[Imported cases of dengue fever diagnosed in metropolitan France, from January 2001 to December 2006]. / Dengue d'importation diagnostiquée en France métropolitaine, janvier 2001-décembre 2006.

INTRODUCTION: Dengue fever is the main emerging vector-borne disease worldwide. It was estimated that 40% of the world population is at risk. A potential vector (Aedes albopictus) is present in four French departments of the southeast area of metropolitan France. METHOD: The authors tried to document the number of imported cases of dengue diagnosed from 2001 to 2006, inclusive, as well as their main features. RESULTS: Between 12 and 28 cases of imported dengue were diagnosed every month during that period (eight to 18 cases per month except for years 2001-2002 during which an important dengue epidemic was documented in the French West Indies). Nearly 40% of the cases were imported between June and September during which the vector is active in the metropolitan area. CONCLUSION: This data underlines the strong and close link between the endemic zones of the French territory (French West Indies and Guyana) and the risk of imported cases to metropolitan France. The identification of this "importation track" entails strengthening the system for detecting and managing imported dengue cases in metropolitan France when a dengue epidemic is detected in the French West Indies.

A case of autochthonous Plasmodium vivax malaria, Corsica, August 2006.

A case of Plasmodium vivax malaria was diagnosed in Corsica in summer 2006. This is the first case of autochthonous transmission of malaria to be reported in Corsica since 1972. Corsica is a well-known malaria endemic region characterised, for several years now by an anophelism situation without malaria disease, due to the presence of An. labranchiae and An. saccharovi able to transmit P. vivax. The occurring sequence of malaria signs in an imported case on 9 July and in an autochthonous case on 5 August, both in Porto, implies a transmission by local Anopheles. This suspicion is reinforced by the results of entomological investigations. However, from June to September 2006, no other P. vivax malaria case and no other autochthonous case were detected in Corsica. Therefore, it seems that no permanent malaria transmission occurs in this island. Mosquito eradication actions and anti-vectorial measures have been reinforced as well as individual prevention measures against imported diseases while travelling in tropical countries. Obviously, detection of one exceptional autochthonous transmission of one malaria case in Corsica does not justify proposing malaria protection to tourists.

[Emerging viral infections in South East Asia and the Pacific region]. / Viroses émergentes en Asie du Sud-Est et dans le Pacifique.

The epidemiology of several viral diseases underwent profound changes in South-East Asia and Oceania over the past decades. This was due to several factors, including the geographical distribution of vectors and the viruses they transmit; increasing traveling and trade; increasing ecological and demographic pressure. We reviewed the current state of knowledge based on published sources and available epidemiological data. The review was limited to potentially emerging viruses in Southeast Asia and the Pacific reported in human cases. Dengue, Chikungunya, and Japanese Encephalitis viruses have recurred on a yearly basis with a steady increase in these regions. Ross River and Barmah viruses now appear regularly in Australia, in an increasing number of cases. Nipah virus strikes regularly with limited but deadly epidemics in Southeast Asia. Finally, infections by lyssaviruses, Kunjin, Murray Valley, or Zika viruses were also reviewed.

[Usefulness of assessing hydration status in elderly patients over 70 years with suspected deep vein thrombosis]. / Intérêt de l'évaluation de l'état d'hydratation chez les patients âgés de plus de 70 ans présentant une suspicion de thrombose veineuse profonde.

INTRODUCTION: Venous thromboembolism and dehydration are frequent conditions in elderly. The objective of this study was to assess the prevalence of dehydration in patients aged over 70 years suspected of deep vein thrombosis (DVT). METHODS: This is a prospective observational study that included patients aged over 70 years and suspected of deep vein thrombosis. Clinical and biological dehydration was diagnosed on the presence of a skin fold, a weight loss≥5%, a thirst, a plasmatic osmolality>295 mOsm/L or blood urea nitrogen/creatinine ratio>20. RESULTS: One hundred and forty-four patients (mean age 81.8±5.8 years) were included. A diagnosis of DVT was retained in 97 patients. Clinical dehydration was not more frequent in the DVT+ group (37.2% vs 35.1%). At baseline, 69.1% of DVT+ patients and 53.2% of DVT- patients had a plasma osmolality greater than 295 mosm/L (NS). BUN/creatinine ratio greater than 20 was found in 58.8% of DVT+ patients and 72.3% of DVT- patients (NS). Clinical and biological dehydration was present in 28.6% of DVT+ patients and in 33.3% of DVT- patients (NS). The positive predictive value of the Wells score≥3 was 86.5%, and negative predictive value of a Wells score≤0 was 85%. CONCLUSION: The presence of dehydration does not appear predictive of the occurrence of DVT and does not influence the statistical performance of the Wells score in elderly patients.

Vaccination campaign following an increase in incidence of serogroup C meningococcal diseases in the department of Puy-de-Dôme (France).

In the department of Puy-de-Dôme, France, 17 cases of invasive meningococcal disease C were notified between March 2001 and the first week of 2002. Among the 15 confirmed cases, 11 (73%) were serogroup C, 2 (13%) serogroup B, and 2 could not be identified. The rapid increase in the number of cases in a period of low endemicity for the rest of the country and the severity of the disease (case fatality ratio 27%, purpura fulminans 64%) led the health authorities to initiate a vaccination campaign targeting children and young adults from 2 months up to 20 years living in a limited area of the department. Around 80,000 people were immunised between 16/01/02 and 09/02/02. More than half of the 1390 immediate side effects were headache and dizziness. As of mid-March, no further case of meningococcal disease has been notified since 6 January.

[Malaria in France: Mainland and territories]. / Le paludisme en France : métropole et outre-mer.

Malaria, which was eliminated first from Metropolitan France (mainland and Corsica), then in the French West Indies and the Reunion Island during the 20(th) century, remains endemic in two French territories: French Guiana and the Indian Ocean Mayotte island. Despite differences in the dominating plasmodial species and epidemiological patterns, these two territories have achieved marked quantitative improvements (in the reported number of cases and severe cases) thanks to efforts undertaken over the past decade. The situation, however, remains a concern from a qualitative standpoint with the emergence of resistance to antimalarial drugs and logistical and administrative issues which hinder access to treatment. Although malaria was eradicated in Metropolitan France half a century ago, competent vectors remain present in part or all of these territories and can give rise to limited outbreaks.

Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion.

In April 2005, an outbreak of Chikungunya fever occurred on the island of Réunion in the Indian Ocean. During winter 2005, six patients developed meningoencephalitis and acute hepatitis due to Chikungunya virus. Our objectives were to determine the incidence and mortality of atypical Chikungunya viral infections and to identify risk factors for severe disease. A hospital-based surveillance system was established to collect data on atypical Chikungunya cases. Case reports, medical records and laboratory results were reviewed and analysed. We defined an atypical case as one in which a patient with laboratory-confirmed Chikungunya virus infection developed symptoms other than fever and arthralgia. We defined a severe atypical case as one which required maintenance of at least one vital function. We recorded 610 atypical cases of Chikungunya fever: 222 were severe cases, 65 affected patients died. Five hundred and forty-six cases had underlying medical conditions (of which 226 suffered from cardiovascular, 147 from neurological and 150 from respiratory disorders). Clinical features that had never been associated with Chikungunya fever were recorded, such as bullous dermatosis, pneumonia, and diabetes mellitus. Hypertension, and underlying respiratory or cardiological conditions were independent risk factors for disease severity. The overall mortality rate was 10.6% and it increased with age. This is the first time that severe cases and deaths due to Chikungunya fever have been documented. The information presented in this article may assist clinicians in identifying the disease, selecting the treatment strategy, and anticipating the course of illness.