Large number of imported chikungunya cases in mainland France, 2014: a challenge for surveillance and response.

During the summer of 2014, all the pre-requisites for autochthonous transmission of chikungunya virus are present in southern France: a competent vector, Aedes albopictus, and a large number of travellers returning from the French Caribbean islands where an outbreak is occurring. We describe the system implemented for the surveillance of chikungunya and dengue in mainland France. From 2 May to 4 July 2014, there were 126 laboratory-confirmed imported chikungunya cases in mainland France.

Differences and commonalities of national field epidemiology training programmes in Europe.

From 1994 to 2009, national field epidemiology training programmes (FETP) have been installed in Spain, Germany, Italy, France and Norway. During their two year duration, different components of the FETP are devised as follows: 63-79 weeks are spent on projects in hosting institutes, 2-26 weeks in outside projects, 9-30 weeks in courses and modules, and 1-2 weeks in scientific conferences. A considerable proportion of the Spanish FETP has is provided conventional class room training . The content of the modules is very similar for all programmes. Except from the Italian programme, all focus on infectious disease epidemiology. The German and Norwegian programmes are so called EPIET-associated programmesas their participants are integrated in the modules and the supervision offered by EPIET, but salaries, facilitators, and training sites are provided by the national programme. These EPIET-associated programmes require strong communications skills in English. Alumni of all five FETP are generally working within the public health work force in their respective countries or at international level, many of them in leading functions. Although three new FETP have been installed since the last published Euroroundup in Eurosurveillance on European FETP in 2001, the progress with respect to the establishment of national FETP or EPIET-associated programmes has been slow. Member States should be aware of how much support EPIET can offer for the establishment of national FETP or EPIET-associated programmes. However, they also need to be ready to provide the necessary resources, the administrative environment and long-term dedication to make field epidemiology training work.

Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005-2006 outbreak on Réunion.

In April 2005, an outbreak of Chikungunya fever occurred on the island of Réunion in the Indian Ocean. During winter 2005, six patients developed meningoencephalitis and acute hepatitis due to Chikungunya virus. Our objectives were to determine the incidence and mortality of atypical Chikungunya viral infections and to identify risk factors for severe disease. A hospital-based surveillance system was established to collect data on atypical Chikungunya cases. Case reports, medical records and laboratory results were reviewed and analysed. We defined an atypical case as one in which a patient with laboratory-confirmed Chikungunya virus infection developed symptoms other than fever and arthralgia. We defined a severe atypical case as one which required maintenance of at least one vital function. We recorded 610 atypical cases of Chikungunya fever: 222 were severe cases, 65 affected patients died. Five hundred and forty-six cases had underlying medical conditions (of which 226 suffered from cardiovascular, 147 from neurological and 150 from respiratory disorders). Clinical features that had never been associated with Chikungunya fever were recorded, such as bullous dermatosis, pneumonia, and diabetes mellitus. Hypertension, and underlying respiratory or cardiological conditions were independent risk factors for disease severity. The overall mortality rate was 10.6% and it increased with age. This is the first time that severe cases and deaths due to Chikungunya fever have been documented. The information presented in this article may assist clinicians in identifying the disease, selecting the treatment strategy, and anticipating the course of illness.

Seventeen years of intervention epidemiology training at Veyrier-du-Lac, 1984-2000.

Early in the 1980s, those involved in public health held symposiums to assess the training of epidemiologists in France showed inadequacies in the teaching of field epidemiology. Hitherto epidemiology in France had been largely confined to research. Evolution of public health practice, with an increasing demand to base decisions on epidemiological data, made it necessary to develop a network of intervention epidemiologists trained to work with standardised methods.

[Evaluation of biological impregnation of a population exposed to high concentration of arsenic in water supply, Ferrette, 1997]. / Evaluation de l'imprégnation biologique d'une population exposée à une concentration élevée en arsenic dans les eaux de distribution, Ferrette, 1997.

BACKGROUND: The population of Ferrette has been exposed to well-water with arsenic (As) levels higher than legal threshold. The aim of this study was to assess the relationships between daily tap-water consumption, As quantities thus ingested and biological arsenical impregnation. METHODS: The study was carried out on a sample of 100 people in the town of Ferrette and 100 people in the town of Seppois-le-Bas where the water quality is satisfactory. Ingested water and As were assessed by the mean of a food questionnaire. The quantity of ingested As was related to the body weight and compared to the tolerable daily intake (TDI) of 2 micrograms/kg/d. Biological impregnation was assessed by measuring out As in hair sample. RESULTS: The daily ingested As intake of Ferrette population ranged from 0 to 32 micrograms/kg/d. One half of the population ingested more than 2 micrograms/kg/d. A quarter of the population ingested more than 4.3 micrograms/kg/d. 15% of Ferrette inhabitants yielded an As hair level higher than 0.1 ng/mg [IC95%: 8.7%-23.5%], versus 7% [IC95%: 2.9-13.9%] for the inhabitants of Seppois-le-Bas (p = 0.07). Among those who ingested an amount of As higher than the TDI, 19% were found to have detectable As hair levels, versus 9% for those who ingested less than the daily acceptable amount (p = 0.18). CONCLUSION: One half of the population of Ferrette absorbed an As amount double to the TDI, evidencing the reality of the exposure. We did not find any statistically significant relation between the ingested As amount and biological As impregnation nor between exposure to water containing excessive As level and As biological impregnation.

[Trends in the HIV/AIDS epidemic in Benin (1990-1993]. / Tendances évolutives de l'épidémie VIH/SIDA au Bénin (1990-1993).

Since 1990 within the framework of a National Program against AIDS, surveillance in the Republic of Benin has relied on disease-control centers established in 20 selected locations. Seropositivity for HIV is always established by Western-blotting and diagnosis of AIDS is based on BANGUI/WHO clinical criteria and positive serologic tests. On June 30, 1993, the cumulative number of AIDS cases reported to the WHO was 12/100000 inhabitants of Benin. The sex-ratio was 2 to 1 and 77.4% of cases occurred in the 20 to 49 year age range. Heterosexual transmission accounted for 75.8% of cases and mother-to-child transmission for 6.4%. Overall the cumulative number of AIDS cases doubled each year from 1990 to 1992. The prevalence of HIV antibodies in target groups has been steady: less than 1% of blood donors and urban or rural women undergoing prenatal examinations. The prevalence of HIV antibodies has risen significantly every year among patients with tuberculosis and people consulting for sexually transmitted diseases. These findings corroborate the notion that the incidence of positive serologic tests for HIV is low in Benin: less than 1% of the adult population.

Etude de la chloroquinoresistance au Nord Benin (Tests in vivo)

"Les auteurs rapportent les resultats de 4 enquetes menees au Nord Benin dans le cadre de la surveillance de la chloroquinoresistance par tests ""in vivo"". Dans ces regions; au minimum; trois souches sur quatre de plasmodium falciparum sont en moyenne encore sensibles a la chloroquine justifiant toujours son utilisation dans le traitement presomptif des acces febriles dans l'Atacora et le Borgou"

[Bacteriological aspects of cholera in Benin (epidemic of 1991)]. / Aspects bactériologiques du choléra au Bénin (épidémie de 1991).

This study showed that the strains of Vibrio cholerae El Tor, Ogawa serotype, isolated during the last cholera outbreak in Benin (1991) are widely sensitive to tetracyclin (84%), sulfamid (96%), ampicillin (98%).

[Seroprevalence of treponematosis among pregnant women in Cotonou (Benin)]. / Séroprévalence des tréponématoses chez des femmes enceintes à Cotonou (Bénin).

A study of frequency of treponematosis among pregnant women in Mother Hood of Zogbo (Cotonou) shows 5.1 +/- 2.8% of positivity with risk of 5% by TPHA and VDRL. The low level of endemicity, associated with the absence of cutaneous lesions of treponematosis in Cotonou may correspond to a syphilis infection. This study points out the necessity to strengthen the struggle against the all other sexually transmitted diseases (MST) in the same way that the HIV infection in Benin.

Community-based evaluation survey of immunizations in Burkina Faso.

A cluster sample survey was conducted in January 1989 in 3 provinces of Burkina Faso to evaluate an immunization programme (based on two contacts, providing inactivated poliomyelitis vaccine plus DPT) that had been launched in 1982-84. The objectives were to estimate neonatal tetanus (NNT) mortality and poliomyelitis prevalence in the study area. The target population (using the same sample of households comprised 2107 live infants born during the preceding year for the NNT survey, and 17,154 children aged 0-9 years for the poliomyelitis survey. The NNT mortality rate was 3.3 per 1000 live births, and the poliomyelitis prevalence rate was 2.8 per 1000 children aged 5-9 years. Dates of onset of poliomyelitis cases among children aged 0-9 years and the numbers of children at risk during the 10-year recall period, reconstituted with demographic indicators taken from standardized life-tables, were used to calculate the incidence rates of poliomyelitis. These rates could be compared in the 5-year period preceding the survey, and showed a decreasing trend consistent with routine surveillance data.

PIP: A cluster sample survey was conducted in January 1989 in 3 provinces of Burkina Faso to evaluate an immunization program (based on 2 contacts, providing inactivated poliomyelitis vaccine plus DPT) that had been launched in 1982-84. The objectives were to estimate neonatal tetanus (NNT) mortality and poliomyelitis prevalence in the study area. The target population (using the same sample of households) comprised 2107 live infants born during the preceding year for the NNT survey, and 17,154 children aged 0-9 years for the poliomyelitis survey. The NNT mortality rate was 3.3/1000 live births, and the poliomyelitis prevalence rate was 2.8/1000 children aged 5-9 years. Dates of onset of poliomyelitis case among children aged 0-9 years and the number of children at risk during the 10-year recall period, reconstituted with demographic indicators taken from standardized life tables, were used to calculate the incidence rates of poliomyelitis. These rates could be compared in the 5-year period preceding the survey, and showed a decreasing trend consistent with routine surveillance data. (author's)

Arbovirus infections and viral haemorrhagic fevers in Uganda: a serological survey in Karamoja district, 1984.

Sera collected in May 1984 from 132 adult residents of Karamoja district, Uganda, were examined by haemagglutination inhibition tests for antibodies against selected arboviruses, namely Chikungunya and Semliki Forest alphaviruses (Togaviridae); dengue type 2, Wesselsbron, West Nile, yellow fever and Zika flaviviruses (Flaviviridae); Bunyamwera, Ilesha and Tahyna bunyaviruses (Bunyaviridae); and Sicilian sandfly fever phlebovirus (Bunyaviridae); and by immunofluorescence tests against certain haemorrhagic fever viruses, Lassa fever arenavirus (Arenaviridae), Ebola-Sudan, Ebola-Zaïre and Marburg filoviruses (Filoviridae), Crimean-Congo haemorrhagic fever nairovirus and Rift Valley fever phlebovirus (Bunyaviridae). Antibodies against Chikungunya virus were the most prevalent (47%), followed by flavivirus antibodies (16%), which were probably due mainly to West Nile virus. No evidence of yellow fever or dengue virus circulation was observed. A few individuals had antibodies against Crimean-Congo haemorrhagic fever, Lassa, Ebola and Marburg viruses, suggesting that these viruses all circulate in the area.