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Background and Objectives Materials and Methods Results Conclusion In 2016, France allowed men who have sex with men (MSM) to donate blood if they had not had sex with men in the previous 12 months. In April 2020, this restriction was relaxed to 4 months due to the lack of negative impact observed on blood safety. This study assesses the impact of reducing this deferral period on epidemiological surveillance indicators.This study compares infection surveillance indicators between two 30‐month periods before (P1) and after (P2) this second deferral change.Overall, 79 donations tested positive for human immunodeficiency virus (HIV) (49 in P1 and 30 in P2), 322 for hepatitis C virus (HCV) (185 and 137), 622 for hepatitis B virus (HBV) (355 and 267) and 1684 for syphilis (799 and 885). Positive donation rates decreased between P1 and P2, except for syphilis: HIV (0.07/10,000 donations vs. 0.04; p > 0.5), HCV (0.25 vs. 0.20; p < 0.05), HBV (0.49 vs. 0.39; p < 0.01) and syphilis (1.10 vs. 1.29; p < 0.001). For all three viruses, residual risks of transmission by transfusion did not increase: HIV (1/7,800,000 donations vs. 1/10,500,000), HCV (1/25,200,000 vs. 1/47,300,000) and HBV (1/6,400,000 vs. 1/6,000,000).Reducing the deferral period for MSM in April 2020 did not negatively impact residual risks, which remained very low, or the rate of positive donations, except for syphilis, which requires careful monitoring. To ensure equal access to blood donation, MSM have been allowed to donate blood under the same conditions as other donors since March 2022 (i.e., no more than one sexual partner in the last 4 months). [ABSTRACT FROM AUTHOR]

Background and Objectives: Data from 21 years (2000–2020) of haemovigilance were used to assess human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) incidence rates in repeat blood donors and the occurrence of transfusion‐transmitted (TT) viral infections. Materials and Methods: Blood donors who converted for HIV, HCV or HBV markers within serial three‐year analysis periods were included. Epidemiological and virological data were retrieved from the national epidemiological donor database and were supplemented with information on blood components and the infection status of recipients of the previous negative donation (D.N‐1) of donors who seroconverted. Results: Incidence rates declined from 1.27 to 0.35/100,000 person‐years for HIV, from 0.59 to 0.19 for HCV and from 1.66 to 0.18 for HBV. Risk factors and lookback for 232 HIV, 90 HCV and 74 HBV seroconversions were investigated. The main risk factor identified at post‐donation interview was having sex with men (47.8% of males) for HIV and a sexual risk for HCV (30.6%) and HBV (37.1%). The viral loads and sequences were retrospectively tested in 191 HIV, 74 HCV and 62 HBV D.N‐1 archived samples. Six (five HBV and one HIV‐1) were positive all low viral loads. Two recipients were infected by red blood cells from two HBV seroconverting donors before the introduction of HBV‐nucleic acid testing. Conclusion: HIV, HCV and HBV incidence rates in blood donors declined over the two past decades in France. There is a very small risk of a blood component that tests negative entering the blood supply resulting in TT infections, especially after introduction of molecular assays in donor screening. [ABSTRACT FROM AUTHOR]

Background and objectives: In France, blood donation deferral for men who have sex with men (MSM) was reduced from permanent to 12 months in July 2016. Assessing noncompliance (rate and reasons) with this criterion is important to maintain a high level of viral safety in blood products. Materials and methods: An anonymous online survey (Complidon) of a sample of blood donors was conducted in 2017. Data were post‐stratified to be representative of all those who donated blood between July 2016 and December 2017. A multivariable analysis was performed to assess factors associated with noncompliance. Results: Among male donors, 0·73% [95% CI: 0·63–0·83] reported having sex with men in the 12 months preceding their donation. Factors associated with noncompliance were as follows: young age, a low educational level, concerns about privacy, and better knowledge of donor selection criteria and the window period than compliant men. More than half of noncompliant MSM donors (57·6% [95% CI: 50·6–64·3]) felt that sexual orientation should not be a criterion for donation, 47·2% [95% CI: 40·4–54·0] did not disclose their male‐to‐male sexual relations in order to avoid being excluded from donating, 40·5% [95% CI: 34·0–47·4] reported using condoms and 21·8% [95% CI: 16·7–27·9] had the same male partner for at least 12 months. Conclusion: Complidon showed that compliance with blood donation criteria in MSM was high, but not optimal, especially among younger men. HIV residual risk did not increase after the implementation of 12‐month deferral. Data from Complidon helped French policymakers to assess the additional HIV risk posed by increased access to blood donation for MSM. [ABSTRACT FROM AUTHOR]

Background: Blood donor selection, consisting of a pre-donation questionnaire and interview, excludes potential donors who may be at risk of transfusion-transmissible infections. Assessing the reasons for noncompliance with blood donor selection criteria is important to maintain a high level of viral safety of blood products.Study Design and Methods: An anonymous French online survey of a sample of blood donors (Complidon) was conducted from September to December 2017. Data were poststratified to be representative of all donors who donated blood between July 2016 and December 2017.Results: Of 420,190 solicited donors, 108,386 completed the survey (26%). Overall, noncompliance was estimated at 5.6%. The least respected criteria regarded sex with more than one partner during the previous 4 months for donors (1.9%) and for donors' partners (1%), travel-related criteria (1.2%) and sex between men during the previous 12 months (0.73% of men). Reasons for noncompliance differed according to criteria. Donors who were non-compliant to sexuality-based criteria mainly said they did not want to be excluded or that the questions were too personal. Conversely, donors who were exclusively non-compliant to criteria other than sexuality-based criteria more often mentioned their non-compliance during the pre-donation interview but were nevertheless authorized to donate blood.Conclusion: Despite noncompliance to blood donor criteria being relatively low in France, it still represents a threat to blood safety. Accordingly, improved communication is important to ensure that donors fully understand each selection criterion and to emphasize to health professionals the importance of listening carefully without judging during pre-donation interviews. [ABSTRACT FROM AUTHOR]

Background. The Demographic Surveillance System established in 1962 in Niakhar, Senegal, is the oldest in Africa. Here, we analyze trends in overall child mortality, malaria, and other causes of death in Niakhar from the beginning of data collection to 2010. Methods. After an initial census, demographic data were updated yearly from 1963 through 2010. From 1984, causes of death were determined by the verbal autopsy technique. Results. During 1963-2010, infant and under-5 mortality rates decreased from 223%0 to 18%0 and from 485%%0 to 41%0, respectively. The decrease was progressive during the entire observation period, except during 1990-2000, when a plateau and then an increase was observed. Malaria-attributable mortality in under-5 children decreased from 13.5%0 deaths per 1000 children per year during 1992-1999 to 2.2%0 deaths per 1000 children per year in 2010. During this period, all-cause mortality among children aged, 5 years decreased by 80%. Conclusions. Inadequate treatment for chloroquine-resistant malaria and an epidemic of meningitis during the 1990s were the 2 factors that interrupted a continuous decrease in child mortality. Direct and indirect effects of new malaria-control policies, introduced in 2003 and completed during 2006-2008, are likely to have been the key cause of the recent dramatic decrease in child mortality. [ABSTRACT FROM AUTHOR]

Complidon avait pour objectif d'évaluer le non-respect des critères de sélection au don de sang, suite à la modification des critères en juillet 2016. Complidon a interrogé, via Internet, les donneurs de sang (DS) ayant fait un don entre septembre et décembre 2017. Au total, 108 386 questionnaires ont pu être analysés, permettant d'estimer que 5,6 % des DS auraient dû être ajournés lors de leur dernier don, car présentant au moins une contre-indication (CI) parmi celles interrogées dans l'étude. Les CI les moins respectées étaient le multipartenariat du donneur (1,9 %) et de son partenaire (1,0 %) au cours des 4 mois précédant le don, celles liées aux voyages (1,2 %) et les rapports sexuels entre hommes dans l'année (0,73 % des hommes). Globalement, les raisons les plus citées pour justifier le non-respect des CI étaient le fait d'en avoir parlé lors de l'entretien pré-don et d'avoir été autorisé à donner (49 %), de l'avoir mentionné dans le questionnaire pré-don sans que la question soit ré-abordée dans l'entretien (15 %), puis la volonté de ne pas être exclu du don (11 %). Cependant, ces pourcentages variaient beaucoup selon les CI : les 2 premières raisons concernaient en majorité les CI relatives aux voyages, alors que ne pas vouloir être exclu concernait surtout les CI liées à la sexualité. Pour ces dernières, 34 % des DS justifiaient leur non-respect par l'usage systématique du préservatif. L'étude montre que les CI au don ne sont pas totalement respectées. Cependant, près de la moitié des répondants déclarant une CI dans Complidon en ont parlé lors de l'entretien pré-don et ont été autorisés à donner, ce qui suggère que ces DS sont à moindre risque que les candidats ajournés. [ABSTRACT FROM AUTHOR]

Depuis juillet 2016, les HSH sont autorisés à donner du sang total s'ils n'ont pas eu de rapports sexuels entre hommes au cours des 12 mois précédents. Cette modification s'est accompagnée d'un suivi renforcé incluant, en complément de la surveillance épidémiologique des donneurs, une enquête auprès des donneurs de sang (Complidon), afin de mesurer leur adhésion aux nouveaux critères de sélection. Complidon a permis d'estimer que 0,73 % des hommes ayant donné leur sang entre le 10/7/2016 et le 31/12/2017, avaient eu des rapports sexuels entre hommes au cours des 12 mois précédant le don. Les facteurs associés à ce non-respect étaient d'avoir moins de 30 ans, d'avoir eu plus d'un partenaire sexuel dans les 12 derniers mois, d'avoir oublié ou dissimulé des informations lors de l'entretien pré-don, de connaître les contre-indications au don, de travailler dans le domaine de la santé et d'avoir trouvé le questionnaire et l'entretien pré-don insuffisamment confidentiels. Malgré ce taux de non-respect au critère HSH 12 mois, l'ouverture du don de sang aux HSH n'a pas eu d'impact, ni sur les taux de dons VIH positifs (0,08 p. 10 000 dons du 1/1/2015 au 9/7/2017 vs. 0,07 du 10/7/2016 au 31/12/2017), ni sur la part des HSH parmi les donneurs VIH positifs (environ 50 % des hommes sur les 2 périodes), ni sur le risque résiduel de transmission du VIH par transfusion (1/4 300 000 dons vs. 1/6 400 000 dons). Ces résultats permettent d'envisager une ouverture plus large du don de sang aux HSH. Deux scénarios sont actuellement à l'étude : ajournement en cas de rapports sexuels entre hommes dans les 4 derniers mois ou ajournement si plus d'un partenaire sexuel dans les 4 derniers mois. [ABSTRACT FROM AUTHOR]

Background and Objectives: Since the advent of AIDS, men who have sex with men (MSM) have often been deferred from blood donation. In France, quarantine plasma donation by MSM donors with the same deferral rules as for other donors was introduced in July 2016 and continued up to March 2022. At this time, MSM‐specific deferral criteria were lifted for all blood or plasma donation. The donor deferral, as well as rate of infectious markers in plasma donors who would have been otherwise deferred for MSM activity, was evaluated and compared with those of the other donors during the same time period from June 2016 to March 2022. Results: A total of 8843 MSM donors made 12,250 plasma donation applications. The overall deferral rate was very high (75.2%), mainly due to the absence of apheresis capacity at the donation site. The deferral criteria for sexual risk were present in 12.1% of MSM donors compared with 1.0% in other plasma and blood donors (p < 0.001). Overall, 994 MSM donors made 2880 plasma donations. Of these, one donation was HIV positive (34.7 vs. 0.6/105 donations by other donors, relative risk [RR]: 61.0 [95% confidence interval [CI]: 8.5–437.7]), one was HBV positive (34.7 vs. 4.5/105, RR: 7.7 [95% CI: 1.1–54.6]) and none were HCV positive (0 vs. 2.4/105). Additionally, 21 donations were syphilis positive (729.2 vs. 10.7/105, RR: 67.9 [95% CI: 44.2–104.4]). A post hoc analysis of eligible MSM donors who were unable to donate plasma due to logistic constraints yielded similar findings. Conclusion: Plasma donation by donors who would have been otherwise deferred for MSM activity was associated with both an increased deferral rate for sexual risk and an increased rate of infectious markers, notably syphilis. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) pandemic continues to have great impacts on the care of non-COVID-19 patients. This was especially true during the first epidemic peak in France, which coincided with the national lockdown. The aim of this study was to identify whether a decrease in stroke admissions occurred in spring 2020, by analyzing the evolution of all stroke admissions in France from January 2019 to June 2020. Methods: We conducted a nationwide cohort study using the French national database of hospital admissions (Information Systems Medicalization Program) to extract exhaustive data on all hospitalizations in France with at least one stroke diagnosis between January 1, 2019, and June 30, 2020. The primary endpoint was the difference in the slope gradients of stroke hospitalizations between pre-epidemic, epidemic peak, and post-epidemic peak phases. Modeling was carried out using Bayesian techniques. Results: Stroke hospitalizations dropped from March 10, 2020 (slope gradient: −11.70), and began to rise again from March 22 (slope gradient: 2.090) to May 7. In total, there were 23,873 stroke admissions during the period March–April 2020, compared to 29,263 at the same period in 2019, representing a decrease of 18.42%. The percentage change was −15.63%, −25.19%, −18.62% for ischemic strokes, transient ischemic attacks, and hemorrhagic strokes, respectively. Discussion/Conclusion: Stroke hospitalizations in France experienced a decline during the first lockdown period, which cannot be explained by a sudden change in stroke incidence. This decline is therefore likely to be a direct, or indirect, result of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Le critère de sélection des donneurs de sang pour les hommes qui ont des relations sexuelles avec les hommes (HSH) a évolué dans de nombreux pays, mais reste toujours au cœur des débats. Au début des années 80, les HSH ont été exclus du don de sang, car étant à haut risque d'infection par le VIH. Grâce à une évolution favorable du contexte épidémiologique du VIH, à l'amélioration de la sélection des donneurs et à la généralisation du dépistage génomique viral, de nombreux pays ont mis en œuvre un ajournement des HSH d'une durée de 12 mois puis 4 ou 3 mois. Aucune augmentation du risque résiduel VIH n'a été observée dans ces pays. En France, le passage à un ajournement de 12 mois en juillet 2016 n'a pas eu d'impact négatif, en termes de prévalence ou d'incidence du VIH, de nombre de dons en infection très récente (ARN-VIH positifs/Ac anti-VIH négatifs) ou de risque résiduel VIH (estimé à 1/6,6 millions de dons sur la période 2016–2018). Suite à ces indicateurs rassurants et à une analyse de risque montrant qu'une durée d'ajournement raccourcie n'augmenterait pas ce risque, celle-ci a été réduite à 4 mois le 2 avril 2020. Plusieurs pays, dont la France, souhaitent aller plus loin en adoptant des critères de sélection identiques pour tous les donneurs, comme vient de le mettre en place le Royaume-Uni. En France, le recul est insuffisant pour permettre l'évaluation de l'impact d'un ajournement de 4 mois. Toutefois, la réduction du risque résiduel VIH observée sur la période 2018–2020 (1/11,6 millions de dons) montre que le contexte est favorable pour envisager dès 2022 une évolution des critères qui ne soient plus fondés sur le genre du ou des partenaires sexuels des donneurs. [ABSTRACT FROM AUTHOR]

Background: Blood donation deferral for men who have sex with men (MSM) in France was reduced from permanent to 12 months in July 2016. To inform a further reduction of the deferral period, an HIV risk assessment was conducted with two scenarios: S1, 4-month deferral; S2, 4-month deferral only in the case of more than one sexual partner (i.e., similar to other blood donors).Methods: Baseline HIV residual risk (RR) was calculated from July 2016 to December 2017, using the Incidence Rate-Window Period method. The impact of both scenarios on RR was assessed using data from surveys on MSM and blood donors, to estimate 1) the number of additional MSM expected to donate in each scenario and 2) HIV incidence among these donors.Results: Baseline HIV RR was estimated at 1 in 6,380,000 donations. For S1, an additional 733 MSM donors, and an additional 0.09 HIV-positive donations were estimated, yielding an unchanged RR of 1 in 6,300,000. For S2, these numbers were estimated at 3102 and 3.92, respectively, yielding an RR of 1 in 4,300,000. Sensitivity analyses showed that, under worst-case assumptions, the RR would equal 1 in 6,225,000 donations for S1 and 1 in 3,000,000 for S2.Conclusion: For both scenarios, the HIV RR remains very low. For S1, the risk is identical to the baseline RR. For S2, it is 1.5 times higher, and sensitivity analysis shows that this estimate is less robust than for S1. The French Minister of Health announced that S1 will be implemented in April 2020. [ABSTRACT FROM AUTHOR]

Depuis juillet 2016, les HSH sont autorisés à donner du sang total s'ils n'ont pas eu de rapports sexuels entre hommes au cours des 12 mois précédant le don. Cette modification n'ayant pas eu d'impact sur le risque résiduel (RR) VIH, une ouverture plus large du don de sang aux HSH est envisagée. Deux scénarios sont étudiés : S1. ajournement si rapports sexuels entre hommes dans les 4 derniers mois ; S2. ajournement si multipartenariat dans les 4 derniers mois. Le RR VIH de référence a été estimé à 1 pour 6 380 000 dons sur la période juillet 2016-décembre 2017. Le RR VIH pour chacun des scénarios est basé sur l'estimation du nombre de donneurs HSH supplémentaires à partir de 3 enquêtes (Baromètre Santé 2016, Enquête Rapport au Sexe 2017 et Complidon 2017) et sur l'incidence du VIH parmi ces donneurs. Dans S1, l'incidence est celle estimée chez les donneurs HSH avec le critère actuel (ajournement 12 mois). Dans S2, elle est obtenue à partir de l'estimation de l'incidence du VIH chez les HSH monopartenaires en population générale. Dans S1, le RR VIH est estimé à 1 pour 6 300 000 dons et l'analyse de sensibilité montre que cette estimation est robuste aux variations des paramètres du modèle. Dans S2, il est estimé à 1 pour 4 300 000 dons, soit 1,5 fois le RR de référence, mais cette estimation est moins robuste puisque le RR maximum serait de 1 pour 3 000 000 dons, 2 fois supérieur au RR de référence. Basé sur ce type d'analyse de risque, l'Australie et le Canada envisagent un ajournement des HSH de 3 mois et le Royaume-Uni est passé à 3 mois d'ajournement fin 2017. La France devrait prendre une décision sur le choix de l'un des deux scénarios étudiés au cours de l'année 2019. [ABSTRACT FROM AUTHOR]

Background: In the last decade, European cities saw the development of "slamming," a practice related to chemsex that combines three elements: a sexual context, psychostimulant drug use, and injection practices. Epidemiological data on this practice is still sparse and media attention might have unintentionally distorted the size of this phenomenon. Therefore, we aimed to estimate the prevalence of men practicing slam and to identify factors associated with this practice.Methods: We used data from the Prevagay 2015 bio-behavioral survey to estimate the prevalence of slamming practices. A time-location sampling was performed among gay-labeled venues in five French cites. Behavioral information was recorded using a self-administered questionnaire. The HIV and HCV serostatus were investigated using ELISA tests on dried blood spots. The factors associated with slamming were assessed using a multiple logistic regression. We applied a weighting mechanism to enhance the generalizability of the estimates.Results: Among the 2646 men who have sex with men (MSM) included in our study, 3.1% reported slamming at least once during their lifetime (95% confidence interval (CI) = 2.2-4.3) and 1.6% (95% CI = 1-2.3) said they participated in a slamming session in the last 12 months. In the multivariate analysis, both HCV and HIV biological status were strongly associated with practicing "slam" in the last 12 months (OR = 13.37 (95% CI = 3.26-54.81) and 4.73 (95% CI = 1.58-14.44), respectively). Furthermore, a ten-point decrease in mental health scores was linked with the practice with an OR of 1.37 (95% CI = 1.08-1.73), indicating poorer mental health.Conclusion: Even though slamming seems to involve a relatively small proportion of MSM, the vulnerability of this sub-group is high enough to justify setting up harm reduction measures and specific care. Training health professionals and creating services combining sexual health and drug dependence could be an effective response. [ABSTRACT FROM AUTHOR]

Background: Over the last 20 years, Hepatitis C virus (HCV) infection prevalence has dramatically increased among HIV-infected men who have sex with men (MSM) in many countries worldwide. It is suspected that this increase is primarily driven by sexual behaviours linked to blood exposure. Monitoring these behaviours is crucial to understand the drivers of the epidemic. This study assessed the prevalence of chronic HCV infection among MSM attending gay venues and associated chronic HCV risk factors. HCV screening and associated factors were described.Methods: The cross-sectional survey PREVAGAY, based on time-location sampling, was conducted in 2015 among MSM attending gay venues in 5 French metropolitan cities. A self-administered questionnaire was completed and capillary whole blood on dried blood spots (DBS) collected. Possible factors associated with chronic HCV prevalence and with HCV screening in the previous year were investigated using Poisson regression.Results: Chronic HCV infection prevalence from DBS analysis was 0.7% [IC95%: 0.3-1.5] in the study's 2645 participants and was 3.0% [1.5-5.8] in HIV-positive MSM. It was significantly higher in those who reported the following: (lifetime) slamming (with or without the sharing of injection equipment); (during the previous year) fisting and chemsex, unprotected anal intercourse with casual partners, using gay websites and/or of mobile-based GPS applications, and having more than 10 sexual partners. Only 41.3% [38.2-44.5] of the participants reported HCV screening during the previous year. Screening was significantly more frequent in MSM under 30 years of age, those who were HIV-positive, those vaccinated against hepatitis B and meningococcus C, and those who reported the following (during the previous year): more than 10 sexual partners, at least one sexually transmitted infection and fisting.Conclusion: Chronic HCV infection prevalence in MSM attending gay venues was significantly higher in HIV-positive MSM and in those with risky sexual behaviours. Reflecting current screening recommendations for specific populations, previous HCV screening was more frequent in HIV-positive individuals and those with risky sexual behaviours. Nevertheless, HCV screening coverage needs to be improved in these populations. Comprehensive medical management, which combines screening and linkage to care with prevention strategies, is essential to control HCV among MSM. [ABSTRACT FROM AUTHOR]