Molecular epidemiology identifies the expansion of the DENV2 epidemic lineage from the French Caribbean Islands to French Guiana and mainland France, 2023 to 2024.

In 2023, dengue virus serotype 2 (DENV2) affected most French overseas territories. In the French Caribbean Islands, viral circulation continues with > 30,000 suspected infections by March 2024. Genome sequence analysis reveals that the epidemic lineage in the French Caribbean islands has also become established in French Guiana but not Réunion. It has moreover seeded autochthonous circulation events in mainland France. To guide prevention of further inter-territorial spread and DENV introduction in non-endemic settings, continued molecular surveillance and mosquito control are essential.

Juvenile Dermatomyositis in Afro-Caribbean children: a cohort study in the French West Indies.

INTRODUCTION: The epidemiology of Juvenile Dermatomyositis (JDM) in non-Caucasian population is poorly described. We performed a study of patients followed up in the French West Indies for JDM. We aimed to describe clinical and biological specificities during childhood. METHODS: Retrospective study covering the period from Januarys 2000-2023. Listings of patients were obtained from multiple sources, namely computerized hospital archives, registry of referent pediatricians and adult specialists in internal medicine and the French National Registry for rare diseases. JDM and organ involvement were defined according to the international ILAR criteria. RESULTS: Twenty-one patients were included over a 23 year-period. Median age at onset was 8.1 years (Range: 2.5-13.9) with a median follow up of 8 years (Range: 2-19). Two-thirds (14/21) had dysphagia at onset and 33% had respiratory involvement. Thirteen had specific autoantibodies (58%), most frequently anti-Mi-2. The median number of flares during childhood was three (1-9). During childhood, 76% had calcinosis lesions. Clinical evolution seemed to be more aggressive for boys than girls (respectively 4.2 versus 2.2 flares (p = 0.04) and 50% vs 18% needing more than one background therapy, p = 0.03). CONCLUSION: This retrospective study is the largest cohort of pediatric patients of Afro-Caribbean and Black African descent treated for JDM in a high-income health system, and the first to describe the incidence and immunological profile in a population of African descent. They had higher rate of calcinosis and similar respiratory involvement. Overall outcomes during childhood were similar to North America and European countries.

HELICOBACTER SCREENING OF GRAND CAYMAN BLUE IGUANA (CYCLURA LEWISI) AND NORTH ANTILLEAN SLIDER (TRACHEMYS DECUSSATA ANGUSTA) ON GRAND CAYMAN, CAYMAN ISLANDS.

The endemic Grand Cayman or blue iguana (Cyclura lewisi) is endangered. Beginning in 2015 significant morbidity and mortality occurred in captive and wild blue iguanas within Grand Cayman's Queen Elizabeth II Botanic Park (QEIIBP). Investigation identified a novel Helicobacter sp., provisionally named Helicobacter sp. Grand Cayman Blue Iguana 1 (GCBI1), as the cause. Invasive green iguanas (Iguana iguana) are believed to play a role in GCBI1 transmission to the blue iguana; however, the origin and transmission pathways have not been determined. To assess the likelihood of blue iguanas asymptomatically harboring GCBI1, in May 2022 population-level screening of captive blue iguanas at QEIIBP was conducted on half (n = 102) of the captive blue iguana population (n = 201) including half of each age class. Helicobacter sp. GCBI1 is closely related to a chelonian Helicobacter sp. and 10 sympatric wild north Antillean sliders (Trachemys decussata angusta) were sampled in October 2019. Combined choana/cloacal swabs were screened by a GCBI1-specific quantitative polymerase chain reaction (qPCR) assay. All samples were negative, suggesting that GCBI1 is not present asymptomatically in the captive blue iguana population or in north Antillean sliders. These results provide support for the hypothesis that GCBI1 is periodically introduced to captive and wild blue iguanas from another species or source.

Epidemiology, characteristics, treatments, and outcomes of adult-onset Still's disease in Afro-Caribbeans: Results from a population-based study in Martinique, French West Indies.

OBJECTIVES: To describe the epidemiology, characteristics, response to initial treatment, and outcomes of Adult-Onset Still's disease (AOSD) in the Afro-Caribbean population of Martinique with free and easy access to specialised care. METHODS: We conducted a retrospective study from 2004 to 2022 in the island of Martinique, French West-Indies which total population was 354 800 in 2021. Patients were identified from multiple sources including standardised databases. To be included, patients had to be residents of the island and fulfilled Yamaguchi and/or Fautrel's criteria for AOSD, or have a compatible disease course, without a diagnosis of cancer, auto-immune disease or another auto-inflammatory disorder. Date of diagnosis, clinical and biological characteristics, treatments, and outcomes were collected. RESULTS: The prevalence was 7.6/100 000 inhabitants in 2021. The mean incidence was 0.4/100 000 during study period. Thirty-three patients (70.6% females) with a median follow-up of 35 months [7.5 to 119] were included. Twenty-six patients (78.8%) had a systemic pattern. Patients with a systemic monocyclic pattern had significantly more polyarticular involvement than patients with systemic polycyclic pattern (p = 0.016). Pulmonary involvement occurred in 51.5% of patients at diagnosis and systemic Pouchot score has been identified as an independent predictive factor for pulmonary involvement; OR of 3.29 [CI 95% 1.20; 9.01]. At first flare, all patients but one received oral glucocorticoids, 11 patients (32.4%) received intravenous glucocorticoids pulse and 12 patients (33%) received anti-IL1 therapy. Nineteen patients (57%) relapsed in a median time of 9 months [6 to 12] Three patients (9%) developed hemophagocytosis lymphohistiocytosis, fatal in 1 case. All deceased patients (n = 4, 11.76%) belonged to the systemic polycyclic pattern, with an event-free survival of 13.6 months [IQR 5.7; 29.5] CONCLUSION: AOSD in the Afro-Caribbean population of Martinique shares some similarities with other ethnic groups, but exhibit differences, such as a high proportion of lung involvement. Comparative studies are needed to confirm these results.

Prevalence of congenital anomalies in the Dutch Caribbean islands of Aruba, Bonaire, and Curaçao.

BACKGROUND: Congenital anomalies represent an important global health issue. Data on the prevalence and pattern of congenital anomalies in the Caribbean region are scarce and lacking altogether in Aruba, Bonaire and Curaçao (ABC islands). METHODS: We performed a population-based surveillance study to determine the prevalence of structural congenital anomalies in the ABC islands, including all live births and stillbirths between January 1, 2008 and December 31, 2017 with major congenital anomalies according to EUROCAT guide 1.5. Terminations of pregnancy for fetal anomaly were included as well. Cases were identified by active case ascertainment, using multiple sources including pediatric patient files and discharge letters, delivery records, and clinical genetic patient files. Total and subgroup prevalence rates were compared between the three islands and to the French West Indies and Northern Netherlands. RESULTS: Total prevalence of congenital anomalies on the ABC islands was 242.97 per 10,000 births. Total prevalence of congenital anomalies in Bonaire (325.15 per 10,000 births) was higher compared to Aruba (233.29 per 10,000 births) and Curaçao (238.58 per 10,000 births), which was mainly attributable to a higher prevalence of limb anomalies, in particular polydactyly, in Bonaire. Total prevalence of congenital anomalies on the ABC islands was comparable to the French West Indies (248.69 per 10,000 births) but significantly lower compared to the Northern Netherlands (298.98 per 10,000 births). In the subgroup prevalence analysis, the prevalence of polydactyly and atrial septal defect on the ABC islands was significantly higher compared with the French West Indies and the Northern Netherlands, while the prevalence of congenital anomalies of the kidney and urinary tract and genetic disorders was significantly lower. CONCLUSIONS: This is the first study to establish the prevalence and pattern of congenital anomalies on the ABC islands, which is important to inform healthcare managers and policymakers and to provide a basis for continuous surveillance of congenital anomalies.

An investigation into the impact of the COVID-19 pandemic on the mental health and the study habits of medical students of the University of the West Indies.

The COVID-19 pandemic has caused increased anxiety among medical students due to the uncertainty of the long-term effects on the future of medical education. There are currently insufficient studies aimed at investigating the changes in the mental health and studying habits of medical students during public health emergencies such as this pandemic, as well as methods that can be incorporated to appropriately manage anxiety effectively. To investigate the psychological impact and associated factors on medical students during the pandemic. This retrospective, cross-sectional study consisted of 291 medical students of the faculty of medical sciences at the university of the West Indies, St. Augustine campus, Trinidad and Tobago. The mental health and study habits of said students were assessed with the use of questionnaires via an online survey platform. Data of our study showed that 56% of the students were experiencing increased stress and anxiety. Students of 82.8% experienced irregular sleeping habits and 76.3% of participants experienced a change in eating habits brought on by the pandemic. Participants of 67.4% studied less than 4 hrs. a day, 61.5% were less productive, 62.2% showed an inability to focus and avoid distractions in their study environment during the COVID-19 pandemic. There is a need for proper supportive strategies to assist students in effectively managing anxiety and depression during public health emergencies such as COVID-19. It is suggested that all universities, colleges and education bodies alike implement a pandemic preparedness course as well as an accessible online support forum.

Fundus Changes in the Offspring of Mothers With Confirmed Zika Virus Infection During Pregnancy in French Guiana, Guadeloupe, and Martinique, French West Indies.

Importance: Most ocular lesions have been described for children with congenital Zika syndrome. The frequency of finding ocular abnormalities is unknown among children exposed to Zika virus (ZIKV) during pregnancy. This study was conducted on newborns whose mothers were positive for ZIKV, confirmed with reverse-transcription polymerase chain reaction (RT-PCR) testing. Objective: To report ocular fundus manifestations in newborns with congenital ZIKV exposure in French Guiana, Martinique, and Guadeloupe, French West Indies, to assess its prevalence. Risk factors, such as the presence of extraocular fetopathies and the gestational term at infection, were sought. Design, Setting, and Participants: This was a cross-sectional multicentric study, conducted from August 1, 2016, to April 30, 2019, for which data were collected prospectively. The study inception was at the beginning of 2016 from the onset of the ZIKV epidemic in the French West Indies. Newborns whose mothers tested positive (by RT-PCR) for ZIKV during pregnancy were included. Interventions: Fundus examination was performed using widefield retinal imaging after pupil dilation. Infection date, delivery mode, and newborn measurements were collected. Main Outcomes and Measures: Anomalies of the vitreous, choroid, retina, and optic disc. Results: A total of 330 children (mean [SD] age, 68 [IQR, 22-440] days; 170 girls [51.5%]) were included. Eleven children (3.3%) had perivascular retinal hemorrhages, and 3 (0.9%) had lesions compatible with congenital ZIKV infection: 1 child had torpedo maculopathy, 1 child had a chorioretinal scar with iris and lens coloboma, and 1 child had a chorioretinal scar. Retinal hemorrhages were found at childbirth during early screening. Lesions compatible with congenital ZIKV infection were not associated with the presence of extraocular fetopathy. Microcephaly was not associated with lesions compatible with congenital ZIKV infection (odds ratio [OR], 9.1; 95% CI, 0.8-105.3; P = .08), but severe microcephaly was associated with an OR of 81 (95% CI, 5.1-1297.8; P = .002). Conclusions and Relevance: Results of this cross-sectional study suggest that the ocular anomalies found may be associated with ZIKV in 0.9% of the exposed population. Ocular lesions were rare, affected mostly the choroid and retina, and seemed to be associated with choroiditis-related scarring that developed during fetal growth.

A comprehensive review of viruses in terrestrial animals from the Caribbean islands of Greater and Lesser Antilles.

Viruses pose a major threat to animal health worldwide, causing significant mortalities and morbidities in livestock, companion animals and wildlife, with adverse implications on human health, livelihoods, food safety and security, regional/national economies and biodiversity. The Greater and Lesser Antilles consist of a cluster of islands between the North and South Americas and is habitat to a wide variety of animal species. This review is the first to put together decades of information on different viruses circulating in companion animals, livestock and wildlife from the Caribbean islands of Greater and Lesser Antilles. Although animal viral diseases have been documented in the Caribbean region since the 1940s, we found that studies on different animal viruses are limited, inconsistent and scattered. Furthermore, a significant number of the reports were based on serological assays, yielding preliminary data. The available information was assessed to identify knowledge gaps and limitations, and accordingly, recommendations were made, with the overall goal to improve animal health and production, and combat zoonoses in the region.

Ancylostoma in dogs in the Caribbean: a review and study from St. Kitts, West Indies.

BACKGROUND: Little is known about the prevalence of Ancylostoma in dogs in the Caribbean. In view of the number of owned free-roaming and feral dogs within the islands and the ideal subtropical climate for parasite development and environmental survival, Ancylostoma could pose a threat to the health of the dogs as well as a zoonotic risk to people. METHODS: To determine whether generalities about Ancylostoma in dogs in the Caribbean could be made and to obtain a better understanding of the prevalence, published (Scielo, Scopus, and PubMed databases) and gray (e.g., student theses, conference presentations) literature was reviewed. Retrieved manuscripts were screened, and relevant data (year, location, dog population, method of diagnosis, positivity rate) were extracted. Data from two dog populations on St. Kitts also were included: a 2014 field study involving dogs with limited veterinary care and data from the Ross University School of Veterinary Medicine's Veterinary Clinic records for 2018-2019. RESULTS: Fourteen manuscripts from the 1950s to 2019, representing ten of the Caribbean islands/countries and the Bahamas, were identified. Methods of diagnosing infection status ranged from simple qualitative or quantitative flotation methods to centrifugation with Sheather's sugar flotation solution or necropsy. Dog populations sampled included stray, owned free-roaming, and owned confined. Reported rates of Ancylostoma infection ranged from 10 to 91%. Studies from the last 10 years indicate positivity rates of 21 to 73%. Ancylostoma positivity rates in the St. Kitts' populations were 61% and 10% for the 2014 and 2018-2019 populations, respectively. CONCLUSIONS: There was no indication that hookworm prevalence has changed over time in the Caribbean, and there were no obvious differences between owned and unowned dogs or free-roaming and confined dogs. The data from St. Kitts were on par with positivity rates from the other islands within the last 10 years and reflective of the impact that veterinary care, including anthelmintic treatment, is expected to have on parasites in pets. There is a clear need to expand the available data for the region and improve control programs for Ancylostoma infections to protect both canine and human health.

Genetic ancestry, admixture, and population structure in rural Dominica.

The Caribbean is a genetically diverse region with heterogeneous admixture compositions influenced by local island ecologies, migrations, colonial conflicts, and demographic histories. The Commonwealth of Dominica is a mountainous island in the Lesser Antilles historically known to harbor communities with unique patterns of migration, mixture, and isolation. This community-based population genetic study adds biological evidence to inform post-colonial narrative histories in a Dominican horticultural village. High density single nucleotide polymorphism data paired with a previously compiled genealogy provide the first genome-wide insights on genetic ancestry and population structure in Dominica. We assessed family-based clustering, inferred global ancestry, and dated recent admixture by implementing the fastSTRUCTURE clustering algorithm, modeling graph-based migration with TreeMix, assessing patterns of linkage disequilibrium decay with ALDER, and visualizing data from Dominica with Human Genome Diversity Panel references. These analyses distinguish family-based genetic structure from variation in African, European, and indigenous Amerindian admixture proportions, and analyses of linkage disequilibrium decay estimate admixture dates 5-6 generations (~160 years) ago. African ancestry accounts for the largest mixture components, followed by European and then indigenous components; however, our global ancestry inferences are consistent with previous mitochondrial, Y chromosome, and ancestry marker data from Dominica that show uniquely higher proportions of indigenous ancestry and lower proportions of African ancestry relative to known admixture in other French- and English-speaking Caribbean islands. Our genetic results support local narratives about the community's history and founding, which indicate that newly emancipated people settled in the steep, dense vegetation along Dominica's eastern coast in the mid-19th century. Strong genetic signals of post-colonial admixture and family-based structure highlight the localized impacts of colonial forces and island ecologies in this region, and more data from other groups are needed to more broadly inform on Dominica's complex history and present diversity.

Maternal Infection and Adverse Pregnancy Outcomes among Pregnant Travellers: Results of the International Zika Virus in Pregnancy Registry.

In this multicentre cohort study, we evaluated the risks of maternal ZIKV infections and adverse pregnancy outcomes among exposed travellers compared to women living in areas with ZIKV circulation (residents). The risk of maternal infection was lower among travellers compared to residents: 25.0% (n = 36/144) versus 42.9% (n = 309/721); aRR 0.6; 95% CI 0.5-0.8. Risk factors associated with maternal infection among travellers were travelling during the epidemic period (i.e., June 2015 to December 2016) (aOR 29.4; 95% CI 3.7-228.1), travelling to the Caribbean Islands (aOR 3.2; 95% CI 1.2-8.7) and stay duration >2 weeks (aOR 8.7; 95% CI 1.1-71.5). Adverse pregnancy outcomes were observed in 8.3% (n = 3/36) of infected travellers and 12.7% (n = 39/309) of infected residents. Overall, the risk of maternal infections is lower among travellers compared to residents and related to the presence of ongoing outbreaks and stay duration, with stays <2 weeks associated with minimal risk in the absence of ongoing outbreaks.

Review: Type 2 diabetes in Latin America and the Caribbean: Regional and country comparison on prevalence, trends, costs and expanded prevention.

PURPOSE: To present an overview of type 2 diabetes status in Latin America and the Caribbean region. METHODS: The data were collected from the International Diabetes Federation Atlas and other available published sources where we identified the prevalence in Latin America and the Caribbean, the trends by regions, and sex. Also, we summarized the type 2 diabetes direct and indirect costs, and the current preventative programs and policies available for each region. RESULTS: Latin America and the Caribbean has one of the fastest-growing prevalence of type 2 diabetes, in particular the Caribbean region. Costs are relatively high in Central American countries and the Caribbean Islands. Currently, type 2 diabetes prevention, diagnosis, and management are insufficient in Latin America and the Caribbean and they do not offer a multidisciplinary integrative approach. CONCLUSION: Effective and preventive multidisciplinary policies should be implemented in Latin America and the Caribbean to decrease the high burden of type 2 diabetes.

Impact of the talent development environment on the wellbeing and burnout of Caribbean youth track and field athletes.

This study examined the perceived talent development environment (TDE) of youth track and field athletes within the Caribbean region and explores the relationship with their subjective wellbeing and burnout levels. A sample of 400 Caribbean youth track and field athletes (male = 198, and female = 202; age 13-20 years) participated in this cross-sectional study. Athletes responded to a survey which included the Talent Development Environment Questionnaire (TDEQ-5), the World Health Organization Wellbeing Index (WHO-5) and the Athlete Burnout Questionnaire (ABQ). Structural equation modelling showed that a positive and supportive TDE was associated with better athlete wellbeing and lower athlete burnout. Moreover, gender and hours of training moderated relationships of athletes' perceptions of their development environment with wellbeing and burnout levels respectively. Furthermore, there was a positive association between the support network and athlete wellbeing, while holistic quality preparation was negatively associated with athlete burnout. Development environments perceived as supportive and geared towards a holistic athlete-centred approach were associated with better athlete wellbeing and lower burnout.

Importation of cats and risk of parasite spread: a Caribbean perspective and case study from St Kitts.

BACKGROUND: In more recent years, international travel with cats has increased. The distribution of cat parasites can change with this movement. Already, subtropical and tropical parasites have been reported by veterinarians in areas where they are not naturally present. Understanding the prevalence of tropical and subtropical parasites in Caribbean islands and the risk of importation to temperate areas could enable improved prevention recommendations and border control import requirements. METHODS: We present a study focused on cat owning students enrolled in a Doctor of Veterinary Medicine (DVM) programme on St Kitts. Owners were interviewed about their cats and their use of parasiticides. Cats were examined for Trichuris felis and Platynosomum fastosum using sugar flotation, Lynxacarus radovskyi using an adhesive tape test, and Dirofilaria immitis using commercial antigen and antibody tests. RESULTS: Data on 115 cats owned by 87 DVM students were collected and 90 cats, all expected to travel to the USA, were examined. Most of the cats were adults and born in St Kitts. Prevalence was reported as 6.8% (95% confidence interval (CI): 2.2-15.1%) for T. felis, 16.2% (95% CI: 8.7-26.6%) for P. fastosum and 6.8% (95% CI: 2.5-14.3%) for L. radovskyi. All D. immitis tests were negative. DVM students reported a high level of deworming (83.3% of the cats), but the number of cats treated per recommendations were low (56.1% for endoparasites and 70.8% for ectoparasites). Also, there was a lack of clarity regarding the purpose of the treatments used and treatments did not appear to be targeted for the parasites present. CONCLUSION: Our results indicate a low prevalence of the parasites of interest in the DVM student cat population compared to other prevalence studies from the Caribbean. However, a degree of non-compliance with parasiticide uses and the high number of cats traveling to the USA indicate a medium risk of importation of tropical and subtropical cat parasites to temperate areas. We recommend stronger health inspections and health screening requirements at the borders including the development of specific parasiticide protocols for cat importation.

Spontaneous community-acquired bacterial meningitis in adults admitted to the intensive care units in the Caribbean French West Indies: Unusual prevalence of Klebsiella pneumonia.

An unusual prevalence of Klebsiella pneumoniae (24%) was observed in 25 adults admitted to the intensive care units of two University Hospitals in the French West Indies, for spontaneous community-acquired bacterial meningitis. All tested isolates had several prominent features of hypervirulent isolates, including rmpa and iuc genes, K1 or K2 capsular serotypes.

Schistosoma mansoni Vector Snails in Antigua and Montserrat, with Snail-Related Considerations Pertinent to a Declaration of Elimination of Human Schistosomiasis.

Investigations leading to a WHO-validated declaration of elimination of schistosomiasis transmission are contemplated for several countries, including Caribbean island nations. With assistance from the Pan American Health Organization, we undertook freshwater snail surveys in two such nations, Antigua and Barbuda, and Montserrat in September and October 2017. Historically, the transmission of Schistosoma mansoni supported by the Neotropical vector snail Biomphalaria glabrata occurred in both countries. Transmission on the islands is thought to have been interrupted by the treatment of infected people, improved sanitation, introduction of competitor snails, and on Montserrat with the eruption of the Soufrière volcano which decimated known B. glabrata habitats. Guided by the available literature and local expertise, we found Biomphalaria snails in seven of 15 and one of 14 localities on Antigua and Montserrat, respectively, most of which were identified anatomically and molecularly as Biomphalaria kuhniana. Two localities on Antigua harbored B. glabrata, but no schistosome infections in snails were found. For snail-related aspects of validation of elimination, there are needs to undertake basic local training in medical malacology, be guided by historical literature and recent human schistosomiasis surveys, improve and validate sampling protocols for aquatic habitats, enlist local expertise to efficiently find potential transmission sites, use both anatomical and molecular identifications of schistosomes or putative vector snail species found, if possible determine the susceptibility of recovered Biomphalaria spp. to S. mansoni, publish survey results, and provide museum vouchers of collected snails and parasites as part of the historical record.

Joint effect of tobacco, alcohol, and oral HPV infection on head and neck cancer risk in the French West Indies.

We investigated the role of tobacco and alcohol consumption on the occurrence of head and neck squamous cell carcinomas (HNSCC), and the joint effects of these factors with oral human papillomavirus (HPV) infection in the French West Indies, in the Caribbean. We conducted a population-based case-control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds ratios (OR) and their 95% confidence intervals (CI). Two-way interactions were assessed on both multiplicative and additive scales. Current smoking (OR = 11.6, 95% CI = 6.7-20.1), drinking more than five glasses of alcohol per day (OR = 2.7, 95% CI = 1.2-4.7), and oral infection with High-risk HPV (OR = 2.4, 95% CI = 1.1-5.0) were significantly associated with HNSCC. The combined exposure to tobacco and alcohol produced a significant synergistic effect on the incidence of HNSCC. Oral infection with High-risk HPV increased the risk of HNSCC in never smokers and nondrinkers. The effects of tobacco, alcohol, and of the combined exposure of tobacco and alcohol were substantially lower in HPV-positive than in HPV-negative HNSCC. This is the first case-control study to investigate the role of tobacco smoking, alcohol drinking and oral HPV infection in an Afro-Caribbean population. Although each of these risk factors has a significant effect, our findings indicate that tobacco and alcohol play a less important role in Hr-HPV-positive HNSCC. Further investigations are warranted notably on the interaction of these three risk factors by cancer site.

General William Gorgas: outstanding medical administrator.

This year marks the 100th anniversary of the death of General William Crawford Gorgas, probably the most famous public health administrator, who first achieved fame for his work in dealing with the epidemic of yellow fever in Cuba in the early 20th century.