[The scourge of vaccine tampering]. / Le fléau de la falsification des vaccins.

Fake vaccine trafficking is a recent but growing phenomenon, which represents a severe threat to public health. During the Covid-19 pandemic, Covid vaccines have been a prime target for traffickers, but all types of vaccines are falsified by profit-hungry criminals.The consequences of falsification on global health are serious: decline in vaccination coverage, loss of control of epidemics claiming yet more victims, resurgence of diseases that been under control. Fake vaccines also fuel the mistrust of populations towards science and towards the authorities.In order to tackle this scourge, a general and coordinated mobilization of all actors concerned is urgently needed: health professionals, political decision-makers, police and customs forces, judges and prosecutors, without forgetting the crucial awareness-raising of public opinion.

Day of Action against Counterfeit Medications in the Congo, Brazzaville, March 22, 2018.

A Day of Action against counterfeit medications was organized in Brazzaville on March 22, 2018, by the French Embassy, the French Institute of the Congo (IFC), and the Ministry of Health and the Population, with the participation of the Chirac Foundation. The success of this day, during which more than 1500 people came to the IFC, may be an original idea for mobilizing civil society on health subjects that directly affect the behavior of young people.

Efficacy of a high free iodine barrier teat disinfectant for the prevention of naturally occurring new intramammary infections and clinical mastitis in dairy cows.

Using a natural exposure trial design, the goal of our study was to evaluate the clinical efficacy of an iodine teat disinfectant with barrier properties and a high level of free iodine relative to a conventional iodine teat disinfectant with no barrier properties and low levels of free iodine. During the 18 wk of the trial, quarter milk samples were collected every 2 wk from 385 dairy cows from 2 herds. Cows on both farms were assigned in a balanced way according to milk yield, number of lactation, days in milk, somatic cell count (SCC) and microbiology culture pretrial into one of following groups: nonbarrier post milking teat disinfectant (NBAR; n = 195 cows; 747 quarters) or barrier postmilking teat disinfectant (BAR; n = 190 cows; 728 quarters). Afterward, at each scoring date every 2 wk, milk SCC was quantified in samples from all mammary quarters and microbiologic culture was only performed on milk samples with SCC >200,000 cells/mL for multiparous cows and SCC >100,000 cells/mL for primiparous cows. A new intramammary infection (NIMI) was defined when a quarter had milk SCC <200,000 cells/mL for multiparous cows and <100,000 cells/mL for primiparous without microorganism isolation, and in a subsequent sampling visit had milk SCC >200,000 cells/mL for multiparous cows and >100,000 cells/mL for primiparous cows, and positive microorganism isolation. A quarter could have several NIMI, but only 1 case per specific pathogen was considered. The most frequently isolated microorganism group on both farms was Streptococcus spp. (6.25% of total mammary quarters), followed by coagulase-negative staphylococci (3.6%) and Corynebacterium spp. (1.5%). In the present study, an interaction occurred between treatment and week of trial on the incidence risk of NIMI. Quarters disinfected with BAR had 54 and 37% lower odds of NIMI than quarters disinfected with NBAR at 8 and 16 wk of the trial, respectively; whereas at other weeks of the study both products had similar incidence risks of NIMI. Overall, teats disinfected with BAR had 46% lower odds of acquiring a clinical mastitis than those disinfected with NBAR. We concluded that the postmilking teat disinfectant with barrier properties and higher free iodine content reduced the risk of clinical mastitis, although differences in new infections were detected at only weekly time points.

The tumor antigen N-glycolyl-GM3 is a human CD1d ligand capable of mediating B cell and natural killer T cell interaction.

The expression of N-glycolyl-monosialodihexosyl-ganglioside (NGcGM3) in humans is restricted to cancer cells; therefore, it is a tumor antigen. There are measurable quantities of circulating anti-NGcGM3 antibodies (aNGcGM3 Abs) in human serum. Interestingly, some people have circulating Ag-specific immunoglobulins G (IgGs) that are capable of complement mediated cytotoxicity against NGcGM3 positive cells, which is relevant for tumor surveillance. In light of the chemical nature of Ag, we postulated it as a candidate ligand for CD1d. Furthermore, we hypothesize that the immune mechanism involved in the generation of these Abs entails cross talk between B lymphocytes (Bc) and invariant natural killer T cells (iNKT). Combining cellular techniques, such as flow cytometry and biochemical assays, we demonstrated that CD1d binds to NGcGM3 and that human Bc present NGcGM3 in a CD1d context according to two alternative strategies. We also showed that paraformaldehyde treatment of cells expressing CD1d affects the presentation. Finally, by co-culturing primary human Bc with iNKT and measuring Ki-67 expression, we detected a reproducible increment in the proliferation of the iNKT population when Ag was on the medium. Our findings identify a novel, endogenous, human CD1d ligand, which is sufficiently competent to stimulate iNKT. We postulate that CD1d-restricted Bc presentation of NGcGM3 drives effective iNKT activation, an immunological mechanism that has not been previously described for humans, which may contribute to understanding aNGcGM3 occurrence.

Long-term survival, prevalence, and cure of cancer: a population-based estimation for 818 902 Italian patients and 26 cancer types.

BACKGROUND: Persons living after a cancer diagnosis represent 4% of the whole population in high-income countries. The aim of the study was to provide estimates of indicators of long-term survival and cure for 26 cancer types, presently lacking. PATIENTS AND METHODS: Data on 818 902 Italian cancer patients diagnosed at age 15-74 years in 1985-2005 were included. Proportions of patients with the same death rates of the general population (cure fractions) and those of prevalent patients who were not at risk of dying as a result of cancer (cure prevalence) were calculated, using validated mixture cure models, by cancer type, sex, and age group. We also estimated complete prevalence, conditional relative survival (CRS), time to reach 5- and 10-year CRS >95%, and proportion of patients living longer than those thresholds. RESULTS: The cure fractions ranged from >90% for patients aged <45 years with thyroid and testis cancers to <10% for liver and pancreatic cancers of all ages. Five- or 10-year CRS >95% were both reached in <10 years by patients with cancers of the stomach, colon-rectum, pancreas, corpus and cervix uteri, brain, and Hodgkin lymphoma. For breast cancer patients, 5- and 10-year CRSs reached >95% after 19 and 25 years, respectively, and in 15 and 18 years for prostate cancer patients. Five-year CRS remained <95% for >25 years after cancer diagnosis in patients with liver and larynx cancers, non-Hodgkin lymphoma, myeloma, and leukaemia. Overall, the cure prevalence was 67% for men and 77% for women. Therefore, 21% of male and 31% of female patients had already reached 5-year CRS >95%, whereas 18% and 25% had reached 10-year CRS >95%. CONCLUSIONS: A quarter of Italian cancer patients can be considered cured. This observation has a high potential impact on health planning, clinical practice, and patients' perspective.

Breast-conservative surgery with and without radiotherapy in patients aged 55-75 years with early-stage breast cancer: a prospective, randomized, multicenter trial analysis after 108 months of median follow-up.

OBJECTIVES: Breast-conserving therapy (BCT), including postoperative whole breast irradiation (WBI), is generally accepted as the treatment of choice for most patients with early-stage breast cancer. The question whether WBI is mandatory in all patients remains one of the most controversial issues in BCT. To answer this question, a randomized, prospective, multicentre study was launched in January 2001. Primary endpoints of the study were to assess the cumulative incidence of in-breast-recurrences (IBR) and overall survival (OAS) after conservative surgery (BCS) with or without WBI. METHODS: From January 2001 until December 2005, 749 patients with unifocal infiltrating breast cancer up to 25 mm, 0-3 positive axillary lymph nodes, no extensive intraductal component or lymphvascular invasion from 11 centres in Italy, were randomly assigned to BCS+WBI (arm 1:373 patients) or BCS alone (arm 2:376 patients). Treatment arms were well balanced in terms of baseline characteristics. Systemic adjuvant therapy was administered according to the institutional policies. Kaplan-Meier method was used for survival analysis and log-rank test to evaluate the difference between the two arms. RESULTS (Last analysis 31.12.2012): After median follow-up of 108 months, 12 (3.4%) IBR were observed in arm 1 and 16 (4.4%) in arm 2. OAS was 81.4% in arm 1 and 83.7% in arm 2. There was no statistically significant difference regarding IBR and death in the two treatment groups. CONCLUSIONS: These data are promising and suggest that WBI after BCS can be omitted in selected patients with early stage breast cancer without exposing them to an increased risk of local recurrence and death. Longer follow-up is needed to further consolidate these results.

Utilização da vacina Escherichia coli J5 na imunização de novilhas leiteiras contra mastites causadas por E. coli / Use of an Escherichia coli J5 vaccine on immunization of dairy heifers against mastitis caused by E. coli

Avaliou-se a eficácia da vacina E.coli J5 na prevenção e no controle de mastites causadas por E.coli por meio da análise da prevalência de infecções intramamárias após o parto, ocorrência e intensidade de casos clínicos de mastite nos primeiros 100 dias de lactação, influência na contagem de células somáticas (CCS) e produção de leite. As novilhas, n=131, foram distribuídas em três grupos de animais - vacinados três vezes, vacinados duas vezes e não vacinados. As imunizações ocorreram 60 dias antes do parto, 30 dias antes do parto e na primeira semana pós-parto, esta última só para o grupo de três vacinações. Foram coletadas amostras de leite para diagnóstico microbiológico e avaliação da CCS, e registrados os dados relacionados à ocorrência e à intensidade dos casos clínicos e à produção de leite nos primeiros 100 dias de lactação. Não houve redução na prevalência de E.coli no pós-parto de novilhas vacinadas, e houve redução na ocorrência de casos clínicos por E.coli em novilhas vacinadas. Não foram observadas diferenças entre grupos com relação à CCS. Novilhas vacinadas com as três doses apresentaram maior produção de leite. A vacinação com E.coli J5 foi eficaz em reduzir a ocorrência de casos clínicos nos primeiros 100 dias da lactação, mas não interferiu na prevalência de infecções intramamárias após o parto, na intensidade de casos clínicos e na CCS.

Immunization of dairy heifers with E.coli J5 vaccine in order to prevent and control mastitis caused by E.coli was evaluated. Prevalence of postpartum intramammary infections by this agent; clinical mastitis occurrence and severity in the first 100 days of lactation, and its influence on somatic cell counts (SCC) and milk yield were analyzed. Heifers (n=131) were randomly assigned into three groups of vaccinated and unvaccinated animals. Immunizations occurred at 60 days prepartum, 30 days prepartum and in the first week after calving. Milk samples were collected for microbiological diagnosis and SCC evaluation, and data related to clinical mastitis occurrence; its severity and milk yield were recorded. No reduction in prevalence of postpartum intramammary infections caused by E.coli was observed in vaccinated heifers. Vaccinated heifers had less clinical mastitis than the unvaccinated group. Milk SCC did not differ between the experimental groups. Milk yield was higher in vaccinated animals. Immunization with the E.coli J5 vaccine was effective in reducing the occurrence of clinical mastitis and increase in milk yield in the first 100 days of lactation but did not affect SCC, prevalence of intramammary infections and severity of clinical mastitis after calving.

Interobserver agreement in breast radiological density attribution according to BI-RADS quantitative classification.

PURPOSE: The authors sought to assess interobserver agreement in classifying mammography density according to quantitative Breast Imaging Reporting and Data System (BI-RADS) criteria. MATERIALS AND METHODS: Six expert mammography readers were tested on a set of 100 mammograms. Interobserver agreement was determined according to the kappa statistic, adjusting for chance agreement, on a four-category (D1 vs. D2 vs. D3 vs. D4) or two-category (D1-2 vs. D3-4) basis. Agreement with a panel of 12 readers who had been tested on the same set in a previous study was also assessed. RESULTS: The six readers showed good agreement when compared in pairs [agreement on a four-category basis was substantial (kappa=0.60-0.80) for 13 pairs and almost perfect (kappa>0.80) for two pairs); agreement on a two-category basis was substantial for 12 pairs and almost perfect for three pairs) or compared with the panel (on a four-category basis, agreement was substantial for five of six readers and almost perfect for one; on a two-category basis, agreement was substantial for all readers). CONCLUSIONS: In agreement with previous studies, visual classification of mammography density according to BI-RADS quantitative criteria was highly reproducible among readers; nevertheless, attribution to the "dense breast" (BI-RADS D3-4) category, which might be adopted as a determinant of different screening protocols (such as adjunct ultrasonography or yearly interval) varied among readers (range 6-15%). Controlled studies should be performed comparing visual with computer-density category attribution, the latter possibly being a better alternative due to its absolute reproducibility.

Proportional incidence and radiological review of large (T2+) breast cancers as surrogate indicators of screening programme performance.

OBJECTIVES: Surrogate measures of screening performance [e.g. interval cancer (IC) proportional incidence] allow timely monitoring of sensitivity and quality. This study explored measures using large (T2+) breast cancers as potential indicators of screening performance. METHODS: The proportional incidence of T2+ cancers (observed/expected cases) in a population-based screening programme (Trento, 2001-2009) was estimated. A parallel review of 'negative' preceding mammograms for screen-detected T2+ and for all ICs, using 'blinded' independent readings and case-mixes (54 T2+, 50 ICs, 170 controls) was also performed. RESULTS: T2+ cancers were observed in 168 screening participants: 48 at first screen, 67 at repeat screening and 53 ICs. The T2+ estimated proportional incidence was 68% (observed/expected = 168/247), corresponding to an estimated 32% reduction in the rate of T2+ cancers in screening participants relative to that expected without screening. Majority review classified 27.8% (15/54) of T2+ and 28% (14/50) of ICs as screening error (P = 0.84), with variable recall rates amongst radiologists (8.8-15.2%). CONCLUSIONS: T2+ review could be integrated as part of quality monitoring and potentially prove more feasible than IC review for some screening services. KEY POINTS: • Interval breast cancers, assumed as screening failures, are monitored to estimate screening performance • Large (T2+) cancers at screening may also represent failed prior screening detection • Analysis of T2+ lesions may be more feasible than assessing interval cancers • Analysis of T2+ cancers is a potential further measure of screening performance.

Mastite subclínica e relação da contagem de células somáticas com número de lactações, produção e composição química do leite em vacas da raça Holandesa / Subclinical mastitis and the relationship between somatic cell count with number of lactations, production and chemical composition of the milk

Verificaram-se a ocorrência de mastite subclínica em animais da raça Holandesa e a relação entre a contagem de células somáticas com a ordem de lactação e com a produção e a composição química do leite. O estudo foi realizado em propriedades integrantes do programa de controle leiteiro da Associação de Criadores de Gado Holandês de Minas Gerais. As variáveis estudadas foram: ordem de lactação, ocorrência de mastite subclínica, contagem de células somáticas (CCS), produção de leite e porcentagens de gordura e de proteína total. A correlação entre CCS e produção de leite foi negativa e entre CCS e porcentagens de gordura e de proteína, positivas. Animais com maior número de lactações apresentaram maior CCS, e com CCS acima de 100.000 cels/ml menor produção de leite.

The subclinical mastitis occurrence and the relationship between somatic cell count (SCC) with parity, milk yield and milk chemical composition, were studied in Holstein cows. The study was carried out in farms belonging to the milk control program of the Associação de Criadores de Gado Holandês de Minas Gerais. Data on lactation order, subclinical mastitis, SCC, milk production, fat contents and total protein contents were analyzed. There was a negative correlation between SCC and milk production and, correlations between SCC and percentage of fat and protein were positive. Higher lactation order cows showed higher SCC, and cows with SCC higher than 100,000 cels/ml showed less milk production.

[Ten years of commitment to persons living with HIV-AIDS: evaluation of the management in three ambulatory treatment centers of the French Red Cross in Africa]. / Dix ans d'engagement auprès des personnes vivant avec le VIH-sida : évaluation de la prise en charge dans trois centres de traitement ambulatoire de la Croix-Rouge française en Afrique.

The French Red Cross (FRC) has developed a strategy for the follow-up of people living with HIV-AIDS in Africa by setting-up and managing healthcare centers specialized in the management of HIV infection. Nearly one hundred and seventy thousand patients have had access to care in fifteen Ambulatory Treatment Centers (ATCs). For the ten years anniversary of the FRC's AIDS programs, we present the results of the evaluation of three ATCs in Africa. These results which show a low mortality rate in the patients on antiretroviral therapy and a very low rate of second line patients (1.5%) confirm the efficiency of the management of people living with HIV in the ATCs and generally of the AIDS programs of the FRC. However, the mortality remains high in patients who have a CD4+ cell count of less than 50/mm3 when antiretrovirals (ARVs) initiation. Services and care dispensed in the ATCs and particularly the antiretroviral therapy have demonstrated their feasibility and efficiency. In ten years, the challenge of the management of HIV has changed. Today, there is a need to integrate additional actions in the area of the supply of primary healthcare, of training and of motivation of the care providers. In addition, the follow-up/evaluation of the patient management programs remains useful to determine the impact and long-term efficacy of ARVs in resource-limited countries.

Shiga toxin-producing and attaching and effacing Escherichia coli in cats and dogs in a high hemolytic uremic syndrome incidence region in Argentina.

Shiga toxin-producing Escherichia coli (STEC), responsible for the hemolytic uremic syndrome, is an endemic pathogen in Argentina. We studied the prevalence of STEC in fecal samples from cats and dogs of Buenos Aires city and suburbs. Cultures were used for screening stx1/stx2 and rfbO157 by multiplex PCR. All E. coli-positive colonies for these genes were further characterized for the eae gene and for serotypes. In dogs, 17 (3.7%), 19 (4.2%) and 34 (7.5%) of samples were positive for stx2, stx1 and rfb, respectively. In cats, six (4.0%) of the samples were positive for stx2, three (2.0%) for stx1 and four (2.7%) for rfbO157. In 18 (4.0%) of the dog samples, a bacteriological diagnosis was obtained by isolation. The percentage of positive isolates corresponding to the rfbO157 and to the stx2 genotypes were 2.9% and 1.1%, respectively. In four of the cat samples, the bacteriological diagnosis for stx2 (2.6% prevalence of STEC) was confirmed. Although these data suggest that the high infection index of STEC in children in Argentina does not seem to be due mainly to the role of cats and dogs, there are some strains with virulence genes in common for humans and their domestic animals.

[French sanitary cooperation in developing countries]. / La coopération sanitaire française dans les pays en développement.

In the face of a worsening public health situation throughout the world, French know-how in the field of sanitary cooperation warrants a far more active commitment from our country. Instead there have been only a few initiatives and we are witnessing a programmed decline of our presence. The statement issued by the Economic and Social Council in 2006--the highlights of which will be presented at this meeting--strongly advocates a voluntary program to revive sanitary cooperation by encouraging civic-spirited young people to express international solidarity through public service in impoverished areas. By compensating the shortage of human resources in developing countries, this program would allow immediate implementation of measures to promote action, training and research not as a replacement operation but rather as a genuine partnership. Deployment of our public aid for development in the field of health-care must not have a detrimental effect on the bilateral dimension of the relationship that indeed requires urgent strengthening. In addition tighter coordination of all parties involved in cooperation activities is needed to ensure greater efficiency and consistency. New funding sources (starting with the airline ticket tax) and greater mobilization of the European Union is necessary to ensure that developing countries have more financial resources to wage the "health-care battle". Reducing the "health-care gap" that cripples development and destabilizes societies must be the first priority of French Cooperation.

[Customer satisfaction analysis in women attending an organized mammographic screening. Pilot study at Trento]. / Il gradimento delle utenti afferenti al servizio di screening mammografico. Studio pilota a Trento.

Present paper reports on the results of a pilot customer satisfaction study carried out on 1.720 consecutive women (18.7 with spontaneous access) attended senology department (Trento and Borgo) in the context of a organized mammography screening programme, started in October 2000. Data were collected by a questionnarie filled by the women after mammography. 4.3% of the invited women reported the receiving the letter late, 0.9% considered it inaccurate, 7.2% had some problems for getting a new date for test, 1.8% of the whole sample reported some problems for external access and 2.2% for internal access to health facilities; 1.9% perceived waiting room as not friendly. The welcoming by the personnel is judged quite well, only 0.6% complained about it. Trento centre, is more efficient than Borgo. In 21.7% of the cases the mammography has been performed within next 30 minutes of the fixed time and in 7.9% besides that. 36.8% of the whole sample perceived mammography as tiresome and 4.1% as painful. The percentage of women reporting mammography disconforting increase, in Trento sample, according the education level as previously reported. The data about perceived quality are satisfactory, on the whole. Anyway it would be opportune to contain the waiting time.