Travel-associated and autochthonous Zika virus infection in mainland France, 1 January to 15 July 2016.

During summer 2016, all the conditions for local mosquito-borne transmission of Zika virus (ZIKV) are met in mainland France: a competent vector, Aedes albopictus, a large number of travellers returning from ZIKV-affected areas, and an immunologically naive population. From 1 January to 15 July 2016, 625 persons with evidence of recent ZIKV infection were reported in mainland France. We describe the surveillance system in place and control measures implemented to reduce the risk of infection.

Large number of imported chikungunya cases in mainland France, 2014: a challenge for surveillance and response.

During the summer of 2014, all the pre-requisites for autochthonous transmission of chikungunya virus are present in southern France: a competent vector, Aedes albopictus, and a large number of travellers returning from the French Caribbean islands where an outbreak is occurring. We describe the system implemented for the surveillance of chikungunya and dengue in mainland France. From 2 May to 4 July 2014, there were 126 laboratory-confirmed imported chikungunya cases in mainland France.

Autochthonous case of dengue in France, October 2013.

In October 2013, autochthonous dengue fever was diagnosed in a laboratory technician in Bouches-du-Rhone, southern France, a department colonised by Aedes albopictus since 2010. After ruling out occupational contamination, we identified the likely chain of local vector-borne transmission from which the autochthonous case arose. Though limited, this second occurrence of autochthonous dengue transmission in France highlights that efforts should be continued to rapidly detect dengue virus introduction and prevent its further dissemination in France.

Comparison of whole-cell versus acellular pertussis vaccine effectiveness in school clusters of pertussis, France, 2013.

OBJECTIVES AND METHOD: We conducted a prospective study in 2013 to compare the whole-cell versus acellular pertussis vaccines effectiveness and duration of protection, following the occurrence of pertussis clusters. RESULTS: During seven school outbreaks, we identified 102 clinical pertussis cases, including 10 cases biologically confirmed by Bordetella pertussis specific PCR, among a cohort of 305 children in 2nd to 6th grade. The risk of pertussis when vaccinated with an acellular vaccine alone was 1.6 (RR=1.6; 95% CI=1.1-2.5) times higher than when vaccinated with a whole-cell vaccine or using a combined schedule. CONCLUSIONS: The limited duration of protection conferred by the acellular vaccine reinforces the 2013 introduction of the pertussis booster at six years old.

Measles outbreak in the Provence - Alpes - Côte d'Azur region, France, January - July 2003.

At the end of May 2003, the Marseilles Hospital Centre's virology laboratory informed the French public heath institute of 5 cases of confirmed measles among young adults living in Marseilles. An investigation was conducted, consulting different community and hospital health services, to determine the virus circulation in the Provence-Alpes-Côte d'Azur (PACA) region by the southern interregional epidemiological cell. The investigation identified 259 cases: 183 clinical, 74 serologically confirmed and 2 epidemiologically linked cases. The first cases were identified during the first six months of 2003, with a peak in April. This outbreak of measles in the PACA region was favoured by poor vaccination coverage, which created groups of susceptible population. The real number of cases was probably higher than the number identified. This investigation has outlined the limitations of the measles surveillance system in France: the sentinel network had not detected any case for this period. France needs to reach the WHO objective of measles elimination by 2010 and the surveillance tools used must be those already used in the most countries that are furthest advanced in the elimination process. To reach this goal, the Direction Générale de la Santé has nominated a working group to be in charge of proposing a national plan to interrupt indigenous measles transmission in France.

Measles outbreak in the Provence-Alpes-Côte d'Azur region, France, January-July 2003.

At the end of May 2003, the Marseilles Hospital Centre's virology laboratory informed the French public heath institute of 5 cases of confirmed measles among young adults living in Marseilles. An investigation was conducted, consulting different community and hospital health services, to determine the virus circulation in the Provence-Alpes-Côte d'Azur (PACA) region by the southern interregional epidemiological cell. The investigation identified 259 cases: 183 clinical, 74 serologically confirmed and 2 epidemiologically linked cases. The first cases were identified during the first six months of 2003, with a peak in April. This outbreak of measles in the PACA region was favoured by poor vaccination coverage, which created groups of susceptible population. The real number of cases was probably higher than the number identified. This investigation has outlined the limitations of the measles surveillance system in France: the sentinel network had not detected any case for this period. France needs to reach the WHO objective of measles elimination by 2010 and the surveillance tools used must be those already used in the most countries that are furthest advanced in the elimination process. To reach this goal, the Direction Générale de la Santé has nominated a working group to be in charge of proposing a national plan to interrupt indigenous measles transmission in France.

Comparative prevalence, incidence and short-term prognosis of cervical squamous intraepithelial lesions amongst HIV-positive and HIV-negative women.

OBJECTIVE: To investigate the impact of HIV infection on the prevalence, incidence and short-term prognosis of squamous intraepithelial lesions (SIL), in a prospective study with 1-year follow-up. METHODS: Between 1993 and 1995, 271 HIV-positive and 171 HIV-negative women at high risk of HIV infection were recruited, 365 (82.6%) of whom completed the 1-year follow-up. The women underwent a Papanicolaou smear test at inclusion and at 6 and 12 months. Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. RESULTS: The SIL prevalence ranged from 7.5% for HIV-negative to 31.3% for HIV-positive women with CD4 cell counts < 500 x 10(6)/l (P < 0.001). Other factors associated independently and significantly with SIL prevalence were HPV-16, 18, 33 and related types, HPV-31, -35, -39 and related types, lifetime number of partners, younger age, past history of SIL and lack of past cervical screening. The SIL incidence ranged from 4.9% in HIV-negative women to 27% in HIV-positive women with CD4 cells < 500 x 10(6)/l (P < 0.001). Progression from low- to high-grade SIL during follow-up was detected in 38.1% of HIV-positive women with CD4 cells < or = 500 x 10(6)/l but in no HIV-negative nor HIV-positive women with CD4 cells > 500 x 10(6)/l. HPV-16, 18, 33 and related types were also associated with higher incidence of SIL and progression from low- to high-grade SIL. CONCLUSION: HIV-induced immunodeficiency is associated with high prevalence, incidence and persistence/progression of SIL. A pejorative influence of HIV infection without marked immunodeficiency is less clear. HIV-positive women with SIL may thus benefit from early treatment when a useful immune response is still present.

Rubella control in France.

In the pre-vaccination era, rubella was regarded as only a mild exanthematous acute viral infection of children. The devastating effects of the disease were first identified in the early 1940s by an Australian ophthalmologist, and further confirmed during the 1962-65 rubella pandemic in Europe and the United States. They result from the transmission of the virus by infected pregnant women to their fetus. The resulting congenital rubella syndrome (CRS) comprises a lengthy list of abnormalities. The most common ones are deafness, ocular and cardiac defects and mental retardation. The objective of rubella vaccination, to which France has subscribed, is the elimination of CRS.

Rubella control in France.

In the pre-vaccination era, rubella was regarded as only a mild exanthematous acute viral infection of children. The devastating effects of the disease were first identified in the early 1940s by an Australian ophthalmologist, and further confirmed during the 1962-65 rubella pandemic in Europe and the United States. They result from the transmission of the virus by infected pregnant women to their fetus. The resulting congenital rubella syndrome (CRS) comprises a lengthy list of abnormalities. The most common ones are deafness, ocular and cardiac defects and mental retardation. The objective of rubella vaccination, to which France has subscribed, is the elimination of CRS [1].

[Traumatic myocardial infarction caused by lead shot]. / Infarctus du myocarde traumatique par plomb de chasse.

The authors report the case of a 32 year old woman who was shot with a shotgun. Acute inferior wall infarction was detected fortuitously on electrocardiography and coronary angiography showed occlusion of the right coronary artery with lead shot. The single coronary lesion, absence, of other cardiac complications (haemopericardium, cardiac perforation, ...) and the favourable outcome with conservative medical treatment has not been previously reported to the authors' knowledge.

[Inflammatory aortic aneurysm and retroperitoneal fibrosis. Report of 6 cases]. / Anévrismes aortiques inflammatoires et fibrose rétropéritonéale. Réflexions à propos de 6 cas.

The inflammatory aneurysm of the abdominal aorta is actually a well known and distinct entity. However its etiology is unknown and its clinical expression often remains a trap. The authors, through a six case experience insist on the surprising characters of the symptoms, and emphasize the contribution of the paraclinical triad (RSV, IUV, and CT Scan). They confirm the benefit of the surgical treatment on the aneurysm on the fibrosis decrease.

[Traumatic arterio-venous fistula. Experience with 9 cases]. / Fistules artério-veineuses traumatiques. Expérience de 9 cas.

Traumatic arteriovenous fistulas (TAF) are rare forms of vascular injuries. The authors report an experience of nine new cases. Three of them result from a minor traumatism, while the six others are iatrogenic. The symptoms and the physical examination are very helpful in the diagnosis. Selective arteriography is the most useful paraclinical examination to confirm the affection and for the choice of the mode of therapy: surgery, selective arterial embolization, alone or used with surgery according to the characteristics and the location of the fistula.

[Dysplasia and spontaneous bilateral dissection of the internal carotid arteries: apropos of a case. Value of surgical treatment]. / Dysplasie et dissection spontanée bilatérale des carotides internes: à propos d'un cas intérêt du traitement chirurgical.

The authors report a case of spontaneous internal carotid artery dissection with a fibromuscular dysplasia of the heterolateral artery. Etiopathogeny, anatomo-pathology, different arteriographic forms and treatment are discussed. The interest of this case is to be found in two aspects: The dysplasia seems to be at the origin of the dissection. It shows that the treatment hereby applied (extra-intracranial bypass) will be of good interest in such situation. The patient became and remain totally asymptomatic 45 months after the second operation.

Management of hepatic artery aneurysm. Case report and literature review.

The authors report the case of a 72-year-old man with new but vague epigastric pain. CT scan and selective coeliac trunk angiography demonstrated a common hepatic artery aneurysm (HAA). He was treated surgically by ligation and excision without revascularization. Asymptomatic hepatic aneurysm should be treated aggressively because the natural course seems to be progression to rupture associated with a high mortality rate. The authors discuss the clinical scenario of patients with HAA and stress the importance of the early treatment. In addition the therapeutic options are explored.

[Skin lesions due to Mycobacterium marinum: surgical ablation. Apropos of a case of false paronychia]. / Lésions cutanées du Mycobacterium marinum: piège chirurgical. A propos d'un cas de faux panaris.

A Mycobacterium marinum panaris-like cutaneous injury was observed in a 5-year old child. Such an affection may require surgical advice. Lack of its knowledge may lead to serious therapeutic mistakes and complications. The authors emphasize the epidemiologic, clinical and paraclinical data allowing the diagnosis and leading to the right treatment. They also point out the place of surgical therapy in these lesions.

[A case of post-mastectomy lymphangiosarcoma]. / A propos d'un cas de lymphangiosarcome post-mammectomie.

Postmastectomy lymphedema and lymphangiosarcoma. A case of 73-year-old woman with postmastectomy lymphedema of the right arm and subsequent lymphangiosarcoma is reported. The diagnosis has been confirmed immunohistologically. The patient had to undergo an amputation of the arm. Presently this treatment offers the greatest chance for survival.

[Soft-tissue sarcomas. Review of 47 patients treated in 10 years in the same institute]. / Les sarcomes des tissus mous. Revue de 47 patients traités en 10 ans dans une même institution.

We have retrospectively examined the records of 47 patients treated in our department between 1977 and 1987 for soft tissue sarcoma of the extremities trunk, head or retroperitoneal space. We also reanalyze the histologic slides of 38 patients with respect to grade and necrosis. Surgery was performed for cure intent in 31 patients. Of these, 20 with a tumor of the extremities, trunk, or head underwent adjuvant radiotherapy. The patients with a high-grade sarcoma also received adjuvant chemotherapy. Local control was achieved in 95% of these 20 patients. These results compare favorably with other reported series. Out of the 8 patients with a tumor of the retroperitoneum, only one is alive without evidence of disease. The histological studies confirmed the relationship between grade and necrosis.

[Assessing the wearing of jewellery by French healthcare professionals]. / Évaluation du port de bijou chez des professionnels de la santé français.

OBJECTIVE: A prospective observation study was undertaken in seven medical centers, in the French region Alpes-Maritime, to assess nail hygiene of healthcare professionals and how often they wear hand jewellery. METHOD: Seven hundred and six healthcare workers in seven medical centers were interviewed from March to April 2008. RESULTS: Among the 706 professionals, 306 (43%) were wearing one or several pieces of jewellery. The nails of 81 (11.5%) were non-standard according to guidelines. Three hundred and forty-four health care professionals (49%) were wearing one or several pieces of jewellery and/or presented with non-standard nails. In univariate analysis, the wearing of jewellery was linked to the medical centre (P<0.001), to the professional category (p<0.001), to the number of times people washed their hands or used hand gel per day (ABHR) by categories (<10 times per day or ≥10 times per day) (P<0.017). In the multivariate analysis, the risk factors linked to the wearing of jewellery were the medical centers, the professional category, and the age. CONCLUSION: There are still too many healthcare professionals who do not comply to French recommendations on hand hygiene concerning the wearing of jewellery and nail hygiene standards.