From Four-Way Linking to a One Health Platform in Egypt: institutionalisation of a multidisciplinary and multisectoral One Health system.

The convergence of humans, animals and our shared environment results in a dynamic in which the health of each group is inextricably linked. Taking into account the fact that the majority of emerging pathogens (e.g. highly pathogenic avian influenza [HPAI], severe acute respiratory syndrome coronavirus, Nipah virus, Middle East respiratory syndrome coronavirus) are zoonotic diseases, Egypt has established a national One Health coordination mechanism. The primary purpose of this mechanism is to provide a comprehensive, strategic approach to concurrent and future health challenges that are facing public and animal heath, including environmental impacts. In this way, the public health, animal health and environment sectors can improve disease mitigation measures, develop stronger and more stable public and animal health services, promote effective national communication strategies and improve One Health collaboration among all relevant sectors. In Egypt, the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) currently assist in hosting the country's Four-Way Linking Task Force with the participation of the convening Ministries (Ministry of Health and Population, Ministry of Environment, and Ministry of Agriculture and Land Reclamation [MOALR] - through the General Organisation for Veterinary Services and the MOALR's laboratories). In the context of the Emerging Pandemic Threats 2 Program, funded by the United States Agency for International Development (USAID), FAO plans to assist Egypt in establishing a robust, multidisciplinary and multisectoral One Health system. This system is based on the solid foundation of the Four-Way Linking Platform, which combines information from four functional streams - epidemiology, laboratories, and animal and human health. Egypt's platform will involve all sectors concerned with HPAI control and combine all stakeholders in an integrated, holistic approach to improve the detection of, response to and control of any threats at the human- animal-environment interface in Egypt.

La coexistence des humains, des animaux et d'un environnement partagé crée une dynamique au sein de laquelle la santé de chaque groupe est inextricablement liée à celle des autres. Confrontée au caractère zoonotique de la majorité des agents pathogènes émergents (par exemple le virus de l'influenza aviaire hautement pathogène [IAHP], le coronavirus responsable du syndrome respiratoire aigu sévère, le virus Nipah, le coronavirus responsable du syndrome respiratoire du Moyen-Orient), l'Égypte a mis en place un mécanisme de coordination Une seule santé. Les objectifs en sont les suivants : a) mieux comprendre l'interaction des facteurs intervenant à l'interface homme­animal­environnement, b) améliorer les mesures d'atténuation de l'impact des maladies, c) oeuvrer en faveur de services de santé publique et de santé animale performants et stables, d) promouvoir des stratégies nationales de communication efficaces et une collaboration multisectorielle Une seule santé entre toutes les entités concernées. En Égypte, l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO) et l'Organisation mondiale de la santé (OMS) contribuent à cette démarche en accueillant le Groupe de travail quadri-directionnel (Four-Way Linking) qui réunit les ministères concernés (ministère de la Santé et de la population, ministère de l'Environnement et ministère de l'Agriculture et de la revalorisation des terres [MOALR], à travers l'Organisation générale des Services vétérinaires et les laboratoires du MOALR). La FAO prévoit de fournir à l'Égypte une assistance visant à mettre en place un système robuste, multisectoriel et multidisciplinaire Une seule santé, dans le cadre de la deuxième phase du Programme sur les menaces pandémiques émergentes financé par l'Agence des États-Unis pour le développement international (USAID). Ce système est basé sur les bases solides déjà posées par la plateforme quadri-directionnelle en place, qui fait converger les informations émanant de quatre circuits opérationnels : l'épidémiologie, les laboratoires, la santé animale et la santé publique. La Plateforme égyptienne fera participer tous les secteurs impliqués dans la lutte contre l'IAHP et réunira les parties prenantes dans une démarche intégrée et holistique visant à améliorer la détection des menaces à l'interface homme­animal­environnement en Égypte ainsi que la réponse qui leur est apportée et leur contrôle.

La confluencia de personas y animales en el medio común a todos nosotros da lugar a una dinámica en la que la salud de cada parte está inextricablemente ligada a la de las demás. Teniendo en cuenta que la mayoría de los patógenos emergentes (influenza aviar altamente patógena [IAAP], coronavirus del síndrome respiratorio agudo severo, virus Nipah, coronavirus del síndrome respiratorio de Oriente Medio, etc.) son zoonóticos, Egipto ha establecido un mecanismo nacional de coordinación en clave de Una sola salud con los siguientes objetivos: a) entender mejor la interrelación de distintos factores en la interfaz de personas, animales y medio ambiente; b) mejorar las medidas de mitigación de enfermedades; c) instituir servicios sólidos y estables de salud pública y sanidad animal; y d) promover dispositivos nacionales de comunicación eficaces y una colaboración multisectorial entre todas las entidades interesadas que se inscriba en los postulados de Una sola salud. En Egipto, la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO) y la Organización Mundial de la Salud (OMS) prestan apoyo actualmente albergando al grupo de trabajo que en el país se dedica a la conexión cuatridimensional (Four-Way Linking) con participación de los ministerios convocantes (Ministerio de Salud y Población, Ministerio de Medio Ambiente y Ministerio de Agricultura y Recuperación de Tierras y por conducto de la Organización General de Servicios Veterinarios y los laboratorios del Ministerio de Agricultura). Como parte de la segunda fase del programa contra las amenazas pandémicas emergentes que financia la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID), la FAO tiene previsto ayudar a Egipto a instituir un robusto sistema pluridisciplinar y multisectorial de Una sola salud partiendo de las sólidas bases que ha sentado el dispositivo de conexión cuatridimensional, que centraliza información procedente de cuatro grandes ámbitos de trabajo: epidemiología, laboratorios, sanidad animal y salud humana. El dispositivo egipcio federará a todos los sectores que intervienen en la lucha contra la IAAP y combinará, desde un planteamiento integrado y holístico, la labor de todos los interlocutores para detectar, controlar y combatir más eficazmente cuantas amenazas surjan en Egipto en la interfaz de personas, animales y medio ambiente.

[Perinatal care for extremely preterm infants. Considerations of the "risks in pregnancy" department]. / Prise en charge de la prématurité extrême. Réflexions du département hospitalo-universitaire (DHU) « risques et grossesse ¼.

Decisions regarding whether to initiate or forgo intensive care for extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients and must be taken into account. After a short review of these factors, we present the thoughts and proposals of the Risks and Pregnancy department. The proposals are to limit emergency decisions, to better take into account other factors than gestational age and prenatal predicted fetal weight in assessing the prognosis, to introduce multidisciplinary consultation in the evaluation and proposals that will be discussed with the parents, and to separate prenatal steroid therapy from decision-making regarding whether or not to administer intensive care.

[Mode of delivery of HIV-infected women: a retrospective study of 358 pregnancies followed in the same hospital between 2000 and 2004]. / Accouchement des patientes enceintes infectées par le VIH: étude rétrospective de 358 grossesses suivies entre 2000 et 2004.

OBJECTIVE: Evaluate the mode of delivery of HIV-infected women and the risk of mother-to-child transmission. PATIENTS AND METHODS: A retrospective study conducted on HIV-infected women who delivered at the maternity ward of Bichat Hospital in Paris between 1st January 2000 and 31(st) December 2004. Pregnancy care, antiretroviral therapy, decision of the mode of delivery and neonate treatment were conformable to the French recommendations. RESULTS: The analysis was performed on 332 cases out of 358 pregnancies followed during this period. 75% received a Highly Active Anti Retroviral Therapy (HAART), 24% an AZT monotherapy and 1% did not receive any antiretroviral treatment. Plasmatic HIV viral load was under the level of detectability (50 copies/ml) for 64,6% of women under HAART and 28,7% of women under AZT monotherapy. Only 31,7% of women under HAART delivered vaginally. 44,7% of women under HAART with undetectable viral load at the moment of delivery delivered vaginally. 59,5% of women who were allowed to deliver vaginally had finally a vaginal delivery. 332 women gave birth to 341 babies with 9 twin pregnancies and one still-birth at 22 WA. Out of these 340 babies, 3 babies whose mother received HAART were HIV infected (2 in utero and 1 per-partum). DISCUSSION AND CONCLUSION: The reasons why only one third of HIV-infected women could deliver vaginally in this study are primarily the persistence of a detectable HIV viral load under HAART. Women's choice of the mode of delivery comes next, which depends on the quality of the counselling about the benefits and risks of the cesarean section in the context of HIV infection. The third reason is obstetrical contra indications to vaginal delivery in the context of HIV infection. In the future, it is possible to reduce the incidence of cesarean section in HIV-infected women by elevating the level of HIV plasmatic viral load which allowed vaginal delivery (1000 copies/ml), by improving the observance to antiretroviral treatment, by adaptating antiretroviral medications posology using determination of serum protease inhibitors concentration and by modifying obstetrical management with less restrictive contra indications to vaginal delivery. However the impact of prophylactic cesarean section when plasmatic HIV viral load is undetectable must still be evaluated.

[Immune response obtained in children vaccinated against measles in Algeria]. / Réponse immunitaire obtenue chez des enfants vaccinés contre la rougeole à Alger.

The sero-conversion rate in 92 children (6 to 13 months old) vaccinated against measles was found to be 64,11%. The results obtained are discussed by the authors. Based on the local epidemiological picture, they recommend the best age for vaccination against this disease in Algeria.