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The authors thank Marianne Chemaly, Sandra Rouxel, Typhaine Poezevara, Amandine Avouac, Emmanuelle Houard, from the National Reference Laboratory for Botulism, ANSES Ploufragan-Plouzané-Niort Laboratory and Laure Diancourt, Julie Germond, Jean Sautereau, from the National Reference Centre for Anaerobic Bacteria and Botulism, Institut Pasteur, Paris. The authors are grateful to the ANSES expert committee panel in charge of assessing animal health and animal welfare risk, and to the working group Botulism, including the authors FM, SL, CLM, CM as well as (in alphabetical order): Catherine Belloc, Stéphane Bertagnoli, Alain Boissy, Henri-Jean Boulouis, Frédéric Carlin, Eric Collin, Jean-Claude Desfontis, Michel Federighi, Maria-Eleni Filippitzi, Matthieu Fournier, Philippe Fravalo, David Fretin, Jean-Pierre Ganiere, Emmanuelle Gilot-Fromont, Etienne Giraud, Lionel Grisot, Nadia Haddad, Viviane Hénaux, Didier Hilaire, Elsa Jourdain, Sophie Le Poder-Alcon, Monique L'Hostis, Gilles Meyer, Elodie Monchatre-Leroy, Hervé Morvan, Pierre Mormède, Carine Paraud, Ariane Payne, Carole Peroz-Sapede, Claire Ponsart, Claude Saegerman, Gaëlle Simon, Michèle Tremblay, Cédric Woudstra, Jean-Pierre Vaillancourt.; International audience; Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium . This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.

Objectives The Central African Republic (CAR), a site of recurrent disease emergence, developed a noteworthy epidemiological surveillance system from the colonial period, but its health measures have remained among the world’s lowest. To understand this disparity between surveillance and public health, we examined selected moments in its history of surveillance and changing relations with public health structures. Methods We conducted archival research in CAR and French archives and 18 semi-structured interviews with key researchers working in CAR. Results We find long-term continuities in privileging surveillance over the health system and population health, making the CAR a ‘‘hotspot’’ for emerging diseases and a ‘‘blind spot’’ of primary health care. From the colonial period, the country attracted considerable support for surveillance, without concomitant investment in public health system. Political disputes and financial constraints have obscured real primary care needs on the ground. Conclusions As both a hotspot and a blind spot for global health, the CAR signals the need to reorient health interventions to address the long-term health of Central African people.

International audience; Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.

International audience; Background: Although rare, anaphylaxis during pregnancy implies a risk to both mothers and newborns.Objective: This systematic review is intended to identify key issues in the diagnosis and management of this condition to support prevention strategies and decrease the risk for death related to anaphylaxis during pregnancy.Methods: We searched MEDLINE, Cochrane, LILACS, SciELO, and Science Direct databases for manuscripts concerning the term "anaphylaxis during pregnancy," without language restrictions. We screened studies, extracted data, and assessed the risk for bias independently in duplicate.Results: We selected 12 articles. Frequency of anaphylaxis during maternity was estimated to be 1.5 to 3.8 per 100,000 pregnancies. Only one study provided anaphylaxis mortality data in pregnant women; the rate of anaphylaxis-related maternal mortality was estimated at 0.05/100,000 live births. No standard definition of anaphylaxis severity has been used. A total of 49% to 74% of anaphylaxis cases were described during caesarean section. Beta-lactam antibiotics (58%), latex (25%), and anesthetic agents (17%) were the main causes. In 17% of reports, causative agents were proven by allergy testing. Moreover, 72% of articles proposed the same management and treatment for a clinical episode of anaphylaxis during pregnancy as for nonpregnant patients, and the use of epinephrine in the patient's care during anaphylaxis in pregnancy.Conclusions: Few studies address anaphylaxis during pregnancy. Most have been produced by nonallergy specialists. Collaboration among different specialists involved in the care of pregnant women should be established to support preventive strategies and reduce avoidable deaths.

Infection, hospitalization and mortality statistics have played a pivotal role in forming social attitudes and support for policy decisions about the 2020-21 SARS-CoV-2 (COVID-19) pandemic. This article raises some questions on some of the most widely-used indicators, such as the case fatality rate, derived from these statistics, recommending replacing them with information based on regular stratified statistical sampling, coupled with diagnostic assessment. Some implications for public health policies and pandemic management are developed, opposing individualistic and holistic approaches.

Loiasis (Loa loa filariasis) is often deemed to be a benign condition but individuals with high microfilarial densities (MFD) are at risk of encephalopathy following ivermectin administration (IVM). As onchocerciasis control programs are based on mass drug administration of ivermectin, these serious adverse events (SAE) hamper their deployment in Central Africa. This thesis aims to better characterize the risk (i) before treatment, by investigating the influence of individual factors on the level of risk, and (ii) after treatment to determine to which extent the pre-treatment MFD can be inferred from the MFD obtained after treatment. Methods: (i) data from two clinical trials conducted in 1995-1996 and 2005 in Cameroon were pooled to model the risk of SAE as a logistic function of age, sex, and MFD (as a fractional polynomial). (ii) Data from six clinical trials with pre- and post-IVM MFD measurements were used to calculate the sensitivity, specificity, and positive and negative predictive values of different post-IVM MFD cutoffs for classifying individuals according to the commonly used pre-treatment thresholds.Results: we outlined how individual factors (age and sex) can influence the level of risk of post-IVM SAE and showed that the threshold above which IVM should be contraindicated could be adapted according to these factors. We also show that the post-treatment threshold of 1,000 mf/mL used to impute the occurrence of a SAE to IVM and L. loa is probably too low, and propose abacuses that can be used to assess this imputability in mass or individual treatments. Conclusions: the therapeutic management of loiasis is still poorly defined. The recent demonstration of its impact on life expectancy should lead to the definition of adequate management strategies for loiasis and its complications after treatment, including in Northern settings.; La loase (filariose à Loa loa) est souvent considérée comme une maladie bénigne mais les individus présentant une forte densité microfilarienne (DMF) dans le sang risquent de développer une encéphalopathie après la prise d’ivermectine (IVM). Les programmes de lutte contre l’onchocercose étant basés sur le traitement de masse des populations par l’IVM, ces événements indésirables graves (EIG) entravent leur déploiement en Afrique centrale. Ce travail vise à mieux caractériser ce risque (i) avant traitement, en étudiant l’influence de facteurs individuels sur le niveau de risque, et (ii) après traitement, en évaluant dans quelle mesure les DMF pré-traitement peuvent être évaluées à partir des DMF mesurées après traitement. Méthodes : (i) les données de deux essais cliniques menés en 1995 et 2005 au Cameroun ont été combinées pour modéliser, par une régression logistique incluant l’âge, le sexe et la DMF (transformée par un polynôme fractionnaire), le risque d’EIG. (ii) Les données de six essais cliniques avec mesure des DMF avant et après traitement par IVM ont été utilisées pour calculer la sensibilité, la spécificité et les valeurs prédictives positive et négative de différents seuils de DMF post-traitement pour classer les individus dans les catégories de risque habituellement retenues avant traitement.Résultats : nous avons précisé comment certains facteurs individuels (âge et sexe) peuvent influencer le niveau de risque d'EIG post-IVM et montré que le seuil au-delà duquel l’IVM devrait être contre-indiquée pourrait être adaptéen fonction de ces facteurs. Nous montrons également que le seuil de DMF post-traitement (1.000 mf/mL) utilisé pour imputer à l’IVM et L. loa la survenue d’un EIG est probablement trop bas, et proposons des abaques qui peuvent être utilisées pour évaluer cette imputabilité lors de traitements de masse ou de traitements individuels.Conclusions : la prise en charge thérapeutique de la loase est encore mal définie. La démonstration récente de son impact sur l’espérance de vie devrait conduire à définir des stratégies de prise en charge adéquates de la loase et de ses complications après traitement, y compris dans les pays du Nord.

Background Persons with a diagnosis of severe mental illness have a life expectancy that is 20 years lower than the general population, and they are disproportionately affected by cardiovascular disorders. Improving the management of cardiovascular risk is one of the main challenges for the public health system. In the care pathway of persons with a diagnosis of severe mental illness, a better understanding of limiting and facilitating factors is required. The objective was to include persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals in the creation and evaluation (feasibility) of a health promotion program designed to improve cardiovascular risk management through empowerment. Methods This study combines a mixed methodology with qualitative and quantitative components. A multicenter prospective qualitative study was conducted in seven mental health units in France and was coordinated by a steering committee composed of persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals. Results This health promotion program must enable persons with a diagnosis of severe mental illness to assert their right to self-determination and to exercise greater control over their lives, beyond their diagnosis and care. Following a preliminary feasibility study, the effectiveness of this new tool will be evaluated using a randomized controlled trial in a second study. Conclusions The findings can be used by health organizations as a starting point for developing new and improved services for persons with a diagnosis of severe mental illness. Trial registration Clinical Trials Gov NCT03689296. Date registered September 28, 2018

International audience; Recent literature strongly supports the hypothesis that mobility restriction and social distancing play a crucial role in limiting the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, it was shown that mobility restriction reduced transmission significantly. This study found that, in the period between the first two waves of the COVID-19 pandemic, there was high positive correlation between trends in the transmission of SARS-CoV-2 and mobility. These two trends oscillated simultaneously, and increased mobility following the relaxation of lockdown rules was significantly associated with increased transmission. From a public health perspective, these results highlight the importance of tracking changes in mobility when relaxing mitigation measures in order to anticipate future changes in the spread of SARS-CoV-2.

In 2017, the reform of the third cycle of medical studies (French acronym R3C) entailed a complete upheaval with, among other aspects, the creation of a new diploma of specialized studies (French acronym DES) including the creation of the infectious and tropical diseases specialty (French acronym MIT). The MIT specialty was integrated within a co-DES together with internal medicine and clinical immunology (French acronym MIIC) and allergology

International audience; IntroductionVoluntary organisations provide essential support to vulnerable populations and front-line health responders to the COVID-19 pandemic. The French Red Cross (FRC) is prominent among organisations offering health and support services in the current crisis. Comprised primarily of lay volunteers and some trained health workers, FRC volunteers in the Paris (France) region have faced challenges in adapting to pandemic conditions, working with sick and vulnerable populations, managing limited resources and coping with high demand for their services. Existing studies of volunteers focus on individual, social and organisational determinants of motivation, but attend less to contextual ones. Public health incertitude about the COVID-19 pandemic is an important feature of this pandemic. Whether and how uncertainty interacts with volunteer understandings and experiences of their work and organisational relations to contribute to Red Cross worker motivation is the focus of this investigation.Methods and analysisThis mixed-methods study will investigate volunteer motivation using ethnographic methods and social network listening. Semi-structured interviews and observations will illuminate FRC volunteer work relations, experiences and concerns during the pandemic. A questionnaire targeting a sample of Paris region volunteers will allow quantification of motivation. These findings will iteratively shape and be influenced by a social media (Twitter) analysis of biomedical and public health uncertainties and debates around COVID-19. These tweets provide insight into a French lay public's interpretations of these debates. We evaluate whether and how socio-political conditions and discourses concerning COVID-19 interact with volunteer experiences, working conditions and organisational relations to influence volunteer motivation. Data collection began on 15 June 2020 and will continue until 15 April 2021.Ethics and disseminationThe protocol has received ethical approval from the Institut Pasteur Institutional Review Board (no 2020-03). We will disseminate findings through peer-reviewed articles, conference presentations and recommendations to the FRC.

Chirurgien-dentiste est un métier de santé dont la particularité est l’engagement du corps durant toute la journée de travail. Amenés à travailler durant un grand nombre d’heures pendant une quarantaine d’années, nombreux sont les praticiens déclarant présenter des gênes ou des dou-leurs musculo-squelettiques ; conséquences des positions prises durant les heures de travail. Ce constat amène à étudier les mécanismes musculaires et la biomécanique qui nous régissent. Cette thèse a pour but d’éclaircir les mécanismes des douleurs pour mieux expliquer les logiques de prévention primaire (avant les premiers symptômes), comme secondaire (après les premiers symptômes) que tout chirurgien-dentiste doit adopter. Une étude transversale est proposée dans le but de déterminer la prévalence par région des douleurs et des malpositions chez une population de chirurgiens-dentistes. L’importance du lien de causalité entre malposition et douleur est alors explorée.

International audience; Avis relatif à l’accès aux vestiaires sportifs collectifs et à la pratique d’activités physiques et sportives de plein air dans le contexte de la pandémie de Covid-19 (HCSP, Avis et Rapport)Daniel CAMUS Christian CHIDIAC, Jean-François GEHANNOn Philippe MINODIER, Jean-Marc BRIGNON, Philippe HARTEMANN, Yves LEVI, Jean-Louis ROUBATY, Fabien SQUINAZI, Agathe BILLETTE de VILLEMEUR, Virginie HALLEY des FONTAINES, Gilles SALVAT, Brigitte MOLTRECHT, Éric GAFFET, Annette COLONNIER, Soizic URBAN-BOUDJELAB, Candice VAUCLINVersion du 3 Août 2020Mise en ligne 7 Août 2020 (16 pages)https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=893SARS-CoV-2 : accès aux vestiaires sportifs et pratiques de sports de plein airDans le contexte actuel de la pandémie de Covid-19, le HCSP évalue les conditions d’accès aux vestiaires sportifs collectifs et à la pratique des activités physiques et sportives collectives de nature et de plein air. Son avis est aussi sollicité sur la rédaction d’un décret du ministère des sports concernant les vestiaires collectifs et les dispositions concernant les établissements sportifs couverts et les établissements de plein air.Le HCSP rappelle les recommandations émises dans ses précédents avis sur la prévention de la transmission virale dans les lieux clos collectifs et à l’extérieur en cas de forte densité de personnes, les mesures barrières et la distanciation physique lors de la reprise de l’activité physique et sportive et des évènements de grande ampleur avec des rassemblements importants de personnes.Il prend notamment en compte l’augmentation de la circulation du virus SARS-CoV-2 au niveau national et international et la diminution du respect des mesures barrières par la population, le fait que les activités physiques et sportives accentuent les risques de transmission du virus Les recommandations sur l’utilisation des vestiaires sportifs et la pratique des sports collectifs dans d’autres pays occidentaux ont été recherchées via Internet.Au vu de ces différents éléments, le HCSP confirme les mesures de prévention qu’il a précédemment préconisées et insiste sur le respect de l’ensemble de ces mesures (dont le port du masque) pour permettre l’accès et l’utilisation des vestiaires collectifs ainsi que pour la réouverture au public des établissements sportifs couverts et de plein air. L’opportunité d’ouvrir ces vestiaires et d’organiser des événements sportifs de grande ampleur doit être évaluée en fonction de la circulation du virus dans les zones concernéesLire aussi :Coronavirus SARS-CoV-2 : Mesures barrières et de distanciation physique en population générale du 24 avril 2020Covid-19 : personnes à risque et mesures barrières spécifiques à ces personnes du 20 avril 2020Coronavirus SARS-CoV-2 : recommandations relatives à la reprise de l’activité physique et sportive du 31 mai 2020Covid-19 : mesures barrières et de distanciation physique dans la restauration commerciale et les débits de boissons (hors restauration collective) du 19 mai 2020Coronavirus SARS-CoV-2 : recommandations relatives aux grands rassemblements populationnels du 17 juin 2020SARS-CoV-2 : organisation de grands rassemblements de plus de 5 000 personnes et de fêtes extérieures dansantes du 21 juillet 2020Ministère des solidarités et de la santé : information aux professionnels de santé

International audience; Measles vaccination is a public health 'best buy', with the highest cost of illness averted of any vaccine-preventable disease (Ozawa et al., Bull. WHO 2017;95:629). In recent decades, substantial reductions have been made in the number of measles cases, with an estimated 20 million deaths averted from 2000 to 2017 (Dabbagh et al., MMWR 2018;67:1323). Yet, an important feature of epidemic dynamics is that large outbreaks can occur following years of apparently successful control (Mclean et al., Epidemiol. Infect. 1988;100:419-442). Such 'post-honeymoon period' outbreaks are a result of the nonlinear dynamics of epidemics (Mclean et al., Epidemiol. Infect. 1988;100:419-442). Anticipating post-honeymoon outbreaks could lead to substantial gains in public health, helping to guide the timing, age-range, and location of catch-up vaccination campaigns (Grais et al., J. Roy. Soc. Interface 2008003B6:67-74). Theoretical conditions for such outbreaks are well understood for measles, yet the information required to make these calculations policy-relevant is largely lacking. We propose that a major extension of serological studies to directly characterize measles susceptibility is a high priority.

L’objectif de cette thèse est de déterminer les pathologies liées à la profession de chirurgien-dentiste et de s’intéresser à la procédure de reconnaissance en tant que maladies professionnelles, ainsi qu’à la prévoyance complémentaire spécifique à la profession. Cette étude a mené à de nombreux constats, notamment celui que les praticiens sont toujours plus nombreux à souffrir des mêmes pathologies, en particulier de troubles musculo-squelettiques, d’affections psychiques et de troubles du sommeil. Les facteurs sont connus, des solutions sont proposées, notamment des actions de prévention, pourtant les résultats sont mitigés. Nous avons réalisé une enquête auprès des chirurgiens-dentistes de France pour connaître leurs pathologies, évaluer leur comportement et tenter d’approfondir les raisons qui freinent la prise de conscience et la mise en œuvre des solutions exposées au cours de leur formation.

Les sportifs de haut niveau sont une population à risque, et sont soumis à de nombreuses pathologies bucco-dentaires. Il existe une relation entre la santé bucco-dentaire des sportifs et leur condition physique. Depuis plusieurs années, le Docteur Nguyen a accompagné la délégation française au cours des Universiades d’été et a pu relever les habitudes d’hygiène bucco-dentaire des jeunes athlètes français et leurs évolutions au cours des différentes éditions de 2001 à 2017. Il sera intéressant de se pencher sur cette évolution au cours de ces années et constater si oui ou non le travail de prévention et de sensibilisation auprès des jeunes sportifs a porté ses fruits.

This assessment was conducted by a multidisciplinary task force of experts, “Emergency Collective Expertise Group—Impact of the COVID-19 pandemic and lockdown on dengue surveillance and vector control interventions” of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES).; International audience; The concurrent circulation of dengue and coronavirus disease 2019 (COVID-19) may produce many unfavourable outcomes-such as co-infections; delays in diagnosis, treatment, and mitigation measures; overwhelming of the healthcare system; underreporting of cases; deterioration in surveillance and control interventions; and exacerbation of social inequalities. Indeed, lockdown is greatly compromising the effectiveness of vector control, especially social mobilization campaigns and preventive insecticide spraying in private spaces (indoor and peridomestic spraying). Thus, failure to appropriately implement the full range of vector control interventions can lead to a reduction in their overall effectiveness and an increasing risk of vector-borne diseases circulating. Consequently, the health community and policy makers should develop proactive policies and allocate adequate resources to prevent and manage the resurgence of dengue and other vector-borne diseases in the new era of COVID-19.

Since the arrival of DAAs disrupted the management of hepatitis C, the eradication of this disease has seemed achievable. In 2016, France set the goal of eliminating this disease by 2025 using these new treatments. However, eliminating a disease requires significant financial investments. We sought to assess the effectiveness and budgetary impact of 3 elimination strategies on a French scale using a budget impact model: a reference strategy, based on the situation in 2016-2018; a strategy in which screening is increased by 10%, and a strategy in which screening is sufficient to achieve elimination by 2025. With a time horizon in 2030, budget impact of the reference strategy is €4.8 billion, and that of strategy #2 is €5 billion; none of these strategies allow the achievement of elimination by 2025. Strategy #3 achieves elimination and its budgetary impact is €5.9bn. These results should be discussed as a model is a representation of reality for which there is some uncertainty, moreover, the prices of treatments and tests are likely to vary. A public health program is necessary to achieve elimination and the cost of that program is not included in our analysis.; Depuis le bouleversement dans la prise en charge de l’hépatite C introduit par l’arrivée des AAD, l’éradication de cette maladie semble atteignable. En 2016, la France s’est fixée comme objectif d’éliminer cette maladie à l’horizon 2025 grâce à ces nouveaux traitements. L’élimination d’une maladie exige cependant des investissements financiers importants. Nous avons cherché à évaluer grâce à un modèle d’impact budgétaire l’efficacité et l’impact budgétaire de 3 stratégies d’élimination à l’échelle française : une stratégie de référence, basée sur la situation de 2016-2018 ; une stratégie dans laquelle le dépistage est augmenté de 10%, et une stratégie dans laquelle le dépistage est suffisant pour atteindre l’élimination en 2025. Avec un horizon temporel en 2030, l’impact budgétaire de la stratégie de référence est de 4,8 Mds€ et celui de la stratégie n°2 est de 5 Mds€ ; aucune de ces stratégies ne permet d’atteindre l’élimination en 2025. La stratégie n°3 permet d’atteindre l’élimination et son impact budgétaire est de 5,9 Mds€. Ces résultats sont à nuancer : la modélisation est une représentation simplifiée de la réalité pour laquelle il existe une certaine incertitude, les prix des traitements et des tests sont susceptibles de varier. Un programme de santé publique doit être mis en place pour atteindre l’élimination et le coût de ce programme n’est pas pris en compte dans notre analyse.

Background: Transmission of many viruses occurs by direct transmission during a close contact between two hosts, or by an indirect transmission through the environment. Several and often interconnected factors, both abiotic and biotic, determine the persistence of these viruses released in the environment, which can last from a few seconds to several years. Moreover, viruses in the environment are able to travel short to very long distances, especially in the air or in water. Summary: Although well described now, the role of these environments as intermediaries or as reservoirs in virus transmission has been extensively studied and debated in the last century. The majority of these discoveries, such as the pioneer work on bacteria transmission, the progressive discoveries of viruses, as well as the persistence of the influenza virus in the air varying along with droplet sizes, or the role of water in the transmission of poliovirus, have contributed to the improvement of public health. Recent outbreaks of human coronavirus, influenza virus, and Ebola virus have also demonstrated the contemporaneity of these research studies and the need to study virus persistence in the environment. Key Messages: In this review, we discuss historical discoveries that contributed to describe biotic and abiotic factors determining viral persistence in the environment.

International audience; A flagship recommendation of the citizen's steering committee on immunization, the mandatory immunization for infants extended to 11 vaccines, introduced in January 2018, is part of a set of recommendations that must be considered as a whole, each component being indispensable to the achievement of objectives: restore confidence in vaccination and increase immunization coverage. Roundtable # 6 participants identified a decade of concrete initiatives that could address, at least in part, the committee's recommendations, including: developing information systems and data generation; simplify the vaccination journey and increase vaccination opportunities; developing training of health professionals; learning vaccines at school; using motivational interviewing in educational intervention; undertaking local initiatives; improving supply and communicate on the value of vaccines. To carry out these actions, it has been proposed that a joint ministerial task-force bringing together the different stakeholders at the national level should be set up to promote their implementation and follow-up, and at regional level, the establishment of an Agences régionales de santé awareness plan making vaccination a priority.

Trade of bushmeat and other wildlife for human consumption presents a unique set of challenges to policy-makers who are confronted with multiple trade-offs between conservation, food security, food safety, culture and tradition. In the face of these complex issues, risk assessments supported by quantitative information would facilitate evidence-based decision making. We propose a conceptual model for disease transmission risk analysis, inclusive of these multiple other facets. To quantify several processes included in this conceptual model we conducted questionnaire surveys with wildlife consumers and vendors in semi-urban centers in Lao People's Democratic Republic (Lao PDR, Laos) and direct observations of consumer behaviors. Direct observation of market stalls indicated an estimated average of 10 kg bushmeat biomass per stall per hour. The socio-demographic data suggested that consumption of bushmeat in urban areas was not for subsistence but rather driven by dietary preference and tradition. Consumer behavioral observations indicated that each animal receives an average of 7 contacts per hour. We provide other key parameters to estimate the risk of disease transmission from bushmeat consumption and illustrate their use in assessing the total public health and socio-economic impact of bushmeat consumption. Pursuing integrative approaches to the study of bushmeat consumption is essential to develop effective and balanced policies that support conservation, public health, and rural development goals., Graphical abstract Unlabelled Image, Highlights • Bushmeat trade in Lao PDR is considerable and likely exceeds sustainable levels. • Bushmeat consumption in urban centers is not a necessity but a preference. • High contact rates between consumers and bushmeat add to the transmission risk. • Integrated assessment of conservation, food security and food safety risks needed

Objectives. To examine health benefits and cost-effectiveness of implementing a freeway deck park to increase urban green space. Methods. Using the Cross-Bronx Expressway in New York City as a case study, we explored the cost-effectiveness of implementing deck parks. We built a microsimulation model that included increased exercise, fewer accidents, and less pollution as well as the cost of implementation and maintenance of the park. We estimated both the quality-adjusted life years gained and the societal costs for 2017. Results. Implementation of a deck park over sunken parts of Cross-Bronx Expressway appeared to save both lives and money. Savings were realized for 84% of Monte Carlo simulations. Conclusions. In a rapidly urbanizing world, reclaiming green space through deck parks can bring health benefits alongside economic savings over the long term. Public Health Implications. Policymakers are seeking ways to create cross-sectorial synergies that might improve both quality of urban life and health. However, such projects are very expensive, and there is little information on their return of investment. Our analysis showed that deck parks produce exceptional value when implemented over below-grade sections of road.

International audience; A strain of Leptospira kirschneri (serogroup Grippotyphosa) was cultured from urine of a mare post-abortion in Brazil and characterized by serogrouping, multiple-locus variable-number tandem repeat analysis, PGFE, and sequencing of genes rrs and secY. Strains of L. kirschneri have apparently never been recovered from horses in tropical area, only in Europe and USA. Knowledge of local epidemiology is important to interpret genetic profiles of leptospires circulating in an area.

Dans un contexte où les inégalités sociales de santé se creusent en Europe et particulièrement en France, il devient urgent de pouvoir mesurer la vulnérabilité sociale des patients afin d’adapter leur prise en charge, notamment dans le secteur des soins primaires. L’objectif principal de ce projet était de valider un score de précarité sociale développé à partir d’un échantillon représentatif de la population générale, le score PRECAR, auprès d’une patientèle en médecine générale. Les objectifs spécifiques étaient d’évaluer la validité externe du score, sa fiabilité, sa validité contre critère (le score EPICES a été utilisé comme gold standard) et son acceptabilité par les médecins et les patients. Une enquête transversale a été menée auprès de 100 médecins généralistes du réseau Sentinelle et de leurs patients. Les questionnaires des scores PRECAR puis EPICES ont été soumis à 1000 patients en consultation puis lors d’un entretien téléphonique secondaire qui répertoriait également des données sociodémographiques et des indicateurs de santé. Chaque patient et chaque médecin était interrogé sur l’acceptabilité du questionnaire du score PRECAR. Le score PRECAR a été remodelé afin de maximiser ses performances vis-à-vis du score EPICES. Le score PRECAR s’est révélé significativement plus élevé chez les patients présentant des indicateurs de santé dégradée. Les questions ont été jugées acceptables par les patients, et les médecins les ont jugées pertinentes et utiles pour leur pratique. Des analyses sont à poursuivre afin de pouvoir intégrer ce score en pratique courante pour les soignants, et de l’utiliser pour la recherche dans le domaine des inégalités sociales de santé.

INTRODUCTION: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. METHODS: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. RESULTS AND DISCUSSION: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. CONCLUSIONS: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

17 p., Given the severity and impact of the current Zika virus (ZIKV) outbreak in the Americas, numerous countries have rushed to develop research studies to assess ZIKV and its potential health consequences. In an effort to ensure that studies are comprehensive, both internally and externally valid, and with reliable results, the World Health Organization, the Pan American Health Organization, Institut Pasteur, the networks of Fiocruz, the Consortia for the Standardization of Influenza Seroepidemiology (CONSISE) and the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) have generated six standardized clinical and epidemiological research protocols and questionnaires to address key public health questions on ZIKV. Methods We conducted a systematic search of ongoing study protocols related to ZIKV research. We analyzed the content of protocols of 32 cohort studies and 13 case control studies for systematic bias that could produce erroneous results. Additionally we aimed to characterize the risks of bias and confounding in observational studies related to ZIKV and to propose ways to minimize them, including the use of six newly standardized research protocols. Results Observational studies of ZIKV face an array of challenges, including measurement of exposure and outcomes (microcephaly and Guillain-Barre´ Syndrome). Potential confounders need to be measured where known and controlled for in the analysis. Selection bias due tonon-random selection is a significant issue, particularly in the case-control design, and losses to follow-up is equally important for the cohort design. Conclusion Observational research seeking to answer key questions on the ZIKV should consider these restrictions and take precautions to minimize bias in an effort to provide reliable and valid results. Utilization of the standardized research protocols developed by the WHO, PAHO, Institut Pasteur, and CONSISE will harmonize the key methodological aspects of each study design to minimize bias at different stages of the study. Biases need to be considered by researchers implementing the standardized protocols as well as by users of observational epidemiological studies of ZIKV.

International audience; Extended-spectrum beta-lactamases (ESBLs) have been recurrently reported in both human and veterinary medicine, and carbapenemases have also emerged in these two sectors. Such resistance phenotypes were increasingly reported in the environment, which both receives and further disseminates multidrug-resistant (MDR) bacteria. Here, we report the high contamination of water samples (68.2%; 15/22) collected in estuaries in Lebanon. From these 15 contaminated sites, a total of 21 ESBL-producing (mostly harbouring the bla(CTX-M-15) gene) and four carbapenemase-producing (two bla(OXA-48) and two bla(OXA-244)) Enterobacteriaceae were recovered. ESBL contamination was also identified in water samples collected from rural wells and spring water, although at a lower frequency. Indeed, 1.9% (3/155) and 6.1% (7/115) of the wells and springs were contaminated, respectively, and all identified isolates were CTX-M-15-producing E. coli. Interestingly, sequence types (STs) previously associated both with animal and human reservoirs were detected (ST38, ST10 and ST131), suggesting a complex source of contamination. This situation is alarming since water drawn from wells or springs is directly intended for human consumption in Lebanon without any further treatment. Moreover, even though water from estuaries is not intended for human consumption, it is used to water animals and irrigate crops. Consequently, water contamination by ESBLs and carbapenemases in Lebanon is potentially a major risk to public health. Part of this work was presented at the 7th Symposium on Antimicrobial Resistance in Animals and the Environment (ARAE).

International audience; BACKGROUND:Highly pathogenic avian influenza A (H5N1) virus has been of public health concern since 2003. Probable risk factors for A(H5N1) transmission to human have been demonstrated in several studies or epidemiological reports. However, transmission patterns may differ according to demographic characteristics of the population and local practices. This article aggregates these data from three studies with data collected in the previous surveys in 2006 and 2007 to further examine the risks factors associated with presence of anti-A(H5) antibodies among villagers residing within outbreak areas.METHODS:We aggregated 5-year data (2006-2010) from serology survey and matched case-control studies in Cambodia to further examine the risks factors associated with A(H5N1) infection among villagers in the outbreak areas.RESULTS:Serotesting among villagers detected 35 (1.5 % [0-2.6]) positive cases suggesting recent exposure to A(H5N1) virus. Practices associated with A(H5N1) infection among all ages were: having poultry cage or nesting area under or adjacent to the house (OR: 6.7 [1.6-28.3]; p = 0.010) and transporting poultry to market (OR: 17.6 [1.6-193.7]; p = 0.019). Practices found as risk factors for the infection among age under 20 years were swimming/bathing in ponds also accessed by domestic poultry (OR: 4.6 [1.1-19.1]; p = 0.038). Association with consuming wild birds reached borderline significance (p = 0.066).CONCLUSION:Our results suggest that swimming/bathing in contaminated pond water and close contact with poultry may present a risk of A(H5N1) transmission to human.

SUMMARYThe Global Meningococcal Initiative (GMI) is an international group of scientists and clinicians with recognized expertise in meningococcal disease including microbiology, immunology, epidemiology, public health and vaccinology. The GMI was established to promote the global prevention of meningococcal disease through education, research and international cooperation. The GMI held its second summit meeting in 2013 to discuss the different aspects of existing meningococcal immunization programmes and surveillance systems. Laboratory confirmation and characterization were identified as essential for informing evidence-based vaccine implementation decisions. The relative merits of different confirmatory methodologies and their applications in different resource settings were a key component of the discussions. This paper summarizes the salient issues discussed, with special emphasis on the recommendations made and any deficiencies that were identified.

International audience; This report sought to critically examine proposals, potentials, and challenges of environmental health observatories with an emphasis on climate change processes. A critical review of existing environmental health observatories was performed, examining their purposes, potential audiences , and technological platforms. The implementation of the Brazilian Climate and Health Observatory (C&HO) is described, and two stages are defined: (i) the requirement analysis and negotiation stage that identified the national and regional institutional players and their roles as data producers/users; and (ii) thematic health-related workshops that reviewed water-related diseases, vector-borne diseases, extreme climate events, and health problems derived from forest fires. The C&HO is an example of making information on climate and health available through an Internet site where data from different origins can be accessed on a common platform. Complex queries are made by users and can be executed over multiple sites, geographically distributed, with all technical details hidden from the end user. At this stage of the C&HO prototype, alongside the queries, users can also produce semi-qualitative graphs and maps. A multi-scale approach was developed using the platform by setting up sentinel sites. Building a successful observatory is a participatory process that involves choosing indicators, data sources, information technology, and languages to best reach different audiences, such as researchers, citizens, public health professionals, and decision makers.

OBJECTIVE The purpose of this article is to present the specific public health indicators recently developed by EUROCAT that aim to summarize important aspects of the public health impact of congenital anomalies in a few quantitative measures. METHODS The six indicators are: (1) congenital anomaly perinatal mortality, (2) congenital anomaly prenatal diagnosis prevalence, (3) congenital anomaly termination of pregnancy, (4) Down syndrome livebirth prevalence, (5) congenital anomaly pediatric surgery, and (6) neural tube defects (NTD) total prevalence. Data presented for this report pertained to all cases (livebirths, fetal deaths, or stillbirths after 20 weeks of gestation and terminations of pregnancy for fetal anomaly [TOPFA]) of congenital anomaly from 27 full member registries of EUROCAT that could provide data for at least 3 years during the period 2004 to 2008. Prevalence of anomalies, prenatal diagnosis, TOPFA, pediatric surgery, and perinatal mortality were calculated per 1000 births. RESULTS The overall perinatal mortality was approximately 1.0 per 1000 births for EUROCAT registries with almost half due to fetal and the other half due to first week deaths. There were wide variations in perinatal mortality across the registries with the highest rates observed in Dublin and Malta, registries in countries where TOPFA are illegal, and in Ukraine. The overall perinatal mortality across EUROCAT registries slightly decreased between 2004 and 2008 due to a decrease in first week deaths. The prevalence of TOPFA was fairly stable at about 4 per 1000 births. There were variations in livebirth prevalence of cases typically requiring surgery across the registries; however, for most registries this prevalence was between 3 and 5 per 1000 births. Prevalence of NTD decreased by about 10% from 1.05 in 2004 to 0.94 per 1000 in 2008. CONCLUSION It is hoped that by publishing the data on EUROCAT indicators, the public health importance of congenital anomalies can be clearly summarized to policy makers, the need for accurate data from registries emphasized, the need for primary prevention and treatment services highlighted, and the impact of current services measured. Birth Defects Research (Part A), 2011.© 2011 Wiley-Liss, Inc.

International audience; The Global Meningococcal Initiative (GMI) was established in 2009 and comprises an international team of scientists, clinicians, and public health officials with expertise in meningococcal disease (MD). Its primary goal is to promote global prevention of MD through education, research, international cooperation, and developing recommendations that include decreasing the burden of severe disease. The group held its first roundtable meeting with experts from Latin American countries in 2011, and subsequently proposed several recommendations to reduce the regional burden of MD. A second roundtable meeting was convened with Latin American representatives in June 2013 to reassess MD epidemiology, vaccination strategies, and unmet needs in the region, as well as to update the earlier recommendations. Special emphasis was placed on the emergence and spread of serogroup W disease in Argentina and Chile, and the control measures put in place in Chile were a particular focus of discussions. The impact of routine meningococcal vaccination programs, notably in Brazil, was also evaluated. There have been considerable improvements in MD surveillance systems and diagnostic techniques in some countries (e.g., Brazil and Chile), but the lack of adequate infrastructure, trained personnel, and equipment/reagents remains a major barrier to progress in resource-poor countries. The Pan American Health Organization's Revolving Fund is likely to play an important role in improving access to meningococcal vaccines in Latin America. Additional innovative approaches are needed to redress the imbalance in expertise and resources between countries, and thereby improve the control of MD. In Latin America, the GMI recommends establishment of a detailed and comprehensive national/regional surveillance system, standardization of laboratory procedures, adoption of a uniform MD case definition, maintaining laboratory-based surveillance, replacement of polysaccharide vaccines with conjugate formulations (wherever possible), monitoring and evaluating implemented vaccination strategies, conducting cost-effectiveness studies, and developing specific recommendations for vaccination of high-risk groups.

Context: General practitioner’s (GP) duty of first recourse is underserved. We wanted to show that patients who require hospitalization should rather, in terms of quality of care, first pass through the GP rather than present themselves to the emergency department (ED).Method: This retrospective study included patients hospitalized through ED, divided into two groups adressed or not adressed by their GP. A score (SQUPEC) evaluated quality of hospital care by different items : length of stay, contact with GP, deprescribing, complications and readmission. The primary endpoint was a strictly higher score to 3 (best score). Secondary criterias were also considered.Results: 316 patients were included. Patients getting the best SQUPEC were more often adressed to ED by their GP (p = 0.0002). During their hospitalization, the GP was more frequently contacted and deprescribing more usually done than for patients consulting by themselves at ED. They were older and got more iatrogenic complications but fewer bedsores. Lengths of stay and early readmissions did not differ between the two groups. Starting an upstream treatment and limiting tests at the hospital promoted optimal SQUPEC.Conclusion: A patient admitted through an ED receives an optimized hospital care if he was initially adressed by his GP. Developing GP's duty of first recourse would optimize care’s pathway. Communication between ambulatory's and hospital's doctors would be encouraged and costs, real public health’s issue, could be reduced.; Contexte : La mission de premier recours du médecin traitant (MT) est insuffisamment reconnue. Nous voulions montrer qu’un patient nécessitant une hospitalisation avait intérêt, en termes de qualité de prise en charge globale, à passer d'abord par son MT plutôt qu’à se présenter de lui-même au service d’accueil des urgences (SAU).Méthode : Cette étude rétrospective incluait des patients hospitalisés via un SAU, répartis en deux groupes : adressés ou non par leur MT. Un score de qualité de prise en charge hospitalière (SQUPEC) cotait la durée de séjour, le contact avec le MT, la déprescription, les complications et la ré-hospitalisation. Le critère de jugement était un score strictement supérieur à 3 (score optimal). Puis des critères secondaires ont été étudiés.Résultats : 316 patients ont été inclus. Ceux obtenant un SQUPEC optimal étaient plus souvent adressés au SAU par leur MT (p = 0.0002). Pendant l’hospitalisation, le MT était plus régulièrement contacté et une déprescription plus souvent faite que chez les patients se rendant d’eux-mêmes au SAU. Ils étaient plus âgés et présentaient plus de complications iatrogènes mais moins d’escarres. La durée de séjour et les ré-hospitalisations précoces ne différaient pas entre les deux groupes. Débuter un traitement en amont et limiter les examens à l’hôpital favorisaient l’obtention d’un SQUPEC optimal.Conclusion : Un patient admis via un SAU bénéficie d’une prise en charge hospitalière optimisée s’il y a initialement été adressé par son MT. Valoriser la mission de premier recours du MT optimiserait le parcours de soins. Le lien ville-hôpital serait encouragé et les coûts, enjeux de santé publique, pourraient être diminués.

N.R. and I.M. are Editorial Board members of the International Journal of Mycobacteriology.; International audience; Tuberculosis (TB) control remains an important public health priority for Bulgaria. The population structure of Mycobacterium tuberculosis is clonal and certain genetic families of this species (e.g., Latin-American-Mediterranean [LAM]) have attracted more attention due to their global dissemination and/or particular pathogenic properties, e.g., association with multidrug resistance (MDR). The aim of this study was to evaluate the prevalence of the M. tuberculosis LAM family in Bulgaria based on the use of different molecular markers. A total of 101 previously spoligotyped M. tuberculosis strains were studied by LAM-specific PCR assay to detect an insertion of IS6110 in the specific genome region. On the whole, clear-cut results were obtained for most strains; spoligotype-based family was reassigned in some of them. At the same time, double bands were amplified in some cases and warrant further validation studies of this method. The higher MDR rate among LAM versus other genotype isolates was observed (P = 0.04). In conclusion, these results suggest a low (

BACKGROUND: Recently, the International Agency for Research on Cancer (IARC) Programme for the Evaluation of Carcinogenic Risks to Humans has been criticized for several of its evaluations, and also for the approach used to perform these evaluations. Some critics have claimed that failures of IARC Working Groups to recognize study weaknesses and biases of Working Group members have led to inappropriate classification of a number of agents as carcinogenic to humans.OBJECTIVES: The authors of this Commentary are scientists from various disciplines relevant to the identification and hazard evaluation of human carcinogens. We examined criticisms of the IARC classification process to determine the validity of these concerns. Here, we present the results of that examination, review the history of IARC evaluations, and describe how the IARC evaluations are performed.DISCUSSION: We concluded that these recent criticisms are unconvincing. The procedures employed by IARC to assemble Working Groups of scientists from the various disciplines and the techniques followed to review the literature and perform hazard assessment of various agents provide a balanced evaluation and an appropriate indication of the weight of the evidence. Some disagreement by individual scientists to some evaluations is not evidence of process failure. The review process has been modified over time and will undoubtedly be altered in the future to improve the process. Any process can in theory be improved, and we would support continued review and improvement of the IARC processes. This does not mean, however, that the current procedures are flawed.CONCLUSIONS: The IARC Monographs have made, and continue to make, major contributions to the scientific underpinning for societal actions to improve the public's health.CITATION: Pearce N, Blair A, Vineis P, Ahrens W, Andersen A, Anto JM, Armstrong BK, Baccarelli AA, Beland FA, Berrington A, Bertazzi PA, Birnbaum LS, Brownson RC, Bucher JR, Cantor KP, Cardis E, Cherrie JW, Christiani DC, Cocco P, Coggon D, Comba P, Demers PA, Dement JM, Douwes J, Eisen EA, Engel LS, Fenske RA, Fleming LE, Fletcher T, Fontham E, Forastiere F, Frentzel-Beyme R, Fritschi L, Gerin M, Goldberg M, Grandjean P, Grimsrud TK, Gustavsson P, Haines A, Hartge P, Hansen J, Hauptmann M, Heederik D, Hemminki K, Hemon D, Hertz-Picciotto I, Hoppin JA, Huff J, Jarvholm B, Kang D, Karagas MR, Kjaerheim K, Kjuus H, Kogevinas M, Kriebel D, Kristensen P, Kromhout H, Laden F, Lebailly P, LeMasters G, Lubin JH, Lynch CF, Lynge E, 't Mannetje A, McMichael AJ, McLaughlin JR, Marrett L, Martuzzi M, Merchant JA, Merler E, Merletti F, Miller A, Mirer FE, Monson R, Nordby KC, Olshan AF, Parent ME, Perera FP, Perry MJ, Pesatori AC, Pirastu R, Porta M, Pukkala E, Rice C, Richardson DB, Ritter L, Ritz B, Ronckers CM, Rushton L, Rusiecki JA, Rusyn I, Samet JM, Sandler DP, de Sanjose S, Schernhammer E, Seniori Costantini A, Seixas N, Shy C, Siemiatycki J, Silverman DT, Simonato L, Smith AH, Smith MT, Spinelli JJ, Spitz MR, Stallones L, Stayner LT, Steenland K, Stenzel M, Stewart BW, Stewart PA, Symanski E, Terracini B, Tolbert PE, Vainio H, Vena J, Vermeulen R, Victora CG, Ward EM, Weinberg CR, Weisenburger D, Wesseling C, Weiderpass E, Zahm SH. 2015. IARC Monographs: 40 years of evaluating carcinogenic hazards to humans. Environ Health Perspect 123:507-514; http://dx.doi.org/10.1289/ehp.1409149.

Listeria monocytogenes is a foodborne pathogen that can cause listeriosis, a severe invasive infection in humans with a particularly high case-fatality rate. Listeriosis is a major public health concern in all world regions, with an increasing incidence in Europe, especially among elderly persons (1,2). L. monocytogenes is genetically heterogeneous (3–5). To help epidemiologic investigation and to define clones, i.e., groups of genetically similar isolates descending from a common ancestor, a variety of typing methods have been used, including pulsed-field gel electrophoresis (5,6), single nucleotide polymorphism typing (7), and multiple housekeeping and virulence gene sequencing (8,9). Some clones implicated in multiple outbreaks have been defined as epidemic clones (EC) (3,5,9–11). ECI and ECIV have been described in several countries (3,5), but because of the lack of standardization of genotyping, a definition of clones is not widely accepted, and current knowledge on the global distribution of L. monocytogenes clones is virtually absent. Multilocus sequence typing (MLST) is a reference method for global epidemiology and population biology of bacteria, and its application to L. monocytogenes (12) effectively allows isolate comparisons across laboratories (www.pasteur.fr/mlst). The aim of this study was to investigate the global distribution of L. monocytogenes MLST-defined clones.

International audience

International audience

Antibiotic overconsumption is the main force driving the emergence of multidrug-resistant bacterial strains. To promote better antibiotic use in France, a nationwide campaign has been run every year from October to March since 2002. In 2007, it was shown that winter outpatient antibiotic consumption had decreased by 26.5% compared to the 2000-2002 baseline period. Here, we quantified outpatient antibiotic use between 2000 and 2010 as a follow-up analysis of the nationwide campaign. Reimbursed outpatient antibiotic prescriptions were extracted from computerized French National Health Insurance databases. Entire series and age group and antibiotic class analyses were computed. Time series analyses used autoregressive moving-average models with exogenous variables and intervention functions. Two periods were considered: October to March “campaign” periods and April to September “warm” periods. Compared to the precampaign (2000-2002) baseline period, the numbers of weekly antibiotic prescriptions per 1,000 inhabitants during campaign periods decreased until winter 2006 to 2007 (−30% [95% confidence interval {CI}, −36.3 to −23.8%]; P < 0.001) and then stabilized except for individuals >60 years of age, for whom prescriptions reached the precampaign level. During the warm periods from April to September, no significant differences were estimated compared to the baseline level for the entire series, but seniors had an increasing trend that became significant as of 2005, reaching +21% (95% CI, +12.9 to +29.6%) in 2009 ( P < 0.0001). These results highlight the need for a better understanding of antibiotic use by the elderly, requiring research with targeted and tailored public health actions for this population.

Les leishmanioses ont un impact important sur la santé humaine dans le monde du fait de leur fréquence, de la gravité de certaines de leurs formes cliniques et parce qu’elles touchent des populations particulièrement vulnérables. La localisation de certains Instituts Pasteur dans les zones d’endémie leishmanienne a de tout temps favorisé les actions de recherche et de santé publique des équipes pasteuriennes vis-à-vis de cette parasitose; Protozoan parasites of the genus Leishmania generate severe human diseases termed leishmaniases. Due to their frequency and the severity of certain clinical forms, these diseases represent a major public health problem and limit the economic growth in various developing countries. The presence of Pasteur Institutes in countries with endemic leishmaniasis has provided important incentives to develop a strong public health agenda in the Pasteur scientific community with respect to this important disease. A concerted effort is now coordinated through the recently created LeishRIIP platform (www.leishriip.org), which aims to identify synergies and complementary expertise between the eleven members of the international network of Pasteur Institutes working on various aspects of the disease including epidemiology, diagnosis, chemotherapy and vaccination.

The aim of this study is the analysis of the historical complexities associated with cancer registries in Spain. After the acceptance of the International Classification of Diseases in 1900, the first cancer incidence survey was in 1902. Following the inteernational initiative by the German Central Committee for Canceer Research (DZK), the Instituto Rubio conducted a census of all cancer patients undeer medical tretment. Spain attended the meeting in Berlin where the International Association for Cancer Research was founded (1908), and the Inteernational Union Against Cancer (IUAC) constitutional congress was held in Madrid (1933). Nonetheless, Spanish was absent from the first cancer registries conference (Copenhagen, September 1946), and from the WHO committe to support cancer registry programming (1950). As a result, contemporary history of Spanish cancer registries starts as late as 1960 in Zaragoza, particularly through the establishment of a Latin language speaking countries registries team., Este estudio tiene como objetivo analizar las complejidades históricas de los registros de cáncer en España. Tras la aceptación en 1900 de la primera clasificación internacional de enfermedades, se produjo en 1902 el primer estudio de incidencia del cáncer. A causa de la iniciativa internacional del Comité Central Alemán para la Investigación sobre el Cáncer (DZK), el Instituto Rubio realizó un censo de todos los pacientes bajo tratamiento médico. España participó en la fundación en Berlín de la International Association for Cancer Research (1908) y el congreso constituyente de la Unión Internacional Contra el Cáncer (UICC) se reunió en 1933 en Madrid, pero no asistió a la primera conferencia de registros de cáncer (Copenhague, septiembre de 1946), ni al comité de programación del registro de cáncer de la OMS (1950). Como resultado, la historia contemporánea del registro de cáncer español empieza en Zaragoza en 1960. La evolución de las técnicas epidemiológicas permite afirmar que España, pionera en los registros hospitalarios, se convirtió al sistema de registros poblacionales tardíamente, en particular gracias a la instauración de un equipo de los registros latinos en el que Zaragoza jugó un papel importante., La présente étude a pour objectif l'analyse des situations historiques complexes du registre des cancers en Espagne. Une fois acceptée en 1900 la première classification internationale des maladies, en 1902 s'est effectuée la première étude d'incidence du cancer. Le partenariat international du Comité central allemand pour la recherche sur le cancer (DZK) a mis en disposition le Instituto Rubio d'élaborer un recensement de tous les patients sous traitement médical. L'Espagne a participé à la fondation à Berlin de l'association internationale de la recherche sur le cancer (1908) et le Congrès constituant de l'Union internationale contre le cancer (UICC) s'est tenu à Madrid en 1933, mais n'a participé à la première conférence des registres des cancers (Copenhague, septembre 1946), ni au comité de programmation du registre de cancer de l'OMS (1950). En conséquence, l'histoire contemporaine du registre de cancer espagnol commence en 1960 à Zaragoza. L'évolution des techniques épidémiologiques permet d'affirmer que l'Espagne, pionnière dans le domaine des registres des hôpitaux, ne s'est convertie au système des registres basés sur la population que tardivement, par le biais notamment de la mise en place d'une équipe des registres latins où Zaragoza a joué un rôle important.

International audience; OBJECTIVE:To describe the reporting of public health research in Francophone sub-Saharan Africa (FSA).STUDY DESIGN:A bibliometric research study of scientific public health publications in FSA, which includes 24 countries and approximately 260 million people.METHODS:Two researchers analysed original articles published in 2007 in the medical or social sciences fields and indexed in Scopus. At least one co-author of articles had to be based in FSA. The analysis focused on research field, public health function (WHO classification), FSA country author's affiliation, language, journal type and global burden of disease (WHO classification).RESULTS:Of 1047 articles retrieved by the search, 212 were from the public health field. The number of articles per country varied from 0 to 36. Public health functions examined were health service research (24.5%), health monitoring (27.4%), prevention (15%) and legislation (0.5%). The distribution of health needs described in the articles was close to that of the WHO data for Africa for 2004: infectious and parasitic diseases (70% vs 54%), maternal and perinatal conditions (15% vs 17%), non-communicable diseases (15.6% vs 21%), and injuries (0.5% vs 8%).CONCLUSION:The areas reported in published articles from sub-Saharan Africa reflect the health needs distribution in Africa; however, the number of publications is low, particularly for prevention. In light of the current focus on evidence-based public health, this study questions whether the international scientific community adequately considers the expertise and perspectives of African researchers and professionals.

International audience; BACKGROUND: Differential consequences of ill health according to individuals' position on the social scale may constitute an important pathway underlying social health inequalities. In the current context, chronic diseases have major consequences on employment. These consequences may play a substantial role in the process of social health inequalities. Understanding the employment consequences of chronic diseases and their socially differentiated nature constitutes a critical field of research for the comprehension and the reduction of social health inequalities. DISCUSSION: In the past decades, studies in various countries have provided evidence of an association between the presence of various chronic conditions and employment outcomes including decreased workforce participation, early retirement, work limitations, sickness absence from work or low access/return to work. However, available data leave unanswered important questions regarding the causal nature and the pathways underlying this association. In addition, only few studies have focused on social inequalities in the employment consequences of specific health conditions. Though, such studies appear essential in order to thoroughly investigate the pathways underlying such inequalities. These pathways deserve to be investigated in future researches. Such researches, in addition to their contribution to a better understanding of social health inequalities, potentially have important public health implications.

International audience; BACKGROUND:Fixed laboratory capacity in Africa may be inadequate; mobile microbiological laboratories may address this issue but their utility has seldom been evaluated.METHODS:During 2012, the Benin Ministry of Health requested mobile microbiological laboratory (LaboMobil®) support following the failure of polysaccharide meningococcal A+C vaccine to prevent an epidemic in five Northern districts. Within four days, the intervention was initiated. A fixed site in Northern Togo, Pasteur Institutes in Côte d'Ivoire and France, and a research laboratory in Burkina Faso provided additional laboratory support.RESULTS:Local laboratories initially reported most cases to have Gram-positive diplococci suggestive of pneumococcal meningitis. The LaboMobil® evaluated 200 cerebrospinal fluid (CSF) samples and 59 stored isolates collected from 149 individuals. Of the 74 individuals with etiologic confirmation, 60 (81%) had NmW135 and 11 (15%) NmX identified; no pneumococci were identified. Testing in France on 30 NmW135 and 3 NmX confirmed the etiology in all cases. All five districts had crossed the epidemic threshold (10 cases per 100,000 per week), all had NmW135 identified and four had NmX identified. NmX were identified as X:ST-181:ccST-181:5-1:10-1:F1-31 and NmW135 as W:ST-11: ccST-11:5:2:F1-1.CONCLUSIONS:In an area with limited local laboratory capacity, a mobile microbiology laboratory intervention occurred in four days through the cooperation of four African and one European country. Results were different from those reported by local laboratories. Despite the introduction of serogroup A meningococcal and 13-valent pneumococcal conjugate vaccines, endemic and epidemic meningitis will continue in the region, emphasizing the usefulness of the LaboMobil® in the short and medium term.

Context: Several studies have shown that doctors consider their patients to be a hindrance todeprescribing. We gathered the patients perspective, never before addressed in this issue of publichealth, to identify solutions to facilitate its implementation.Method and Results: A qualitative study, consisting of semi-directive interviews of 28 polymedicatedpatients who were grouped according to their reaction to deprescribing.The majority of patients agreed to deprescribing, seeking autonomy and responsibility. Olderpatients, dependent, isolated and anxious, refused deprescribing, considering it too risky and withoutbenefit.The barriers to the acceptance and implementation of deprescribing were fear of: drugs andpathologies, poorly understood by the patients; losing a possible therapeutic benefit; withdrawalsyndrome and the recurrence of symptoms; the required effort and the lack of support; breach oftrust with their physician.The solutions proposed by both patients and doctors to deprescribe drugs were similar. To becomeinvolved, the patient needs to be educated and made aware of his responsibilities. He must behelped to free himself of his medication and non-pharmacological alternatives must be proposed.The general practitioner, better trained, must dare to remove drugs. A “customized deprescribingplan” for all polymedicated patients needs to be created, coordinating all healthcare providers andrelatives.Conclusion: Deprescribing is a difficult process even when it is agreed to by the patient. The solutionsproposed aim at overcoming the barriers identified, but they necessitate the implementation ofconcrete public health measures.; Contexte : plusieurs études ont montré qu’aux yeux des médecins les patients constituaient unobstacle à la déprescription. Nous avons cherché à recueillir leur avis, jamais abordé sur cet enjeu desanté publique, et à identifier des solutions pour en faciliter la mise en oeuvre.Méthode et Résultats : cette étude qualitative par entretiens semi-directifs incluait 28 patientspolymédiqués, catégorisés en fonction de leur réponse à la déprescription.Les patients qui acceptaient la déprescription étaient majoritaires, en quête de responsabilité etd’autonomie. Les patients plus âgés, dépendants, isolés et anxieux, la refusaient, la jugeant risquéeet sans avantage.Les obstacles à l’acceptation et à la mise en oeuvre de la déprescription étaient la peur : desmédicaments et des pathologies, mal connus des patients ; de perdre un bénéfice thérapeutique ;du syndrome de sevrage et du retour des symptômes ; des efforts à fournir et du manque desoutien ; de rompre la confiance avec le médecin.Les solutions proposées alors par les patients pour déprescrire, rejoignaient celles des médecins.Pour s’impliquer, le patient a besoin d’éducation et de responsabilisation. Il faut l’aider à sedétacher de son traitement et lui offrir des alternatives non-médicamenteuses. Le médecin traitant,mieux formé, doit oser déprescrire. Il faut créer un « Projet de déprescription personnalisé » pourtout patient polymédiqué, coordonnant tous les professionnels de santé et les aidants.Conclusion : la déprescription est difficile même si les patients l’acceptent. Les solutions proposéesvisent à surmonter les obstacles identifiés mais nécessitent la mise en place d’actions de santépublique concrètes.

International audience; We used a quantitative microbiological risk assessment model to describe the risk of Campylobacter and Salmonella infection linked to chicken meals prepared in households in Dakar, Senegal. The model uses data collected specifically for this study, such as the prevalence and level of bacteria on the neck skin of chickens bought in Dakar markets, time-temperature profiles recorded from purchase to consumption, an observational survey of meal preparation in private kitchens, and detection and enumeration of pathogens on kitchenware and cooks' hands. Thorough heating kills all bacteria present on chicken during cooking, but cross-contamination of cooked chicken or ready-to-eat food prepared for the meal via kitchenware and cooks' hands leads to a high expected frequency of pathogen ingestion. Additionally, significant growth of Salmonella is predicted during food storage at ambient temperature before and after meal preparation. These high exposures lead to a high estimated risk of campylobacteriosis and/or salmonellosis in Dakar households. The public health consequences could be amplified by the high level of antimicrobial resistance of Salmonella and Campylobacter observed in this setting. A significant decrease in the number of ingested bacteria and in the risk could be achieved through a reduction of the prevalence of chicken contamination at slaughter, and by the use of simple hygienic measures in the kitchen. There is an urgent need to reinforce the hygiene education of food handlers in Senegal.

Contains fulltext : 110866.pdf (Publisher’s version ) (Open Access) ABSTRACT: BACKGROUND: By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. METHODS: As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature.In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. RESULTS: The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. CONCLUSIONS: We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.

International audience; Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population-based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.

International audience; The Global Meningococcal Initiative (GMI) is composed of an international group of scientists, clinicians and public health officials with expertise in meningococcal immunology, epidemiology and prevention. The primary goal of the GMI is the promotion of the global prevention of invasive meningococcal disease through education and research. The GMI members reviewed global meningococcal disease epidemiology, immunization strategies, and research needs. Over the past decade, substantial advances in meningococcal vaccine development have occurred and much has been learned about prevention from countries that have incorporated meningococcal vaccines into their immunization programs. The burden of meningococcal disease is unknown for many parts of the world because of inadequate surveillance, which severely hampers evidence-based immunization policy. As the field of meningococcal vaccine development advances, global surveillance for meningococcal disease needs to be strengthened in many regions of the world. For countries with meningococcal vaccination policies, research on vaccine effectiveness and impact, including indirect effects, is crucial for informing policy decisions. Each country needs to tailor meningococcal vaccination policy according to individual country needs and knowledge of disease burden. Innovative approaches are needed to introduce and sustain meningococcal vaccination programs in resource-poor settings with a high incidence of meningococcal disease.

International audience; Heart failure with preserved ejection fraction (HFPEF) is increasingly recognized as a major public health problem worldwide. Significant advances have been made in our understanding of the epidemiology of HFPEF over the past two decades, with the publication of numerous population-based epidemiological studies, large heart failure registries, and randomized clinical trials. These recent studies have provided detailed characterization of larger numbers of patients with HFPEF than ever before. This review summarizes the state of current knowledge with regards to the disease burden, patient characteristics, clinical course, and outcomes of HFPEF. Despite the wealth of available data, substantive gaps in knowledge were identified. These gaps represent opportunities for further research in HFPEF, a syndrome that is clearly a rising societal burden and that is associated with substantial morbidity and mortality.