French guidelines for the outpatient management of Ebola virus disease: Applicability by family physicians.

BACKGROUND: During the last alarming Ebola Virus Disease (EVD) outbreak, the French Ministry of Health developed guidelines for the outpatient management of EVD. We aimed to assess family physicians' (FP) knowledge of EVD, to assess their working conditions, and to collect their opinion about the applicability of these guidelines in France. METHODS: Cross-sectional quantitative study (telephone or email) performed (November 2014-June 2015) during the EVD outbreak. Relevant results were further analyzed with a qualitative study (interviews) based on grounded theory (June-September 2016), after the end of the EVD outbreak. RESULTS: Thirty-three FPs out of 100contacted answered our survey (response rate: 33%). We interviewed five FPs. Their knowledge of EVD was good. Information sent by post, especially from the national medical association, was considered the best means of information and was preferred to emails. Compliance with guidelines was based on their ease of understanding and application (common sense). The main difficulty in applying these guidelines was the unusual recommended equipment that seemed unnecessary as the management of these patients was based on their interview (anamnesis) and isolation without examination. EVD had little impact on the FPs' practice, they only trained their secretaries to screen for suspected EVD patients and refer them to the mobile emergency unit. CONCLUSION: FPs had good knowledge of EVD and guidelines. This seemed important to prevent the outbreak in France as they were ready to cope with such a situation, thanks to guidelines they could easily adjust to their practice.

Strengthened Ebola surveillance in France during a major outbreak in West Africa: March 2014-January 2016.

Introduction An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases. METHODS: Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure. RESULTS: From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications. CONCLUSION: No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.

Blood safety strategies for human T-cell lymphotropic virus in Europe.

BACKGROUND: To prevent the blood transmission of human T-cell lymphotropic virus (HTLV), different countries have introduced anti-HTLV blood screening. Furthermore, leucoreduction of blood components has been implemented to preclude the transmission of infectious agents present in white blood cells. STUDY DESIGN AND METHODS: To evaluate the current European strategies adopted to ensure the blood safety for HTLV, a European investigation spanning a period from 2003 to 2008 was carried out. RESULTS: In 2003, of the 23 included countries, 11 performed anti-HTLV screening, four of which (Scandinavian countries) only did it on first-time donors. Norway and Finland stopped it in 2007 and 2008, respectively. Two groups may be defined according to increasing prevalence rates per 10 000 donations in first-time donors: Scandinavia and Ireland (0 to 0.17), France, the Netherlands and UK (0.45 to 0.48); Romania was clearly apart from all other participating countries (5.33). HTLV-positive donors (88.6%) either come from endemic areas (82.3%) or declare to have a sexual partner coming from endemic areas (6.3%). Of the 283 HTLV-positive donations that could be characterized, 6.6% were HTLV-II. Fourteen of 22 countries currently use systematic leucoreduction, at least in cellular blood components. Six countries perform both universal anti-HTLV screening and blood cell leucoreduction. CONCLUSION: The implementation of leucoreduction did not modify the blood HTLVscreening policy, except for Norway and Finland. Several screening strategies in low endemic countries performing leucoreduction were discussed. However, the withdrawal of anti-HTLV screening should be decided after assessing the remaining HTLV transfusion risk.

[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College]. / Programme en transfusion des étudiants en médecine. Collège des enseignants en transfusion sanguine.

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

[Risk behavior among blood donors: efficacy of a new questionnaire]. / Comportements à risque chez les donneurs de sang: efficacité d'un nouveau questionnaire.

The clinical selection of volunteers for blood donation is essential to reduce the risk of viral transmission by blood transfusion. The aim of this study was to evaluate a new questionnaire for a pre-donation medical interview. This questionnaire was developed by transfusion practitioners, epidemiologists and professional investigators, and focused on risk behaviors of blood donors and their partners. Five blood banks in the French Ile-de-France region (around Paris), participated in the study from May 1995 to January 1996. All participating doctors were specifically trained by professional investigators. The sex and the age of donors, the type of collection, the duration of interviews and the reasons for exclusion from donation were recorded. The results were compared to those of a prior study dealing with a sample of 15,000 donors presenting the same characteristics, whose blood was taken of at the same collection sites in 1993. Of the 1,527 volunteers donating blood, 14% were interviewed in fixed centers and 86% by moving teams (38% in firms, 22% in towns, 13% in civil service facilities, 13% in school or academic centers). For 15.9% of the volunteers, this was the first donation (range: 7.3% in fixed centers to 41.5% in school and academic centers). The mean duration of the interview was 11 min (10 min for volunteers included, 14 min for donors excluded from donation). It decreased from 14 min at the beginning of the study to 10 min by the end of the study. The percentage of donors excluded for risk behavior (3.7% in 1995-96 vs 1.5% in 1993, P < 0.001), or medical reasons (12.2% in 1995-96 vs 8.4%, in 1993, P < 0.001) was significantly greater in 1995-96 than in 1993 (15.9% vs 9.9%, P < 0.001). In 1995-96, 35.0% of exclusions for risk behavior were related to male homosexuality, multiple partners or the risk behavior of the partner vs 12% in 1993 (P < 0.001). The risk of exclusion was 5.5 times higher for donors not living in a couple. The results obtained demonstrated the value of this new approach to the medical interview.