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The risk of a blood donation contaminated with hepatitis E virus (HEV) entering the blood supply before introducing universal HEV-RNA screening in France was estimated to assess the benefit of such a measure.The results of selective HEV nucleic acid testing (HEV-NAT) performed in mini pool of six plasma donations between 2018 and 2020 were extrapolated to the whole blood donor (BD) population after adjustment on three variables: regional establishment, sex and age group.Among the 246,285 plasma donations collected from 172,635 BDs tested for HEV-RNA, 248 (10.1/10,000) were positive. The extrapolation to all BDs led to an estimated rate of 5.9/10,000 donations (95% confidence interval [CI]: 4.5-7.4) which would be positive to HEV-RNA and a prevalence of 9.9/10,000 BDs (95% CI: 7.5-12.3). This prevalence was 4.4 times higher in males than females (16.8/10,000 vs. 3.8/10,000, p 10The risk of an HEV-RNA-positive donation entering the blood supply was estimated at 1 in 1682 donations. This risk does not translate directly to the risk of HEV transfusion transmission, which mainly depends on the total number of viral particles in the transfused blood component and the sensitivity of NAT.

Since the discovery of the human immunodeficiency virus (HIV) 35 years ago, the epidemic is still ongoing in France. To monitor the dynamics of HIV transmission and assess the impact of prevention campaigns, the main indicator is the incidence. One method to estimate the HIV incidence is based on biomarker values at diagnosis and their dynamics over time. Estimating the HIV incidence from biomarkers first requires modeling their dynamics since infection using external longitudinal data. The objective of the work presented here is to estimate the joint dynamics of two biomarkers from the PRIMO cohort. We thus jointly modeled the dynamics of two biomarkers (TM and V3) using a multi-response nonlinear mixed-effect model. The parameters were estimated using Bayesian Hamiltonian Monte Carlo inference. This procedure was first applied to the real data of the PRIMO cohort. In a simulation study, we then evaluated the performance of the Bayesian procedure for estimating the parameters of multi-response nonlinear mixed-effect models.

BACKGROUND: Migrant populations are overrepresented among persons diagnosed with HIV in the European Union and the European Economic Area. Understanding the timing of HIV acquisition (premigration or postmigration) is crucial for developing public health interventions and for producing reliable estimates of HIV incidence and the number of people living with undiagnosed HIV infection. We summarize a recently proposed method for determining the timing of HIV acquisition and apply it to both real and simulated data. METHODS: The considered method combines estimates from a mixed model, applied to data from a large seroconverters' cohort, with biomarker measurements and individual characteristics to derive probabilities of premigration HIV acquisition within a Bayesian framework. The method is applied to a subset of data from the European Surveillance System (TESSy) and simulated data. FINDINGS: Simulation study results showed good performance with the probabilities of correctly classifying a premigration case or a postmigration case being 87.4% and 80.4%, respectively. Applying the method to TESSy data, we estimated the proportions of migrants who acquired HIV in the destination country were 31.9%, 37.1%, 45.3%, and 45.2% for those originating from Africa, Europe, Asia, and other regions, respectively. CONCLUSIONS: Although the considered method was initially developed for cases with multiple biomarkers' measurements, its performance, when applied to data where only one CD4 count per individual is available, remains satisfactory. Application of the method to TESSy data, estimated that a substantial proportion of HIV acquisition among migrants occurs in destination countries, having important implications for public health policy and programs.

Sex between men is the most frequent mode of HIV transmission in industrialised countries. Monitoring risk behaviours among men who have sex with men (MSM) is crucial, especially to understand the drivers of the epidemic. A cross-sectional survey (PREVAGAY), based on time-location sampling, was conducted in 2015 among MSM attending gay venues in 5 metropolitan cities in France. We applied the generalised weight share method (GWSM) to estimate HIV seroprevalence for the first time in this population, taking into account the frequency of venue attendance (FVA). Our objectives were to describe the implementation of the sampling design and to demonstrate the importance of taking into account sampling weights, including FVA by comparing results obtained by GWSM and by other methods which use sample weights not including FVA or no weight. We found a global prevalence of 14.3% (95% CI (12.0–16.9)) using GWSM and an unweighted prevalence of 16.4% (95% CI (14.9–17.8)). Variance in HIV prevalence estimates in each city was lower when we did not take into account either the sampling weights or the FVA. We also highlighted an association of FVA and serological status in the most of investigated cities.

Estimates of the annual numbers of foodborne illnesses and associated hospitalizations and deaths are needed to set priorities for surveillance, prevention, and control strategies. The objective of this study was to determine such estimates for 2008–2013 in France. We considered 15 major foodborne pathogens (10 bacteria, 3 viruses, and 2 parasites) and estimated that each year, the pathogens accounted for 1.28–2.23 million illnesses, 16,500–20,800 hospitalizations, and 250 deaths. Campylobacter spp., nontyphoidal Salmonella spp., and norovirus accounted for >70% of all foodborne pathogen–associated illnesses and hospitalizations; nontyphoidal Salmonella spp. and Listeria monocytogenes were the main causes of foodborne pathogen–associated deaths; and hepatitis E virus appeared to be a previously unrecognized foodborne pathogen causing ≈68,000 illnesses in France every year. The substantial annual numbers of foodborne illnesses and associated hospitalizations and deaths in France highlight the need for food-safety policymakers to prioritize foodborne disease prevention and control strategies.

International audience; 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 Aim :ed 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.

In France, measures including curfew and lockdown were implemented to control the COVID-19 pandemic second wave in 2020. This study descriptively assesses their possible effects, also relative to their timing. A considerable decrease in incidence of COVID-19 cases and hospital admissions was observed 7 to 10 days after mitigation measures were put in place, occurring earlier in metropolitan areas which had implemented these first. This temporal coincidence suggests the measures’ positive impact, consistent with international experiences.

Background The advent of effective direct-acting antivirals (DAAs), has prompted an assessment of the French Hepatitis C virus (HCV) screening strategy, which historically targeted high-risk groups. One of the options put forward is the implementation of combined (i.e., simultaneous) HCV, Hepatitis B virus (HBV) and HIV screening for all adults at least once during their lifetime (“universal combined screening”). However, recent national survey-based data are lacking to guide decision-making regarding which new strategy to implement. Accordingly, we aimed to provide updated data for both chronic hepatitis C (CHC) and B (CHB) prevalence and for HCV and HBV screening history, using data from the BaroTest and 2016 Health Barometer (2016-HB) studies, respectively. Methods 2016-HB was a national cross-sectional phone based health survey conducted in 2016 among 20,032 randomly selected individuals from the general population in mainland France. BaroTest was a virological sub-study nested in 2016-HB. Data collected for BaroTest were based on home blood self-sampling on dried blood spots (DBS). Results From 6945 analyzed DBS, chronic hepatitis C (CHC) and B (CHB) prevalence was estimated at 0.30% (95% Confidence Interval (CI): 0.13-0.70) and 0.30% (95% CI: 0.13-0.70), respectively. The proportion of individuals aware of their status was estimated at 80.6% (95% CI: 44.2-95.6) for CHC and 17.5% (95% CI: 4.9-46.4) for CHB. Universal combined screening would involve testing between 32.6 and 85.3% of 15-75 year olds according to whether we consider only individuals not previously tested for any of the three viruses, or also those already tested for one or two of the viruses. Conclusions Our data are essential to guide decision-making regarding which new HCV screening recommendation to implement in France. They also highlight that efforts are still needed to achieve the WHO’s targets for eliminating these diseases. Home blood self-sampling may prove to be a useful tool for screening and epidemiological studies.

Background Universal antenatal HIV screening programmes are an effective method of preventing mother-to-child transmission. Aims To assess the coverage and yield of the French programme on a nationally representative sample of pregnant women, and predictive factors for being unscreened or missing information on the performance/ result of a HIV test. Methods Data came from the medical records of women included in the cross-sectional 2016 French National Perinatal Survey. We calculated odds ratios (OR) to identify factors for being unscreened for HIV and for missing information by multivariable analyses. Results Of 13,210 women, 12,782 (96.8%) were screened for HIV and 134 (1.0%) were not; information was missing for 294 (2.2%). HIV infection was newly diagnosed in 19/12,769 (0.15%) women screened. The OR for being unscreened was significantly higher in women in legally registered partnerships (OR: 1.3; 95% CI: 1.1–1.6), with 1–2 years of post-secondary schooling (OR: 1.6; 95% CI: 1.2–2.1), part-time employment (OR: 1.4; 95% CI: 1.1–1.8), inadequate antenatal care (OR: 1.9; 95% CI: 1.5–2.4) and receiving care from > 1 provider (OR: 1.8; 95% CI: 1.1–2.8). The OR of missing information was higher in multiparous women (OR: 1.4; 95% CI: 1.2–1.5) and women cared for by general practitioners (OR: 1.4; 95% CI: 1.1–1.9). Conclusions The French antenatal HIV screening programme is effective in detecting HIV among pregnant women. However, a few women are still not screened and awareness of the factors that predict this could contribute to improved screening levels.

International audience; To generate hypotheses on possible sources of Shiga toxin-producing Escherichia coli (STEC) serogroup O80 associated hemolytic-uremic syndrome (HUS), we explored differences in factors associated with STEC O80 associated HUS, compared with STEC O157 or STEC of other serogroups, in France during 2013-16. STEC was isolated from 153/521 (30%) reported HUS cases: 45 serogroup O80, 46 O157 and 62 other serogroups. Median ages were 1.1 years, 4.0 years and 1.8 years, respectively. O80 infected patients were less likely to report ground beef consumption (aOR [adjusted Odds Ratio] 0.14 95% CI [Confidence Interval] 0.02-0.80) or previous contact with a person with diarrhea or HUS (aOR 0.13 95%CI 0.02-0.78) than patients infected with STEC O157. They were also less likely to report previous contact with a person presenting with diarrhea/HUS than patients infected with other serogroups (aOR 0.13 95%CI 0.02-0.78). STEC O80 spread all over France among young children less exposed to known risk factors of O157 or other STEC infections, suggesting the existence of different reservoirs and transmission patterns.

Convenience Samples by Internet and the Press - Gay and Lesbian Press Survey 2011. Since 1985, the Gay Press Survey, based on a convenience sample, has collected data through an anonymous self-administered questionnaire on lifestyles and preventive sexual behavior among Men having Sex with Men or MSM (Bochow et al., 2003). First broadcast in the gay press, the questionnaire, since 2004, has also been available online via information or gay dating sites. From 15 May to 15 July 2011, the survey Gay News was renewed and collected a total of 10,587 questionnaires MSM residing in France, 1,084 via the press and 9,503 via the Internet. This article describes the methodology developed and the main results by comparing the two collection methods. The advantages and limitations of Internet use over paper in convenience sample surveys are discussed.

Objective The presentation describes the design and the main functionalities of two user-friendly applications developed using R-shiny to support the statistical analysis of morbidity and mortality data from the French syndromic surveillance system SurSaUD. Introduction The French syndromic surveillance system SursaUD® has been set up by Sante publique France, the national public health agency (formerly French institute for public health - InVS) in 2004. In 2016, the system is based on three main data sources: the attendances in about 650 emergency departments (ED), the consultations to 62 emergency general practitioners’ (GPs) associations SOS Medecins and the mortality data from 3,000 civil status offices [1]. Daily, about 60,000 attendances in ED (88% of the national attendances), 8,000 visits in SOS Medecins associations (95% of the national visits) and 1,200 deaths (80% of the national mortality) are recorded all over the territory and transmitted to Sante publique France. About 100 syndromic groupings of interest are constructed from the reported diagnostic codes, and monitored daily or weekly, for different age groups and geographical scales, to characterize trends, detect expected or unexpected events (outbreaks) and assess potential impact of both environmental and infectious events. All-causes mortality is also monitored in similar objectives. Two user-friendly interactive web applications have been developed using the R shiny package [2] to provide a homogeneous framework for all the epidemiologists involved in the syndromic surveillance at the national and the regional levels. Methods The first application, named MASS-SurSaUD, is dedicated to the analysis of the two morbidity data sources in Sursaud, along with data provided by a network of Sentinel GPs [3]. Based on pre-aggregated data availaible daily at 10:30 am, R programs create daily, weekly and monthly time series of the proportion of each syndromic grouping among all visits/attendances with a valid code at the national and regional levels. Twelve syndromic groupings (mainly infectious and respiratory groups, like ILI, gastroenteritis, bronchiolitis, pulmonary diseases) and 13 age groups have been chosen for this application. For ILI, 3 statistical methods (periodic regression, robust periodic regression and Hidden Markov model) have been implemented to identify outbreaks. The results of the 3 methods applied to the 3 data sources are combined with a voting algorithm to compile the influenza alarm level for each region each week: non-epidemic, pre/post epidemic or epidemic. The second application, named MASS-Euromomo, allows consulting results provided by the model developed by the European project EuroMomo for the common analysis of mortality in the European countries (www.euromomo.eu). The Euromomo model, initially developed using Stata software, has been transcripted in R. The model has been adapted to run in France both at a national, regional and other geographical administrative levels, and for 7 age groups. Results The two applications, accessible on a web-portal, are similarly designed, with: - a dropdown menu and radio buttons on the left hand side to select the data to display (e.g. filter by data source, age group, geographical levels, syndromic grouping and/or time period), - several tab panels allowing to consult data and statistical results through tables, static and dynamic charts, statistical alarm matrix, geographical maps,... (Figure 1), - a “help” tab panel, including documentations and guidelines, links, contact details. The MASS-SurSaUD application has been deployed in December 2015 and used during the 2015-2016 influenza season. MASS- Euromomo application has been deployed in July 2016 for the heat- wave surveillance period. Positive feedbacks from several users have been reported. Conclusions Business Intelligence tools are generally focused on data visualisation and are not generally tailored for providing advanced statistical analysis. Web applications built with the R-shiny package combining user-friendly visualisations and advanced statistics can be rapidly built to support timely epidemiological analyses and outbreak detection. Figure 1: screen-shots of a page of the two applications

In the last decade, interest has been focused on human immunodeficiency virus (HIV) antibody assays and testing strategies that could distinguish recent infections from established infection in a single serum sample. Incidence estimates are obtained by using the relationship between prevalence, incidence, and duration of recent infection (window period). However, recent works demonstrated limitations of this approach due to the use of an estimated mean "window period." We propose an alternative approach that consists in estimating the distribution of infection times based on serological marker values at the moment when the infection is first discovered. We propose a model based on the repeated measurements of virological markers of seroconversion for the marker trajectory. The parameters of the model are estimated using data from a cohort of HIV-infected patients enrolled during primary infection. This model can be used for estimating the distribution of infection times for newly HIV diagnosed subjects reported in a HIV surveillance system. An approach is proposed for estimating HIV incidence from these results.

Introduction L’objectif de cette etude est d’estimer les prevalences du VHC, VHB et la couverture vaccinale (CV) declaree contre le VHB chez les hommes ayant des rapports sexuels avec des hommes (HSH) frequentant les lieux de convivialite gay en 2015 et de decrire les facteurs associes. Materiels et methodes Une enquete transversale anonyme utilisant une methode d’echantillonnage probabiliste (« Time-Location sampling ») a ete menee aupres des HSH frequentant les bars, saunas et backrooms de 5 villes francaises entre septembre et decembre 2015. Un questionnaire comportemental et un auto-prelevement de sang capillaire par ponction digitale et depot sur papier buvard ont ete collectes. L’ARN du VHC, l’antigene de surface du VHB (AgHBs) ont ete recherches. Les facteurs associes ont ete testes par regression de Poisson multivariee (p Resultats Sur les 5324 HSH sollicites, 2645 HSH ont participe a l’etude, 26 etaient ARN VHC positifs (+) et 18 AgHBs+. Les prevalences des VHC et VHB etaient estimees a 0,7 % [IC95 % : 0,3–1,5] et 0,6 % [0,2–1,3] dans cette population HSH et a 3,0 % [1,5–5,8] et 1,5 % [0,6–3,6] chez les HSH VIH+. En analyse multivariee, etre ARN VHC + etait notamment associe a la seropositivite VIH, a l’injection de drogues en contexte sexuel (slam) au cours de la vie, a la pratique du Fist avec des partenaires occasionnels dans l’annee et a la frequentation de sites de rencontre via internet ou applications geolocalisees. Etre AgHBs+ etait notamment associe au fait d’avoir fait des etudes superieures, d’etre dans une situation financiere difficile, de frequenter les saunas, backrooms ou lieux exterieurs de drague et d’avoir eu au moins une penetration anale avec un partenaire occasionnel dans l’annee ; la vaccination contre le VHB etait protectrice. La CV declaree contre le VHB etait estimee a 63,0 % [60,0–65,9] dans cette population et a 65,2 % [57,6–72,1] chez les HSH VIH + Elle etait notamment associee au fait d’avoir fait des etudes superieures, d’etre a l’aise financierement, d’avoir eu au moins une infection sexuellement transmissible dans l’annee, d’avoir ete depiste pour le VHC dans l’annee, d’etre ARN VHC+ et vaccine contre le meningocoque C. Conclusion En comparaison avec la population generale, la prevalence de l’ARN du VHC etait legerement superieure dans cette population HSH et celle du VHB relativement comparable. Ces resultats incitent a renforcer les actions de prevention couplant vaccination et depistage notamment pour les HSH VIH+ et/ou ayant des partenaires multiples.

To better understand the diversity of practices and behaviours to prevent HIV with casual partners, data from a large convenience sample of men who have sex with men (MSM) in France were categorised into different prevention profiles: no anal intercourse, consistent condom use during anal intercourse, risk-reduction practices (serosorting, seropositioning) and no discernible prevention practice (NDPP). Categories were applied to HIV-positive respondents with controlled (CI; n=672) and uncontrolled infection (UI; n=596), HIV-negative (n=4,734) and untested respondents (n=663). Consistent condom use was reported by 22% (n=148) of HIV-positive-CI respondents, 13% (n=79) of HIV-positives UI, 55% (2,603) of HIV-negatives, and 50% (n=329) of untested (p

Resume Objectif L’evaluation du risque transfusionnel est une etape indispensable qui doit preceder toute strategie de depistage d’un agent pathogene transmissible par transfusion. Suite a la survenue de plusieurs cas de transmission par transfusion du VHE en France, une evaluation de risque pour ce virus a ete realisee. Methode Nous avons utilise une methode basee sur la prevalence de l’ARN-VHE sur les dons de plasma servant a la preparation du plasma PFC-SD. Pour estimer cette prevalence sur l’ensemble des dons, les donnees ont ete redressees sur les facteurs de risque du VHE (sexe, âge et region de residence) en faisant l’hypothese qu’ils etaient identiques chez les donneurs de plasma et de sang total. Resultats Parmi les 57 101 dons de plasma testes en 2013, 24 etaient ARN-VHE positifs (taux brut de 4,2 pour 10 000 dons). Apres redressement, le nombre total de dons de sang ARN-VHE positifs a ete estime a 788, soit un taux de 2,65 pour 10 000 dons (IC 95 % : 1,6–3,7) ou 1/3800 dons (1/6200–1/2700). Ce taux est 12 fois plus eleve chez les hommes que chez les femmes, augmente avec l’âge et varie selon la region. Conclusion Le risque de contamination d’un don de sang par le VHE a ete estime a 1 pour 3800 dons en 2013. Une donnee essentielle est toujours manquante pour evaluer maintenant ce risque chez les receveurs : la dose minimale infectieuse. De plus, ce risque-receveur devra etre evalue selon les caracteristiques des patients transfuses : presence d’une immunite anti-VHE, existence d’une hepatopathie chronique ou d’une immunodeficience.

Background Violence against women by their male intimate partners (IPV) during pregnancy may lead to negative pregnancy outcomes. We examined the role of IPV as a potential risk factor for miscarriage in Guatemala. Our objectives were: (1) To describe the magnitude and pattern of verbal, physical and sexual violence by male intimate partners in the last 12 months (IPV) in a sample of pregnant Guatemalans; (2) To evaluate the influence of physical or sexual IPV on miscarriage as a pregnancy outcome. Methods All pregnant women reporting to the maternity of a major tertiary care public hospital in Guatemala City from June 1st to September 30th, 2006 were invited to participate in this cross-sectional study. The admitting physician assessed occurrence of miscarriage, defined as involuntary pregnancy loss up to and including 28 weeks gestation. Data on IPV, social and demographic characteristics, risk behaviours, and medical history were collected by interviewer-administered questionnaire. Laboratory testing was performed for HIV and syphilis. The relationship between IPV and miscarriage was assessed through multivariable logistic regression. Results IPV affected 18% of the 1897 pregnant Guatemalan women aged 15-47 in this sample. Verbal IPV was most common (16%), followed by physical (10%) and sexual (3%) victimisation. Different forms of IPV were often co-prevalent. Miscarriage was experienced by 10% of the sample (n = 190). After adjustment for potentially confounding factors, physical or sexual victimisation by a male intimate partner in the last 12 months was significantly associated with miscarriage (ORadj 1.1 to 2.8). Results were robust under a range of analytic assumptions. Conclusions Physical and sexual IPV is associated with miscarriage in this Guatemalan facility-based sample. Results cohere well with findings from population-based surveys. IPV should be recognised as a potential cause of miscarriage. Reproductive health services should be used to screen for spousal violence and link to assistance.

Before the introduction of highly active antiretroviral therapy (HAART) in 1996, monitoring the epidemics of HIV infection was extensively based on back-calculating the number of new HIV infections from AIDS surveillance data and knowledge of the AIDS incubation period distribution. However, the increase in the AIDS incubation period induced by HAART has complicated the use of AIDS diagnosis data only, and made it necessary to supplement these data with HIV diagnosis data. We explore the advantage of combining HIV and AIDS surveillance data in the context where the HIV diagnosis data are available only for the most recent years. Extending the earlier work of Aalen et al. (Statist. Med. 1997; 16(19):2191-2210) based on a discrete-time Markov model that describes simultaneously disease progression, HIV diagnosis and treatment intake, we propose a penalized likelihood approach to estimate smooth HIV incidence, together with HIV diagnosis rates. The smoothing parameter is chosen using an approximated cross-validation criterion. In a simulation study, we show that incorporation of HIV test information improves the precision of the estimation of the incidence of infections in recent periods. The method is illustrated using HIV and AIDS surveillance data collected by the Institut de Veille Sanitaire, France.