Evaluation of a model for efficient screening of tuberculosis contact subjects.

RATIONALE: Contact tracing is an important component of tuberculosis (TB) control programs. Standardization of contact investigation protocols can make them more efficient. OBJECTIVES: To develop a model to select contact subjects for screening. METHODS: We prospectively collected standardized data on 325 TB index cases and their 2,009 contacts. Factors that independently influenced the risk of TB infection were included in the model, which was then validated in a second prospective cohort of 88 cases of TB and their 618 contacts. MEASUREMENTS AND MAIN RESULTS: A total of eight independent risk factors were identified (odds ratio; 95% confidence interval): age, with three subgroups: 6-14 years (3.6; 1.6-8.0); 15-29 years (3.7; 1.8-7.7); > or =30 years (4.1; 2.0-8.5); cavitation on the index case's chest radiograph (1.6; 1.1-2.2); an index case sputum smear with 100 or more acid-fast bacilli per field (1.8; 1.2-2.8); household contact at night (2.1; 1.3-3.2); first-degree family relationship with the index case (2.1; 1.3-3.3); active smoking by the contact (1.6; 1.1-2.4); free health care (2.0; 1.2-3.2); and birth in a country with TB incidence rate higher than 25 of 100,000 (2.2; 1.5-3.2). Predictive probabilities were chosen to ensure false-negative rates lower than estimated TB infection background. The number of contacts to be investigated was reduced by 26% while maintaining a false-negative rate of 8%. CONCLUSIONS: This study provides a standardized contact screening model which reduces resources required without negatively affecting disease control.

Surveillance of hemolytic uremic syndrome in children less than 15 years of age, a system to monitor O157 and non-O157 Shiga toxin-producing Escherichia coli infections in France, 1996-2006.

BACKGROUND: Since the 1980s, Shiga toxin-producing Escherichia coli (STEC), especially E. coli O157:H7, has been an important cause of food borne disease in industrial countries. In France, as there was no routine screening for STEC in clinical laboratories, enhanced surveillance of hemolytic uremic syndrome (HUS) in children less than 15 years of age was established in 1996 to monitor trends in the incidence of STEC infections. METHODS: The surveillance system was based on a voluntary national network of pediatricians of 31 pediatric nephrology units in public hospitals. RESULTS: From 1996 to 2006, the mean annual incidence of HUS was 0.71 cases per 100,000 children less than 15 years of age and 1.87 cases per 100,000 children less than 5 years of age. STEC infections were confirmed in 66% of patients; STEC O157 was the most common serogroup identified in STEC-related HUS (83%). In this 11-year period, 96% of HUS cases were sporadic and only 2 outbreaks caused by STEC O157 and by a dual infection of STEC O26 and O80 were detected. CONCLUSIONS: An evaluation of the surveillance of pediatric HUS showed that it is a simple and useful system for monitoring trends in STEC infections in France. It provides the information needed to measure the impact of new and changing vehicles of STEC transmission, and evaluate the effectiveness of prevention measures.

Sociodemographic factors that contribute to the development of extrapulmonary tuberculosis were identified.

BACKGROUND AND OBJECTIVES: The majority of cases of tuberculosis occur among males, but the majority of cases with extrapulmonary tuberculosis (EPTB) occur among females. The aim of this study was to identify independent risk factors associated with EPTB. METHODS: A multivariable logistic regression model was used. Eighteen thousand, six hundred seventeen cases of tuberculosis, notified through the French national mandatory network between 1 January 1997 through 31 December 2001, were included in the analysis. Because of multiple interactions, different multivariable models were built for each area of birth (Europe, North Africa, Sub-Saharan Africa, and Asia). RESULTS: Risk factors for EPTB vary according to area of birth. Women born in Asia or North Africa were at a higher risk of developing an EPTB than men. In Sub-Saharan Africa, age was associated with EPTB. Human immunodeficiency virus infection was an independent risk factor for EPTB in the European groups only with an OR of 2.48 (CI 99% 1.84-3.34). CONCLUSION: This analysis contributes to a better understanding of host-related factors associated with EPTB. As clinical presentation of EPTB is extremely variable, the identification of groups at higher risk may help in the early detection of cases.

[Epidemiology of tuberculosis]. / Epidémiologie de la tuberculose.

Tuberculosis in France is still a topical question. The national incidence rate was 11.2 cases per 100,000 population in 2000 and has been stable since 1997. The situation is particularly worrying in the Ile-de-France region where the incidence is twice the national rate. It reaches 50 cases per 100,000 in Paris. The proportion of cases with human immunodeficiency virus infection has decreased, but the tuberculosis cases rates are 8 times higher in foreigners, especially in young adults. Social deprivation and migration from countries with high tuberculosis incidence contribute to this situation. Targeting public health initiatives with appropriate fundings should be implemented to combat tuberculosis.

[Epidemiology of bacterial meningitis in France in 1999]. / Epidémiologie des méningites bactériennes en France en 1999.

In France, two sources of data, the mandatory notification and the laboratory network EPIBAC, allow the health authorities to follow the incidence of bacterial meningitis (BM) and to assess the relative frequency of the micro-organisms responsible for such infection. In 1999, more than 1,000 cases of BM were notified in France. The more common micro-organisms were: Streptococcus pneumoniae 46%, Neisseria meningitidis 32% and Streptococcus agalactiae(or Streptococcus B) 11%. Listeria monocytogenes and Haemophilus influenzae accounted for 6% and 5% of the cases respectively. In 1999, the incidence per 100,000 inhabitants of meningitis due to pneumococci (0.81), to streptococci B (0.19) and tuberculosis meningitis (0.17) were stable since 1995. The incidence rate of meningitis due to Listeria (0.10) and to H. influenzae (0.08) shows a regular decrease since 1992. The impact of preventive measures of meningitis due to Listeria and H. influenzae B has been clearly demonstrated through the dramatic decrease of meningitis due to these micro-organisms.

Legionella pneumophila serogroup 1 strain Paris: endemic distribution throughout France.

An analysis of 691 French clinical Legionella isolates showed that the endemic L. pneumophila serogroup 1 strain Paris was responsible for 12.2% of all cases of legionellosis and had a specific pulsed-field gel electrophoresis pattern. We also demonstrated the presence of this endemic clone throughout Europe.

Introduction of SARS in France, March-April, 2003.

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription-polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22-23. Timely detection, isolation of probable case-patients, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.