Measles in vulnerable populations: An outbreak in Roma settlements of Loire-Atlantique, France, 2019.

In May 2019, a measles outbreak occurred in the French subregion of Loire-Atlantique, particularly affecting Roma settlements. Various obstacles hindered the implementation of postexposure measures among Roma population, resulting in the spread of the cases to other settlements. Suspected cases of measles were immediately investigated and concerned settlements were visited for measles-mumps-rubella (MMR) vaccination. From July 1 to September 3, 2019, a first and then a second Health Reserve team helped for vaccination on the affected and then also the measles-free settlements. Vaccination uptake was monitored with the use of the department's vaccination center immunization registry. Genotyping of selected samples was performed for comparison with viruses circulating at the same time in France and Romania. As of September 16 2019, 109 cases of measles were confirmed among Roma population, including 99 (91%) children under 15 years. Of the 85 people eligible for vaccination, 60 (71%) had not been vaccinated and 23 (27%) had an unknown vaccination status. Sequence comparison revealed that 28/29 sequenced D8 strains were 100% identical to the strain responsible for a large number of cases throughout France in 2019, and to two sequences reported in Romania among sporadic cases. The vaccination campaign resulted in 1136 people on 35 settlements receiving at least one dose of MMR vaccine and in the increase of one-dose MMR vaccine coverage at 24 months from 43% (23/53) to 91% (48/53). With measles transmission continuing in Europe, efforts must be made to meet immunization coverage targets, particularly in hard-to-reach communities where outbreaks may be difficult to control.

Acceptance of pregnant women's vaccination against pertussis among French women and health professionals: PREVACOQ-1 and -2 studies.

OBJECTIVES: Protection of French young infants against pertussis only relies on their relatives' vaccination. The alternative is vaccination of pregnant women against pertussis (cocooning strategy), but this strategy is not yet recommended in France. We assessed the acceptance of this strategy among French postpartum women and health professionals. PATIENTS AND METHODS: We performed a multicenter survey in 2016 among postpartum women and health professionals (family physicians, obstetricians-gynecologists, midwives, and medical students) to determine the acceptance of anti-pertussis vaccination. We evaluated knowledge, perception, and attitude towards vaccination to identify factors associated with acceptance. RESULTS: Questionnaires were completed by 52% (1208/2337) of women and 40% (694/1754) of health professionals. Seventy-seven per cent of women (95% CI: 74-79) and 93% of health professionals (95% CI: 91-95) were favorable to anti-pertussis vaccination of pregnant women. Thirty-three per cent (227/687) of health professionals believed that pertussis induced life-long immunity and 20% (136/687) of them were not aware of the cocooning strategy. In multivariate analysis, factors associated with acceptance among women were younger age, higher knowledge, having received advice during pregnancy, being vaccinated against influenza, and having never refused any vaccine; among health professionals, factors associated with acceptance were belief that inactivated vaccines are obstetrically safe, regular practice of influenza vaccination in pregnant women, pertussis cocooning strategy, and never prescribing preventive homeopathy for influenza. CONCLUSION: Vaccination of pregnant women against pertussis should be well-accepted by informed mothers and health professionals. If this strategy were to be implemented in France, efforts should be made towards adequate information.

Renal dysfunction in adults during measles.

BACKGROUND: Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. METHODS: A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24 hours was carried out in the Nantes Teaching Hospital, between January and December 2011. The renal function was assessed using the modification of diet in renal disease (MDRD) equation. RESULTS: Thirty-eight patients were included, 17 (45%) presented with a clearance below 90 mL/min. One patient presented with acute renal failure, with a clearance at 37 mL/min, and proteinuria at 2.8 g/L. His renal function was restored on day 2. CONCLUSION: Acute renal failure can occur during measles in adults. Serum creatinine should be systematically assessed during the initial medical evaluation.

[Socio-economic impact of one decade of ARV therapy for people living with HIV in Senegal]. / Impact socio-économique d'une décennie de prise en charge thérapeutique pour les personnes vivant avec le VIH traitées par ARV au Sénégal.

A retrospective biographical survey was conducted based on a patient sample whose median ARV treatment duration was nine years (within the framework of ANRS Cohort 1215 in Dakar) in order to document the long-term socio-economic outcomes for PLHIV. The study shows that, overall, socio-economic indicators did not significantly deteriorate since treatment initiation. The patients' socioeconomic profile-defined by their type of employment and wages, by gender-is identical to that of the general population. Medical care through ARV therapy has helped limit the disease's negative social impact. However, the economic insecurity experienced by these patients, comparable to that of the general population, is a threat to their medical care over the long term.

[Sexual complaints and dysfunction among PLHIV receiving ARV treatment for ten years in Senegal]. / Plaintes et dysfonctions sexuelles des personnes vivant avec le VIH (PVVIH), traitées par antirétroviraux (ARV) depuis une dizaine d'année au Sénégal.

The sexual health of people who have been living with HIV (PLHIV) and who have been receiving ARV drug treatment for several years is still a virtually unexplored topic in Africa today. A study was conducted in Senegal on people who have been treated with ARVs for ten years. Half of those interviewed believe that their sexuality has deteriorated. HIV infection has become a chronic disease in which sexual dysfunction related to the disease or age is interpreted in the context of popular representations of HIV infection and those on sexuality defined by social norms.

[Disclosing HIV status: the experience of PLHIV after 10 years of ARV treatment in Senegal]. / Le partage du statut sérologique des personnes vivant avec le VIH à 10 ans de traitement antirétroviral au Sénégal.

Rates of HIV status disclosure observed in Africa, especially to partners, are too low for an optimal implementation of preventive strategies. Access to antiretroviral drugs appears to have facilitated disclosure in the short term, but knowledge is insufficient about long-term practices. A study held with 185 people living with HIV (PLHIV) examined factors associated with disclosure in general and with partners over 10 years of antiretroviral treatment in Dakar. Two third of PLHIV disclosed their status to at least one person, and 56% with their partners. The main results concern factors associated with disclosure to partners (having a child, knowing one's partner status) which are different from factors associated to disclosure in general (duration of ART treatment, secondary or higher education level, being a member of an association). After ten years, 44% of people still living in couple has not disclosed (no significant differences by sex and marital regime). These results invite to regularly offer counselling to PLHIV during follow-up.