Population-based analysis of invasive fungal infections, France, 2001-2010.

To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001-2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (-14.3%/year) but increased in non-HIV-infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non-HIV-infected patients and should be a major public health priority.

[Epidemiology of mucormycosis in metropolitan France, 1997-2010]. / Épidémiologie des mucormycoses en France métropolitaine, 1997-2010.

It is difficult to estimate the increase of the incidence of mucormycosis at a country level because of the low number of studies in general population. This article analyzes and completes the initial data of a previous study carried out between 1997 and 2006 by covering the period 1997-2010 and by integrating a detailed study of the risk factors, confirming the existence of a real increase of incidence of mucormycosis linked with the increasing number of the persons at risk.

Detection of events of public health importance under the international health regulations: a toolkit to improve reporting of unusual events by frontline healthcare workers.

BACKGROUND: The International Health Regulations (IHR (2005)) require countries to notify WHO of any event which may constitute a public health emergency of international concern. This notification relies on reports of events occurring at the local level reaching the national public health authorities. By June 2012 WHO member states are expected to have implemented the capacity to "detect events involving disease or death above expected levels for the particular time and place" on the local level and report essential information to the appropriate level of public health authority. Our objective was to develop tools to assist European countries improve the reporting of unusual events of public health significance from frontline healthcare workers to public health authorities. METHODS: We investigated obstacles and incentives to event reporting through a systematic literature review and expert consultations with national public health officials from various European countries. Multi-day expert meetings and qualitative interviews were used to gather experiences and examples of public health event reporting. Feedback on specific components of the toolkit was collected from healthcare workers and public health officials throughout the design process. RESULTS: Evidence from 79 scientific publications, two multi-day expert meetings and seven qualitative interviews stressed the need to clarify concepts and expectations around event reporting in European countries between the frontline and public health authorities. An analytical framework based on three priority areas for improved event reporting (professional engagement, communication and infrastructure) was developed and guided the development of the various tools. We developed a toolkit adaptable to country-specific needs that includes a guidance document for IHR National Focal Points and nine tool templates targeted at clinicians and laboratory staff: five awareness campaign tools, three education and training tools, and an implementation plan. The toolkit emphasizes what to report, the reporting process and the need for follow-up, supported by real examples. CONCLUSION: This toolkit addresses the importance of mutual exchange of information between frontline healthcare workers and public health authorities. It may potentially increase frontline healthcare workers' awareness of their role in the detection of events of public health concern, improve communication channels and contribute to creating an enabling environment for event reporting. However, the effectiveness of the toolkit will depend on the national body responsible for dissemination and training.

Progress in the surveillance and control of Legionella infection in France, 1998-2008.

BACKGROUND: In France, the notification of Legionnaires' disease (LD) has been mandatory since 1987. Following a study showing an important under-reporting of the disease, the surveillance system was strengthened in 1997: the urinary antigen detection test was introduced as a new diagnostic tool and guidelines for prevention and control of the disease were implemented. After these measures, the incidence of LD increased gradually, reaching 2.5 per 100,000 in 2005, and then slightly decreased (2.0 per 100,000 in 2008). METHODS: Data from the mandatory notification system and from the national reference centre for Legionella were analysed. Analysis covered the 1998-2008 period. RESULTS: During the period 1998-2008 a total of 11147 cases of LD were reported in France through the mandatory system. The majority of cases were diagnosed by urinary antigen test. The median age of cases was 61 years, the male to female ratio was 2.9, and the case fatality rate was 13%. Exposure during travel was documented for 17% of cases. A hospital-acquired infection was suspected for 9% of cases, and this percentage decreased from 21% in 1998 to 7% in 2008. Over this period, 14 community outbreaks were identified involving 380 cases, and cooling towers were the most probable source of infection for 13. No outbreak was reported in 2008. Registration at the regional level of all cooling towers became mandatory at the end of 2004, and the 1997 prevention and control guidelines were updated in 2005. In recent years, several regulations have also been implemented in the hospital setting and care homes for the elderly. CONCLUSION: All these measures have contributed to strengthen the French surveillance system and improve our ability to better prevent, detect, and control LD.

Increasing incidence of zygomycosis (mucormycosis), France, 1997-2006.

We analyzed hospital records to provide a population-based estimate of zygomycosis incidence and trends over a 10-year period at a national level in France. Data showed an increasing incidence from 0.7/million in 1997 to 1.2/million in 2006 (p<0.001). We compared our data with those from the French Mycosis Study Group, a recently established voluntary network of French mycologists coordinated by the National Reference Center for Mycoses and Antifungals. We documented that incidence of zygomycosis increased, particularly in patients with hematologic malignancies or bone marrow transplants. The role of previous exposure to antifungal drugs lacking activity against zygomycetes could explain this increase but does not appear exclusive. Incidence also increased in the population of patients with diabetes mellitus. We conclude that observed trends reflect a genuine increase of zygomycosis cases in at-risk populations.

[Risk of importation of tropical diseases in metropolitan France: dectection, alert, response]. / Risques d'importation des maladies infectieuses exotiques en France métropolitaine: détection, alerte et réponse.

The French public health institute is responsible for promoting and coordinating threats the detection and assessment of health risks, and for suggesting possible responses. Transmissible diseases affecting both human and animal health are the focus of surveillance networks. Early detection of potential infectious threats is based on the screening of "alert signals" identified through routine surveillance networks and other systems. The quality and accuracy of these signals is first verified, before assessing, through a multidisciplinary approach, the risk of introduction and dissemination. This article examines specific cases illustrating the process of detection, risk analysis and response, with respect to infectious threats that are endemic in tropical regions and have the potential to be imported into metropolitan France. For both novel pathogens and exotic diseases--which, not being endemic in France, are less well known--the analysis and response process must regularly be adapted to the latest epidemiological, clinical and biological findings, taking interactions between the pathogen, host, and environment into consideration. The need to improve reaction times and risk assessment is also discussed.

[Epidemiology of tuberculosis in France]. / Epidémiologie de la tuberculose en France.

Tuberculosis causes an ever-increasing public health burden throughout the world and is one of the World Health Organization's top priorities. In France, the incidence of tuberculosis has been stable at around 10 cases per 100 000 inhabitants per year since 1997. In 2004, the incidence rate in 2004 was 9.2 per 100 000, with substantial geographic disparities: the Ile-de-France region (including Paris and its suburbs) accounted for more than 40% of all reported cases (20.8 per 100 000). Incidence rates of tuberculosis vary according to the geographic origin: in France, this rate is highest among people from sub-Saharan Africa (incidence rate: 166.7 per 100.000 compared with 5.0 per 100.000 for those born in France). Pulmonary tuberculosis is the disease form most commonly observed (71.5% of cases). Among those cases, 76.9% were laboratory-confirmed in 2004. National guidelines to improve case management and disease control were updated in 2003 and 2005. Funding must be made available to reinforce tuberculosis surveillance and to conduct public health initiatives targeted at the populations most at risk.

[Epidemiology of tuberculosis in France in 2003]. / Situation épidémiologique de la tuberculose en France en 2003.

Tuberculosis is still a concern in France, especially in the Paris region and among people originating from highly endemic countries. In 2003, 6098 cases of tuberculosis were notified in France (10.2 per 100000). The patients' median age was 42 years, and 61% of patients were male. Most cases involved pulmonary tuberculosis (71.7%), but there were also 113 cases of tubercular meningitis (1.9%). Among documented cases, 43.9% were of foreign origin and 47.8% of patients were born abroad. The incidence among people born in France declined year on year until 2003, but has increased in the last two years in the 0- to 14-year age group. At the same time the incidence of tuberculosis has been increasing among young people born in sub-Saharan Africa, and the number of cases due to multidrug-resistant strains is also increasing. Official guidelines have been updated in order to improve the prevention and control of tuberculosis. Enhanced surveillance and appropriately funded public health initiatives are needed to reinforce the fight against tuberculosis in France.

Introduction of SARS in France, March-April, 2003.

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription-polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22-23. Timely detection, isolation of probable case-patients, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.