Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: the TELECHIK cohort study on Reunion island.

Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.

Individual and contextual risk factors for chikungunya virus infection: the SEROCHIK cross-sectional population-based study.

The purpose of the study was to weigh the community burden of chikungunya determinants on Reunion island. Risk factors were investigated within a subset of 2101 adult persons from a population-based cross-sectional serosurvey, using Poisson regression models for dichotomous outcomes. Design-based risk ratios and population attributable fractions (PAF) were generated distinguishing individual and contextual (i.e. that affect individuals collectively) determinants. The disease burden attributable to contextual determinants was twice that of individual determinants (overall PAF value 89.5% vs. 44.1%). In a model regrouping both categories of determinants, the independent risk factors were by decreasing PAF values: an interaction term between the reporting of a chikungunya history in the neighbourhood and individual house (PAF 45.9%), a maximal temperature of the month preceding the infection higher than 28.5 °C (PAF 25.7%), a socio-economically disadvantaged neighbourhood (PAF 19.0%), altitude of dwelling (PAF 13.1%), cumulated rainfalls of the month preceding the infection higher than 65 mm (PAF 12.6%), occupational inactivity (PAF 11.6%), poor knowledge on chikungunya transmission (PAF 7.3%) and obesity/overweight (PAF 5.2%). Taken together, these covariates and their underlying causative factors uncovered 80.8% of chikungunya at population level. Our findings lend support to a major role of contextual risk factors in chikungunya virus outbreaks.

Influenza season in Réunion dominated by influenza B virus circulation associated with numerous cases of severe disease, France, 2014.

The 2014 seasonal influenza in Réunion, a French overseas territory in the southern hemisphere, was dominated by influenza B. Resulting morbidity impacted public health. Relative to the total number of all-cause consultations over the whole season, the rate of acute respiratory infection (ARI) consultations was 6.5%. Severe disease occurred in 32 laboratory-confirmed influenza cases (31.7 per 100,000 ARI consultations), 16 with influenza B. The observed disease dynamics could present a potential scenario for the next European influenza season.

[Chikungunya virus infection in the Indian Ocean: lessons learned and perspectives]. / L'infection a virus chikungunya dans l'Océan Indien: leçons et perspectives.

After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXth centuries, a full evaluation of the chikungunya epidemic that occurred in 2005-2006 is provided including both lessons learned and future perspectives. On the positive side, the epidemic has allowed improvement of clinical and pathophysiological knowledge, epidemiological surveillance, vector control, awareness of entomology, avenues for research, and understanding of economic and societal repercussions. On the negative side, the epidemic revealed the limitations of a health care system in an island setting, need for an effective sanitary policy, low public-spiritedness, poor diffusion and understanding of public health announcements, endemization of chikungunya virus in the Indian Ocean, absence of vaccine, and global spread of tropical disease. Discussion of perspectives for future arbovirus disease outbreaks in the Indian Ocean is set against the background of climatic change, unequal socioeconomic progress, and high population growth in the Indian Ocean region.

[Perceived morbidity and community burden of chikungunya in La Reunion]. / Morbidité perçue et impact communautaire du chikungunya a l'île de La Réunion: enquête de cohorte en population TELECHIK.

BACKGROUND: Persistence of clinical manifestations, especially polyarthralgia and fatigue, is a characteristic feature of chikungunya virus (CHIK-v) infection. The purpose of this study was to measure the impact of prolonged or late-onset manifestations of CHIK-v infection on the self-perceived health of people on Reunion Island. METHODS: This retrospective cohort survey, dubbed TELECHIK survey, was conducted eighteen months after the end of the chikungunya outbreak on a representative random sample from the SEROCHIK population-based survey conducted on Reunion Island. A total of 1094 subjects whose CHIK-v specific IgG antibody status had been documented were interviewed about current symptoms. RESULTS: Analysis of data showed 45% of CHIK+ vs 14% of CHIK- subjects reporting musculoskeletal pain (P < 0.001), 56% vs. 44% reporting fatigue (P = 0.003), 77% vs. 53% reporting cerebral manifestations (P < 0.001), 51% vs. 34% reporting sensorineural impairments (P < 0.001), 18% vs. 13% reporting digestive complaints (P = 0.06), and 38% vs. 32% reporting skin involvement (P = 0.13). The mean delay between infection and interview was two years (range, 15-34 months). Analysis of data after correction for age, gender, body mass index and comorbidity indicated that rheumatic pain, fatigue, cerebral manifestations and sensorineural impairments were more likely in CHIK+ than CHIK- subjects but the likelihood of digestive and skin manifestations was the same. CONCLUSION: With a mean delay of two years after infection, 45% to 77% of CHIK+ subjects reported prolonged or late-onset symptoms attributable to CHIK-v. These results indicate that persistent manifestations of chikungunya infection have a heavy impact on rheumatologic, neurological and sensorineural health.

An interdisciplinary approach to controlling chikungunya outbreaks on French islands in the south-west Indian ocean.

The outbreak of chikungunya that occurred on French Island territories in the southwest Indian Ocean in 2005 and 2006 caused severe morbidity and mortality. In the aftermath, French authorities set up a scientific task force including experts in epidemiology, public health, entomology, virology, immunology, sociology, animal health, community and hospital medicine. The mission of the task force was to conceive and propose research programs needed to increase understanding of the disease and epidemic and to help public health officials in improving epidemic response measures. The purpose of this article is to describe the findings of the task force at the end of its two-year existence and initial outcomes in the the areas studied. Discussion emphasizes topics requiring further study.

[One case of nosocomial A(H1N1)v2009 influenza in Réunion Island]. / Un cas de grippe A(H1N1)v2009 nosocomiale à la Réunion.

A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.

[Severe cases of A(H1N1)v2009 infection in Réunion Island in 2009 and 2010]. / Formes graves d'infection par le virus A(H1N1)v2009 à La Réunion en 2009 et en 2010.

In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.

[Status report on public health in Mauritius in 2009]. / Situation et enjeux sanitaires à l'île Maurice en 2009.

Mauritius is an island nation off the coast of Africa in the southwestern Indian Ocean. Improved socio-sanitation conditions over the past years have dramatically decreased the incidence of tropical diseases to levels comparable with those observed in developed countries. Some tropical illnesses including malaria, schistosomiasis, cysticercosis and lymphatic filariasis have been eradicated. Others such as amibiasis, typhoid fever and leprosy have become rare. However, because of the island's geographical proximity to countries with uncontrolled and suboptimal socio-sanitation conditions and its humid subtropical climate, there is a continued risk for certain vector transmitted tropical diseases such as Chikungunya and dengue. In addition, the incidence of HIV infection and AIDS has been rising rapidly since 2004 and tuberculosis remains a public health problem. Better living conditions have also been accompanied by an increase in cardiovascular and metabolic diseases that, along with cancer, are now the main causes of morbidity and mortality.

[2007 cholera epidemic in Comoros islands: a step towards endemisation?]. / Epidémie de choléra de 2007 aux Comores: un nouveau pas vers l'endémisation?

In 2007, a cholera epidemic occurred on two of the three islands of the Comoros archipelago: Grande Comore and Moheli. This study is based on data from the files of the 1571 patients admitted to five cholera treatment centers (CTC). The outbreak lasted for ten months. A dramatic peak was observed in July and August corresponding to the traditional wedding season during which hundreds of guests including returning diaspora gather to celebrate "Grand Marriages". Initial stool cultures identified Vibrio cholerae O1, Ogawa serotype. The in-center fatality rate was 1.85%. Poor socio-economical conditions combined with a rapid turnover of health personnel and delayed response of the health authorities could lead to endemisation.

[Disseminated histoplasmosis caused by Histoplasma capsulatum in a renal transplant patient: first case report in the Reunion Island]. / Premier cas d'histoplasmose disséminée a Histoplasma capsulatum a la Réunion, chez une transplantée rénale.

The purpose of this report is to describe the first case of indigenous disseminated histoplasmosis caused by Histoplasma capsulatum in a patient on immunosuppression 22 months after renal transplantation in the Reunion Island. Involvement was predominantly pulmonary and outcome was rapidly fatal. Diagnosis based on isolation of characteristic intramacrophagic Histoplasma capsulatum yeast cells from bronchoalveolar fluid was delayed since indigenous cases of this opportunistic infection were unprecedented. In addition to demonstrating the difficulty of achieving diagnosis in places located outside endemic areas without modern facilities, this case underlines the potentially the poor prognosis of disseminated histoplasmosis. This disease should be included in differential diagnosis in the Reunion Island where many patients undergo immunosuppresion and receive organs shipped in from outside locations.

[Is it worth delivering Direct-Current Counter shock to critically ill patients with supra-ventricular tachyarrhythmia?] / Vaut-il la peine de délivrer un choc électrique aux patients de réanimation avec tachycardie supra-ventriculaire ?

Supra-ventricular tachyarrhythmia and its treatment have been poorly investigated in ICU patients. AIMS: To evaluate efficacy and safety of cardioversion for supra-ventricular tachyarrhythmia in the intensive care unit (ICU). PATIENTS AND METHODS: Prospective inclusion of all patients who presented supra-ventricular tachyarrhythmias lasting≥30seconds in a single medico-surgical ICU, except cardiac surgery. Anti-arrhythmic drugs and/or direct-current cardioversion were administered on a liberal basis. RESULTS: During the 15-month study period, 108/846 patients (12.8%) experienced supra-ventricular tachyarrhythmias. Anti-arrhythmic drugs were administered in 78 patients (72%); mostly amiodarone (92%), and/or magnesium (23%), resulting in an overall conversion rate of 68%. Direct-current cardioversion was used in 26 patients (24%), (24 patients received drug enhancement by anti-arrhythmic drugs) with an immediate 80.8%-success rate. CONCLUSION: Direct-current cardioversion was associated with sustained conversion to sinus rhythm in 80.8% of ICU patients with supra-ventricular tachyarrhythmias, although most of them had already received drug enhancement.

A medical enigma : what "gale chinoise (Chinese scabies)" meant 150 years ago.

CONTEXT: The meaning of the term "gale chinoise" mentioned in some articles about French overseas territories in the 19th century, remains unclear. In response to a query of an American colleague dermatologist trying to find out what it meant 150 years ago, we attempted to elucidate the nature of this ancient disease, which today would be translated literally as Chinese scabies. METHOD: We submitted the query to a panel of civilian and military French tropical medicine specialists including dermatologists, through two networks : Association Amicale Santé Navale et d'Outre-Mer and Société de Pathologie Exotique. RESULTS: Very few answers were received from the approximately 400 colleagues in these networks. They mentioned : ciguatera, other types of ichtyosarcotoxism, smallpox, and leprosy. Several said they never encountered this term during many years spent in French Polynesia, and none was able to find irrefutable proof of their suggestion. Discussion and conclusion. Leprosy, smallpox, ciguatera? The identity of "gale chinoise" remains an enigma ; it might have been intended to designate several different diseases.

HTLV-1 infection in Reunion.

OBJECTIVES: Although regularly looked for in blood donors, HTLV infections are very rare in Reunion. We aimed to describe HTLV infections locally. PATIENTS AND METHODS: HTLV infections were identified from the database of the Reunion University Hospital administrative database (PMSI) between 2000 and 2016. Diagnosis was performed with HTLV 1/2 enzyme immunoassay test and confirmed by Western blot. RESULTS: We reported three asymptomatic and four symptomatic HTLV infections, including two tropical spastic paraparesis/HTLV-1 associated myelopathies (TSP/HAM) and two adult T-cell leukemia/lymphoma (ATLL), diagnosed between 2000 and 2016. CONCLUSION: Reunion is a low HTLV prevalence area, which could be explained by its settlement history. The present report underlines the local circulation of HTLV and symptomatic infections.

[Chikungunya virus infection: review through an epidemic]. / Infection à virus Chikungunya: revue générale par temps d'épidémie.

The Chikungunya virus is an alpha arbovirus, first identified in 1953, transmitted by Aedes, mosquitoes, responsible for a little documented uncommon acute specifically tropical disease. Its main symptoms are fever, a rash, and debilitating arthralgia. An unprecedented Chikungunya epidemic is ongoing on the Reunion Island (775,000 inhabitants) with over 244,000 reported and 205 deaths (directly or indirectly linked) as of April 20 2006. Aedes albopictus, long present on the island, is the assumed vector. It had already been identified as the vector for type 2 Dengue fever in 1997-1978 (200,000 cases) for type 1 Dengue fever in 2004 (300 cases). After the Grande Comore Island epidemic, the first cases were reported in the Reunion Island in March 2005. The epidemic was a surprise because of its unexpected emergence, its magnitude, and clinical cases rarely or never described before: severe forms, central neurological involvement, hepatic cytolyse, severe lymphopenia, severe dermatological involvement, deaths, and neonatal infections. This is the first manifestation of the intrusion CHK virus on the island, which benefits from a sub-tropical climate, but also of an occidental healthcare environment, with a non-immune population. This is also the first time that a Chikungunya epidemic is described in this part of the world.

History of health in the Indian Ocean: care, prevention, teaching, and research from the 17(th) to the mid-20th century.

In 1498, the Portuguese crossed the Cape of Good Hope. It was not until the period of 1633 and 1666, dates of the founding, respectively, of the Compagnie de l'Orient and the Compagnie des Indes orientales, that the way was definitively opened for trade between France and India. Because so many sailors developed scurvy after voyages that lasted 4 to 5 months, the French settled on Bourbon Island (Réunion) and Ile de France (Mauritius), to provide them with medical care. Created in 1689 by Louis XIV, the Navy Health Service was responsible for health in the colonies until it was replaced in 1890 by the Colonial Health Service. European medicine began its slow diffusion around the Indian Ocean in Pondicherry (India). The naval doctors reported their experiences in the Archives de médecine navale (1864-1889), and the colonial doctors afterwards in the Archives de médecine navale et coloniale (1890-1896). The health system in Madagascar developed strongly during 19(th) and 20(th) centuries, and the subsequent development of health care in the other Indian Ocean islands became closely linked to that of Madagascar. On Bourbon, the two navy hospitals in Saint-Paul and Saint-Denis treated only naval and military personnel. The colony had no hospital providing care for civilians and poor people until three civilian doctors opened a maison de santé (health house) in 1846.

[Malaria in the Comoros Archipelago in 2015: status after 15 years of fight]. / Le paludisme dans l'Archipel des Comores : état des lieux en 2015 après quinze années de lutte.

The four volcanic islands of the Comoros archipelago are an area of intense, stable and permanent malaria transmission, almost exclusively with Plasmodium falciparum. Our purpose is to describe the current situation on malaria in Mayotte and Comoros in 2015, after the implementation of various strategies of control during the past 15 years. In 2015, Mayotte is in the phase of elimination of malaria. In the three islands forming the Union of Comoros, the transmission is much lower in the islands of Anjouan (incidence of 0.02‰) and Moheli (incidence of 0.14‰), ranking the two islands in pre-elimination phase. Grande Comore (incidence of 3.68‰) remains in the control phase with not enough time to assess what the mass treatment campaign long-term effects might be. These strategies could be applied in other islands with endemic malaria and with limited population.

[Post nearly Drowning Vibrio alginolyticus Septicemia Acquired in Reunion (Indian Ocean)]. / Septicémie à Vibrio alginolyticus au décours d'une presque noyade à La Réunion (océan Indien).

AbstractWe report the first case of Vibrio alginolyticus septicemia in the Indian Ocean (Reunion Island), in a patient (70-year-old-man) with multiple underlying conditions, following a nearly drowning in the lagoon of Reunion. From now on, V. alginolyticus should be considered as a possible agent of septicemia in the Indian Ocean, particularly following marine activities.

Introduction of a PCT-based algorithm to guide antibiotic prescription in COPD exacerbation.

OBJECTIVES: Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin (PCT) is a useful biomarker that helps reduce the rate of antibiotic therapies. However, its proper cut-off levels are often unknown. We aimed to assess the impact of a PCT-based algorithm to guide antibiotic therapy prescription in COPD exacerbations. METHODS: We conducted an observational, retrospective, and before/after study. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation. We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies. The primary endpoint was the rate of antibiotic prescriptions. RESULTS: A total of 124 patients before protocol and 121 patients after protocol were included. Antibiotic prescriptions decreased by 41% after protocol introduction (59% vs. 35%, P<0.001), with no increase in morbidity and mortality at Day 30. Compliance with protocol was complete in 60% of cases and partial (no PCT guidance to discontinue antibiotics) in 8% of cases. Both antibiotic duration (8.3 days vs. 8.7 days) and length of hospital stay (8.5 days vs. 8.3 days, P=0.78) did not change. CONCLUSION: Hospital physicians are already using PCT-based algorithm to guide antibiotic prescription in COPD exacerbations. Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients.

[The register of activity at the Ebola treatment center in Forecariah (Guinea) from april 23 to june 5, 2015: analysis and thoughts]. / Bilan d'activité du centre de traitement Ebola de Forécariah (Guinée) du 23 avril au 5 juin 2015 : analyse et réflexions.

The register of activity at the Ebola Treatment Center (ETC) in Forecariah (Guinea), from April 23 to June 5, 2015 is presented for analysis. The viral load of each patient is evaluated by the cycle threshold (Ct). One hundred and thirty patients were seen in Triage at the ETC, of which 24 (18.5%) patients who failed to meet theWHO case criteria for viral hemorrhagic fever were excluded from admission to the ETC. Of the 106 patients admitted in the ETC, 72 (67.9%) were declared non-cases after the results of their two PCR (drawn 48 hours apart) tests were negative. Thirty-four patients were tested positive for Ebola virus disease (EVD): 19 women and 15 men (sex ratio: male/female = 0.78), mean age of 33.51 ± 20.1 years (extremes of 42 days to 70 years), of which six children were aged below 8 years. The median initial Ct value was 21.6 ± 6.3 cycles in this group. Enquiry into patient contacts was only able to identify actual contacts in 20 of these patients (58.8%). Thirteen patients were ultimately cured of EVD (six men and seven women) - with a median age of 31.8 years (extremes of 4 to 54 years). These patients presented on admission with a median Ct value of 21.88 ± 6.2 cycles (extremes of 17.6 to 31.7). Of the six children aged below 8 years, only one survived. Twenty-one patients (61.76%) with EVD died (9 men and 12 women) - median age, 34 ± 21 years (extremes of 42 days to 70 years). They presented on admission with a median Ct value of 18 ± 7 cycles (extremes of 12 to 24). The single most important factor associated with lethality was the Ct value at the time of admission to the ETC (P = 0.0004), i.e., the lower the Ct value, the higher the lethality rate or simply stated, the higher the viral load, the greater the lethality. Age, sex, identification of contact, and delay between the onset of symptoms and admission did not prove to be predictive of death outcome in our series.