Search

National audience; L’accident d’injection de réactivité («Reactivity Initiated Accident» (RIA)) est un accident dit detype grave, caractérisé par une insertion de réactivité dans le cœur d’un réacteur nucléaire. Il induit uneexcursion de puissance quasi-instantanée, avec un dépôt significatif d’énergie dans les crayons de combustibles, soumettant ainsi ceux-ci à une situation de stress extrême. Dans le cadre de l’étude d’accidentsde ce type, le centre CEA de Cadarache, à travers son Laboratoire de Préparation et de Réalisation desEssais (LPRE), exploite un réacteur de recherche de type piscine destiné à reproduire sur un crayon decombustible irradié, prélevé dans une centrale en activité, une situation de stress équivalente à celle d’unaccident de type RIA. Le crayon, constitué d’un ensemble de pastilles d’uranium empilées sur une hauteurd’un mètre environ, et placé dans une gaine en alliage de zirconium de 9.5 mm de diamètre et 0.57 mmd’épaisseur, est soumis à un transitoire de puissance pouvant atteindre jusqu’à 20 GW en 10 à 100 ms.

Mary Hamel and colleagues in the RTS,S Clinical Trials Partnership report updated safety and efficacy results from an ongoing Phase 3 trial, including calculations of vaccine impact (malaria cases prevented). Please see later in the article for the Editors' Summary, Background A malaria vaccine could be an important addition to current control strategies. We report the safety and vaccine efficacy (VE) of the RTS,S/AS01 vaccine during 18 mo following vaccination at 11 African sites with varying malaria transmission. Methods and Findings 6,537 infants aged 6–12 wk and 8,923 children aged 5–17 mo were randomized to receive three doses of RTS,S/AS01 or comparator vaccine. VE against clinical malaria in children during the 18 mo after vaccine dose 3 (per protocol) was 46% (95% CI 42% to 50%) (range 40% to 77%; VE, p, Editors' Summary Background Every year, more than 200 million cases of malaria occur worldwide, and more than 600,000 people, mainly children living in sub-Saharan Africa, die from this parasitic disease. Malaria parasites are transmitted to people through the bites of infected night-flying mosquitoes and cause fever that needs to be treated promptly with anti-malarial drugs to prevent anemia (a reduction in red blood cell numbers) and life-threatening organ damage. Malaria transmission can be prevented by using long-lasting insecticides sprayed on the indoor walls of homes to kill the mosquitoes that spread the malaria parasite or by sleeping under insecticide-treated nets to avoid mosquito bites and further reduce mosquito numbers. Widespread use of these preventative measures, together with the introduction of artemisinin combination therapy (an effective anti-malarial treatment), has reduced the global burden of malaria by 45% in all age groups, and by 51% among young children, since 2000. Why Was This Study Done? Unfortunately, the emergence of insecticide and drug resistance is threatening this advance in malaria control. Moreover, additional interventions—specifically, effective malaria vaccines—will be needed to eliminate malaria in the large areas of Africa where malaria transmission remains high. Currently, there is no licensed malaria vaccine, but RTS,S/AS01, the most advanced malaria vaccine candidate, is undergoing phase 3 clinical trials (the last stage of testing before licensing) in infants and children in seven African countries. The RTS,S Clinical Trials Partnership reported encouraging results on the efficacy and safety of RTS,S/AS01 during 12 months of follow-up in 2011 and 2012. Here, researchers report on the 18-month efficacy and safety of RTS,S/AS01. Vaccine efficacy (VE) is the reduction in the incidence of a disease (the number of new cases that occur in a population in a given period) among trial participants who receive the vaccine compared to the incidence among participants who do not receive the vaccine. What Did the Researchers Do and Find? The researchers randomly assigned 6,537 infants aged 6–12 weeks and 8,923 children aged 5–17 months to receive three doses of RTS,S/AS01 or a control vaccine. During 18 months of follow-up, there were 0.69 episodes of clinical malaria (a high temperature and parasites in the blood) per person-year among the children who received all the planned doses of RTS,S/AS01 (the “per protocol” population) and 1.17 episodes per person-year among the control children—a VE against clinical malaria in the per-protocol population of 46%. A similar VE was seen in an intention-to-treat analysis that included all the enrolled children, regardless of whether they received all of the planned vaccine doses; intention-to-treat analyses reflect the real-life situation—in which children sometimes miss vaccine doses—better than per-protocol analyses. In intention-to-treat analyses, the VE among children against severe malaria (fever, parasites in the blood, and symptoms such as anemia) and hospitalization for malaria was 34% and 41%, respectively. Among infants, the VE against clinical malaria was 27% in both per-protocol and intention-to-treat analyses; the vaccine showed no protection against severe malaria or hospitalization. In both infants and children, VE waned with time since vaccination. Across all the study sites, RTS,S/AS01 averted an average of 829 and 449 cases of clinical malaria per 1,000 children and infants vaccinated, respectively. Finally, the serious adverse event meningitis (inflammation of the tissues lining the brain and spinal cord) occurred more frequently in trial participants given RTS,S/AS01 than in those given the control vaccine, but the incidence of other serious adverse events was similar in both groups of participants. What Do These Findings Mean? These and other findings show that, during 18 months of follow-up, vaccination of children and young infants with RTS,S/AS01 prevented many cases of clinical and severe malaria and that the impact of vaccination was highest in regions with the highest incidence of malaria. They indicate, as in the earlier analysis, that the VE against clinical and severe malaria is higher in children than in young infants and suggest that protection wanes over time. Whether or not the vaccine played a causal role in the observed cases of meningitis cannot be determined from these results, and the occurrence of meningitis will be followed closely during the remainder of the trial. Other study limitations (for example, variations in the clinical characteristics of participants from one center to another) may also affect the accuracy of these findings and their interpretation. However, by showing that even a modest VE can avert a substantial number of malaria cases, these findings suggest that vaccination with RTS,S/AS01 could have a major public health impact in sub-Saharan Africa. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001685. Information is available from the World Health Organization on all aspects of malaria (in several languages), including malaria immunization; the World Malaria Report 2013 provides details of the current global malaria situation; the World Health Organization also provides information on its Global Immunization Vision and Strategy (in English and French) The US Centers for Disease Control and Prevention provides information on malaria, including a selection of personal stories about malaria Information is available from the Roll Back Malaria Partnership on the global control of malaria and on the Global Malaria Action Plan (in English and French); its website includes a fact sheet about malaria in Africa The latest results from the phase 3 trial of RTS,S are available on the website of the PATH Malaria Vaccine Initiative, a global program of the international nonprofit organization PATH that aims to accelerate the development of malaria vaccines and ensure their availability and accessibility in the developing world MedlinePlus provides links to additional information on malaria and on immunization (in English and Spanish)

Resume Par une etude prospective sur une annee, les auteurs ont montre que les complications des mutilations genitales feminines constituaient 7,3 % des consultations externes en gynecologie et que la majorite de ces complications etaient decouvertes entre 15 et 24 ans (36 cas sur 49). Les principaux motifs de consultation etaient la dyspareunie et l’impossibilite des rapports sexuels (30 cas sur 49). La vulvoplastie sous anesthesie locale avec un traitement en ambulatoire a ete tres efficace (plus de 90 % de succes) et beaucoup moins onereuse que la chirurgie sous anesthesie generale.

International audience

Une étude parasitologique du paludisme a été réalisée dans deux quartiers centraux de la ville de Yaoundé pendant un an. Le quartier Essos borde un bas-fond marécageux et le quartier Obili présente des bassins de pisciculture. Les enquêtes, trimestrielles, ont été réalisées sur un échantillon de 22 et 16 familles à Essos et Obili respectivement. 960 prélèvements sanguins ont été examinés dans les deux quartiers. La prévalence plasmodiale est de 25,4 plus ou moins 2,7%, l'indice gamétocytique de 1,7 plus ou moins 0,8% et la charge parasitaire moyenne de 310 parasites/microlitre de sang. L'indice plasmodique est significativement plus élevé à Essos qu'à Obili : 28,7 plus ou moins 3,6% (n=592) et 20,1 plus ou moins 4,1% (n=368) respectivement (p

A parasitological study of malaria was carried out in two central districts of Yaounde (Cameroon) for one year. The Essos district was built near marshy shallows. The Obili district was comparable to Essos but there were many poorly maintained fish breeding pounds. Surveys were carried out quarterly in each district with a sample of 22 and 16 families at Essos and Obili respectively. The whole members of the families were examined. The study showed that the plasmodic index cumulated for the two districts was 25.4 +/- 2.7% (n = 960). The gametocytic index was 1.7 +/- 0.8% and the parasitic density was 310 parasites/microliters of blood. A significative difference in the plasmodic index was observed between the two districts: 28.7 +/- 3.6% (n = 592) in Essos and 20.1 +/- 4.1% (n = 368) in Obili (p0.02). The plasmodic index was higher in the 6 to 15 age group (37.5%) but the higher parasitic density was observed in the 0 to 5 age group (1,100 parasites/microliters of blood). Seasonal variations were noticed with the higher indexes in small dry season and the lower indexes in the big dry season.

En l'absence de données antérieures, la sensibilité de #Plasmodium falciparum$ à la chloroquine à la dose de 25 mg/kg de poids per os en 3 jours, a été évaluée in vivo par une enquête effectuée en juin 1990, en début de saison des pluies, dans la ville de Moundou au Sud du Tchad. 195 enfants ont été prélevés à l'école catholique de jeune fille et dans le quartier Djarabé, 28 enfants avec une parasitémie moyenne initiale de 1700 GRP/mm2 ont été suivis. Aucune résistance de type RII ou RIII n'a été mise en évidence. La chloroquine doit donc rester le traitement présomptif de l'accès palustre. (Résumé d'auteur)