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Rabies is a zoonosis of viral origin responsible for tens of thousands of human deaths each year in countries where dog rabies is not controlled and where post-exposure prophylaxis -PEP- is not available to populations the most vulnerable. In France, the epidemiology of rabies has changed for 20 years and our territory is currently declared free from rabies in terrestrial animals since 2001. This favorable epidemiology no longer justifies the administration of PEP in individuals exposed to an animal -except bats- in France except in French Guiana because of the risk of desmodin-type rabies in South America.RAGE La rage est une zoonose d’origine virale responsable de plusieurs dizaines de milliers de décès humains chaque année dans les pays où la rage du chien n’est pas contrôlée et où la prophylaxie post-exposition n’est pas accessible aux populations les plus vulnérables. En France, l’épidémiologie de la rage a changé depuis 20 ans et notre territoire est actuellement déclaré indemne de rage des mammifères terrestres depuis 2001. Cette épidémiologie favorable ne justifie plus l’administration de prophylaxie post-exposition chez les individus exposés à un animal -hors chauve-souris- en France, sauf en Guyane en raison du risque de rage desmodine en Amérique du Sud.

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens.Les morsures animales et humaines sont un motif fréquent d’admission aux urgences et leur infection est fréquente, alors qu’elles sont souvent banalisées. Les complications peuvent aller d’une simple dermohypodermite au choc septique, notamment chez les patients aspléniques lors d’infection à Capnocytophaga canimorsus. D’autres infections moins communes sont possibles comme la « rat-bite fever », la leptospirose, la tularémie, et l’évaluation des prophylaxies postexpositionnelles (antitétanique, antirabique ; VIH, VHB en cas de morsures humaines) est primordiale. L’antibioprophylaxie reste controversée, mais est recommandée pour certains groupes de patients, et se doit de couvrir les germes retrouvés fréquemment lors de morsures.

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens.

The objective of this study is to determine the effects of mobile telephony on the improvement of post-exposure prophylaxis compliance at the Abidjan anti-rabies center.This is a descriptive and analytical cross-sectional study, which ran from September 2014 to May 2015. The data collection took place in two stages: first interview of all patients at the anti-rabies center at their first consultation, then a telephone interview three days after, only for those who had abandoned their prophylaxis.The results indicated that after telephone calls, the dropout rate dropped from 59.3% to 44.8%. Discontinuations were less frequent in patients who received a veterinary surveillance notice (ORa = 0.23, 95% CI [0.11-0.48]), who had at least one veterinary certificate (ORa = 0.25 95% CI [0.15-0.43]) or more than two doses of vaccine (ORa = 0.23, 95% CI [0.12-0.42]) before telephone call. However, dropout rates were high in patients aged 20 to 29 years (ORa = 2.66, 95% CI [1.25-5.68]) and in patients with category III exposure (ORa = 2.19, 95% CI [1.12-54.3]).These results show that mobile telephony is a useful tool for educating patients to adhere to post-exposure prophylaxis. However, information and public awareness campaigns on the fatal outcome of rabies must be organized.

The transmission of an infectious disease can occur through exposure to blood or other potentially infectious body fluids, particularly in the event of skin-puncture injuries for healthcare workers, and during sexual intercourse. These situations are known as accidental blood exposures and sexual exposures respectively. Combined actions carried out have allowed to significantly reduce risks, either to healthcare professionals (by standard precautions, provision of safety devices, Hepatitis B vaccination made compulsory in the 1990s, antiretroviral post-exposure prophylaxis that should be initiated as soon as possible after exposure), or to people engaging in unprotected sex (by prevention messages, condom promotion, and antiretroviral post-exposure prophylaxis). In any case, treatment of people infected by chronic diseases such as HBV or HIV, as well as possible drug eradication of HCV, are key for decreasing post-exposure risk of disease transmission. Post-exposure prophylaxis should be initiated as early as possible and intended for use only in patients with high-risk exposures. Knowledge of source person serostatus, information of exposed person on prevention, benefits and risks of treatment, and follow-up procedure are key points. Procedures to be followed in the event of an exposure must be known by all. Arrangements set up to allow risk assessment and management of exposed people rely on hospital services operating on a permanent basis.

Introduction le but de cette étude était de décrire les connaissances, attitudes et pratiques du personnel des salons de coiffure sur l'infection à VIH à Lomé. Méthodes il s'est agi d'une étude descriptive, dont la population d'étude était constituée par les patrons et les apprentis des salons de coiffure de la préfecture d'Agoè-nyivé à Lomé entre le 1er octobre 2016 et le 31 mars 2017. Les différents paramètres étudiés étaient les données sur la connaissance générale du VIH, les attitudes et pratiques sur le VIH/sida dans les salons de coiffure. Résultats au total, 203 patrons et apprentis présents dans les 68 salons de coiffure des préfectures d'Agoè-nyivé ont été enquêtés. L'infection à VIH/ sida était connue par tous (100%) les participants et 79,3% d'entre eux la définissaient comme étant une infection sexuellement transmissible. Le port de tablier ou de gants avant certains gestes de coiffure était fait dans respectivement 33(51,5%) et 35(48,5%) salons de coiffures. Aussi, dans 60(88,2%) salons de coiffure, une décontamination des objets tranchants était faite avant leur usage. Cependant, l'alcool était le désinfectant le plus utilisé par la majorité (89,3%) du personnel des salons de coiffure. Aussi, l'ébullition pendant en moyenne 7 minutes était réalisée par 79,8% des coiffeurs. En cas d'accident d'exposition au sang, 69,6% du personnel des salons de coiffure faisaient un nettoyage du site exposé avec de l'alcool. Conclusion cette étude a montré que les coiffeurs/coiffeuses et leurs apprentis ont de bonnes connaissances sur l'infection à VIH/sida, sur ses modes de transmission et ses moyens de prévention dans les salons de coiffure. Cependant, certaines pratiques dont les méthodes de désinfections du matériel souillé et la conduite en cas d'accidents d'exposition au sang étaient mauvaises.

Human rabies is a major public health problem in many African countries, including Ivory Coast. The objective of this study was to evaluate the influence of human rabies knowledge on compliance with post-exposure prophylaxis.We conducted a descriptive and analytical cross-sectional study from September 2014 to May 2015 at the Abidjan Rabid Center, Treichville. After having given their consent, were interviewed, patients who came for a first consultation and who gave a mobile phone number available for the appointment reminder after abandoning or not starting the post-exposure prophylaxis. Data were processed with Epi Info version 3.5.3. Pearson's chi-square test and Fisher's exact test were used for statistical analysis with a significance level of 5%.A total of 744 patients were interviewed. Men accounted for the majority (58.2%) of those surveyed, with a sex ratio (M/F) of 1.7. The average age of patients was 24.55 (±17.3) years. The analysis showed that 42.6% (317/744) of the interviewees had heard of human rabies. However, having heard of human rabies did not influence adherence to post-exposure prophylaxis (P0.05). Nevertheless, the post-exposure prophylaxis regimen was completed more often by subjects who knew that agitation is a sign of rabies than those who did not (ORa=0.4343, 95%CI=[0.204-0.925]). Subjects knowledgeable about disease transmission (animal bites) were less likely to continue their post-exposure prophylaxis than those unaware of this relationship (ORa=8.544, 95%CI=[1.002-72.869]).The main factors identified in this study that influenced the observance of post-exposure prophylaxis were knowledge of the manifestation of human rabies (signs of agitation) and of the mode of transmission of this disease (animal bites). With a view for better prevention against human rabies, rural and urban populations should be informed, educated and sensitized about this 100% life-threatening but vaccination-preventable disease.

L’infection par le virus de l’immunodéficience (VIH) reste un problème de santé public dans le monde. Les jeunes adultes sont ceux qui paient le tribut le plus lourd dans l’épidémie du VIH, 40% de nouveaux cas sont dans la tranche d’âge de 15 à 24 ans. Il existe quatre stratégies de prévention de l’infection VIH. La prophylaxie post-exposition (PEP) par l’administration d’un traitement antirétroviral chez les patients exposés en situation post-coïtale est une de ces stratégies. La probabilité de transmission du VIH dépend du type d’exposition, de l’état d’infectivité de la source et de la susceptibilité de la personne ayant été exposée. Le risque pour un individu d’acquérir le VIH après un accident d’exposition peut être calculé en multipliant le risque que la personne source soit VIH positive par le risque lié à l’exposition. La prophylaxie est recommandée lorsque le risque de transmission est supérieur à 1/1000, à considérer lorsque le risque est compris entre 1/1000 et 1/10 000. Lorsque le risque de transmission est inférieur à 1/10 000, la prophylaxie n’est pas recommandée. Dans tous les cas l’évaluation du risque doit se faire au cas par cas. La plupart des recommandations récentes recommandent 2 inhibiteurs nucléosidiques de la transcriptase inverse (NRTI) associés soit à un inhibiteur de l’intégrase (INI), soit à un inhibiteur de protéase boosté par le Ritonavir (IP/r). Le traitement sera initié idéalement dans les 24h et au plus tard 72h après l’exposition et dure 28 jours. Un contrôle de la sérologie VIH sera réalisé à 8 et 12 semaines avec un test sanguin de 4ème génération. Un soutien psycho-social et un accompagnement sont proposés pendant cette période. [Prophylaxis in case of non-occupational exposure to human immunodeficiency virus (hiv): an update] Infection with the human immunodeficiency virus (HIV) remains a public health concern worldwide. Young adults are the most affected by the pandemic, with 40% of new cases concerning people from the 15-24 year age group, which also is the most sexually active. There are four prevention strategies of HIV infection. One of them is post-exposure prophylaxis (PEP) by the administration of antiretroviral therapy, which can be used in post-coital situation for exposed patients. The probability of HIV transmission depends on the type of exposure, infectivity level of the source, and susceptibility of the exposed person. The risk of acquiring HIV after an exposure incident can be calculated by multiplying the risk that the source person is HIV-positive by the risk of exposure. Prophylaxis is recommended when the risk of transmission is greater than 1/1,000 and must be considered when the risk is between 1/1,000 and 1/10,000. When this risk is below 1/10,000, prophylaxis is not recommended. All cases need to be evaluated on an individual basis. Most recent guidelines recommend two nucleoside reverse transcriptase inhibitors (NRTI) associated with either an integrase inhibitor (INI) or a boosted protease inhibitor (PI/r). The treatment should be initiated as soon as possible after exposure, preferably within 24 h or, at the latest, within 72 h. The treatment duration is 28 days. HIV serology is performed at Day 0, Week 8 and Week 12 using a 4th generation blood test. Counselling on HIV prevention should be provided during the follow-up.

The emergency room is a stressful environment with poor privacy. Even so, sexually transmitted infections (STIs) need to be handled in such a setting. Some STIs can hide behind common clinical pictures. Signs and symptoms of acute retroviral syndrome, other STIs as well as the initiation of postexposure prophylaxis (PEP) need to be known and managed by an emergency physician and are discussed in this article.Même dans le contexte stressant et parfois peu confidentiel des urgences, le sujet délicat des infections sexuellement transmissibles (IST) doit être abordé. Celles-ci peuvent se cacher derrière certains tableaux cliniques fréquemment rencontrés. De même, les signes et symptômes de la primo-infection VIH ou d’autres IST, ainsi que l’initiation d’une prophylaxie post-expositionnelle (PEP), qui reste une course contre la montre, sont des points-clés à maîtriser par l’urgentiste et sont abordés dans cet article.

Two challenges were identified to improve the place of PEP in combined prevention: (1)#160;improvement of healthcare professionals#8217; knowledge, practices and attitudes; and (2)#160;revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support./ce:para.

Chronic hepatitis B virus (HBV) infection leads to a risk of developing cirrhosis and hepatocellular carcinoma. In France, where the prevalence of HBV is low, mother-to-child transmission is the cause of chronic infection in more than one-third of cases. After exposure, the risk of chronic infection is the highest for newborns (90 %). The World Health Organization implemented a global immunization program in 1991, applied in France in 1994. A significant number of children are infected each year, however, and failure of postexposure prophylaxis is reported in 4-10 % of newborns. We report 11 children with chronic HBV infection due to failure of serovaccination, followed up in two centers between 1993 and 2015. We discuss maternal screening, serovaccination, and follow-up conditions, as well as the role of maternal viral load, amniocentesis, and mode of delivery as risk factors. These observations confirm that serovaccination failures are related to the nonobservance of recommendations for maternal screening or postexposure prophylaxis, and to a high maternal viral load (10

Antiretroviral drugs are primarily used to treat people living with HIV but can also reduce the risk of transmission. The first application of this prophylactic approach was in the prevention of mother-to-child transmission, which comprises three components: 1) antiretroviral therapy during pregnancy to reduce maternal viral load, 2) pre-exposure prophylactic treatment of the fetus in utero and intrapartum, and 3) postexposure neonatal treatment. This has resulted in a sharp reduction in mother-to-child transmission, to well below 1 % in France today. "Treatment as prevention" (TASP) is now widely recommended to prevent sexual transmission to partners of people living with HIV articularly when a couple wishes to have children. Achieving and sustaining undetectable viral load is an important means of reducing the risk of sexual transmission in serodiscordant couples and also of controlling the pandemic worldwide. The other uses of antiretroviral drugs to protect HIV-negative people at risk include post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). Prevention has both individual and collective dimensions and involves several components, including behavioral changes, serological testing, and use of antiretrovirals.

Two challenges were identified to improve the place of PEP in combined prevention: (1) improvement of healthcare professionals’ knowledge, practices and attitudes; and (2) revision of the guidelines concerning first-line prescription, the conditions for access to PEP, and sexual health support. .

In Nantes, the Médecins du Monde bus goes out three nights a week to meet women working as prostitutes. The objective is to create a connection, to inform and to prevent the risks inherent to their activity. In this article a nurse shares with us the experience of her round.

Every day physicians are confronted with situations that require evaluation concerning the indication for a post-exposition prophylaxis (PEP) for HIV or, less frequently, for hepatitis B (HBV). There is no specific prophylaxis for hepatitis C (HCV). In light of the experience gained in the domain of HIV in the last years, some international guidelines for PEP have been changed with regard to the choice of drugs and when to start PEP. This article attempts to resume the different factors contributing to the evaluation of PEP according to the local guidelines and to introduce the foreseen changes in the new Swiss-guidelines for PEP that will be released in autumn 2013.

Despite the availability of effective anti-rabies vaccine, rabies keeps affecting people in developing countries such as Côte d'Ivoire. The low compliance with Post Exposure Prophylaxis (PEP) partially explains this situation. This study was aiming at studying the reasons to abandon PEP. This descriptive and cross-sectional study has taken place at the anti-rabies Center of Abidjan from October 1st to December 2009. Data were collected in two steps: we first interviewed all the patients at the anti-rabies center during their first consultation, and then phone interviews were conducted one month later, only with exposed patients who abandoned their PEP. These phone calls allowed us to complete the questionnaire (the status of the animal and PEP discontinuation). Patients' verbal informed consent was obtained prior to data collection. Besides, patients were explained the risks they were exposed to and were advised to complete immunization. The results obtained revealed that, out of 220 people included in the study, 116 (52.7%) abandoned the PEP. The compliance was lower with the protocol of five injections compared to that of four injections. More than half of the patients abandoned PEP after the first injection. In 32.8% of patients who abandoned PEP, the animal was dead, disappeared, was destroyed or there were no information about it one month after bite or scratch. Animal owners' refusal of taking in charge the victims (20%) and the lack of financial resources for purchasing the vaccine (13.6%) were the most frequent reasons to abandon PEP. To increase the protection of the human population against rabies and to increase the compliance with PEP protocols, the improvement of financial accessibility to the vaccine for population and the elaboration of compulsory regulations for animal owners to take in charge the PEP are necessary.

News related to HIV/AIDS was marked in 2012 both by emerging therapies, as well as by the changes management strategies. Therefore, we will discuss the crucial issue of when to start antiretroviral therapy, which appears to be more and more early. Furthermore, after the U.S. validation of the pre-exposure prophylaxis for individuals at high risk of HIV acquisition, prevention of HIV transmission has returned to the spotlight. Finally, we will review some promising novel molecules whose mechanisms of action, half-life or low dosage open the door to new treatment strategies.

International audience; Rabies virus, a neurotropic lyssavirus responsible for unavoidable fatal encephalitis, is transmitted by saliva of infected animals through bite, scratch or licking of broken skin or a mucous membrane. Infection can be prevented by timely prevention (wash for several minutes, antisepsis and vaccination completed by antirabies immunoglobulins [Ig] according to the severity of exposure). The 55,000 human deaths estimated annually worldwide result mainly from uncontrolled canine rabies in enzootic countries (particularly in Africa and in Asia), attributable to a lack of resources or interest for this disease. Bat rabies, henceforth first cause of human's rabies in many countries in America, affects a very small number of individuals but seems more difficult to control. Shortened vaccine protocols, rationalized use of Ig and development of products of substitution should enhance access of exposed patients to prevention. Finally, research on the biological cycle, the pathogeny and on escape of virus-induced mechanisms from the immune system should continue to pave the way for presently unknown treatments of clinical rabies.

News related to HIV/AIDS was marked in 2012 both by emerging therapies, as well as by the changes management strategies. Therefore, we will discuss the crucial issue of when to start antiretroviral therapy, which appears to be more and more early. Furthermore, after the U.S. validation of the pre-exposure prophylaxis for individuals at high risk of HIV acquisition, prevention of HIV transmission has returned to the spotlight. Finally, we will review some promising novel molecules whose mechanisms of action, half-life or low dosage open the door to new treatment strategies.

Every day physicians are confronted with situations that require evaluation concerning the indication for a post-exposition prophylaxis (PEP) for HIV or, less frequently, for hepatitis B (HBV). There is no specific prophylaxis for hepatitis C (HCV). In light of the experience gained in the domain of HIV in the last years, some international guidelines for PEP have been changed with regard to the choice of drugs and when to start PEP. This article attempts to resume the different factors contributing to the evaluation of PEP according to the local guidelines and to introduce the foreseen changes in the new Swiss-guidelines for PEP that will be released in autumn 2013.

Control of human rabies in developing countries depends on prevention in dogs. The purpose of this study was to evaluate the cost-saving potential for the public health sector of intervention to control rabies in animal-host reservoirs. An existing deterministic model was adapted to allow study of dog-to-human rabies transmission. Model parameters were fitted to data from routine weekly reports on the number of rabid dogs and human rabies exposures in N'Djamena, Chad. At the onset of study, the estimated effective reproductive ratio (Re) was 1.01 indicating stable low-level endemic rabies transmission. Simulations were performed to determine what effects mass vaccination and culling of dogs would have on the incidence of human rabies. Findings showed that a mass campaign allowing single parenteral vaccination of at least 70% of the canine population would be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to that of "postexposure prophylaxis" (PEP) which would not reduce future human exposure. Results showed that a sustained 5-year PEP program together with a dog-vaccination campaign would be as cost-effective as PEP alone. Beyond a time-frame of 7 years, combining parenteral dog vaccination campaigns with human PEP appeared to be more cost-effective than human PEP alone.

When one approaches the issue of the follow-up of workers occupationally exposed to asbestos the first question to resolve is "what counselling to give?" This constitutes an essential first step because it allows people to decide whether or not they wish to accept the proposed follow up programme. The difficulty relates to the idea of exposure to a carcinogen. Facing this question is never easy and generates emotional responses that cannot be ignored. Therefore the content should include elements that allow an understanding of the diseased concerned, the risk (depending on the type of exposure), the benefits and limits of screening, and an awareness of the possible consequences of follow up. The programme should allow enough time for one to one discussion with a professional to consider all aspects. It may be necessary to meet for a second time. This counselling may be given, to subjects over 50 years old, in the framework of either the occupational health or social security services. The counselling of people exposed to asbestos justifies, in itself, a follow up programme and represents its main benefit. It should guarantee the worker's most elementary right: to decide for himself in full knowledge of the facts.

The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan.We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up.Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39%], 78 female patients [61%]), average age 24.8 years (four-54 years). The most frequent exposures were due to rape (n=74), condom rupture (n=29), and occasional unprotected sex (n=21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93% of the cases; 80.5% of patients completed 28 days of chemoprophylaxis, while 8.6% interrupted the treatment, and 10.9% were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7%). Only 34 patients (26.6%) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion.Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.