Impact on blood safety of the last arboviruses outbreaks in French Polynesia (2012-2018).

BACKGROUND: Several successive arbovirus outbreaks have affected French Polynesia (FP) in the recent past years due to different dengue serotypes (DENV) present for several decades, Zika (ZIKV) (2013-2014) and chikungunya (CHIKV) (2014-2015) viruses with a potential impact on blood safety and blood supply due to the geographical isolation of these islands. This study reports an assessment of the impact of these outbreaks on blood products supply and infectious safety in FP and discuss the effectiveness of implemented preventive measures. METHODS: To ensure the infectious safety of blood products during outbreaks, several measures have successively been introduced as the selection of donors suspected of infection, the nucleic acid testing (NAT) and the pathogen reduction of platelets and plasmas. RESULTS: The donor deferral rate increased by 6% between 2012 and 2014 without changes in the number of collected donations. NAT excluded five blood donations reactive for DENV RNA, 42 for ZIKV and 34 for CHIKV. As Zika screening could not been implemented before the third month of the outbreak, 36 blood products from ZIKV-infected donors were transfused to 26 recipients. However, no transfusion-transmitted arbovirus has been reported. CONCLUSION: The last past arboviruses outbreaks did not have a significant impact on blood supply in FP. The measures introduced to prevent arbovirus transmission by transfusion were able to maintain infectious safety for all blood products without impairing self-sufficiency.

Current Zika virus epidemiology and recent epidemics.

The Zika virus (ZIKV) is a mosquito-borne flavivirus (Aedes), similar to other arboviruses, first identified in Uganda in 1947. Few human cases were reported until 2007, when a Zika outbreak occurred in Yap, Micronesia, even though ZIKV activity had been reported in Africa and in Asia through virological surveillance and entomological studies. French Polynesia has recorded a large outbreak since October 2013. A great number of cases and some with neurological and autoimmune complications have been reported in a context of concurrent circulation of dengue viruses. The clinical presentation is a "dengue-like syndrome". Until the epidemic in French Polynesia, no severe ZIKV disease had been described so far. The diagnosis is confirmed by viral genome detection by genomic amplification (RT- PCR) and viral isolation. These two large outbreaks occurred in a previously unaffected area in less than a decade. They should raise awareness as to the potential for ZIKV to spread especially since this emergent disease is not well known and that some questions remain on potential reservoirs and transmission modes as well as on clinical presentations and complications. ZIKV has the potential to spread to new areas where the Aedes mosquito vector is present and could be a risk for Southern Europe. Strategies for the prevention and control of ZIKV disease should include the use of insect repellent and mosquito vector eradication.

Management and treatment outcomes of tuberculous patients, eastern Paris, France, 2004.

BACKGROUND: France was one of the few European countries without a national tuberculosis (TB) treatment outcome monitoring system until 2007. OBJECTIVE: To examine TB management and treatment outcomes in the eastern Paris region, and to identify patient- and management-dependent factors affecting treatment outcome. METHODS: This retrospective study focused on all cases of microbiologically confirmed Mycobacterium tuberculosis cases diagnosed in 2004 in the eastern Paris region, one of the areas of France with the highest frequency of TB. RESULTS: Treatment outcomes of 629 identified cases (males 69.6%, median age 37 years, socio-economically disadvantaged 44%, foreign-born 78%) were as follows: treatment success 70.1% (95%CI 66.5-73.7), treatment interruption 4.9% (95%CI 3.2-6.6), loss to follow-up 15.0% (95%CI 12.2-17.8), death 5.7% (95%CI 3.9-7.9), transfers 4.3% (95%CI 3.5-5.1). Non-completion of treatment was associated with sputum smear positivity, injection drug use, non-adherence and irregular follow-up in univariate analysis, and with irregular follow-up and non-adherence in multivariate analysis. Duration of TB treatment and follow-up medical visits were not applied as recommended in more than a third of cases. CONCLUSION: The treatment success rate observed in this study (70.1%) is below the World Health Organization target of 85%, and requires the implementation and evaluation of interventions to increase treatment success rates.

[Follow-up with the assistance of TB-info software of 208 tuberculosis patients who were treated in 2004]. / Intérêt de l'utilisation du logiciel TB-info pour le suivi des patients mis sous traitement antituberculeux: analyse des 208 patients de la cohorte 2004.

INTRODUCTION: The impact of the TB-info software was assessed on the care of patients treated with antituberculosis regimen (ATT). METHODS: Cohort study of patients with tuberculosis who received an ATT in 2004 in two hospitals and five medical centres in Paris. Follow-up was implemented with the TB-info software. Data were compared to those of the 1999-2003 cohort. RESULTS: Two hundred and nine ATT were initiated in 2004, with a mean duration of 7.2 months. Demographic and clinical data reflected this population precariousness: 79% were foreign-born, 25% lived in institutions and half of them had no or unusual health insurance. Compared to the previous cohort, viral co-infections were tested in more than 80% cases and showed association with HIV, HBV or HCV in 11, 10 and 5% of the patients, respectively. Twenty-one patients were lost for follow-up (11%) and 76% of the smear-positive pulmonary tuberculosis therapies were declared successful but only 34% were declared cured with the WHO criteria. CONCLUSION: Analysis of the data obtained with TB-info software showed an improvement of tuberculosis patients care with more co-infection tested and less lost for follow-up. These results confirm the usefulness of this software for patients care and assessment of physicians practice in France.

[Comparison of various tuberculosis screening strategies based on tuberculin testing in schoolchildren in Paris]. / Comparaison de différentes stratégies de dépistage de la tuberculose par test tuberculinique chez les enfants scolarisés en classe de CM2 à Paris.

BACKGROUND: Following the discontinuation in 2004 of routine tuberculin testing in children in France, we have performed a study aiming at assessing the relevancy and identifying the best modalities of continuation of tuberculosis screening activities in schoolchildren in Paris. METHOD: The study was conducted in children attending the last grade of primary school. A preliminary case control study was carried out in order to identify risk factors for abnormal tuberculin test results. Data on tuberculin testing activities conducted in 2004 were analyzed in order to compare the impact and the efficiency of five different target populations for screening. The impact of each of the screening strategies was assessed as the number of tuberculosis infections for which a specific treatment has been proposed and their efficiency as the average number of tuberculin tests needed to identify such an infection. RESULTS: Beside multiple BCG vaccinations, the main risk factor for an abnormal tuberculin test result was the fact that at least one of the child's parents was born in a country of high tuberculosis prevalence. Within the five strategies tested, two can be selected on the basis of their impact and efficiency: the testing of all children and the targeting of the testing to children with characteristics putting them at high risk of tuberculosis. DISCUSSION: For Paris or other large cities in France, decision-makers will have to consider the local tuberculosis epidemiology, the resources that can be devoted to tuberculosis screening of schoolchildren and the regional specificities of the new BCG vaccination policy.

Tuberculosis in European cities: establishment of a patient monitoring system over 10 years in Paris, France.

BACKGROUND: Tuberculosis (TB) is a persistent public health problem in European cities. France has been unable to report on treatment outcomes until now, and it is not known whether the World Health Organization (WHO) target cure rate of 85% has been met. METHODS: All patients placed under treatment in four hospitals and five out-patient Social Medical Centres in Paris were followed up between 1996 and 2005. Patient monitoring and evaluation were performed using a new software programme, TB-INFO. RESULTS: In a cohort of 1127 patients, 76% had pulmonary TB, of whom 39% were smear-positive, 81% were foreign-born and 9.3% were human immunodeficiency virus positive. At the end of the follow-up, 16% were cured and 54% had completed treatment. Among the 1118 non-multidrug-resistant patients, these percentages were 17% and 46%, respectively, for smear-positive pulmonary patients. Some patients died (1.9%) or failed treatment (0.1%), but many more defaulted (20.5%) as they interrupted treatment (1.5%), were lost to follow-up (19.5%) or were transferred out (7.9%). CONCLUSIONS: This 10-year follow-up of TB patients, managed with TB-INFO software, shows that a patient monitoring system can be implemented in France, providing essential information. Treatment success in this cohort of patients was far below the WHO target.

[Evaluation of prescription practices and of the rational use of medicines in Niger]. / Evaluation des habitudes de prescription et de l'usage rationnel des médicaments au Niger. Enquêtes successives dans 19 centres de santé intégrés de la région de Tahoua.

With the aim of evaluating an essential drugs and costs recovery program in Niger, rational drug use and prescribing patterns were studied in 19 health centers in Tahoua region. Drug use indicators were measured by retrospective and prospective surveys, achieved before and after a training intervention for nurses in using national standard treatments guideline. In the first study period, 627 retrospective randomized prescriptions and 295 prospective prescriptions in successive consultations were collected, and in the second period, ten months later, 665 and 274 prescriptions, respectively. Findings were compared between the two periods, and discussed in regard to referentials and data from other studies. The average number of drugs per prescription increased from 2.96 to 3.14 (p < 0.01) between the two periods, and the percentage of prescriptions with injections from 29.9 to 36.6% (p < 0.02), whereas the percentage of prescriptions containing antibiotics decreased from 75.2 to 68% (p < 0.01). These values were higher than regional or international standards, which were 2 for the average of drugs 17% for the injections and 50% for the antibiotics. Prescribing in essential and generic names of the national drug list was very close to 100% for the two periods. The average cost of prescriptions increased from 437 to 553 francs CFA (p < 0.001), which was higher than the calculated reference cost of 400 francs, but lower than data in literature. Correct prescriptions according to standard treatment guideline were only around 50%, in the two retrospective surveys. The averages of consultation time were 5.4 and 6.1 minutes for the two prospective surveys respectively, and dispensing times were 3.1 and 3.4 minutes, longer than those noticed in most of other studies in developing countries. Prescribed drugs were actually dispensed in almost 100% of the cases during the two periods. Drugs were properly labeled in 92.8% of the cases in the first period survey, and in 89.7% of the cases in the second (p < 0.03), whereas the percentage of patients who knew the correct dosage for drugs delivered increased from 64.4% to 75.5% (p < 0.01). Drug formularies and treatment guidelines were available in all facilities except in one case. Key drug availability ratio at the time of visit were good, in spite of a regression from 97.6 to 85.6% between the two periods. Improving drug purchasing and communal management in the health centers, this program contributed to the availability of essentials generic drugs delivered in a satisfactory way to the patients, and to set up a favorable professional environment for the nurses. On the other hand, the training courses seemed to have a limited impact on prescribing patterns for the nurses. However, better availability of drugs, as well as dispatching courses on the two retrospective surveys periods, could have underestimated this impact. Increasing prescription cost, although remaining compatible with costs recovery of drugs, was probably caused by the negative evolution of some indicators: abusive use of injections, higher number of drugs prescribed, few prescriptions according to standard treatment. These bad habits, often the most dangerous, justify undertaking actions of adapted formation, but also of communication with the patients, which should be regularly evaluated. For that, it will be necessary to have more qualitative indicators, helpful for the assessment of most efficient therapeutic attitude, tempting to value the global impact of these actions on health populations in developing countries.