Hepatitis B virus in drug users in France: prevalence and vaccination history, ANRS-Coquelicot Survey 2011-2013.

People who use drugs (PWUD) are a key population for hepatitis B virus (HBV) vaccination and screening. We aimed to estimate the seroprevalence of HBs antigen (HBsAg) and self-reported HBV vaccination history in French PWUD attending harm reduction centres using data from the ANRS-Coquelicot multicentre survey conducted in 2011-2013 in 1718 PWUD. Self-fingerprick blood samples were collected on dried blood spots to detect the presence of HBsAg. HBsAg seroprevalence was estimated at 1·4% [95% confidence interval (CI) 0·8-2·5]. It varied between PWUD born in high (7·6%, 95% CI 2·7-19·1), moderate (2·2%, 95% CI 0·8-5·7) and low (0·7%, 95% CI 0·3-1·5) endemic zones. Factors independently associated with HBsAg carriage were being born in a moderate or high endemic zone or reporting precarious housing. Self-reported HBV vaccination history varied from 47·4% in high endemic zones, to 59·3% and 62·6% for moderate and low endemic zones, respectively. Our results suggest that drug use plays a small and substantial role, respectively, in HBsAg carriage in PWUD born in high/moderate and low endemic zones.

[The use of administrative health databases in infectious disease epidemiology and public health]. / Apport des bases médico-administratives en épidémiologie et santé publique des maladies infectieuses.

BACKGROUND: The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS: Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS: Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS: The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.

[Quantitative estimate of the risk of blood donation contamination by infectious agents]. / Estimation quantitative du risque de contamination d'un don de sang par des agents infectieux.

The occurrence of asymptomatic penetration of certain infectious agents in blood presents a risk of transmission of one of these agents during blood transfusion. Although well controlled for some infectious agents (HIV, HTLV, HCV, HBV), this risk is nevertheless neither documented nor quantified for other pathogens that are responsible for serologically unscreened or undetectable infections at the time of blood donation. This risk is generally low in endemic situations, although it increases for particular time periods and locations when clustered cases or outbreaks occur. Prevention measures may then be implemented (interruption of blood collection, quarantined donations, etc.). These measures can have an important impact, particularly by limiting the supply of blood products to health care facilities. It is therefore important for these measures to be adapted to the risk of transmission through blood transfusion. Quantitative risk estimates of blood donation contamination can therefore contribute to guiding those measures. In this context, in early 2005, the French Public Health Institute (InVS) started a project with the aim of obtaining a priori quantitative risk estimates of contamination of a blood donation by infectious agents for various scenarios in terms of incidence and time-space distribution. The objective of this article is to update the last estimates of residual risks of the major transfusion-transmitted viral infections (HIV, HTLV, HCV and HBV) and to present the work realized by the working group << Quantitative estimate of the risk of blood donation contamination by infectious agents>>.

[Study of the predictive value of detection tests for silent aspirations]. / Etude de la valeur prédictive des tests de détection des fausses routes silencieuses.

UNLABELLED: Screening for aspiration in patients with swallowing disorders is important in preventing complications. The tests used in this regard are insufficient due to silent aspiration relating to abnormal protective reflexes in many patients with swallowing problems. OBJECTIVE: The aim of this study is to determine the predictive values of simple tests in screening for silent aspiration. MATERIAL AND METHOD: The reference test used was videofluoroscopic examination on swallowing. In the presence of aspiration (FR+) the presence (ME+) or not (ME-) of a cough of throat clearing was noted. The tests being studied were a nasal test with isotonic saline and swallowing according to a set time. RESULTS: For screening for aspiration the presence of a "wet voice" was considered to be a sign of reduced protective reflexes. 1) During the nasal test, the results are 100% for the positive predictive value (VPp) and 83.3% for the negative predictive value (VPn); 2) These results are respectively 84.6% and 35.9% during the swallowing test. Regarding screening for silent aspiration, 1) during the nasal test, the results are 62.5% for the positive predictive value (VPp) and 36.3% for the negative predictive value (VPn); 2) These results are respectively 54.5% and 26.6% during the swallowing test. CONCLUSION: This preliminary study points out the lack of predictive value of the nasal test and the swallow test for the silent aspirations. However the results could be useful for other researchers developing other tests in this area.

Effects of moderate dietary supplementations with n-3 fatty acids on macrophage and lymphocyte phospholipids and macrophage eicosanoid synthesis in the rat.

The effects of a moderate dietary intake of n-3 polyunsaturated fatty acids were determined on the eicosanoid synthesis by rat peritoneal macrophages: the availability of arachidonic acid (20:4 (n-6)) and eicosapentaenoic acid (20:5 (n-3] in the membrane phospholipids of peritoneal macrophages and splenic lymphocytes and the synthesis of the main eicosanoids were evaluated in parallel. The n-6/n-3 ratio was decreased from 13.5 in the control diet rich in 18:2(n-6) to about 2 by an addition of either linseed oil providing 18:3(n-3) (linseed oil diet) or fish oil providing 20:5(n-3) and 22:6(n-3) (fish oil diet). The dietary linoleic acid content was at least 3.5% of energy in each diet. In peritoneal macrophage and splenic lymphocyte membrane phospholipids, arachidonic acid content was significantly decreased with the linseed oil and fish oil diets. 20:5(n-3) content was significantly raised up in the linseed oil group (3-fold in macrophage phospholipids) and more strikely in the fish oil group (7-fold). In response to a stimulation by the calcium ionophore A23187, peritoneal macrophages released 6-ketoPGF1 alpha, TXB2, PGE2 and LTB4 and/or 5, but no or few peptidoleukotrienes. The linseed oil did not affect significantly the synthesis of these eicosanoids, except for LTB5, which was increased 2-fold. In contrast, the fish oil diet led to significant decreases in the productions of 6-ketoPGF1 alpha and PGE2 (-50%) and LTB4 (-40%) and to a 10-fold increase in the release of LTB5. TXB2 was also decreased (-35%), but not significantly. These results and the parallel evolutions of the two ratios 20:4(n-6)/20:5(n-3) and LTB4/LTB5 showed that eicosanoid synthesis is greatly dependent on the relative availability of the two substrates in competition.

Comparison of the effects of feeding quercetin or flavone on hepatic and intestinal drug-metabolizing enzymes of the rat.

The influence of dietary flavone and quercetin on the components of the drug metabolizing enzyme system was examined in the liver and small intestine of the rat. Quercetin given at a concentration of 1% in the diet for 14 days produced no significant changes on phase I or phase II enzyme activities. In contrast, 0.25% flavone caused significant increases in relative liver weight, microsomal and cytoplasmic proteins, and cytochrome P-450 content. The activities of hepatic ethoxyresorufin, pentoxyresorufin and ethoxycoumarin deethylases were significantly increased (by 20, 30 and 2.5-fold, respectively) over control levels. Hepatic UDP-glucuronyl transferase and glutathione transferase activities were increased 3-4-fold. In contrast, flavone induced no changes in these two intestinal enzyme activities. It is concluded that flavone produces an induction that shows both phenobarbital- and methylcholanthrene-type characteristics and that its effects on conjugating enzymes is tissue specific.

Adsorption-desorption and leaching of phenylurea herbicides on soils.

Adsorption-desorption equilibria of phenylurea herbicides (chlortoluron, isoproturon, metobromuron, chloroxuron, difenoxuron) were determined in two different soils. Organic carbon content of the soils ranged from 1.1-5.6% and the clay fraction from 25-30%. Spiked aqueous suspensions of soils were centrifuged and urea derivative concentrations in the aqueous phase were determined using a HPLC-UV system. Adsorption isotherms conformed to the Freundlich equation. Freundlich K(f) values indicated that organic carbon was the main factor affecting urea sorption in the studied soils. The R(f)values calculated from the soil column displacement closely correlated with the adsorption K(f) values. Results indicated that chloroxuron and difenoxuron were sorbed to a larger extent than the other three ureas on the two soils; as expected their mobilities through soil columns were very limited. The similarity between the molecular structures of chloroxuron and difenoxuron enables us to assume the phenoxy group to be the main structural feature in the adsorption phenomenon. The relationships between sorption, leaching and some characteristics of urea molecules such as water solubility and octanol-water partition coefficient were also examined.

Epidemiological characteristics and medical follow-up of 61 patients with acute hepatitis C identified through the hepatitis C surveillance system in France.

This study aimed to describe current epidemiological and clinical characteristics, medical follow-up and outcome in the real practice of acute hepatitis C (AHC) patients. AHC cases were retrospectively identified through the French Hepatology Reference Centres Surveillance system and additional data were collected. Sixty-one patients with AHC were identified (sex ratio: M/F 1.7/1; mean age 39 years). Forty-four (72%) had documented seroconversion within a 6-month period. Main reported risk exposures were intravenous or nasal drug use (35%), invasive medical procedures (25%) and sexual contact with a HCV-positive partner (20%). Spontaneous clearance of HCV RNA was observed in seven out of 16 patients followed without therapy. This study confirms the major role of drug use in HCV transmission and highlights the role of invasive medical procedures and occupational exposure.

Modulation of rat and human lymphocyte function by n-6 and n-3 polyunsaturated fatty acids and acetylsalicylic acid.

The effects of in vitro additions of between 10 and 100 microM n-6 and n-3 polyunsaturated fatty acids were examined on the proliferation of stimulated T lymphocytes in culture. For both phytohemagglutinin-induced human blood lymphocytes and concanavalin-A-induced rat splenic lymphocytes, the largest inhibitory effects were obtained with 22:4 n-6 and 22:6 n-3, and to a lesser extent with 20:5 n-3. Arachidonic acid 20:4 n-6, the main eicosanoid precursor, was not inhibitory, it even stimulated rat lymphocyte proliferation. Acetylsalicylic acid stimulated both human and rat lymphocyte proliferation. The effects of moderate decreases in the dietary n-6/n-3 ratio by either linseed oil or fish oil maximum eicosapentaenoic acid (MaxEPA) were determined on rat lymphocyte proliferation and natural killer (NK) cell activity in vitro. Dietary changes did not affect mitogen-induced lymphocyte proliferation in vitro, but proliferation of unstimulated lymphocytes was significantly lowered (4-fold) with the n-3-enriched diets. Dietary fish oil but not linseed oil significantly increased the NK cell activity of rat splenic lymphocytes. The n-3-enriched diets, especially the fish oil diets, reduced the stimulatory effect of in vitro added acetylsalicylic acid (aspirin) on lymphocyte proliferation.

Comparative efficacy of theophylline and caffeine in the treatment of idiopathic apnea in premature infants.

The purpose of our prospective randomized study was to compare the efficacy of theophylline ethylenediamine and caffeine sodium citrate in the treatment of idiopathic apnea in premature infants. Sixteen infants with three or more severe apneic attacks were studied. Twenty-four-hour cardiorespiratory recordings immediately before and after randomization and four days later showed similar significant decreases of the apnea frequency in both theophylline- (group 1, n = 8) and caffeine-treated infants (group 2, n = 8). No undesirable side effects were observed, except for tachycardia in one infant in group 1. We suggest reasons for preferring caffeine to theophylline in the control of idiopathic apnea in premature infants: caffeine is as efficient and easier to administer.