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Abstract: 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 &y& Elsevier]

Introduction: La fréquence des zygomycoses semble augmenter, notamment parmi les personnes immunodéprimées. Nous voulions estimer l’incidence des zygomycoses dans la population française en décrivant les caractéristiques cliniques et épidémiologiques de cette infection fongique grave. Méthodes: Les nouvelles admissions liées à une zygomycose en France métropolitaine entre 1997 et 2006, extraites de la base de données anonymisée du PMSI, ont été analysées selon l’année d’hospitalisation, l’âge, le sexe, le département de résidence des patients, les formes cliniques de la maladie et les pathologies associées. Résultats: 547 cas de zygomycoses (289 hommes et 258 femmes) étaient identifiés. L’âge moyen était de 54,8 ans (0 à 96 ans). Le taux d’incidence annuel moyen atteignait 0,9 cas par million de personnes et augmentait avec l’âge : 0,2/106 chez les moins de 15 ans vs 2,5/106 chez les 65 ans et plus. L’incidence annuelle augmentait au cours du temps : de 0,7 cas/106 en 1997 à 1,2 cas/106 en 2006. Les formes invasives (pulmonaires, rhinocérébrales ou disséminées) étaient les plus fréquemment rapportées (37 %), suivies des formes cutanées ou gastro-intestinales (34 %). La localisation n’était pas précisée pour 29 % des cas. Les pathologies associées incluaient notamment une immunosuppression (20 %) ou un diabète (19 %). Conclusion: Les données de surveillance passive à travers le PMSI permettent de mieux documenter les tendances. Elles montrent une augmentation régulière de l’incidence des zygomycoses en France. Toutefois les caractéristiques clinico-épidémiologiques, mycologiques et thérapeutiques de la maladie nécessitent des analyses complémentaires. Une étude rétrospective plus approfondie va être menée dans ce but, à partir des dossiers médicaux des patients identifiés par le PMSI et le CNRMA. [Copyright &y& Elsevier]

Summary: Little information is available on the characteristics of infants hospitalized for acute bronchiolitis in France. An analysis of hospital records (PMSI) was conducted at the national level to describe the cases of bronchiolitis that require hospitalization among infants under 1year of age and the factors associated with death. The analysis of all admissions that occurred during 2009, for which the diagnosis of acute bronchiolitis was recorded in the PMSI database for infants aged less than 1year, was performed. Cases were described according to age, sex, underlying conditions (including bronchopulmonary dysplasia, cystic fibrosis, and congenital heart disease), length of hospital stay, recurrent admissions, admission to an intensive care unit (ICU), and use of assisted ventilation. Factors associated with death during hospitalization were studied by logistic regression. The hospitalization rate was 35.8 per 1000 infants under 1year in 2009 in France. Approximately 10% of hospitalized infants required ICU admission. Twenty-two infants died. The estimated case-fatality rate was 0.08% among hospitalized infants and 0.56% for those hospitalized in the ICU. Mortality among all infants under 1 year was 2.6/105 in France. Factors associated with death were bronchopulmonary dysplasia (OR=6.7, 95% CI [1.5–29.8]), hospitalization in an ICU (OR=6.46, 95% CI [2.4–17.4]), and the use of assisted ventilation (OR=6.2, 95% CI [2.2–17.1]). This study has enabled the quantification of the rate of hospitalization and mortality, and a better description of infants who need hospitalization. The results are consistent with international literature, but further prospective analysis will be needed to better describe the cases at higher risk, aiming to improve their management. [ABSTRACT FROM AUTHOR]

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]