Incidence and prevalence of Toxoplasma gondii infection in women in France, 1980-2020: model-based estimation.

Toxoplasmosis is a worldwide zoonosis due to Toxoplasma gondii, a ubiquitous protozoan parasite of warm-blooded animals including humans. In pregnant women, primary infection can cause congenital toxoplasmosis resulting in severe malformations in the newborn. Since 1978, public health authorities in France have implemented a congenital toxoplasmosis prevention programme, including monthly serological screening of all seronegative pregnant women, and treatment in case of seroconversion. However, this programme does not produce systematic surveillance data on incidence and prevalence. Our objective was to estimate the incidence and prevalence of T. gondii infection, and the incidence of seroconversion during pregnancy in women in France. We used a catalytic model to estimate incidence and prevalence of Toxoplasma infection between 1980 and 2020 in women of childbearing age. We used age- and time-specific seroprevalence data obtained from the National Perinatal Surveys (NPS) conducted in 1995, 2003 and 2010. We assumed that incidence depends both on age and calendar time, and can be expressed as the product of two unknown functions. We also estimated incidence of seroconversion during pregnancy in 2010 from the NPS and the National Surveillance of Congenital Toxoplasmosis (ToxoSurv). We combined data of 42208 women aged 15-45 years with serology available from the three NPS. For women aged 30 years the modelled incidence decreased from 7·5/1000 susceptible women in 1980 to 3·5/1000 in 2000. In 2010 the incidence was 2·4/1000. The predicted incidence and prevalence for 2020 was 1·6/1000 and 27%, respectively. The incidence of seroconversion during pregnancy in 2010 was estimated at 2·1/1000 susceptible pregnant women (95% CI 1·3-3·1) from the NPS and 1·9 (95% CI 1·8-2·1) from ToxoSurv. Incidence and prevalence of Toxoplasma infection has decreased markedly during the last 30 years. This decrease may be explained by a lower exposure to the parasite by changes in food habits and by improved hygiene practices in meat production. Modelled estimations were consistent with estimates observed in other studies conducted previously in France. The catalytic modelling provides reliable estimates of incidence and prevalence of Toxoplasma infection over time. This approach might be useful for evaluating preventive programme for toxoplasmosis.

Pregnancy-related listeriosis in France, 1984 to 2011, with a focus on 606 cases from 1999 to 2011.

This study describes trends in the incidence of pregnancy-related listeriosis in France between 1984 and 2011, and presents the major characteristics of 606 cases reported between 1999 and 2011 to the French Institute for Public Health Surveillance through the mandatory notification system. The incidence of pregnancy-related listeriosis decreased by a factor of 12 from 1984 to 2011. This reduction was a result of progressive implementation of specific Listeria monocytogenes control measures in food production. A lower incidence of pregnancy-related listeriosis was observed in regions with a lower prevalence of toxoplasmosis. Given that dietary recommendations in pregnancy target both toxoplasmosis and listeriosis prevention, we suppose that recommendations may have been delivered and followed more frequently in these regions. Cases reported between 1999 and 2011 (n=606) were classified as maternal infections with ongoing pregnancy (n=89, 15%), fetal loss (n=166, 27%), or live-born neonatal listeriosis (n=351, 58%). The majority of live-born neonatal listeriosis cases (n=216, 64%) were preterm births (22­36 weeks of gestation), of whom 14% (n=30) were extremely preterm births (22­27 weeks of gestation). Eighty per cent of mothers reported having eaten high risk food during pregnancy. A better awareness of dietary recommendations in pregnant women is therefore necessary.

Prevalence of toxoplasmosis in France in 1998: is there a difference between men and women? At what age do children become infected?

BACKGROUND: The only national seroprevalence data currently available on toxoplasmosis in France are from the national perinatal surveys of pregnant women conducted in 1995 and 2003. These surveys are national, exhaustive and cross-sectional studies of all pregnant women who give birth in France during one specified week. These cross-sectional studies, conducted among women of childbearing age (defined as 18 to 45 years), showed a positive correlation between seroprevalence and age, with a significant regional disparity. This study was performed in order to compare the prevalence of toxoplasmosis antibodies in men and women in the 18-45 age group, to confirm regional variations and to estimate the seroprevalence of toxoplasmosis in France for different age groups, particularly among children and among adults aged over 45 years. METHODS: Serum samples from 2060 subjects were available from a national serum bank that was established in 1997 as part of a European study on vaccine preventable diseases. The sera were tested for IgG antibodies in 2008-2009, by ELISA test, at the laboratory of parasitology-mycology, CHU Grenoble. RESULTS: The seroprevalence for the population aged 1-64 years was 55.4%. Seroprevalence did not vary between the sexes, except among those aged over 45 years, where it was higher in men than in women. Toxoplasmosis seroprevalence varied significantly by regions for all ages. It increased with age and we noted a stronger increase in prevalence in adolescents (10-20 years) than in other age groups. CONCLUSION: This study showed that children have limited exposure to Toxoplasma gondii and that seroprevalence in men and women does not differ for the population aged 45 years and under. This study confirms the geographical disparity in prevalence in France that has been found in other studies in women of childbearing age. This disparity cannot be explained by different laboratory techniques, because sera were tested in a single laboratory. The study also raises the possibility of extrapolating seroprevalences from ENP to the general population and thus estimating the seroprevalence in the French population.

Prevalence of Chlamydia trachomatis: results from the first national population-based survey in France.

BACKGROUND: Few studies have estimated Chlamydia trachomatis (CT) prevalence in the general population, most prevalence studies being based on people already attending healthcare settings. OBJECTIVES: To estimate the prevalence of CT in France, assess the feasibility of home sampling without any face-to-face intervention and identify risk factors associated with CT infection using data from the Contexte de la Sexualité (CSF) survey on sexual behaviour; a national population-based survey, carried out by telephone in 2006. METHODS: A random subsample of sexually experienced people aged 18-44 (N=4957) were invited to participate in a CT home-sampling study (NatChla study). Participants' samples were tested for CT by PCR. Percentages were weighted for unequal selection probabilities and post-stratified based on French population census data. Independent risk factors were identified by logistic regression. RESULTS: CT prevalence in people aged 18-44 was estimated at 1.4% (95% CI 0.8% to 2.6%) for men, and 1.6% (95% CI 1.0% to 2.5%) for women. Increased rates were found in subjects aged 18-29: 2.5% (95% CI 1.2% to 5.0%) for men and 3.2% (95% CI 2.0% to 5.3%) for women. CT infection was associated, for both genders, with having their last sexual intercourse with a casual partner. Other risk factors were for men, having last intercourse with a new partner, living in the Paris area, and for women, multiple partners during the previous year, same sex partners and a low level of education. CONCLUSIONS: CT prevalence in France is similar to that in other developed countries. Home sampling proved feasible and useful to reach members of the population with limited access to traditional care.

Congenital toxoplasmosis in France in 2007: first results from a national surveillance system.

When immunocompetent people become infected with the parasite Toxoplasma gondii, the disease is generally asymptomatic. However, transplacental transmission of T. gondii may lead to severe congenital infection including in utero abortion, foetal death, or neurological or ocular damage of the foetus. France has had a national programme to prevent congenital toxoplasmosis since 1978. However, although estimated seroprevalence in pregnant women has fallen from 84% in the 1960s to 44% in 2003, no reliable data have been available on the annual number of cases of congenital toxoplasmosis or the severity of infection. In 2006, the French National Institute for Public Health Surveillance (Institut de Veille Sanitaire) and the National Reference Centre for Toxoplasmosis recommended that a national laboratory-based surveillance system be used for the surveillance of the disease. In 2007, 31 laboratories reported at least one congenital case through the surveillance system, giving a total of 272 cases. A total of 11 terminations of pregnancy were reported (six abortions and five foetal deaths). Of the live-born cases, 206 were asymptomatic, 28 were symptomatic and seven had a severe form of the disease. As there were 818,700 births in France and French overseas departments in 2007, the overall prevalence of congenital toxoplasmosis observed that year was 3.3 (95% confidence interval (CI): 2.9 to 3.7) per 10,000 live births and the incidence rate of the disease at birth was 2.9 (95% CI: 2.5 to 3.2) per 10,000 live births; the estimated incidence rate of symptomatic congenital toxoplasmosis was 0.34 (95% CI: 0.2 to 0.5) cases per 10,000 live births.

Toxoplasmosis among pregnant women in France: risk factors and change of prevalence between 1995 and 2003.

BACKGROUND: Congenital toxoplasmosis may affect any organ, produce severe complications such as hydrocephalus and lead to ocular lesions which can appear late after birth. Fetal outcome can be fatal. During pregnancy, the mother can become infected, particularly by eating undercooked meat or poorly washed raw fruits and vegetables. In France, prevention of congenital toxoplasmosis is based on serial serology tests, performed repeatedly until delivery for pregnant women who remain negative then at the first prenatal visit. METHODS: We used toxoplasmosis serology data collected during national perinatal surveys conducted in 1995 and 2003 to estimate toxoplasmosis prevalence, assess risk factors and ascertain time trends in prevalence. In each survey, socioeconomic variables as well as the serological status for toxoplasmosis were collected for all pregnant women who had terminated a pregnancy during a given week period. RESULTS: In 2003, 15,108 pregnant women were included; the prevalence of Toxoplasma infection was 43.8% (95% CI: 43.0-44.6). Prevalence increased with age and was greater for those who lived in the Southwest of France, the greater Paris area and in overseas districts. In 2003, as in 1995, prevalence increased with education level, occupational status of the household and number of pregnancies. Prevalence decreased 19% between 1995 and 2003. The decrease was significantly greater for pregnant women aged less than 30 years than for those aged more or equal to 30 years. CONCLUSION: Although it decreased over time, toxoplasmosis prevalence remained higher in France than in other European countries. With more than one out of two women in France susceptible of having Toxoplasma infection, it is important to promote preventive measures to avoid infection during pregnancy.

Maternal admissions to intensive care units in France: Trends in rates, causes and severity from 2010 to 2014.

INTRODUCTION: Maternal intensive care unit admission is an indicator of severe maternal morbidity. The objective of this study was to estimate rates of maternal intensive care unit admission during or following pregnancy in France, and to describe the characteristics of women concerned, the severity of their condition, associated diagnoses, regional disparities, and temporal trends between 2010 and 2014. METHODS: Women hospitalised in France in intensive care units during pregnancy or up to 42 days after pregnancy between January 2010 and December 2014 were identified using the national hospital discharge database (PMSI-MCO). Trends in incidence rates were quantified using percentages of average annual variation based on a Poisson regression model. RESULTS: In total, 16,011 women were admitted to intensive care units, representing an overall incidence of 3.97‰ deliveries. This number decreased significantly by 1.7% on average per year. For women who gave birth (60.5% by C-section), 62.5% of admissions occurred during their hospitalisation for delivery. The SAPS II score, an indicator of severity, significantly increased from 18.4 in 2010 to 21.5 in 2014. Obstetrical haemorrhage (39.8%) and hypertensive complications during pregnancy (24.8%) were the most common reasons for admission. In mainland France, the Ile-de-France (i.e., greater Paris) region had the highest rates of intensive care units admission (5.05‰) while the Pays-de-la-Loire region had the lowest (2.69‰). CONCLUSION: The rate of maternal intensive care unit admission decreased from 2010 to 2014 in France, with a concomitant increase in case severity. In-depth studies are needed to understand the territorial disparities identified.

French situation concerning the Swedish Chlamydia trachomatis variant.

In 2006, a plasmid deletion mutant of Chlamydia trachomatis was identified in Sweden that can not be detected with those commercial tests targeting the deleted area. In order to study the spread of this strain in France, a laboratory-based surveillance system was set up by the National Reference Centre for Chlamydiae and the Institut de Veille Sanitaire. Among 1,141 C. trachomatis-positive specimens from all over France, the new variant was only detected in one case. This case was a non-French resident consulting a sexually transmitted infections clinic. Although the new variant does not seem to be established in France as yet, surveillance based on the testing of C. trachomatis-positive samples from all over France continues.

Surveillance of human listeriosis in France, 2001-2003.

Mandatory notification of listeriosis began in France in 1999. Enhanced public health surveillance, including routine molecular characterisation of Listeria monocytogenes strains, epidemiologic follow up of cases, and collection of food samples, has improved the sensitivity of outbreak detection and response. The incidence of listeriosis declined from 4.5 cases/million in 1999-2000 to approximately 3.5 cases/million during the period 2001-2003. Clinical, demographic and microbiological characteristics of listeriosis in France remained stable during this time period. Maternal-fetal infections accounted for 24% of all cases. Serovar 4b accounted for 49% of cases and 60% of case clusters. The incidence of listeriosis in France has declined and is now lower than in several other European countries.

Rectal lymphogranuloma venereum surveillance in France 2004-2005.

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis strains belonging to the L1, L2 or L3 genotype. An alert about an outbreak of LGV among MSM in the Netherlands was published in January 2004. The first cases of rectal LGV in France were retrospectively diagnosed in March 2004 and sentinel surveillance for LGV was implemented in April 2004. Most of the participating centres were located in the cities of Paris and Bordeaux. Only confirmed rectal LGV cases were included in the surveillance. Rectal specimens from men that were found to be positive for C trachomatis by PCR were sent to the National Reference Centre for Chlamydia infection for genotyping. Simple epidemiological data provided by clinicians and genotyping results were sent to the Institut de Veille Sanitaire (InVS) where data were anonymously recorded. A total of 328 C. trachomatis rectal strains isolated in men were genotyped by the end of December 2005. Of these, 244 (74%) were LGV strains belonging to the L2 genotype. No L1 or L3 C. trachomatis genotype was found. Diagnosis was made retrospectively for 46 cases. The median age of patients with LGV was 39 years. HIV status was known for 96 patients: 82/96 (85%) were HIV-infected. Most LGV cases were diagnosed in the Paris area (92%). Among the remaining 26% C. trachomatis strains, genotypes Da and G were the most frequent. As with syphilis in recent years, the emergence of LGV in Europe is mainly affecting HIV-infected MSM. The screening and treatment of STIs should be included in the clinical follow-up of all HIV-infected MSM.

Rectal lymphogranuloma venereum surveillance in France 2004-2005.

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis strains belonging to the L1, L2 or L3 genotype. An alert about an outbreak of LGV among MSM in the Netherlands was published in January 2004. The first cases of rectal LGV in France were retrospectively diagnosed in March 2004 and sentinel surveillance for LGV was implemented in April 2004. Most of the participating centres were located in the cities of Paris and Bordeaux. Only confirmed rectal LGV cases were included in the surveillance. Rectal specimens from men that were found to be positive for C trachomatis by PCR were sent to the National Reference Centre for Chlamydia infection for genotyping. Simple epidemiological data provided by clinicians and genotyping results were sent to the Institut de Veille Sanitaire (InVS) where data were anonymously recorded. A total of 328 C. trachomatis rectal strains isolated in men were genotyped by the end of December 2005. Of these, 244 (74%) were LGV strains belonging to the L2 genotype. No L1 or L3 C. trachomatis genotype was found. Diagnosis was made retrospectively for 46 cases. The median age of patients with LGV was 39 years. HIV status was known for 96 patients: 82/96 (85%) were HIV-infected. Most LGV cases were diagnosed in the Paris area (92%). Among the remaining 26% C. trachomatis strains, genotypes Da and G were the most frequent. As with syphilis in recent years, the emergence of LGV in Europe is mainly affecting HIV-infected MSM. The screening and treatment of STIs should be included in the clinical follow-up of all HIV-infected MSM.

Surveillance of listeria infections in Europe.

In addition to the economic consequences and threats associated with outbreaks, listeriosis remains of great public health concern, as it has one of the highest case fatality rates of all the foodborne infections (20%-30%), and has common source epidemic potential. Changes in the way food is produced, distributed and stored have created the potential for diffuse and widespread outbreaks involving many countries. In 2002, a survey was carried out to assess the need for and the feasibility of a European network on listeria infections in humans. Data on surveillance systems and laboratory methods were collected through two postal surveys sent to the national Centres for communicable disease surveillance and to the listeria reference laboratories. Surveillance systems for listeria infections were in operation in 16 out of the 17 countries surveyed, and 16 countries had a national reference laboratory (NRL). All countries based their case definition of listeriosis on the isolation of Listeria monocytogenes. Fourteen NRLs performed at least one typing method on human strains. At least 13 countries already carried out or expressed willingness to carry out characterisation of isolates by pulsed field gel electrophoresis (PFGE) of L. monocytogenes strains isolated from human cases following a standard protocol. The participants concluded that there was a clear added value to having a European surveillance network for listeria infections, particularly for outbreak detection and investigation, and that a surveillance network based on the existing national surveillance systems was feasible.

[An outbreak of appendectomies in La Désirade, Guadeloupe, August 1995-July 1996]. / Une épidémie d'appendicectomies à la Désirade, Guadeloupe, août 1995-juillet 1996.

BACKGROUND: In October 1995, over 50 cases of appendectomies among the 1.605 residents of the island La Désirade (Guadeloupe) were reported by the only island clinician to the local health authority. We describe the outbreak investigations which were implemented in order to describe the phenomenon and generate hypotheses on its cause. METHODS: An exhaustive case finding of residents having undergone appendectomy between 10 August 1995 and 22 July 1996 was conducted. We reviewed the medical charts of the cases; read pathology slides; interviewed cases and their families to retrieve detailed clinical history; studied the prevalence of markers of infection and of stool pathogens and analysed water supply quality data. RESULTS: We identified 226 cases of appendectomy (14% of the island population), 40% in May-June 1996, 46% in males and 40% under 15 years of age. Clinical, biological and pathological findings were heterogeneous and did not support the hypothesis of an outbreak of appendicitis. The study of abdominal symptoms in the families of the cases did not support person to person transmission but revealed frequent, subacute or chronic abdominal complaints. The analysis of markers of infection or of stool bacteria and parasites in a self selected sample of the island population was not suggestive. Water supply did not show any bacterial or chemical contamination. CONCLUSION: The investigation of a large outbreak of appendectomies was unable to find a single infectious or toxic origin to a high prevalence of chronic abdominal symptoms in an isolated population. An inappropriate medical answer in an isolated population probably turned heterogeneous complaints into an outbreak with major public health consequences.

[Epidemiology of sexually transmitted infections in France]. / L'épidémiologie des infections sexuellement transmissibles en France.

BACKGROUND: Sexually transmitted infections (STI) in France are reported on a voluntary basis through several sentinel surveillance systems. METHODS: To monitor STI, sentinel laboratory- or clinician-based surveillance systems were set up by the Institut de Veille Sanitaire: gonorrhea surveillance (Renago) in 1986, Chlamydia infections surveillance (Renachla) in 1989, and more recently, syphilis surveillance in 2000 and rectal lymphogranuloma venereum (LGV) in 2004. RESULTS: From 2000 to 2003, 1,089 syphilis infections were reported. Most of the cases were diagnosed in men having sex with men (MSM) and were mainly reported by STI clinics located in the Paris area. From 1997 to 2000, an increase of gonorrhea was observed each year. After two years of stable trend, the prevalence of gonorrhea increased again in 2003. From 2002 to 2004, 123 LGV cases were diagnosed in France and were observed only in MSM. Since 2001, Chlamydia infections have steadily increased, particularly in women. COMMENTS: Because STI surveillance is based on a voluntary basis, the number of reported cases is probably lower than the number of STI diagnosed in France. However, the data provided by the different surveillance systems reveals that STI have been increasing in France since 1997. Moreover, the resurgence of syphilis in 2000 and the emergence of rectal LGV in 2004 indicate that these STI occur mainly in MSM. Trends on incidence and patients characteristics observed in France are similar to those of several Europeans countries. European Public Health interventions are becoming necessary to prevent and control STI.

Comparison of infective endocarditis in patients with and without previously recognized heart disease.

In a consecutive series of patients with infective endocarditis, we compared the charts of 123 nonaddicted patients without previously known heart disease with those of 174 patients with native valve disease. The 2 groups were similar in age, sex, clinical findings, and mortality rates, but infective endocarditis was more often located on the aortic valve, more often due to Streptococcus bovis and enterococci in patients without previously known heart disease.

The capacity of Porphyromonas gingivalis to multiply under iron-limiting conditions correlates with its pathogenicity in an animal model.

Isolates of Porphyromonas gingivalis have various abilities to induce infections in an animal model. The hypothesis of this study was that pathogenic strains of P. gingivalis could multiply under iron-limiting conditions, while non-pathogenic strains could not. Three pathogenic strains (W50, W83, and ATCC 49417) grew to a final optical density (660 nm) > 2 in horse serum, while the growth of the 3 non-pathogenic strains (ATCC 33277, LB13D-2, and HW24D-1) was negligible. When an excess of hemin or ferric chloride was added to the serum, significant growth of the non-pathogenic strains occurred. Under iron-limiting conditions, the pathogenic strains of P. gingivalis had a much lower requirement for human iron-loaded transferrin and hemin than the non-pathogenic strains. Proteolytic degradation of transferrin, which may be associated with the release of iron, was not markedly different for pathogenic and non-pathogenic strains. In addition, no relationship could be established between the level of 55Fe uptake from 55Fe-transferrin and the pathogenicity of strains. Our study provided evidence that the ability of P. gingivalis to multiply in vitro under iron-limiting conditions may be correlated with its ability to induce infections in an animal model. Isolates of P. gingivalis possessing a low requirement for iron are likely to have a higher potential for initiating periodontal infections.

Catheter related sepsis during long-term parenteral nutrition in paediatric gastroenterology patients: a study of 185 consecutive central venous catheters.

We report the results of a prospective study of catheter-related sepsis (CRS) in 154 gastroenterology paediatric patients treated for medical (n = 102) or surgical (n = 52) disorders. Over 2 years, 185 central venous catheters (CVC) were placed, including 155 Broviac and 30 Jonathan Shaw CVC. CVC remained in place 13,331 days (6,539 days of cyclic parenteral nutrition), with a mean catheter life of 72 days. Forty-eight episodes of CRS occurred, most of them due to coagulase-negative staphylococci (n = 29) and Staphylococcus aureus (n = 17). CRS rate was 0.26, with an overall incidence of 1 infection per 278 days of parenteral nutrition (PN). Factors significantly associated with CRS were: age 1-5 years (p < 0.01), a medical indication for treatment (p < 0.001) and summer months of PN (p < 0.01). Interestingly, CRS occurred predominantly (65%) within the first 2 months following CVC placement and the risk of infection correlated with local haemorrhage at the time of insertion (p < 0.01). Appropriate systemic therapy, without removing the catheter, permitted resolution of 90.9% (40/44) of all CRS and 100% (28/28) of CRS due to coagulase-negative staphylococci.

Surveillance of sexually transmitted diseases by laboratory networks in France.

In France, most of sexually transmitted diseases (STDs) are diagnosed by clinicians in the private sector (general practitioners, gynaecologists, dermatologists who specialise in venereal disease, and urologists) but genitourinary medicine (GUM) clinics a

Surveillance of meningococcal disease in France, 1990-1997.

The surveillance of meningococcal disease in France is based on four complementary sources of data. 1. Meningococcal disease has been a notifiable disease since 1902. A case definition for surveillance was introduced in 1985, based on the isolation of Ne

The number of gonococcal infections identified by the RENAGO network is increasing.

Surveillance of sexually transmitted infections (STIs) in France is based mainly on laboratory reporting, as STIs are not among the diseases notified by physicians. The network RENAGO (Reseau National du Gonocoque) was set up in 1986 to monitor national t