[Sexual exposure to HIV in the French armed forces between 2005 and 2007]. / Expositions sexuelles au VIH dans les armées françaises de 2005 a 2007.

BACKGROUND: Non-occupational HIV exposure in the French forces has been placed under epidemiological surveillance since 2000. This surveillance programme provides an indirect indicator of risky sexual behaviour among military personnel. PATIENTS AND METHODS: All cases of non-occupational exposures in French military personnel that meet the notification criteria, wherever they occur, are reported by a military physician, with data being collected from 2005 to 2007. RESULTS: Between January 2005 and December 2007, 2241 cases of sexual exposure within the French forces were filed. The annual incidence was 214.3 per 100,000 with an average patient age of 26 years. Sexual exposures concerned men in 99.2% of cases and occurred overseas in 92.9% of cases. Partners were sex-workers in 66.7% of cases. Failure to use condoms adequately during sexual intercourse was reported in 15.5% of cases. In cases where condoms were used, exposure to HIV resulted either from condom rupture or slippage. Postexposure HIV prophylaxis was prescribed in 70.5% of cases. DISCUSSION: The majority of cases of sexual exposure reported in the French armed forces involved high risk of HIV transmission. However, since the beginning of surveillance in 2000, no cases of HIV seroconversion have been reported following postexposure antiretroviral prophylaxis. The non-occupational postexposure prophylaxis strategy is not in question.

[Sexually transmitted diseases and sexual contamination with human immunodeficiency virus in the French Forces in 2006]. / Infections sexuellement transmissibles et contaminations sexuelles par le virus de l'immunodéficience humaine dans les armées françaises en 2006.

BACKGROUND: Servicemen constitute a group at risk for exposure to sexually transmitted diseases (STD) and for this reason specific surveillance of STD and human immunodeficiency virus (HIV) seroconversion has been conducted in the French Armed Forces since 1996. METHODS: All cases of STD and HIV seroconversion occurring in military personnel and corresponding to the notification criteria are reported by a military doctor, wherever the diagnosis is made. Incidence rates are calculated based on numbers of military personnel provided by the Ministry of Defence Social Observatory. RESULTS: In 2006, 67 cases of STD and 10 of HIV seroconversion due to sexual contamination were reported in the French Forces. The incidence of STD and HIV seroconversion was respectively 19.2 and 2.8 cases per 100,000. Gonorrhoea was the principal notified STD, with half of the cases of HIV seroconversion involving acute HIV infection. 59.7% of STD and 70.0% of HIV seroconversion were contracted in metropolitan France. DISCUSSION: STD and HIV seroconversion remain a subject of concern for the French Medical Forces despite low rates of incidence.

Neglected tropical diseases (NTD): French-speaking researchers-fighters call for an integrated approach to diagnosis.

The French-speaking Network for Neglected Tropical Diseases (RFMTN), created under the aegis of Aviesan in April, 2016, has among its 5 objectives, those to promote interactions between the French-speaking institutions who are members, to develop collaborative programs making it possible to respond to requests for proposals and to advocate effectively to political bodies and funders. To mark the milestone of its first two years of existence, it held a plenary conference in Montpellier (France) on October 22 and 23, 2018, at which experts from numerous African, French and international scientific institutions participated very actively. This article presents the essence of the debates.

Pierre Richet (1904-1983), fighting onchocerciasis and totalitarism.

While Eugène Jamot's name is associated with the combat against sleeping sickness, Pierre Richet is permanently linked to the battle against river blindness, which he first reported in 1936 in two neighboring households in Garango (Burkina Faso). Onchocerciasis remained a continuous interest, through his last article "The OCCGE and Onchocerciasis", written in 1983. Nonetheless over the course of these five decades, Richet's trajectory was far from that of a specialist dedicating his life to a single disease. After a decade essentially spent fighting trypanosomiasis, came a decade of war in which the specialist in endemism joined the Free French Army and put his organizational know-how at General Lerclerc's disposal, from Morocco to Indochina, via Germany. On his return to Africa in 1953, he extended the principle of mobile teams to the other major endemic diseases accessible to treatment and to vaccines. Richet organized first the combat against leprosy and launched vaccination programs. In 1955, he returned to the battle against onchocerciasis and deployed the first large-scale insecticide program in Chad. The intermediate term failure of this prototype fermented his scientific, interdisciplinary, and organizational thought, which flourished at Bobo-Dioulasso. At the dawn of the independence of French-speaking African countries, and against the political tides of the time, he obtained in 1960 the creation of a supranational organization, the OCCGE, common to 8 countries of West Africa, and he headed it for a decade. Drawing lessons from the past and in the absence of effective pharmaceutical treatment, Richet the physician played the entomological card with one hand, with technical support from Orstom (IRD); this detailed work enabled the development of a strategy. With the other hand, he played the multilateral card, which led in 1974 to the launching of the extraordinary Onchocerciasis Control Program (OCP). If it is Jamot who awakened Africa, Richet is the person who restored its view but also millions of hectares of cultivable land.

[Real time epidemiological surveillance within the armed forces: concepts, realities and prospects in France]. / Surveillance épidémiologique en temps réel dans les armées; concepts, réalités et perspectives en France.

BACKGROUND: In 2002, the North Atlantic Treaty Organization took five initiatives in order to enhance the defence capacities against the massive destruction weapons, one of them concerned the development of an interoperable surveillance system, giving in real time some informations permitting early warning to the commanders. Thoughts in France to improve the military surveillance system, methodological constraints and first results are shown. METHODS: Medical, technological, human and organisational aspects had to be taken into account to develop real time surveillance within the armed forces, and also specific military constraints. In order to evaluate the validity of its methodology, the "Institut de médecine tropicale du service de santé des armées" developed a prototype, set up in French Guyana and which took part in a second time at a multinational exercise. RESULTS: The "surveillance spatiale des épidémies au sein des forces armées de Guyane" has been set up in 2004, formed by both a recording and an analysis networks. This system permits to provide in real time some dashboards directly operational for the commanders. The exhaustiveness rate has been evaluated at 104%, compared to the traditional surveillance. It permitted three times to detect outbreaks several weeks before the other systems. Some limits have been identified, as the use of personal digitalized assistants. The involvement in a multinational exercise showed the system's efficacy, by detecting two simulated outbreaks, but also its interoperability. In 2006, it has been decided to extend the concept by deploying its second generation within the French armed forces in Djibouti. The "alerte et surveillance en temps réel" disposal permitted to take into account multiple geographical localizations. CONCLUSION: A real time surveillance system is an essential alarm disposal, however it is only an information tool within the complex activity of piloting the sanitary situation. It must be integrated within the whole situation expertise supports, represented also by medical intelligence, epidemiological investigations and prediction of the epidemiological phenomenon evolution.

[Chikungunya fever in La Reunion Island--2006]. / Le chikungunya a La Réunion en 2006.

The epidemic of Chikungunya fever that has affected the population of La Reunion since Christmas 2005 will be remembered as the most serious public health crises in the island's history. A number of lessons have been learned from this experience with a disease initially considered as benign. In addition to providing a concise chronological account of epidemiological events from the beginning of the outbreak in March 2005, this article describes what was done, what has been learned up to now, what could have been done and what remains to be done. After this outbreak Chikungunya fever can no longer be considered as transient strictly benign disease. Nor can the population or authorities of La Reunion ever again consider that economic development protects them from the hazards of the tropical environment.

[Correlation between rainfall and meningococcal meningitis in Niger]. / Corrélation entre la pluviométrie et la méningite a méningocoque au Niger.

The term "meningitis belt" was coined by Lapeyssonnie in 1963 to describe a zone in Africa where epidemic meningitis occurs sporadically during the dry season. The purpose of this study was to evaluate the relationship between the recorded rainfall and reported incidence of meningococcal meningitis in Niger from 1996 to 2002. A total of 58 277 cases of meningococcal meningitis were reported in Niger during the study period. The mean annual incidence was 82.2 per 10(5) inhabitants. Two epidemic years occurred during the study period, i.e., 1996 with 183 cases per 105 inhabitants and 2000 with 140 cases per 10(5). The incidence increased during the dry season and decreased at the beginning of the rainy season. Calculation of the correlation coefficient between rainfall and incidence of meningococcal meningitis showed a statistically significant negative correlation (r = -0.27; P = 0.01). Neisseria meningitidis sero-group A was predominant but strains of Neisseria meningitidis sero-group W135 have been found in specimens collected since 2002. Outbreaks of meningococcal meningitis epidemics are multi-factorial. Multivariate analysis of all factors would allow implementation of preventive measures earlier than the epidemic prediction strategy based on threshold rates proposed by the World Health Organization.

B-mode ultrasound in the diagnosis of maxillary sinusitis in intensive care unit.

Radiological maxillary sinusitis (RMS) is not an easily diagnosed in Intensive Care Unit (ICU). B-mode ultrasound of paranasal sinuses, validated for the ambulatory patients, was evaluated in a prospective study. One hundred fifty three ultrasound examinations were performed on 30 critically ill patients and compared to CT scan or radiography (Blondeau's view). Two levels of positive echographia are described: positive echographia corresponding with a moderate lesion, cupuliform echographia when the lesion is more significant. Its good predictive negative value when the echographia is negative and its predictive positive value of 100% when the echographia is cupuliform allow to recommend B-mode ultrasound as the best investigation for the diagnosis of maxillary sinusitis in a ICU. Diagnostic ultrasound represents a rapid, painless, innocuous and easily reproducible means of monitoring.

The blackfly Simulium buissoni and infection by hepatitis B virus on a holoendemic island of the Marquesas archipelago in French Polynesia.

The hematophagous blackfly Simulium buissoni causes skin lesions on an island in the Marquesas archipelago that is holoendemic for hepatitis B virus (HBV). To test the hypothesis of the possible role of this fly in the transmission of hepatitis B, 506 children (age range 2-11 years) were examined for the presence of skin lesions, and attempts were made to detect HBV DNA in and on blackflies using two polymerase chain reaction methods. The mean number of skin lesions showed a positive correlation with the age of these children (r = 0.12, P < 0.05). Furthermore, it was significantly higher in the rural zone than in the urban zone (mean +/- SD 41.02 +/- 31.71 versus 17.73 +/- 13.43; P < 0.05), and showed a correlation with a higher infection rate (73.9% versus 41.3%). Of the 45 pools of 10 insects tested, HBV DNA was not detectable on the inside of the insect, but was detectable on the flies (1-10 particles/insect in three positive pools). Infection by HBV conveyed by the flies is theoretically possible, but their indirect role via the numerous skin lesions caused on children is likely to explain such a high level of transmission.

Comparison of immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA) and haemagglutination inhibition (HI) test for the detection of dengue antibodies. Prevalence of dengue IgG-ELISA antibodies in Tahiti.

An immunoglobulin G enzyme-linked immunosorbent assay (IgG-ELISA) for the detection of dengue antibodies is described and compared to the haemagglutination inhibition test (HI). The sensitivity, specificity and agreement rate between the 2 techniques were good. The coefficients of correlation between IgG-ELISA and HI results, using dengue 1-4 antigens, were highly significant (P less than 0.001 for either antigen). IgG-ELISA was rapid, and easy to perform and suitable for large-scale studies. Between April and June 1987, a baseline serosurvey of the prevalence of dengue antibodies in age-stratified samples of children was carried out in Tahiti using IgG-ELISA. 327 children were tested against each dengue serotype. There was no significant difference between sex. Overall rates ranged from 7.4% in children under 5 years to 83.1% in those aged 15-19 years. Dengue 4 being the only serotype involved since 1979, specific responses to dengue 4 were found in higher proportion among children under 8 years old, while the IgG-ELISA responses were more widely reactive among children aged above 8 years (P less than 0.001). The acquisition rate of dengue 4 antibodies was 2.95% on average per year in children under 8 years of age.

Prevalence of hepatitis B virus infection in the Austral archipelago, French Polynesia: identification of transmission patterns for the formulation of immunization strategies.

A sero-epidemiological survey of hepatitis B virus (HBV) infection in a randomly selected sample of 957 persons from the population of the Austral Island group in French Polynesia was conducted as a first step before developing an immunization programme strategy. Prevalence rates of HBsAg ranged from 3.09% to 27% in the different islands of the group with a weighted mean of 10.48%, while the prevalence rate for at least one marker ranged from 46.91% to 81.03% with a weighted mean of 64.12%. In the 0-11 months and 1-4 years age groups, 2.08% and 10.57%, respectively, of the children were HBsAg carriers. These findings, when compared to the mean population carrier rate of 10.48%, suggest that HBV transmission occurred mostly after the first year of life. The highest prevalence rate for HBeAg positivity was in the 5-19 years age group (more than 40% of the HBsAg carriers were HBeAg positive), suggesting that contagiousness was greatest in childhood and adolescence. HBsAg was found in 11.45% of women of child-bearing age and HBeAg in 19.09% of women positive for HBsAg. It is concluded that immunization of newborns and infants, using vaccine alone, should be the most effective strategy for reducing HBV infection in the Austral Islands archipelago.

Finger-prick blood collection and computer-assisted enzyme-linked immunosorbent assay for large-scale serological studies on leprosy.

An immunoglobulin M anti-phenolic glycolipid 1 assay was standardized and optimized using specimens of dried blood collected on commercial precut filter paper discs, followed by a computer-assisted enzyme-linked immunosorbent assay (ELISA). The correlation between venepuncture and finger-prick methods, the calibration of the quantity of absorbed blood, and the reproducibility of the ELISA test were excellent. A slight decline of activity was observed when the samples were stored for 3 months at +4 degrees C. Skimmed milk can be used as diluent instead of bovine serum albumin, contributing to lessening the cost of the test. Using the method described, as many as 300 samples can be collected in the field and 480 ELISAs per day can be run in the central laboratory by one trained person.

One year evaluation of immunogenicity conferred by a Chinese hamster ovary cell recombinant hepatitis B vaccine in a French Polynesian newborn immunization programme.

In 1988, a hepatitis immunization programme, using a Chinese hamster ovary (CHO) cell recombinant vaccine, was implemented for newborn children in the Austral archipelago (French Polynesia). Three different schedules were used: (i) 4 vaccine doses at months (M) 0, M1, M2 and M12; (ii) 3 vaccine doses at M0, M1, M6; and (iii) 3 vaccine doses at M0, M1, M2. Results at the one year follow-up may be summarized as follows. Of 197 infants who received one or more doses of CHO-recombinant vaccine, (i) none was an HBsAg carrier; (ii) 89.5% had anti-HBs-antibody titres greater than 10 miu/ml; and (iii) 95.9% had seroconverted for at least one of the 2 antibodies studied (anti-HBs or anti-pre-S2). After 2 doses (M0, M1), anti-HBs seroconversion rate and geometric mean titre were, respectively, 82.6% and 98.47 miu/ml. After 3 doses, seroconversion rates and geometric mean titres were, respectively, 91.1% and 200.59 miu/ml using schedule M0, M1, M2, and 100% and 1253.4 miu/ml using the M0, M1, M6 schedule. None of the 7 vaccinated neonates born to HBsAg/HBeAg positive mothers was found to be an HBsAg carrier. These preliminary results indicate that, in field conditions, vaccination with a CHO-recombinant vaccine resulted in high immunogenicity.

Dengue 1 epidemic in French Polynesia, 1988-1989: surveillance and clinical, epidemiological, virological and serological findings in 1752 documented clinical cases.

An epidemic of dengue 1 occurred in French Polynesia in December 1988 and June 1989. This paper records (i) the trend of the outbreak and its surveillance and (ii) the clinical, epidemiological and virological data obtained from 1752 documented cases. The epidemic reached its peak in February in Tahiti Island, 7 weeks after its recognition. Among 6034 suspect cases reported by sentinel physicians, 60.3% were < 20 years old. The illness was classical dengue. No fatality or case of dengue haemorrhagic fever/dengue with shock syndrome was reported. Of 4792 patients subjected to laboratory testing, 41% were confirmed as positive. The serological attack rate was c. 40%. The estimated number of dengue infections in the Windward Islands was about 20,000. Transmission was associated with Aedes aegypti. Study of documented cases showed a higher confirmation rate in both the civilian population < 15 years old (46.5%) and the susceptible French military population (47.6%) than in older civilians (31.1%, P < 0.05). Furthermore, primary dengue infections were predominant in both of the first 2 groups. The diagnosis was mostly confirmed (i) by virus isolation on day < 5 of illness and (ii) by detection of immunoglobulin (Ig) M on day > or = 5 of illness. The study showed that adequate surveillance of an epidemic requires both clinically and laboratory-based systems.

Evaluation of gelatin particle agglutination assay for the detection of anti-PGLI antibodies. Comparison with ELISA method and applicability on a large scale study using blood collected on filter paper.

Given the technical difficulties of the ELISA method, a gelatin particle agglutination test (MLPA) has been developed recently for the detection of anti-PGLI antibodies. The purpose of this study was to compare these 2 tests. MLPA was found to be less specific than ELISA (91% versus 98%, chi 2 = 66.8, p less than 0.001). The sensitivity of both tests was of 95% for the diagnosis of multibacillary patients. In the case of paucibacillary patients. MLPA was found to be less sensitive than ELISA (21% versus 35%, chi 2 = 6.98, p greater than 0.01). The agreement between the 2 tests for a positive or a negative result was satisfying (85% to 100%), except for the weakly seropositive individuals (71%). The correlation between OD obtained with ELISA and antibody titre obtained with MLPA was statistically significant (r = 0.70, p less than 0.001). Conversely to ELISA, MLPA was not applicable on blood samples absorbed on filter paper without a serious loss of sensitivity. In conclusion, this study demonstrated that the MLPA test can only reliably detect anti-PGLI antibodies in multibacillary cases.

Longitudinal study on relapses of leprosy in Polynesian multibacillary patients on dapsone monotherapy between 1946 and 1970.

Between 1946 and 1970, 295 new leprosy patients were detected in French Polynesia, of whom 145 were multibacillary. Of these 145, put on dapsone monotherapy, 131 reached bacteriological negativity in a period of time ranging from 2 to 12 years (average 4.72 years) and were followed-up for a period of time ranging from 19 to 43 years (median follow-up period after bacteriological negativity; 18 years). Among the 131 patients, 36 relapses were detected, the first one 4 years after bacteriological negativity and the last one 26 years after. The crude relapse rate was 27.5%, the risk of relapse was 1.39 per 100 patient years and the cumulative relapse probability, calculated using the lifetable method, reached 0.38 +/- 11 by year 31 of the study. From these findings one may assume that, at least in French Polynesia, one-third to one-half of multibacillary patients put on dapsone monotherapy would relapse if still present 36 years after bacteriological negativity. Such results re-emphasize the need for leprosy patients to be treated with multidrug therapy as recommended by WHO.

Leprosy in French Polynesia. Epidemiological trends between 1946 and 1987.

The analysis of computerized data (OMSLEP system) on patients from French Polynesia followed since 1940 has shown a decrease in the mean annual detection rates for leprosy, all forms combined, from 24.73 per 100,000 inhabitants in 1946 to 8.1 per 100,000 in 1987 (y = -0.49 x + 45.83; p < 0.05). In fact, the decrease was significant (y = -1.18 x + 83.54; p < 0.05) during the first half of the study period (1946-66), but not during the second half (1967-87). Similarly, a significant decrease in all of the specific mean annual detection rates (according to the form of leprosy and to the sex and age of patients), in the proportion of multibacillary patients among the total of newly detected cases, and in the proportion of all patients with disabilities at the onset of leprosy was observed only during the first half of the study period (1946-66). Nevertheless, when comparing age-specific cumulative detection rates, calculated by 10-year age groups over the period 1946-66, to those of the period 1967-87, an ageing of the leprosy population was noted. Finally, the decrease of mean annual detection rates was greater in the smaller populations of remote islands than in the population of Tahiti, the main island, where 70% of the total population were living during the study period. This decline was shown to correspond to an effective improvement of the leprosy situation which could be attributed, among other factors (such as economic development and systematic BCG vaccination), to the implementation of a control programme for leprosy in 1950. The introduction in 1982 of multidrug therapy for all patients suffering active leprosy has raised the hope of a subsequent decline of leprosy in French Polynesia in the near future.

[Value of public opinion polls for evaluating the acceptability of epidemiologic surveys in urban areas]. / Intérêt des sondages d'opinion pour évaluer l'acceptabilité en zone urbaine des enquêtes épidémiologiques.

A prevalence study on non communicable diseases related to nutrition, alcoholism and tabagism is planned in French Polynesia. The methodology used, although complicated, has been successful in insular states of the South Pacific with either traditional or transitional ways of life. Acceptability level of the study in the urban area of Papeete (Tahiti) has been tested by a public opinion poll using the quota method in order to obtain valuable information on feasibility of the project. The public opinion poll showed that 75% of people would participate, 19.5% would be reluctant and 5.5% would hesitate. The good results must be carefully interpreted with regards to the multi-ethnic structure of French Polynesian population, and to the limits of the quota method.

[Epidemiology of primary liver cancer in French Polynesia]. / Epidémiologie du cancer primitif du foie en Polynésie française.

Thirty-one cases of primary liver cancer recorded since 1980 to 1988 in French Polynesia are studied. Four risk factors are brought to the fore: male, more than 50 years old, birth in Austral archipelago and in this case AgHBs carriage. The relative risk for birth in Austral archipelago reach to 9.23. The relative risk for AgHBs carriers from this archipelago reach to 42.7. Costs of primary liver cancer and to immunization against hepatitis B virus are compared. Authors suggest to start an immunization program.