Incidence of gonococcal and chlamydial infections and coverage of two laboratory surveillance networks, France, 2012.

Surveillance of sexually transmitted diseases in France is based on voluntary networks of laboratories and clinicians. Despite the importance of incidence data in improving knowledge about the national context and in international comparisons, such data were not previously available. During nationwide quality control of laboratories, mandatory for all laboratories, we conducted a survey in June 2013 to estimate the incidence rates of gonococcal and chlamydial infections for 2012 and to estimate the proportion of diagnoses performed (coverage) by the country's two laboratory-based sentinel networks for these diseases. Estimated incidence rates for 2012 were 39 per 100,000 persons aged 15 to 59 years for gonorrhoea and 257 per 100,000 persons aged 15 to 49 years for chlamydia. These rates were consistent with the average levels for a group of other Western countries. However, different estimates between countries may reflect disparate sources of surveillance data and diverse screening strategies. Better comparability between countries requires harmonising data sources and the presentation of results. Estimated coverage rates of the gonococcal and chlamydial infection surveillance networks in France in 2012 were 23% and 18%, respectively, with substantial regional variations. These variations justify improving the representativeness of these networks by adding laboratories in insufficiently covered areas.

High-level azithromycin-resistant Neisseria gonorrhoeae clinical isolate in France, March 2014.

We report the first case in France of a high-level azithromycin-resistant Neisseria gonorrhoeae (minimum inhibitory concentration (MIC) = 96 mg/L) assigned to MLST7363 (NG-MAST ST6360), also resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone. The patient was a 51 year-old heterosexual man who returned following 1g azithromycin monotherapy. Mechanisms of azithromycin resistance were a C2599T mutation in the four copies of the rrl gene and a novel mutation in the promoter of the mtrR gene.

Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France.

BACKGROUND: Since 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators. METHODS: We estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18-54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants' most recent sexually transmitted infections other than genital candidiasis. RESULTS: Overall, 2.5% (95% confidence interval: 2.2%-2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%-1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women. CONCLUSION: Self-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.

First cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in France, investigations and implications for the prevention of human-to-human transmission, France, May 2013.

In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before symptom onset. Contact tracing identified a secondary case in a patient hospitalised in the same hospital room. No other cases of MERS-CoV infection were identified among the index case's 123 contacts, nor among 39 contacts of the secondary case, during the 10-day follow-up period.

First two autochthonous dengue virus infections in metropolitan France, September 2010.

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, southeast France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.

Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009.

This article describes the characteristics of 574 deaths associated with pandemic H1N1 influenza up to 16 July 2009. Data (except from Canada and Australia) suggest that the elderly may to some extent be protected from infection. There was underlying disease in at least half of the fatal cases. Two risk factors seem of particular importance: pregnancy and metabolic condition (including obesity which has not been considered as risk factor in previous pandemics or seasonal influenza).

The 2009 pandemic H1N1 influenza and indigenous populations of the Americas and the Pacific.

There are few structured data available to assess the risks associated with pandemic influenza A(H1N1)v infection according to ethnic groups. In countries of the Americas and the Pacific where these data are available, the attack rates are higher in indigenous populations, who also appear to be at approximately three to six-fold higher risk of developing severe disease and of dying. These observations may be associated with documented risk factors for severe disease and death associated with pandemic H1N1 influenza infection (especially the generally higher prevalence of diabetes, obesity, asthma, chronic obstructive pulmonary disease and pregnancy in indigenous populations). More speculative factors include those associated with the risk of infection (e.g. family size, crowding and poverty), differences in access to health services and, perhaps, genetic factors. Whatever the causes, this increased vulnerability of indigenous populations justify specific immediate actions in the control of the current pandemic including primary prevention (intensified hygiene promotion, chemoprophylaxis and vaccination) and secondary prevention (improved access to services and early treatment following symptoms onset) of severe pandemic H1N1 influenza infection.

[Chagas disease in France: estimated number of infected persons and cardiac diseases in 2009, by risk groups]. / Maladie de Chagas en France: estimation du nombre de personnes infectées et d'atteintes cardiaques en 2009, selon les groupes & risque.

An estimation of the number of Trypanosoma cruzi infected individuals and expected number of Chagasic cardiomyopathies in France (excluding French Guyana) was conducted in June, 2009 by InVS. Different risk groups were identified: Latino-Americans (LA) from endemic area (naturalized, legal and illegal migrants, adopted children), children born from LA's mother, French Guyanese living in Metropolitan France, expatriated and travellers from endemic countries. Prevalence rates by country of origin were applied to official data on risk populations obtained from the International Adoption Agency, Tourism Direction and French ministries (Finances, Foreign Affairs and Migrations). Around 157,000 individuals were potentially exposed. It is estimated than 1,464 [895-2,619] are infected by T. cruzi, of which 63 to 555 may evolve towards a chronic cardiomyopathy. This figure is within the range of earlier estimations of InVS and Guerri-Guttenberg. Taking into account illegal immigrants, the expected number of infected individuals in France should increase greatly this estimation.

Observational study of anorectal Chlamydia trachomatis infections in France through the lymphogranuloma venereum surveillance network, 2010-2015.

The objective of this article is to describe the epidemiology of lymphogranuloma venereum (LGV) and non-LGV Chlamydia trachomatis anorectal infections in France and to examine the characteristics of the affected populations via a voluntary sentinel surveillance system for LGV between 2010 and 2015. Anorectal samples positive for C. trachomatis (CT) were sent by the participating laboratories to the National Reference Center for CT for LGV identification. Biological and clinical data were collected by biologists and clinicians. There were 1740 LGV episodes and 2248 non-LGV episodes. Continuous monitoring highlighted a sharp increase in the number of LGV and non-LGV anorectal infections, which were 2.3-fold and 6.5-fold, respectively. Most of the infections occurred in men who have sex with men. LGV patients were older than non-LGV patients and were more frequently human immunodeficiency virus (HIV)-positive compared to non-LGV patients. Anorectal LGV was significantly associated with residence in Paris, HIV co-infection, concurrent syphilis and bloody anal discharge. Undocumented patient characteristics were strongly associated with anorectal LGV. The anorectal LGV epidemic is poorly controlled in France. Early detection and prompt treatment of patients and their sexual partners are required to prevent transmission in the context of pre-exposure prophylaxis (PrEP) for HIV infection.

Molecular epidemiology of penicillinase-producing Neisseria gonorrhoeae isolates in France.

OBJECTIVES: Characterizing the molecular epidemiology of antibiotic resistance is crucial for a better understanding of the evolution and spread of resistance in Neisseria gonorrhoeae. Here, we examine the molecular epidemiology of penicillinase-producing N. gonorrhoeae (PPNG) isolates in France. METHODS: We investigated 176 PPNG isolates collected between 2010 and 2012 by the National Reference Centre in France. Genotyping was performed using the NG-MAST technique, blaTEM genes were Sanger-sequenced, and plasmids were characterized by PCR-typing. RESULTS: We revealed the existence of four major clusters representing about one-third of PPNG circulating in France. These clusters were related to ST1479 (18/176, 10.2%), to ST1582 (15/176, 8.5%), to ST8922 (10/176, 5.6%), and to ST1285 (9/176, 5.1%). Wild-type TEM-1 was identified in 151 (151/176, 85.8%) PPNG isolates, and TEM-1 variants were mostly represented by the M182T mutation (14/176, 8%), followed by P14S/L (8/176, 4.5%), G228S (2/176, 1.1%), and Q269K (1/176, 0.6%). The blaTEM genes were carried by African (157/176, 89.2%), Asian (13/176, 7.4%), and Toronto/Rio (6/176, 3.4%) plasmids. The M182T variants were found in various genetic backgrounds, whereas the P14S variants were disseminated clonally. The G228S and Q269K variants belong to one of the four major clusters of PPNG, which suggests a recent de novo emergence of these mutations. CONCLUSIONS: Our results show that approximately one-third of the penicillinase-producing N. gonorrhoeae isolates in France belong to one of four major clusters and that the spread of the different TEM variants is associated with distinct patterns of molecular epidemiology.

[Requests for residency permits due to medical reasons from foreigners in the Val-d'Oise county between 1999 and 2003]. / Demandes de séjour pour raison médicale des malades étrangers dans le département du Val-d'Oise de 1999 à 2003.

The requests for residence permits from foreigners who wish to remain in France for health reasons are submitted for review to the county public health medical officer. This article reports on the quantitative and qualitative evolution and progression of these requests in a county located near Paris. The number of requests has drastically increased, from 152 in 1999 to 1,823 in the year 2003. The majority of the applicants were women and individuals from sub-Saharan Africa. HIV infection was the most frequent reason cited for the submission of requests, but its relative proportion has decreased over time from 25% in 1999 to 15% of overall requests made in the year 2003, which is then followed by diabetes (8% of all requests), hypertension (5%), and tuberculosis (4%). The decision handed down from the authorities was favourable for residence based on the need for healthcare in 74% of the cases. The health status of the illegal immigrants remains difficult to determine and systematically track; therefore, the applications for residency granted on medical grounds serve as a practical and efficient means to assess and map the existing situation.

[Evaluation of the pertinence of international courses on human African trypanosomiasis]. / Evaluation de la pertinence du cours international sur les trypanosomoses humaines africaines.

The goal of this study was to evaluate the adequacy and relevance of a training course on Human African Trypanosomiasis, targeted to reach support and coordination staff in charge of activities being carried out in related prevention and control programmes. A questionnaire was emailed to the four course organisers and the 65 participants. The response rate among the participants was 41%. The training needs expressed covered issues such as treatment, diagnostic and epidemiological techniques, improved knowledge of the disease, and control planning. The lectures given were adapted for participants' professional activities. At the time of the evaluation (one to three years after the course) 67% of the participants had begun implementing the knowledge they had acquired and applying it to their practice, particularly in the area of programme planning. The analysis of the questionnaire's results pointed to the sections of the course that would benefit from modifications, such as the need for the development of lessons and modules in the areas of patient management and planning for future training sessions.

[Residence permit for foreigners for healthcare in France: survey on the advice of the public health medical officers]. / Autorisation de séjour pour soins des malades étrangers en France: enquête sur les avis des médecins inspecteurs de santé publique.

BACKGROUND: Public health medical officers of the different French administrative districts are called in to advise the public authorities (Préfet) on requests for a residence permit from foreigners seeking healthcare asylum in France. Using a medical report chart, the medical officer specifies whether the foreigner requires treatment, whether lack of medical care can have exceptionally serious consequences and whether the patient can obtain a suitable treatment in his/her own country. Considering the marked increase in the number of requests for healthcare asylum and the potential subjective aspect of the medical officer's advice, a survey was conducted to assess medical officers'practices. METHODS: In March 2002, a questionnaire was addressed by email to the medical officers practising in the 94 administrative districts of metropolitan France. They were to give their advice about two fictional requests for healthcare asylum; the fictional requests closely mimicked real situations which frequently raise difficult issues. The two seekers were a 57-year-old man from Comoros treated for hypertension and noninsulin-dependent diabetes mellitus (case 1) and a 33-year-old woman from the Ivory Coast followed after treatment for tuberculosis (case 2). RESULTS: Among the 94 district medical officers contacted, 42 (45%) responded. Respectively 88% (case 1) and 67% (case 2) of the medical officers considered that the patient required medical care because lack of care would have serious consequences, but for 26% (cases 1 and 2), treatment could be delivered in the country of origin. Finally, the advise proposed by the different officers varied: for 33% (case 1) and 53% (case 2) of the medical officers, asylum in France for healthcare was unjustified. CONCLUSIONS: In spite of a low response rate, this survey shows the subjectivity of the advice provided by medical officers, raising the question of its fairness. Our study suggests that this subjectivity is related to the vagueness of the questions asked to the medical officers and the lack of a frame of reference on which to base their advice.

Cervical screening in Africa: discordant diagnosis in a double independent reading. DYSCER-CI Group.

Interobserver variation in the cytological diagnosis of cervical lesions poses a problem for public health screening programs. This study assessed the frequency of discordant diagnoses between two independent cytopathologists in the screening of African women. In Abidjan, Côte d'Ivoire, 2157 women were recruited from three outpatient gynecology clinics and screened for cervical abnormalities and genital and human immunodeficiency virus (HIV) infections. The degree of agreement between the cytopathologists was assessed by kappa statistics. The overall agreement was poor (kappa = 0.33); however, the degree of agreement increased with the severity of the lesions and was fairly good (kappa = 0.53) for high-grade and invasive lesions requiring curative treatment. Discordance was associated with HIV infection but not with genital infections. For a prevention program of cervical cancer in this African context, strategies must be developed to minimize errors in cervical screening. Particularly, HIV-infected women require a systematic rereading to reduce false-negative results.

Hepatitis B and C infections, human immunodeficiency virus and other sexually transmitted infections among women of childbearing age in Côte d'Ivoire, West Africa.

Few studies have been conducted in developing countries to estimate the prevalence of hepatitis C virus (HCV) infection and its association with human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs). We have screened for hepatitis B virus (HBV) and HCV markers 200 HIV-1-positive, 23 HIV-2-positive and 206 HIV-negative women attending gynaecology clinics in 1995/96 in Abidjan, Côte d'Ivoire, a sample selected among 2198 consecutive consultants. Taking into account the prevalence of 21.7% for HIV in this population, the overall prevalence of anti-HBV core antibody was 81.6%, that for hepatitis B surface antigen was 9.9% and for HCV antibody was 3.3%. HIV infection and other STDs were not associated with HBV or HCV markers. Moreover, HBV and HCV markers were not statistically associated. Our results confirm the high prevalence of HIV in Abidjan and the endemic situation of HBV infection. Furthermore, HCV infection is not infrequent in this developing country setting, not explained by sexual transmission.

Genital mycoplasmas among pregnant women in Cóte d'Ivoire, West Africa: prevalence and risk factors.

A cross-sectional study was conducted among pregnant women in Côte d'Ivoire to assess the prevalence and the factors associated with mycoplasma colonization. A positive culture was found in 400 of 551 women (73%); Ureaplasma urealyticum was identified in 22%, Mycoplasma hominis in 20% and both microorganisms in 31%. Mycoplasma colonization was not associated with genital symptoms or signs. Young age, low educational level, antimicrobial chemotherapy before consultation and presence of bacterial vaginosis were factors independently associated with M. hominis colonization. Among women colonized with M. hominis, HIV seroprevalence was 21% in women with high amounts of M. hominis (> or = 10(4) colour-changing units per ml) versus 7% in women with lower amounts (P=0.01). U. urealyticum was found more often in unmarried women and when pregnancy was less than 20 weeks. Mycoplasma colonization is frequent among pregnant women in Abidjan, but their pathogenicity requires further study.

Short-term follow up of cervical squamous intraepithelial lesions associated with HIV and human papillomavirus infections in Africa.

A prospective study in gynaecology clinics was conducted in Abidjan, Côte d'Ivoire, to assess the short-term evolution of squamous intraepithelial lesions (SILs). Of 94 women with a cytological diagnosis of SIL, 38 were infected with HIV. The average follow-up period after the initial smear was 5 months. Detection of human papillomavirus (HPV) by polymerase chain reaction (PCR) was performed at both the time of enrolment and final follow-up smear. There were 39 cases of persistent SILs. HIV-positive women had a higher percentage of persistent SIL (76%) than HIV-negative women (18%, relative risk (RR)=4.3, 95% confidence interval (CI) = 2.4, 7.7). SILs were more frequent among women infected with HPV at the time of enrolment or with persistent HPV infection, but these associations disappeared after adjusting for HIV serostatus. Spontaneous regression of SILs commonly occurs in HIV-negative African women. HIV-infected women with cervical dyskaryosis require gynaecology follow-up.

PIP: A prospective study was conducted in a gynecology clinic in Abidjan, Cote d'Ivoire, to assess the short-term evolution of cervical squamous intraepithelial lesions (SIL) associated with HIV and human papillomavirus (HPV) infections. Final analysis included 94 women with cytological diagnosis of SIL, who were seen for initial and follow-up smear control. All women underwent HIV antibody testing after pre-test counseling upon recruitment, and polymerase chain reaction was performed to detect HPV. Out of the 94 women, 38 were infected with HIV and 39 had persistent cases of SIL. HIV-positive women had a higher percentage of persistent SIL (76%) than those who were HIV-negative. SIL incidence was more frequent among women infected with HPV at the time of enrollment or with persistent HPV infection. This study concludes that if HPV infection plays a major role in cervical SIL, other factors contribute to the progression or regression of the lesion, particularly HIV-induced immunosuppression. Therefore, HIV screening should be offered to women with SIL, and specific gynecology follow-up should be conducted on HIV-infected women with cervical SIL in Africa.

Excluding blood donors at high risk of HIV infection in a west African city.

OBJECTIVE: To examine the potential impact of deferral of blood donors at high risk of HIV infection in a west African city where blood is screened for HIV antibodies but no other special measures are taken to protect the blood supply. DESIGN: Cross sectional study. SETTING: National Blood Transfusion Centre and Project RETRO-CI, an international collaborative AIDS research project, Abidjan, Côte d'Ivoire. SUBJECTS: 1257 male first time blood donors. INTERVENTIONS: Blood donors were interviewed about demographic and behavioural characteristics and tested for HIV antibodies by enzyme immunoassay and, if positive, synthetic peptide based tests. MAIN OUTCOME MEASURES: HIV antibody status in relation to presence of behavioural risk factors; calculation of sensitivity, specificity, and predictive values of specific criteria for excluding HIV infected donors. RESULTS: The overall prevalence of HIV infection was 11.4%. The most important risk factors for HIV positivity were prostitute contact and being aged 30-39 years. For identifying seropositive donors individual criteria had sensitivity, specificity, and positive predictive values ranging from 15% to 98%, 38% to 91%, and 17% to 30% respectively. Prostitute contact in the past five years would have excluded 31% of all donors and 73% of HIV infected donors. 27% of those excluded would have been HIV positive. CONCLUSIONS: The widespread assumption that donor deferral is not feasible in sub-Saharan Africa needs reassessment. In Abidjan this approach was well accepted and potentially effective. Donor deferral requires evaluation as a strategy for improving blood safety in resource poor areas with high rates of HIV infection.

PIP: During February-November 1991 in Abidjan, the Ivory Coast, interviews with 1257 male first-time blood donors and screening of their blood for antibodies to HIV-1 and HIV-2 were conducted at the National Blood Transfusion Center to determine whether it is feasible to exclude or defer donors at high risk of HIV infection. 143 (11.4%) men had antibodies to HIV. The multivariate analysis showed that the strongest risk factor for HIV infection was sex with prostitutes in the last 5 years without regular condom use (odds ratio [OR] = 10, confidence interval [CI] = 6.6-15) followed by prostitute contact in the last 5 years regardless of condom use (OR = 8.4, CI = 5.6-12.6), and an age of 30-39 years (OR = 6.9, CI = 18). 27% of all donors with prostitute contact in the last 5 years were infected (positive predictive value). If the center had used prostitute contact in the last 5 years as a criterion, it would have discarded 31% of all units of blood. Thus, more than 75% of all potentially excluded units would have been from donors infected with HIV. The sensitivity, specificity, and positive predictive values ranged from 15% to 98%, 38% to 91%, and 17% to 30%, respectively. These findings suggest that it is feasible in Abidjan to exclude donors based on behavioral characteristics of those most at risk of HIV infection. Donor deferral should be evaluated as a strategy to improve blood safety in resource-poor areas with high rates of HIV infection.

[Histology and physiology of black skin]. / Histologie et physiologie de la peau noire.

The aim of this article is to review the experimental knowledge concerning black skin. We point out its histological and physiological features without discussing here the specific pathology of black patients. Under the microscope skin structure is roughly the same in all races, but morphological differences exist, particularly within the epidermis, with potential practical consequences. In comparison with white skin, the black skin stratum corneum is equal in thickness but more compact: about twenty cell layers are observed in blacks versus sixteen layers in whites. The lipid content of black epidermis is also somewhat higher, and this perhaps explains the greater cellular cohesion, hence the difficulty in stripping off the black horny layer. These findings could also explain a slightly inferior permeability of black skin to certain chemicals. The hair of blacks in naturally more brittle and more susceptible to breakage and spontaneous knotting than that of whites. The kinky or wooly form of black hair, the weak intercellular cohesion between cortical cells and the specific hair grooming practices among black people account for these effects. The higher electrical resistance of black skin suggests that the black epidermis would be less hydrated than white epidermis. Anatomically, the amount of sweat glands in black and white skins is identical and varies with climatic changes but not with racial factors. Likewise, sweating is thought to be similar in both races, taking into account the contradictory results from studies, but black subjects withstand humid heat better while whites cope better with dry heat.(ABSTRACT TRUNCATED AT 250 WORDS)