Lessons learned from ten investigations of waterborne gastroenteritis outbreaks, France, 1998-2006.

Ten outbreaks of waterborne acute gastroenteritis (AGE) have been investigated in France since 1998. These outbreaks have affected populations of over 1,000 people, with generally high attack rates. The causal agents have been identified in six of these events. Aetiologies involved mainly noroviruses and Cryptosporidium sp. The point of entry of the contamination was located in the distribution network in five outbreaks (waste water backflows in four cases and one case of contamination induced by maintenance work) and at the water collection facilities in five other cases. Once the outbreak was detected, epidemiological and environmental investigations and crisis management followed well-established procedures. Further progress in public health surveillance will depend on more complete and rapid detection and reporting. Automated analysis of health insurance data on the reimbursement of drugs for AGE should help make detection more complete. Improved reactivity depends primarily on the operator immediately reporting incidents that indicate a possible massive contamination of the water network to health authorities - in particular complaints from the population, which are the only early-warning alerts in the case of waste water backflows.

The mortality impacts of fine particles in France.

INTRODUCTION: Worldwide, air pollution has become a main environmental cause of premature mortality. This burden is largely due to fine particles. Recent cohort studies have confirmed the health risks associated with chronic exposure to PM2.5 for European and French populations. We assessed the mortality impact of PM2.5 in continental France using these new results. METHODS: Based on a meta-analysis of French and European cohorts, we computed a shrunken estimate of PM2.5-mortality relationship for the French population (RR 1.15 [1.05:1.25] for a 10µg/m(3) increase in PM2.5). This RR was applied to PM2.5 annual concentrations estimated at a fine spatial scale, using a classical health impacts assessment method. The health benefits associated with alternative scenarios of improving air quality were computed for 36,219 French municipalities for 2007-2008. RESULTS: 9% of the total mortality in continental France is attributable to anthropogenic PM2.5. This represents >48,000 deaths per year, and 950,000years of life lost per year, more than half occurring in urban areas larger than 100,000 inhabitants. If none of the municipalities exceeded the World Health Organization guideline value for PM2.5 (10µg/m(3)), the total mortality could be decreased by 3%, corresponding to 400,000years of life saved per year. CONCLUSION: Results were consistent with previous estimates of the long-term mortality impacts of fine particles in France. These findings show that further actions to improve air quality in France would substantially improve health.

Molecular characterization of isolates of waterborne Cryptosporidium spp. collected during an outbreak of gastroenteritis in South Burgundy, France.

In September 2001, a waterborne outbreak of gastroenteritis occurred in eastern France. Of 31 fecal samples from symptomatic individuals, 19 tested positive for Cryptosporidium with two PCRs targeting the Hsp70 and the 18S rRNA genes of CRYPTOSPORIDIUM: Sequencing of the PCR fragments produced sequences identical to that of Cryptosporidium parvum genotype 1.