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Nutritional problems are a common manifestation of psychological suffering of an infant and the dysfunction of the mother-infant interaction. The results of a psychological support programme run by Me´decins Sans Frontie`res for severely malnourished children and their mothers in Hebron (Palestine) are described. From December 1995 to May 2000, 382 infants from 0 to 3 years of age were admitted into an integrated nutritional programme involving psychotherapy after treatment failure in a strictly medico-nutritional programme. The mother-infant interaction as well as the psychological state of the mother and infant were evaluated on inclusion, after 3 months and at discharge from the programme. Early interaction between the mother and malnourished infant are described in this article. A resolution of psychological issues and nutritional status was seen after psychotherapy. The parallel between the improvement of mother-child interaction and improvement of nutritional status raises the question of whether psychological screening should be included in nutritional programmes, in all contexts of food scarcity, in order to improve the care of malnourished infants. [Copyright &y& Elsevier]

It is difficult to estimate the increase of the incidence of mucormycosis at a country level because of the low number of studies in general population. This article analyzes and completes the initial data of a previous study carried out between 1997 and 2006 by covering the period 1997-2010 and by integrating a detailed study of the risk factors, confirming the existence of a real increase of incidence of mucormycosis linked with the increasing number of the persons at risk., (© 2013 médecine/sciences – Inserm / SRMS.)

Introduction: Scabies is a contagious parasitic infestation that is benign in most cases; however, delay in diagnosis and treatment can cause numerous problems for patients and people in their vicinity, as well as a risk of secondary spread. Following numerous reports suggesting increased incidence of scabies in France, we analysed various available indicators., Methods: We analysed spontaneous and mandatory reports submitted to public health bodies as well as sales figures for scabies treatments in France over the period between 1999 and 2010., Results: Reports submitted to public health structures suggest an increase in the number of cases of scabies both within the community and in healthcare establishments. An increase was seen in regional and national sales of scabies treatments. At the national level, between 2005 and 2009, sales rose from 283 to 402 bottles per 100,000 persons per year (+10% per year) for benzyl benzoate and from 216 to 495 treatments per 100,000 persons per year (+22%) for ivermectin. Based on these data, the minimum estimated annual incidence of scabies in France is 328 cases per 100,000 persons., Discussion: There is some discussion surrounding the interpretation of these data, particularly the bias associated with reporting practice and with the protocols used to treat affected subjects and those in their vicinity. However, all of the information gathered indicates a real increase in the incidence of scabies in France, as a result of which we recommend increased information for the general public, clinical practitioners and public health partners in order to ensure early diagnosis and treatment., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

One of the objectives of the surveillance systems implemented by the French National Institute for Public Health Surveillance is to detect communicable diseases and to reduce their impact. For emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. The surveillance systems detect a variety of events, or "signals" which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, or an abnormal number of cases for a well-known disease. These signals are first verified and analyzed, then classified as: potential public health threat, event to follow-up, or absence of threat. Through various examples, we illustrate the method and criteria which are used to analyze and classify these events considered to be emerging. The examples highlight the importance of host characteristics and exposure in groups at particular risk, such as professionals in veterinarian services, health care workers, travelers, immunodepressed patients, etc. The described method should allow us to identify future needs in terms of surveillance and to improve timeliness, quality of expertise, and feedback information regarding the public health risk posed by events which are insufficiently documented., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

The French public health institute is responsible for promoting and coordinating threats the detection and assessment of health risks, and for suggesting possible responses. Transmissible diseases affecting both human and animal health are the focus of surveillance networks. Early detection of potential infectious threats is based on the screening of "alert signals" identified through routine surveillance networks and other systems. The quality and accuracy of these signals is first verified, before assessing, through a multidisciplinary approach, the risk of introduction and dissemination. This article examines specific cases illustrating the process of detection, risk analysis and response, with respect to infectious threats that are endemic in tropical regions and have the potential to be imported into metropolitan France. For both novel pathogens and exotic diseases--which, not being endemic in France, are less well known--the analysis and response process must regularly be adapted to the latest epidemiological, clinical and biological findings, taking interactions between the pathogen, host, and environment into consideration. The need to improve reaction times and risk assessment is also discussed.

Tuberculosis causes an ever-increasing public health burden throughout the world and is one of the World Health Organization's top priorities. In France, the incidence of tuberculosis has been stable at around 10 cases per 100 000 inhabitants per year since 1997. In 2004, the incidence rate in 2004 was 9.2 per 100 000, with substantial geographic disparities: the Ile-de-France region (including Paris and its suburbs) accounted for more than 40% of all reported cases (20.8 per 100 000). Incidence rates of tuberculosis vary according to the geographic origin: in France, this rate is highest among people from sub-Saharan Africa (incidence rate: 166.7 per 100.000 compared with 5.0 per 100.000 for those born in France). Pulmonary tuberculosis is the disease form most commonly observed (71.5% of cases). Among those cases, 76.9% were laboratory-confirmed in 2004. National guidelines to improve case management and disease control were updated in 2003 and 2005. Funding must be made available to reinforce tuberculosis surveillance and to conduct public health initiatives targeted at the populations most at risk.

Tuberculosis is still a concern in France, especially in the Paris region and among people originating from highly endemic countries. In 2003, 6098 cases of tuberculosis were notified in France (10.2 per 100000). The patients' median age was 42 years, and 61% of patients were male. Most cases involved pulmonary tuberculosis (71.7%), but there were also 113 cases of tubercular meningitis (1.9%). Among documented cases, 43.9% were of foreign origin and 47.8% of patients were born abroad. The incidence among people born in France declined year on year until 2003, but has increased in the last two years in the 0- to 14-year age group. At the same time the incidence of tuberculosis has been increasing among young people born in sub-Saharan Africa, and the number of cases due to multidrug-resistant strains is also increasing. Official guidelines have been updated in order to improve the prevention and control of tuberculosis. Enhanced surveillance and appropriately funded public health initiatives are needed to reinforce the fight against tuberculosis in France.

Cholera epidemics in refugee camps represent a major public health emergency. In camps, precarious living conditions contribute to the transmission of the vibrio. Among the major epidemics reported in camps, we note as well those which have affected Africa in the last two decades. These epidemics are characterized by high attack rates and high case fatality ratios. Attack rates in refugee camps can exceed 5%. Appropriate control measures are adopted at international level. Actions carried out urgently must allow the proper supply of water, the control of excreta, and the improvement of general sanitary conditions and individual hygiene. Efficient management of cases in specialized cholera treatment centres (CTC) should decrease the case fatality ratio to less than 1%. Treatment is mainly based on the prompt rehydration of patients. For wide camps, rapid access to oral rehydration units is essential. Availability of all necessary equipment in kit form is required.