 313 new TB cases were diagnosed among the homeless population: 179 through the programme among shelter users, and 134 among homeless people not using shelters. Half of the strains were clustered in 35 distinct patterns (2-48 cases/cluster). The clustering of TB cases steadily decreased in shelters during the 13 years of the survey, from 14.3 to 2.7 related cases per year (P < 0.01) and from 75% to 30% of related cases among all TB cases (P < 0.01). In contrast, there was only a slight trend towards a decrease in homeless people not using shelters. CONCLUSION: Active case finding in homeless shelters resulted in a decrease in case clustering, mainly in shelter users. Genotyping contributed to confirming the positive impact of the intervention.

[Screening contacts for latent tuberculosis infection (LTBI) using an interferon test in Paris in 2009]. / Dépistage de l'infection tuberculeuse latente (ITL) à Paris à l'aide d'un test interféron chez des sujets contact en 2009.

There are two reasons for screening contacts: one is to identify cases of secondary tuberculosis disease (TB) and the other is to identify new cases of latent tuberculosis infection (LTBI). The tuberculin skin test (TST) and the interferon-gamma-release assay (IGRA) have their limitations when used for the detection of LTBI. They neither allow a definite diagnosis of LTBI nor provide information as to the date of onset. The present study was observational, multi-centre (four centers) and retrospective. Six hundred and one contacts were included. The results of the QFT test showed 88 positive (15 %). Among the 144 index cases, all presented with pulmonary disease and 89 cases were sputum positive. In our series, 101 contacts belonged to the family circle. The four factors that had a significant positive impact on the result of the QFT test were: increasing age, the region of birth of the contact (high incidence areas), both of which may indicate old infection, while contact within the family and sputum positivity of the index case probably indicate recent infection. Only sputum positivity influenced the decision to treat the LTBI. We propose a tool aimed at facilitating the decision making process in QFT positive cases. Estimation of the duration of LTBI should help the physician to decide on the need for preventative treatment as well as a search for factors that increase the risk of progression to TB disease.

[Current events in vaccination]. / Actualités en matière de vaccination.

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

[Current events in vaccination]. / Actualités en matière de vaccination.

The annual meeting of the Infectious Disease Society of America (IDSA); which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve--but for how long?--the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55%, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.

[Impact of routine pediatric varicella vaccination on the epidemiology of herpes zoster]. / Impact de la vaccination de routine de l'enfant contre la varicelle sur l'épidémiologie du zona.

OBJECTIVE: This literature review addresses the following question: what elements point to an impact of routine chicken pox vaccination of children on the incidence of shingles? DESIGN: The search strategy involved an electronic search (Medline database via PubMed) and crossed references. Articles were selected by reading their abstracts. RESULTS: There were few published studies dealing with the question. A total of 13 publications reported seven longitudinal studies on the incidence of shingles and six mathematical models. The population studies were all American, and reported discordant results, four reporting an increase, and three, stability in the incidence of shingles. Four of the six mathematical models concerned the impact of routine chicken pox vaccination on shingles epidemiology. All showed a transitory short-term increase in the incidence of shingles (on condition that vaccine was effective and coverage high) and a long-term incidence of shingles lower than the current rate. CONCLUSIONS: The currently available data is insufficient for any conclusion to be drawn as to the impact of routine pediatric chicken pox vaccination on the incidence of shingles. Monitoring the incidence of shingles in countries either recommending or not such vaccination should be maintained.

[Comparison of various tuberculosis screening strategies based on tuberculin testing in schoolchildren in Paris]. / Comparaison de différentes stratégies de dépistage de la tuberculose par test tuberculinique chez les enfants scolarisés en classe de CM2 à Paris.

BACKGROUND: Following the discontinuation in 2004 of routine tuberculin testing in children in France, we have performed a study aiming at assessing the relevancy and identifying the best modalities of continuation of tuberculosis screening activities in schoolchildren in Paris. METHOD: The study was conducted in children attending the last grade of primary school. A preliminary case control study was carried out in order to identify risk factors for abnormal tuberculin test results. Data on tuberculin testing activities conducted in 2004 were analyzed in order to compare the impact and the efficiency of five different target populations for screening. The impact of each of the screening strategies was assessed as the number of tuberculosis infections for which a specific treatment has been proposed and their efficiency as the average number of tuberculin tests needed to identify such an infection. RESULTS: Beside multiple BCG vaccinations, the main risk factor for an abnormal tuberculin test result was the fact that at least one of the child's parents was born in a country of high tuberculosis prevalence. Within the five strategies tested, two can be selected on the basis of their impact and efficiency: the testing of all children and the targeting of the testing to children with characteristics putting them at high risk of tuberculosis. DISCUSSION: For Paris or other large cities in France, decision-makers will have to consider the local tuberculosis epidemiology, the resources that can be devoted to tuberculosis screening of schoolchildren and the regional specificities of the new BCG vaccination policy.

[Current management of acute pediatric rhinosinusitis in France]. / Etat actuel de la prise en charge des infections rhinosinusiennes aiguës de l'enfant en France.

A multidisciplinary panel of specialists and general practitioners provided definitions for the different forms of acute pediatric rhinosinusitis, with a description of the main symptoms and signs. They emphasized the role of concomitant systemic diseases, such as allergy and immunological disorders. Incidence, description, and management of complications are presented. They also provided the indications for radiological examination and microbiological investigations. The adequate medical management, particularly the place and the type of antibiotics, is analyzed and discussed, and guidelines for practical situations are suggested.

[Marcel Petitmengin (1881-1908), pharmacist botanist: his life, his work]. / Marcel Petitmengin (1881-1908), pharmacien botaniste: sa vie, son ceuvre.

Marcel Petitmengin was born in Nancy in January 1881. Student at the school of pharmacy and preparator in its laboratory for natural history, he received his diploma in 1904. He had already published some papers on botany and belonged to the International Academy for Geographical botany. He choose the flora of Mount Viso, in Italy, for his philosophical thesis. In the same time, he worked on greek flora with Maire, then on Primulaceae from Asia. Having published about fifty papers on botany, he died from tuberculosis in October 1908, being twenty-seven years old. Very faithful, he took part actively in protestantism in Nancy.