[History of human epidemic and endemic diseases in the southwest Indian Ocean]. / Histoire des épidémies et des endémoépidémies humaines dans le sud-ouest de l'océan Indien.

Smallpox has been known in the Mascarene Islands since 1729, and in 1898, the vaccinogenic and anti-rabies Institute of Tananarive, the future Pasteur Institute of Madagascar, was created to combat it. Cholera first arrived in the Mascarenes in 1819, but did not affect the Comoros Islands and Madagascar until the current pandemic. Bubonic plague has beset the ports of Madagascar and the Mascarenes since 1898. Girard and Robic developed the anti-plague vaccine in 1931 at the Pasteur Institute of Madagascar. The Mascarenes lost their reputation as Eden when malaria arrived in 1841, and this disease remains prominent in Madagascar and Comoros. Leprosy has been known in La Réunion since 1726 and is still very present in Mayotte, Anjouan, and Madagascar. Leptospirosis is a public health problem, except in Madagascar and the Comoros. Dengue, chikungunya, and Rift Valley fever are also present. HIV/AIDS is not a major concern, except in Mauritius, where it was spread by injection drug use, in the Seychelles and in Madagascar's largest cities. Madagascar is the principal site worldwide of chromoblastomycosis, first described there in 1914.

[Epidemiological survey of leprosy conducted in metropolitan France between 2009 and 2010]. / Enquête épidémiologique sur la lèpre en France métropolitaine en 2009 et 2010.

BACKGROUND: There is no official leprosy register in France. The last epidemiological survey on leprosy in metropolitan France was done between 1995 and 1998. We performed a new epidemiological study of leprosy in metropolitan France in 2009 and 2010. PATIENTS AND METHODS: We contacted 85 dermatology and infectious disease units by e-mail or by telephone in order to determine the number of leprosy patients either being followed up or newly diagnosed in 2009 and 2010. RESULTS: The response rate was 87%. In 2010, 127 patients were being followed up in metropolitan France, mostly at dermatology units (78%). Seventy-five patients were on anti-bacillary treatment and the prevalence was 0.011/10,000. There were 39 new cases diagnosed in 2009 and 2010 (mean 19 cases/year) (low case-detection rate: 0.003 per 10,000 inhabitants). Among the new cases, seven patients (18%) were of French origin, with two from metropolitan France and five from French overseas territories. DISCUSSION: Our study confirms the persistence of imported leprosy in France and shows no significant decrease in the number of new cases since 1998 (19 vs. 18 new cases/year) or in disease prevalence (0.013 vs. 0.011 per 10,000 inhabitants). This prevalence is very far removed from the one per 10,000 inhabitants proposed by the World Health Organization as the criteria for endemic disease. Most patients in our survey were immigrants (82%). Lepromatous forms (46%) were more frequent than the tuberculoid forms (33%). All patients had either travelled to or lived in areas of high leprosy prevalence, including metropolitan subjects. CONCLUSION: Leprosy remains present in metropolitan France, and it is still important to continue teaching about it at medical faculties in order to ensure diagnosis of new patients as early as possible.

Health promotion in South East Asia.

PIP: The countries of the South East Asia region, which includes Bangladesh, Bhutan, Pakistan, Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, and Thailand, have undertaken a variety of strategies to address the health challenges in the region. The ever-growing pressure of population in the region has allowed rapid transmission of communicable diseases like malaria, tuberculosis (TB), leprosy, and HIV/AIDS. One of the innovative community-based health initiatives in response to this problem is Indonesia's Primary Health Care Project. This project aimed to develop a sustainable health infrastructure by training medical staff, coordinators, village cadres, midwives and those working for TB programs; provision of ongoing guidance and education in this area; and provision of medicines and funds. The project has pioneered a process towards positive changes. Another strategy is the collaboration of youth groups, island development committees, and health workers in Maldives which has led to the declaration of two islands (Madifushi and Haa Alif Berinmadhoo) as 'no smoking' islands. In addition, Sarvodaya has successfully developed a methodology to involve Buddhist monks in AIDS prevention and control through "the Buddhist approach to AIDS prevention in Sri Lanka."^ieng

Leprosy in the Comores 1981-88.

The evolution of the leprosy endemic in the République Fédérale Islamique des Comores between 1981 and 1988 is described. Leprosy on Grande Comore seems to be extinct. On the island of Anjouan the yearly detection rate is 0.38 per 1,000 with a high multibacillary rate (34%). Leprosy is highly endemic in children: during the last 6 years, 30% of multibacillary and 44% of paucibacillary cases are detected in the less than 15 years age group. Detection seems to be early as illustrated by the high proportion of paucibacillary patients with a small number of skin lesions and a low proportion of patients with severe infirmity. In the detection process both patient's and doctor's delays are short. Most diagnoses are suspected by relatives or others who had the disease in the past and who referred the suspects directly to the specialised service.

[Short-term clinical and histological evaluation of combination drug therapy of leprosy in Mayotte]. / Evaluation clinique et histologique à court terme de la polychimiothérapie contre la lèpre à Mayotte.

Leprosy in Mayotte affects 480 persons in a population of 80,000 inhabitants. 229 patients have been treated every day by association of Rifampicin, Clofazimine and Isoniazide. This study make a clinical, histological and bacteriological valuation after treatment, during a period of 3 years. With paucibacillary patients, whom received 1 year of mean treatment and after 2 years under observation, histology for short-dated can stay positive and active. With multibacillary patients, whom received 26 months of mean treatment and most of the time after 1 year under observation, the all of morphological index is negative, sometime bacteriology is positive, less often than histology. For middle- and long-dated, histology should allow a good valuation for disease evolution, specially for interpolar leprosy patients.

[A new plan in the campaign against leprosy in Anjouan. Preliminary results]. / Nouveau plan de lutte contre la lèpre à Anjouan. Premiers résultats.

Treatment of PB leprosy patients with 10 weekly doses of RMP 600 mg gave a cure rate of 88% or more at 3 years as judged by histopathology. There were no severe neurological complications. The future will show if this regimen also prevents relapses. In MB leprosy a 2 months regimen of daily RMP, ETH, DDS followed by 10 months of daily ETH, DDS with weekly RMP gave excellent clinical and bacteriological results. There were no relapses during 2 and 3 years after the end of therapy among 111 newly diagnosed and previously treated patients (95% confidence interval 3.3%) of whom 67 were new patients (95% confidence interval 5.3%). The hepatotoxicity of this regimen has to be followed closely. The results illustrate the possibility to cure MB leprosy by a treatment of finite duration.

Some health problems of the Maldives.

It is difficult to quantify the major health scourges from which the Maldivians suffer because of the scattered nature of their settlements and their conservative attitudes to health and hygiene-related matters. Projects to improve the quality of the health and disease data have been instituted by the World Health Organization (WHO) and the Maldivian Ministry of Health. The paper analyses information that has since become available on three major ill-health conditions in the Maldives, namely infant deaths, malaria and leprosy.

[Current epidemiologic aspects of leprosy on the Island of Reunion (Indian Ocean]. / Aspects épidémiologiques actuels de la lèpre dans l'île de la Réunion (Océan Indien).

In the view of a cost/effectiveness study of the anti-leprosy organization in French Reunion island, an epidemiological evaluation had been realized from all existing records. 324 cards had been collected but only 62% of known patients are followed under surveillance. The clinical spectrum is characterized by a greater part of lepromatous or border-line types by the mere fact of male forms. The prevalence is 0.5 per 1000 and the average incidence is 0.02 per 1000. Nevertheless, the patients show few disabilities. This low endemic level, the positive growing old of leprosy population, the high frequency of relationship amongst patients, induce the idea that the disease is under extinction with a low intra-familiar contamination. But the main goal will be a better surveillance of known patients.