Prevalence and risk factors for Extended-Spectrum Beta-Lactamase-producing- Enterobacteriaceae in French military and civilian travelers: A cross-sectional analysis.

BACKGROUND: International travel is a risk factor for colonization with Extended-Spectrum Beta-Lactamase-producing- Enterobacteriaceae (ESBL-E). We describe the prevalence of and risk-factors for ESBL-E colonization in civilian and military travelers. METHODS: Patients hospitalized in the infectious diseases department of Bégin Military Hospital (France) from May 2012 to November 2015, who had traveled abroad over the past two months, were screened for intestinal colonization with ESBL-E. RESULTS: Forty-one out of 166 travelers (24.7%) had ESBL-E colonization, predominantly Escherichia coli. The risk factors for ESBL-E colonization in the univariate analysis were a treatment with any antibiotic in the last two months (OR 4.19, 95% CI 1.91-9.16) or with a beta-lactam in the same period (OR 3.35, 95% CI 1.44-7.82), and an hospitalization in the last two months (OR 3.96, 95% CI 1.91-9.16). The military status, military mission or military accommodation were not associated with an increased risk of ESBL-E colonization. In the multivariate analysis, a treatment with any antibiotic in the last two months was significantly associated with ESBL-E colonization (OR 6.71, 95% CI 3.36-19.08). CONCLUSION: Antibiotic treatment in the two previous months is strongly predictive of ESBL-E colonization in international travelers, while the military status and its specific living conditions are not.

The French Military influenza surveillance system (MISS): overview of epidemiological and virological results during four influenza seasons--2008-2012.

QUESTION UNDER STUDY: Influenza is a viral infection caused by a pathogen with considerable ability for genetic mutation, which is responsible for seasonal outbreaks as well as pandemics. This article presents the results of epidemiological and virological monitoring of four successive influenza outbreaks in the French armed forces, for the period 2008 to 2012. METHODS: The main events monitored were acute respiratory infection (ARI). Weekly incidence rates were calculated by relating cases to the number of servicepersons monitored. RESULTS: In continental France, the incidence rates for ARI and for medical consultation attributable to influenza were highest during the pandemic and decreased to reach their lowest values in 2010­2011 and 2011­2012. In terms of virological results, the 2008­2009 outbreak was mainly due to the A(H3N2) virus, while the 2009­2010 pandemic and the following season saw the emergence of the A(H1N1) pdm09 strain. The last season 2011­2012 was characterised by a predominant circulation of A(H3N2) viruses. CONCLUSIONS: Despite some limitations, the MISS represents a good source of information about influenza in young people. Virological results are compatible with those reported by most other influenza surveillance networks, but could be improved by a better knowledge of the other respiratory viruses in circulation in the military community.

Is serving in the armed forces associated with tobacco or cannabis initiation? A study of onset sequences before and after joining the French armed forces.

The aim of this study was to evaluate whether joining the military could constitute a predictor of subsequent tobacco or cannabis use. Data from four cross-sectional surveys conducted between 2005 and 2009 in the French armed forces were used to constitute a retrospective cohort (n=4208). A Markov multi-state model was fitted, estimating the probabilities at 1year for all possible pathways between entry into the military profession, tobacco initiation and cannabis initiation. The model was adjusted for current substance use status. Substance initiation appeared to mainly occur before entering the services than during the service period (3.0 times greater likelihood for tobacco and 2.5 times greater likelihood for cannabis). Probabilities of primo-initiation (i.e. starting with that substance) before joining the services were similar for tobacco (3.6% at one year) and cannabis (3.5%). When the study was restrained to current users, although differences were not statistically significant, probabilities of substance primo-initiation during the service period seemed to be greater than before. While the substance use itinerary in the French general population most often begins by tobacco, military seem to have a higher propensity to cannabis primo-initiation, which could traduce more sensation-seeking behaviors. If certain results in our study could also evoke a propensity to substance initiation during the service period, we did not find evidence to verify the hypothesis of a military social inducing effect. Further research is needed to identify behavioral characteristics which could explain increased use during the service period.

The accuracy of self-reported data concerning recent cannabis use in the French armed forces.

BACKGROUND: The aims were to evaluate the accuracy of self-report of past-month cannabis use in a representative sample of French military staff members and to evaluate the scale of the prevarication bias. METHOD: Data from three cross-sectional surveys conducted between 2005 and 2008 (n = 3493) were used. The characteristics of self-report (sensitivity, specificity, positive predictive value and negative predictive value) were computed using tetrahydrocannabinol detection in urine as the reference. RESULTS: The prevalence for past-month cannabis use was 16.1% and for positive testing was 13.4%. The discriminant power of self-report was good, with an area under the receiver operating characteristics curve 0.90. Specificity (94.5%) and negative predictive values (97.8%) were good, but sensitivity (85.7%) and positive predictive values (70.4%) were lower. The lowest sensitivity values were observed in the higher categories of personnel and in the Navy, which could reflect some prevarication in these sub-populations who might believe they were more exposed to sanctions if detected. CONCLUSIONS: Despite certain limitations of urine analysis as a reference, because of its poor detection of occasional users, our study is in favour of good accuracy of self-reported data on cannabis use, even among the military. However, our results, derived from a population study, do not enable any assumptions on the validity of self-reported data collected during individual testing procedures for the purpose of improving occupational safety.

A cluster of acute diarrhea suspected to be cholera in French travelers in Haiti, December 2010.

A cluster of 21 cases of watery diarrhea suspected to be cholera that involved French military policemen and young volunteers occurring in the context of the Haiti cholera outbreak is described. The attack rate (AR) was higher among young volunteers (71.4%) than among policemen (15.3%) (p < 0.0001). There was a significant association between raw vegetables consumption and watery diarrhea in the young volunteer group. If we consider the raw vegetables consumers only, AR was lower among doxycycline-exposed subjects (relative risk: 0.2; 95% confidence interval: 0.1-0.4). The main aspect that is of scientific interest is the potential prophylactic effect of doxycycline used for malaria prophylaxis on the watery diarrhea AR.

Mortality among active-duty male French Armed Forces, 2006-10.

BACKGROUND: In the Armed Forces, knowledge about the causes of deaths is required in order to develop prevention strategies. This study presents the main characteristics of causes of deaths among male active-duty personnel in the French Armed Forces during the 2006-10 period and compares them with the general French male population. METHODS: The data are provided by military public health surveillance. Comparisons of the specific mortality rates (MR) were performed using a Poisson regression. Standardized mortality ratios (SMRs) were calculated to compare mortality with the general French male population. RESULTS: There were 1455 deaths among male active-duty personnel during the study period [MR: 100.9 per 100,000 person-years (PY); 95% confidence interval 95.7-106.1]. The 17-24 age group was characterized by violent deaths: transport accident (MR: 45.9 per 100,000 PY) and suicide (18.8 per 100 000 PY). Overall SMRs show significantly lower MR compared with the French national MR with the exception of SMR for transport accident and suicide in the 17-24 age group. CONCLUSIONS: There is a significantly lower deficit of mortality compared with the French male general population, reflecting a strong healthy worker effect. However, health promotion programmes should continue to put emphasis on transport accident especially among the 17-24 age group.

The value of urinary prostate cancer gene 3 (PCA3) scores in predicting pathological features at radical prostatectomy.

UNLABELLED: Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? PCA3 scores correlate to numerous histoprognostic factors, specifically tumour volume and positive surgical margins. These results may have a clinical impact in the near future on the selection of patients eligible to undergo active surveillance and nerve-sparing surgery. OBJECTIVE: To assess correlations between Prostate CAncer gene 3 (PCA3) levels and pathological features of radical prostatectomy (RP) specimens, which define cancer aggressiveness. PATIENTS AND METHODS: After digital rectal examination (DRE), first-catch urine was collected from 160 patients with localized prostate cancer. The PCA3 score was calculated using the Gene Probe Progensa(™) assay. PCA3 scores were then correlated to the pathological features of the RP specimens. RESULTS: PCA3 scores correlated significantly with tumour volume (r= 0.34, P < 0.01). A PCA3 score of >35 was an independent predictor in a multivariate analysis of a tumour volume >0.5 mL (odds ratio [OR] 2.7, P= 0.04). It was also an independent predictor of positive surgical margins (OR 2.4, P= 0.04). Receiver-operator characteristic curves indicated PCA3 as the most accurate predictor of positive margins (area under the curve [AUC] 0.62), in addition to a positive biopsy percentage (AUC 0.52). There was also a significant difference in the mean PCA3 score between Gleason score patient groups (6 vs ≥ 7) and pathological stage groups (pT0/2 vs pT3/4). CONCLUSIONS: PCA3 scores correlate to numerous histoprognostic factors, specifically tumour volume and positive surgical margins. These results may have a clinical impact in the near future on the selection of patients eligible to undergo active surveillance and nerve-sparing surgery.

Adverse events following pandemic influenza vaccine Pandemrix® reported in the French military forces--2009-2010.

BACKGROUND: In the face of the A(H1N1) 2009 influenza pandemic, in October 2009 the French military health service (SSA) initiated a large vaccination campaign with Pandemrix(®) vaccine in the military forces. The aim of this study was to describe vaccine adverse events (VAE) reported during this campaign. METHODS: VAE and the number of people vaccinated were surveyed by the SSA Epidemiological network across all military forces during the campaign, from October 2009 to April 2010. For each case, a notification form was completed, providing patient and clinical information. Three types of VAE were considered: non-serious, serious and unexpected. RESULTS: There were 315.4 reported VAE per 100,000 vaccinations. Vaccination and VAE incidence rate peaks coincided with influenza epidemic peak in early December. The number of injected doses was 49,138, corresponding to a 14.5% vaccination coverage among military personnel, and 155 VAE were reported, including 5 serious VAE (1 Guillain-Barre syndrome, 2 malaises and 1 convulsive episode). Most VAE were non-serious (97.1%). Among these, 6 cases of local, rapidly regressive paresthesia were observed. DISCUSSION: The military VAE surveillance system constitutes the only observatory on benign VAE in France. The reporting rate was much higher after the pandemic vaccine than after the seasonal vaccine, which may be a reflection of stimulated reporting. This report provides a useful description of VAE among military personnel during a mass emergency vaccination program, showing that the tolerance of the pandemic vaccine appeared acceptable.

Malaria outbreak among French army troops returning from the Ivory Coast.

In 2006, a French Army unit reported 39 malaria cases among service persons returning from Ivory Coast. Thirty, including three serious forms, occurred after the return to France. The risk of post-return malaria was higher than the risk in Ivory Coast. Half of the imported cases had stopped post-return chemoprophylaxis early.

Survey of alcohol, tobacco, and cannabis use in the French army.

The aim of the current study is to describe the consumption rate of alcohol, tobacco, and cannabis in the French Army. A cross-sectional two strata randomized survey was performed between October 2006 and March 2007 using self-report questionnaires (n = 990) to collect individual characteristics, consumption, and addictive behaviors with urinal tests for cannabis (n = 985). The surveyed sample comprised 59% privates, 26% non-commissioned officers, and 6% officers, was predominantly male (89%) and young (median age: 29 years), and had a low level of education (60% attended secondary school). The consumption rate was high: 54.1% were active tobacco smokers, 56.0% were heavy drinkers, 20.5% declared drunkenness more than once per month, 52.6% at least experienced cannabis while 12.3% were occasional users, 8.2% were regular users, and 15.0% displayed multi-risk behaviors. Consumption was higher in the younger age (18 to 25 years) and lower educational group, leading to a high prevalence among privates and suggesting an "army effect." However, large scale behavioral social studies may help distinguish between personal and peer effect among the targeted population.

[Airport malaria]. / Paludisme d'aéroport.

Airport malaria is a particular form of autochthonous malaria: it happens when the Plasmodium infected Anopheles genus mosquito travels from an endemic area to a malaria free airport. Since 1969, 30 cases of airport malaria have been reported in France, 2 during summer 2008. The severity of airport malaria is explained by the frequency of Plasmodium falciparum infecting non immune individuals and an often important diagnosis delay. It is a compulsory notification disease in France. The International Health Regulations (IHR) require states to check that airplanes coming from malaria or arboviral endemic area are systematically disinsected. Vector control measures have to be implemented within a distance of at least 400 meters around the perimeter of airports in malaria or arboviral endemic areas. In France, this measure applies to all airports of French overseas territories, except for the island of Saint-Pierre and Miquelon.

[Rubella seroprevalence in 234 military young women aged between 19 and 31 years]. / Séroprévalence de la rubéole chez 234 jeunes femmes militaires âgées de 19 à 31 ans.

OBJECTIVE: The main objectives of this study were to estimate, among young French women joining the french army, 1) their protective immunity against rubella, 2) the origin of this immunity (immunization or infection), 3) the rubella vaccine coverage and 4) the knowledge of these subjects on the disease and its methods of prevention. METHODS: The study was conducted between December 1(st) 2006 and April 30(th) 2007 among 234 military women born 1976 to 1987. The results of rubella serology were obtained either in the medical files or after prescription of a serology. The dates of vaccination were collected on the military medical files and on the personal health records. A questionnaire was used to estimate the knowledge of these women on rubella. RESULTS: 234 women were included in our study. Results of serology were available for 224 of them. The serologic susceptibility to rubella virus was 6.7%. The mean age at the time of the serological investigation was 21.9 years. The vaccinal history was able to be collected for 45% of the immune women and 7 of the 15 non-immune women. Among the immune women, 74% had an antecedent of vaccination against rubella. The rate of rubella vaccine coverage was estimated at 70.5%. The proportion of the non-vaccinated immune women decreased during time, for the benefit of the vaccinated immune women. The knowledge on rubella disease did not differ according to the maternal status of the women. Near a quarter of them ignored the disastrous consequences for he foetus. DISCUSSION: This study shows a high seroprevalence of about 93% while the rubella vaccine coverage is estimated at 70.5%, letting suppose the persistence of the wild virus. The prevention campaigns and the efforts begun to vaccine all the non-immune women of childbearing age must be pursued.

Methicillin-susceptible, doxycycline-resistant Staphylococcus aureus, Côte d'Ivoire.

We report 2 outbreaks of Panton-Valentine leukocidin-positive, doxycycline-resistant, methicillin-susceptible Staphylococcus aureus infections in French soldiers operating in Côte d'Ivoire. In a transssectional survey, nasal carriage of this strain was found in 2.9% of 273 soldiers about to be sent to Côte d'Ivoire and was associated with prior malaria prophylaxis with doxycycline.