Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infectologia/tendências , Criação de Animais Domésticos/normas , Animais , Gestão de Antimicrobianos , Clima , Doenças Transmissíveis Emergentes/prevenção & controle , Doenças Transmissíveis Emergentes/transmissão , Planejamento em Desastres , Surtos de Doenças/prevenção & controle , Resistência Microbiana a Medicamentos , Contaminação de Alimentos , Política de Saúde , Humanos , Controle de Infecções , Cooperação Internacional , Saúde Pública/legislação & jurisprudência , Condições Sociais , Doença Relacionada a Viagens , Medicina Veterinária/tendências , Poluição da Água , Abastecimento de ÁguaRESUMO
In France, Bacillus CalmetteGuérin (BCG) vaccination by multipuncture device was withdrawn in 2006. In 2007, universal mandatory BCG vaccination was replaced by vaccination of high-risk children. To evaluate the impact of these changes on tuberculous meningitis (TBM) epidemiology, data on culture-positive and culture-negative (or unknown microbiological result) TBM in ≤5 years olds were collected from 20002011. Ten culture-positive and 17 culture-negative TBM cases were identified, with an annual incidence rate ranging from 0.16 to 0.66 cases per 10 million inhabitants. The average annual numbers of TBM cases were 2.7 and 1.8 from 20002005 and 20062011, respectively. In Ile-de-France where all children are considered at risk, the overall incidence rates were 1.14 and 0.29 per million for the two periods. In other regions where only at-risk children are vaccinated since 2007, rates were 0.30 and 0.47, respectively. None of these differences were significant. Annual incidence rates for each one year age group cohort were comparable before and after changes. Childhood TBM remains rare in France. No increase in incidence was observed after changes in BCG vaccination strategy. Ongoing surveillance should be maintained, as a slight increase in TBM in the coming years remains possible, in the context of suboptimal vaccination coverage of high-risk children.
Assuntos
Vacina BCG , Política de Saúde , Tuberculose Meníngea/prevenção & controle , Vacinação/legislação & jurisprudência , Criança , Pré-Escolar , França/epidemiologia , Humanos , Programas de Imunização , Incidência , Lactente , Masculino , Mycobacterium tuberculosis/efeitos dos fármacos , Teste Tuberculínico , Tuberculose Meníngea/epidemiologia , População Urbana , Vacinação/estatística & dados numéricosRESUMO
OBJECTIVE: To analyse diagnostic delay in tuberculosis (TB) patients. DESIGN: Cross-sectional study: all patients with TB notified to the French national surveillance system from April to June 2010 were interviewed face-to-face using a standardised questionnaire to assess symptom history and health-seeking trajectories. RESULTS: Of 225 patients enrolled, 172 (76.4%) had pulmonary TB, including 88 who were smear-positive. Mean delay between first symptoms and diagnosis (total delay) was 97 days (median 68, IQR 33-111), with a mean of 47 days (median 14, IQR 0-53) between first symptoms and health care contact (patient delay), and 48 days (median 25, IQR 6-67) between health care contact and diagnosis (health system delay). Factors independently associated with shortened total delay were medical insurance (OR 0.24, P = 0.014) and previous TB (OR 0.28, P = 0.049). Those associated with reduced patient delay were initial fever (OR 0.42, P = 0.03) and being followed by a general practitioner (OR 0.22, P = 0.004), while those associated with reduced health system delay were first health care contact within a hospital (OR 0.15, P < 0.001). Empirical antibiotic treatment was associated with increased health system delay (OR 4.4, P = 0.001). CONCLUSION: TB diagnostic delay needs to be reduced in France. This may be achieved through improved access to care, earlier hospital referral, and less use of empirical antibiotic treatment.
Assuntos
Antibacterianos/uso terapêutico , Diagnóstico Tardio , Acessibilidade aos Serviços de Saúde , Tuberculose/diagnóstico , Adulto , Idoso , Estudos Transversais , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Prospectivos , Encaminhamento e Consulta , Escarro/microbiologia , Inquéritos e Questionários , Fatores de Tempo , Tuberculose Pulmonar/diagnóstico , Adulto JovemRESUMO
One of the objectives of the surveillance systems implemented by the French National Institute for Public Health Surveillance is to detect communicable diseases and to reduce their impact. For emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. The surveillance systems detect a variety of events, or "signals" which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, or an abnormal number of cases for a well-known disease. These signals are first verified and analyzed, then classified as: potential public health threat, event to follow-up, or absence of threat. Through various examples, we illustrate the method and criteria which are used to analyze and classify these events considered to be emerging. The examples highlight the importance of host characteristics and exposure in groups at particular risk, such as professionals in veterinarian services, health care workers, travelers, immunodepressed patients, etc. The described method should allow us to identify future needs in terms of surveillance and to improve timeliness, quality of expertise, and feedback information regarding the public health risk posed by events which are insufficiently documented.