Reunion, a sentinel territory for influenza surveillance in Europe.

In Réunion, a French overseas territory located in the southern hemisphere, increase in influenza activity is generally observed several months earlier than in Europe. Influenza activity is monitored in Réunion through a multi-source surveillance system including sentinel practitioners network, hospital emergency department, laboratory and mortality. Since 2009, three successive influenza epidemics occurred on the island. The largest was observed in 2009 while epidemics in 2010 and 2011 were much weaker. In terms of circulating strains, B viruses were predominant at the beginning of the 2009 epidemic but they were completely evicted once A(H1N1)pdm09 circulation started. In 2010, A(H1N1)pdm09 virus was predominant again, but a constant co-circulation of B viruses was observed. In 2011, A(H3N2) virus circulated. The same viruses were identified a few months later in mainland France in the respective seasons. Since 2009, virus circulation, epidemiological trends and health impact of influenza have been similar to those observed in Europe. Influenza surveillance in Réunion may therefore give reliable early information which should be considered apart from the surveillance in mainland France. Then, it might be even a more suitable predictor for Europe than other temperate southern hemisphere countries.

[Severe cases of A(H1N1)v2009 infection in Réunion Island in 2009 and 2010]. / Formes graves d'infection par le virus A(H1N1)v2009 à La Réunion en 2009 et en 2010.

In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.

[Evolution of Enterobacteriaceae resistance to antibiotics in Reunion Island: emergence of extended-spectrum beta-lactamases]. / Evolution de la résistance des entérobactéries aux antibiotiques sur l'île de la Réunion: émergence des bêta-lactamases à spectre élargi.

AIM OF THE STUDY: The antibiotic resistance of enterobacteriacae knows a worldwide worrying evolution with an increase of the extended spectrum betalactamases (ESBL) that spread into the community. Few publications describe this problem in the Indian Ocean area. The aim of this study is first to identify in Félix Guyon Hospital (Reunion Island) the emergent antibiotics resistance for enterobacteriaceae between 1997/1998 and 2006/2007 periods, at second, to update the prophylactic and therapeutic measures for handling the risk linked to multiresistant enterobacteriaceae in our hospital and third, to assess the risk in Reunion Island and especially at the community level. METHODS: The antibiotic susceptibility of 7814 enterobacteriaceae strains collected among patients, during 1997/1998 and 2006/2007 periods, were analysed as well as the consumption of the third generation cephalosporins, imipenem and fluoroquinolones. RESULTS: Within a span of time of 10 years, an important increase (+57 %) of the resistance prevalence of enterobacteriaceae is observed. The resistance by the ESBL production mechanism is predominant especially for Enterobacter cloacae and Escherichia coli. An important use of broad spectrum antibiotics is correlated with this resistance evolution. CONCLUSION: The emergence of ESBL-producing enterobacteriaceae in our hospital is impairing both therapeutic and health care. It requires a much better control of antibiotics prescriptions and therefore, an important multidisciplinary implication. A proof molecular analysis would allow to evaluate the risk more precisely, especially at the community level.

Preliminary analysis of the pandemic H1N1 influenza on Reunion Island (Indian Ocean): surveillance trends (July to mid-September 2009).

First infections with the 2009 pandemic H1N1 influenza virus were identified on Reunion Island in July 2009. By the end of July, sustained community transmission of the virus was established. Pandemic H1N1 influenza activity peaked during week 35 (24 to 30 August), five weeks after the beginning of the epidemic and has been declining since week 36. We report preliminary epidemiological characteristics of the pandemic on Reunion Island in 2009 until week 37 ending September 13.