Showing papers by "Institut de veille sanitaire published in 2001"

Confounding and effect modification in the short-term effects of ambient particles on total mortality: Results from 29 European cities within the APHEA2 project

Abstract: We present the results of the Air Pollution and Health: A European Approach 2 (APHEA2) project on short-term effects of ambient particles on mortality with emphasis on effect modification. We used daily measurements for particulate matter less than 10 microm in aerodynamic diameter (PM10) and/or black smoke from 29 European cities. We considered confounding from other pollutants as well as meteorologic and chronologic variables. We investigated several variables describing the cities' pollution, climate, population, and geography as potential effect modifiers. For the individual city analysis, generalized additive models extending Poisson regression, using a smoother to control for seasonal patterns, were applied. To provide quantitative summaries of the results and explain remaining heterogeneity, we applied second-stage regression models. The estimated increase in the daily number of deaths for all ages for a 10 microg/m3 increase in daily PM10 or black smoke concentrations was 0.6% [95% confidence interval (CI) = 0.4-0.8%], whereas for the elderly it was slightly higher. We found important effect modification for several of the variables studied. Thus, in a city with low average NO2, the estimated increase in daily mortality for an increase of 10 microg/m3 in PM10 was 0.19 (95% CI = 0.00-0.41), whereas in a city with high average NO2 it was 0.80% (95% CI = 0.67-0.93%); in a relatively cold climate the corresponding effect was 0.29% (95% CI = 0.16-0.42), whereas in a warm climate it was 0.82% (95% CI = 0.69-0.96); in a city with low standardized mortality rate it was 0.80% (95% CI = 0.65-0.95%), and in one with a high rate it was 0.43% (95% CI = 0.24-0.62). Our results confirm those previously reported on the effects of ambient particles on mortality. Furthermore, they show that the heterogeneity found in the effect parameters among cities reflects real effect modification, which is explained by specific city characteristics.

Two consecutive nationwide outbreaks of Listeriosis in France, October 1999-February 2000.

Abstract: In France, listeriosis surveillance is based on mandatory notification of all culture-confirmed cases, with systematic typing of isolates and routine collection of the patient's food history. From October 1999 to March 2000, two outbreaks of listeriosis were detected through this enhanced surveillance system. In outbreak 1, analysis of the food histories of cases suggested brand X "rillettes," a pâte-like meat product, as the vehicle of infection, and the outbreak strain of Listeria monocytogenes was subsequently isolated from the incriminated rillettes. In outbreak 2, a case-control study showed that consumption of jellied pork tongue was strongly associated with infection with the outbreak strain (odds ratio = 75.5, 95% confidence interval: 4.7, 1,216.0). However, trace-back results did not permit incrimination of any particular manufacturer of jellied pork tongue, and the outbreak strain was not isolated from the incriminated food or from any production sites. Consumption of jellied pork tongue was discouraged on epidemiologic evidence alone. The consecutive occurrence of these two outbreaks confirms the epidemic potential of listeriosis, even in a context of decreasing incidence, and underlines the importance of timely case-reporting and systematic typing of human L. monocytogenes strains to allow early detection and separate investigation of different clusters.

Effect of prevention measures on incidence of human listeriosis, France, 1987-1997.

Abstract: To assess the impact of preventive measures by the food industry, we analyzed food monitoring data as well as trends in the incidence of listeriosis estimated through three independent sources: the National Reference Center of Listeriosis; a laboratory-based active surveillance network; and two consecutive nationwide surveys of public hospital laboratories. From 1987 to 1997, the incidence of listeriosis decreased by an estimated 68%. A substantial reduction in the proportion of Listeria monocytogenes-contaminated products was observed at the retail level. The temporal relationship between prevention measures by the food industry, reduction in L. monocytogenes-contaminated foodstuffs, and reduction in listeriosis incidence suggests a causal relationship and indicates that a substantial part of the reduction in illness is related to prevention efforts.

Hepatitis C in a Ward for Cystic Fibrosis and Diabetic Patients Possible Transmission by Spring-Loaded Finger-Stick Devices for Self-Monitoring of Capillary Blood Glucose

Abstract: OBJECTIVE: To identify the routes of transmission in a nosocomial outbreak of hepatitis C virus (HCV) infection. DESIGN: Epidemiological investigation, including screening for HCV of hospitalized patients, and a retrospective cohort study, review of hygiene and medical practices, and molecular comparison of HCV isolates. SETTING: A specialized care unit for cystic fibrosis (CF) and diabetic patients at an acute-care facility in the south of France. RESULTS: Of the 57 CF patients (age in 1995: 2-28 years), 38 (66.7%) were tested and 22 (57.9%) were anti-HCV positive. Eight (50%) of 16 patients with anti-HCV antibody tested by polymerase chain reaction were viremic. No patients had received blood products or had any history of intravenous drug use. All 18 (100%) patients with CF who had ever undergone self-monitoring of capillary blood glucose in the unit were anti-HCV positive, compared to 4 (20%) of 20 who had not (relative risk, 5.0; 95% confidence interval, 2.1-12.0). Seventy (39.5%) of the patients with diabetes were screened for anti-HCV; 12 (18.8%) tested positive, with 3 (25%) positive for HCV-RNA. Patients with diabetes had routine capillary blood glucose monitoring while hospitalized and shared with CF patients the same spring-triggered devices for capillary blood glucose monitoring. The disposable platform of the devices was not changed between patient use. All HCV isolates belonged to the type 1, subtype b, and phylogenetic analysis showed a close homology by sequencing of NS5b and E2/HVR regions. CONCLUSION: As reported earlier for the hepatitis B virus, shared spring-triggered devices for capillary blood glucose monitoring by finger puncture may transmit HCV. Strict application of Standard Precautions procedures is warranted in any healthcare setting.

Estimation of measles reproduction ratios and prospects for elimination of measles by vaccination in some Western European countries

Abstract: The objective of this study is to estimate the measles reproduction ratio for eight Western European vaccination programmes. Because many plausible age-structured transmission patterns result in a similar description of the observations, it is not possible to estimate a unique value of the reproduction ratio. A method is developed to estimate bounds and confidence intervals for plausible values of the reproduction ratios using maximum likelihood methods. Lower and upper bounds for plausible values of the basic reproduction ratio are estimated to be 7.17 (95% CI 7.14-7.20) and 45.41 (95% CI 9.77-49.57), corresponding to lower and upper bounds on critical vaccine coverage of 86.6% and 98.1%. Of the eight evaluated vaccination programmes, four have vaccine coverage below the lower bound and allow measles to persist, and four have vaccine coverage at the upper bound and may eventually eliminate measles.

Unsafe injecting practices among attendees of syringe exchange programmes in France.

Abstract: Aims. To describe syringe exchange programme attendees and their injection practices. Design. Cross-sectional study (one week in 1998). Data were collected through a standardized questionnaire. Setting. 60/74 syringe exchange programmes (SEPs) in France. Participants. Clients requesting syringes in 60 SEPs. Measurements. Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. Findings. 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20. 8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and buprenorphine high-dosage was the substance most used (73%). In the previous month, 45% of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine-HD group had better social status and safer injection practices. Conclusions. In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.

Short-Term Effects of Air Pollution on Mortality in the Cities of Rouen and Le Havre, France, 1990–1995

Abstract: In this study, the authors examined the short-term effects of ambient air pollution on mortality across 2 French cities: Rouen and Le Havre. In Poisson regression models, which controlled for day-of-week effects, the authors used nonparametric smoothing to control for temporal trend, weather, and influenza epidemics. In Rouen, an interquartile range increase of 60.5–94.1 μg/m3 of ozone was associated with an increase of 4.1 % (95% confidence interval = 0.6, 7.8) of total mortality. Daily variations in sulfur dioxide (interquartile range increase = 17.6–36.4 μg/m3) were also associated with an 8.2% increase (95% confidence interval = 0.4, 16.6) in respiratory mortality. An increase of 6.1% (95% confidence interval = 1.5, 10.9) of cardiovascular mortality was also observed with an interquartile range increase of nitrogen dioxide (i.e., 25.3–42.2 μg/m3). With respect to Le Havre, an interquartile range increase in daily levels of sulfur dioxide (11.3–35.6 μg/m3) was associated with an increase of ap...

Définition de priorités dans le domaine des zoonoses non alimentaires

Abstract: Resume En juillet 2000, l'Institut de veille sanitaire a reuni un groupe d'experts pour definir les priorites et les moyens a mettre en œuvre afin d'ameliorer la connaissance, la prevention et le controle des zoonoses non alimentaires. Le groupe devait definir la liste des maladies a considerer, hierarchiser les maladies en fonction de leur importance en sante publique, identifier les besoins pour chacune d'elles, juger de l'adequation des programmes et des systemes de surveillance en place a ces objectifs. En cas d'inadequation, des actions devaient etre proposees pour atteindre ces objectifs et des priorites d'action determinees. A partir d'une premiere liste de 37 maladies analysee en fonction de criteres definis par le groupe, les maladies ont ete classees comme prioritaires, importantes ou non prioritaires. Pour les maladies prioritaires et importantes, le processus de priorisation continue et les resultats seront disponibles en mai 2001.

Minced beef and human salmonellosis: review of the investigation of three outbreaks in France.

Abstract: The synthesis of investigations of three salmonellosis outbreaks which occured in France between 1998 and 2000 confirms the role of the consumption of minced beef and highlights the importance of prevention measures.

Circumvention of herd immunity during an outbreak of meningococcal disease could be correlated to escape mutation in the porA gene of Neisseria meningitidis.

Abstract: Meningococcal strains isolated during an outbreak were shown to belong to the ET-5 complex and to harbor a mutation in the VR2 region of the porA gene. They were less susceptible to the bactericidal effect of normal human serum than was the ET-5 wild-type strain. These results are of concern, as PorA is a potential target in vaccine design.

Bioterrorism preparedness and response in European public health institutes.

Abstract: The terrorist attacks on 11 September 2001 and the deliberate release of anthrax in the United States had consequences for public health not only there, but also in Europe. Europe's public health systems had to manage numerous postal materials possibly contaminated with anthrax. Our survey aimed to document the response of European public health institutes to recent bioterrorist events to identify the gaps that need to be addressed; 18 institutes from 16 countries participated in this Euroroundup. Bioterrorist threats in Europe were hoaxes only, and should be considered as a "preparedness exercise" from which three lessons can be drawn. Firstly, because of inadequate preparedness planning and funding arrangements, Europe was not ready in October 2001 to respond to bioterrorism. Secondly, although European institutes reacted quickly and adapted their priorities to a new type of threat, they need adequate and sustained support from national governments to maintain their overall capacity. Thirdly, the recent crisis demonstrated the need for increased investment in epidemiology training programmes and the establishment of a technical coordination unit for international surveillance and outbreak response in the European Union.

Surveillance des effets à court terme de la pollution atmosphérique sur la mortalité en milieu urbain. Résultats d'une étude de faisabilité dans 9 villes françaises

Abstract: Position du probleme : Cette etude avait pour objectif de quantifier les effets a court terme de la pollution atmospherique sur la mortalite et d'evaluer la faisabilite de la mise en place d'un dispositif de surveillance epidemiologique dans 9 villes francaises. Methodes : Le recueil, l'exploitation et l'analyse des donnees temporelles ont suivi un protocole commun standardise. Les donnees de pollution dependaient du developpement des reseaux locaux de mesure (indicateurs mesures, nombre de stations). Les techniques d'analyse utilisees (etudes de series temporelles) ont fait appel aux modeles additifs generalises (GAM). Resultats : Dans les 9 zones considerees, des associations entre la mortalite toutes causes, cardio-vasculaire et respiratoire, et les indicateurs de pollution ont ete observees. Ces associations etaient generalement de type lineaire sans seuil. Globalement, les exces de mortalite lies a un accroissement inter-quartiles de la pollution acido-particulaire variaient, selon les polluants, entre 0,3 et 3,5 % pour la mortalite totale ; 0,5 et 6,3 % pour la mortalite cardio-vasculaire et entre 0,1 et 12 % pour la mortalite respiratoire. Concernant la pollution photo-oxydante, ils variaient entre 0,4 et 7,3 % pour la mortalite totale, 1,4 et 6,7 % pour la mortalite cardio-vasculaire et entre 1,7 et 30,4 % pour la mortalite respiratoire. Conclusion : Malgre un protocole commun standardise, certaines disparites, inherentes aux particularites locales, ont ete constatees (longueur des series temporelles, nombre de stations de mesure et de polluants disponibles...). Neanmoins, cette etude pilote a montre que la surveillance epidemiologique multi-centrique des effets de la pollution atmospherique etait realisable. Cependant, cela necessite de valider les resultats obtenus par une nouvelle analyse des donnees de mortalite sur une periode d'etude plus longue, et d'etudier egalement la faisabilite et la pertinence de recourir a d'autres indicateurs sanitaires tels que les admissions hospitalieres.

The use of smallpox virus as a biological weapon: the vaccination situation in France.

Abstract: In the context of its plan to fight against bioterrorism, the Ministry of Health asked the Institut de Veille Sanitaire to evaluate the epidemic risk from a release of the small pox virus, and to make recommendations on potential vaccination strategies to be implemented. A benefit/risk assessment of various vaccination scenarios, including vaccination of the whole French population, was carried out to evaluate the severity of a terrorist action threat. This analysis concludes that at this stage, vaccination action does not seem to be justified. Even in the case of a real threat, the vaccination of frontline healthcare personnel, and in particular of contacts of cases, must be given priority.

Europe-wide surveillance for sexually transmitted infections: a timely and appropriate intervention.

Abstract: Sexually transmitted infections (STIs), including HIV, pose a significant threat to the health and wellbeing of Europeans and require concerted and sustained intervention. Over the past decade, the number of reported cases of STIs, including antimicrobial resistant Neisseria gonorrhoeae, has increased appreciably, and outbreaks of syphilis have recently been reported in many Member states of the European Union (EU). Young people, homosexual men, and those with poor access to health care (including preventive and educational services) seem to be particularly affected, with increased travel and migration, high risk sexual behaviours, and a deterioration of public health responses to STI control (for example, partner notification) being key driving factors. Many of these demographic and behavioural trends are similar across EU states, as is the desire to develop and implement effective STI prevention and control programmes.

Meningococcal W135 infection epidemics associated with pilgrimage to Mecca in 2000

Abstract: Introduction Du 3 au 7 avril 2000, 4 cas d'infections a meningocoque (IM) de serogroupe W135, dont 2 fatals, ont ete signales chez des pelerins revenant de la Mecque et dans leur entourage immediat. La rarete de la souche en France, son appartenance au complexe clonal implique dans plusieurs epidemies en Europe et en Amerique, la forte letalite observee, ont conduit la Direction Generale de la Sante (DGS) a recommander, le 8 avril, une chimioprophylaxie par rifampicine a tous les pelerins et les personnes vivant a leur domicile. L'Institut de Veille Sanitaire (InVS) a mene une investigation afin de decrire l'epidemie, de suivre la diffusion de la souche dans la population et d'evaluer l'impact des mesures mises en place et l'eventuel besoin d'autres mesures specifiques. Methodes Un cas etait confirme lorsqu'une souche isolee apres le 22 mars d'un milieu habituellement sterile etait identique a la souche epidemique (W135, 2a: P1-2,5- complexe clonal ET37). Un cas etait probable lorsqu'il survenait chez un pelerin ou un contact de pelerin presentant soit une IM clinique (liquide cephalorachidien purulent ou purpura fulminons) soit une souche W135 dont les caracteristiques etaient impossibles a determiner. Pour chaque cas un questionnaire standardise, elabore en collaboration avec les pays europeens concernes par l'epidemie, a ete applique. Resultats Au 20/11/2000, 25 cas confirmes et 2 cas probables ont ete identifies ; 85 % des cas sont survenus pendant les 7 premieres semaines de l'epidemie. La letalite a ete de 18 %. Les patients de plus de 50 ans representaient 66 % des cas (6/9) avant le 9 avril 2000 et 17 % des cas (3/18) apres cette date. Chez 4 patients il s'agissait d'une mono-arthrite. Aucun foyer de cas groupes n'a ete identifie. Quatre cas sont survenus parmi les 19100 pelerins (taux d'attaque : 21/100 000), 9 parmi des personnes vivant a leur domicile, 7 parmi des sujets ayant eu un contact direct avec un pelerin hors foyer et, pour 7 cas, aucun contact direct avec un pelerin n'a ete trouve. Ces 7 cas sont survenus apres la 3 e semaine de l'epidemie. Aucun cas n'est survenu chez des personnes ayant suivi la chimioprophylaxie par rifampicine. Dix-huit cas sont survenus apres la diffusion des recommandations de la DGS, dont 5 appartenaient a la population visee par les mesures. Conclusion Ces donnees suggerent que la souche epidemique n'est pas differente des autres souches en terme de virulence et de transmissibilite. Huit mois apres la fin du pelerinage, le nombre de cas lies a l'epidemie est reste limite en France. Cependant, les caracteristiques des cas les plus recents sont en faveur de la persistance de la circulation du clone epidemique dans la population generale. La DGS recommande aux pelerins se rendant au pelerinage de La Mecque 2001 la vaccination par le vaccin quadrivalent A,C,W135,Y.

[Short-term relationships between urban atmospheric pollution and respiratory mortality: time series studies].

Abstract: Time series studies conducted in the field of air pollution aim at testing and quantifying short-term relations which can exist between daily air pollution levels and daily health effects. The method used for this type of survey has sometimes been misunderstood mainly because individual factors and indoor exposure to air pollutants were not taken into account. The adjustment on these individual confounding factors commonly used in classic epidemiologic studies (case-control studies, cohort studies) is not adequate to times series studies which are based on aggregate data. This is different for those factors that change over time according to the levels of air pollution (meteorological conditions, influenza epidemics, trend of health cases) which, when being analysed, must be taken into account either indirectly through time modelling or directly through non-linear modelling processes. During this last decade, numerous studies using the time series method have been published and have found short-term associations between daily levels of air pollution commonly observed and daily respiratory mortality. The consistency of the numerous results published in the international literature are more arguments in favour of non-confounding short-term relations between air pollution and respiratory mortality.

National policies for preventing antimicrobial resistance - the situation in 17 European countries in late 2000.

Abstract: A survey carried out within Member States of the European Union and Norway shows that in all but two countries national surveillance of microorganisms resistant to antibiotics existed in December 2000. In Italy, Ireland and Scotland, the systems were set up very recently (respectively in 1998, 1999 and 1999). Moreover, excepting of Ireland and Scotland, all countries have a national system for data collection on the consumption of antibiotics, namely since 2000 in Austria, Italy and Luxembourg. Several of these systems were set up after 1998 when the recommendations of the European conference ‘The Microbial Threat’ held in Copenhague were published. In addition, a certain number of other measures have been undertaken since then: education campaigns to the population in England and Wales, in Ireland or in France, creation of committees specifically in charge of consumption surveillance in Italy or of the prevention of resistance in Belgium or in Ireland, publications of recommendations on the good use of antibiotics in Austria and in Finland, etc.

Épidémiologie de la coqueluche en France

Abstract: Resume Malgre l'atteinte de niveaux de couverture vaccinale tres eleves depuis plus de 30 ans avec un vaccin dont le pouvoir protecteur a ete confirme par les donnees de surveillance et d'investigations d'epidemies, la coqueluche n'a pas ete eliminee en France. Les donnees d'une enquete multicentrique hospitaliere realisee en 1993–94, ainsi que celles obtenues a travers le reseau de surveillance hospitalier pediatrique Renacoq etabli a la suite de cette etude, ont permis de caracteriser l'epidemiologie actuelle de la maladie et de comprendre la raison de la persistance de la circulation de Bordetella pertussis. Une duree de protection conferee par la vaccination d'environ dix ans a conduit, dans un contexte d'absence de rappel naturel lie a la reduction de la circulation de la bacterie sauvage, a la constitution d'un reservoir de grands enfants et jeunes adultes susceptibles. Ceux-ci constituent, en particulier dans les departements ou la couverture vaccinale est la plus elevee, la principale source de contamination des tres jeunes nourrissons avant qu'ils n'aient pu etre proteges par une serie vaccinale complete. Ce constat a ete a la base de l'introduction en 1998 dans le calendrier vaccinal francais, d'un rappel de vaccination contre la coqueluche a 11–13 ans, reposant sur l'utilisation des nouveaux vaccins acellulaires. Le suivi de l'impact de cette mesure en particulier sur l'incidence de la maladie dans la premiere annee de vie est effectuee par les pediatres et bacteriologistes volontaires participant au reseau Renacoq.

Surveillance of HIV/AIDS in Europe: update at end 2000.

Abstract: In the Western area of Europe, AIDS incidence decreased by 12% in 2000 compared to 1999 (22 cases per million population). In the Eastern area, the incidence of notified cases remained low, but newly diagnosed cases are still rising. In the Centre, the rates of AIDS cases and HIV infections remain low. EuroHIV (European Centre for the Epidemiological of AIDS) coordinates the surveillance of AIDS in the WHO European Region since 1984 and of newly diagnosed HIV infection since 1999. The main findings of the latest update at end 2000 are presented here (1). To take into account the diversity of the epidemiological situation in the region, countries have been grouped into three geographic areas: the West (the 15 countries of the European Union plus Norway, Switzerland, Iceland, Israel, Malta) the East (the 15 Newly Independent States of the former Soviet Union) and the Centre (the remaining countries of the region).

Les facteurs de risque de leptospirose en France : une étude cas-témoins nationale (1999)

Abstract: Resume L'objectif de cette etude etait d'identifier les facteurs de risque de leptospirose pour ameliorer la prevention de cette maladie et preciser les indications vaccinales. Une etude cas-temoins appariee a ete mise en place. Les cas ont ete identifies a partir des listes du Centre national de reference (CNR) des leptospires et deux temoins ont ete selectionnes dans le meme hopital que le cas. Un questionnaire standardise a ete propose par telephone aux sujets. Cent deux cas eligibles ont ete identifies entre le 1er juillet 1999 et le 15 fevrier 2000. Parmi eux, 97 cas ont ete interroges, 37 % avaient une serologie positive, surtout pour Icterohaemorrhagiae. Dans l'analyse univariee, plusieurs des expositions etaient liees a une leptospirose incluant contact avec des rongeurs, activites en eau douce et des blessures. Les resultats de l'analyse multivariee sont en cours. Ils seront discutes dans le contexte de l'amelioration de la prevention de cette maladie.

Impact de l’exclusion des donneurs ayant séjournédans les îles britanniques sur le risque résiduel de transmission du VIH par transfusion de produits sanguins labiles

Abstract: Resume Objectif – Parmi les mesures susceptibles de reduire le risque de transmission de l’agent du nouveau variant de la maladie de Creutzfeldt-Jakob, l’exclusion du don de sang des donneurs ayant sejourne dans les iles britanniques entre 1980 et 1996 a ete envisagee. L’objectif de cette etude etait d’estimer l’impact d’une augmentation du nombre de dons issus de nouveaux donneurs qu’impliquerait l’exclusion des donneurs ayant sejourne dans les iles britanniques (ib) sur le risque residuel de transmission du VIH par transfusion de produits sanguins labiles. Methodes – Le risque residuel de transmission du VIH lie aux dons effectues pendant la fenetre serologique, estime sur la totalite des dons preleves en France sur la periode 1996–1998, a ete exprime comme une combinaison lineaire des risques residuels chez les donneurs connus et les nouveaux donneurs. Chez les donneurs connus, l’estimation a ete realisee a partir du taux de densite d’incidence du VIH et chez les nouveaux donneurs, a partir de la methode « des tests de sensibilite differente ». Plusieurs hypotheses ont ete faites sur les pourcentages d’exclusion de donneurs allant de – 5 % a – 35 % donnant lieu a sept simulations d’impact sur le risque residuel. Resultats – Le risque residuel de transmission du VIH a ete estime, sur la totalite des dons preleves sur la periode 1996-1998, a 0,70 pour 1 million de dons, soit un nombre de dons preleves pendant la fenetre serologique se situant entre cinq et six. Sous l’hypothese ou tous les donneurs ayant sejourne dans les ib seraient exclus du don (35 %) et remplaces par des nouveaux donneurs, le risque residuel passerait de 0,70 a 0,86 pour 1 million de dons. Cette augmentation de 24 % correspondrait au prelevement, sur trois ans, d’un a deux dons infectieux supplementaires. Conclusion – Cette analyse montre qu’une exclusion massive de donneurs, compensee par le recrutement de nouveaux donneurs, aurait un impact faible mais quantifiable sur le risque residuel de transmission du VIH. Cette augmentation de risque a ete un des elements pris en compte dans la decision de ne pas exclure les donneurs ayant sejourne dans les ib entre 1980 et 1996.

Personal Exposure of Workers to Atmospheric PAHs on Gasworks Sites - The SOLEX Study

Abstract: The aim of the SOLEX study was to estimate the personal exposure of workers to atmospheric polycyclic aromatic hydrocarbons (PAHs) on former gasworks sites in the Paris metropolitan area. Devices to sample gas and particulate phases for 9 PAHs were carried during one working day of a study week in November 1997 by 24 workers and in June 1998 by 19 workers with contrasted job profiles involving different opportunities for contact with the soil; among these volunteers, some were active in the process of contaminated soil remediation during the November study period. PAH concentrations were measured by high-performance liquid chromatography.Subjects working on the site under remediation were clearly more exposed (684.1 ng/m3 for total PAHs in November 1997) than workers, without close contact with soil, whose PAH exposure was similar to that measured by fixed monitors in the ambient air in Paris. The contrasts were weaker in June 1998, when soil remediation had nearly been completed. Only subjects involved i...

Epidemic of hepatitis A among homosexual men in Paris, 2000

Abstract: On 15 June 2000, the Institut de Veille Sanitaire (InVS) in Saint-Maurice, France, was contacted by a physician from the infectious diseases service at Bichat hospital, Paris, about the occurrence of several cases of hepatitis A in homosexual men infected with HIV (1). At the same time, a member of a network of private physicians (REZO 85) confirmed the recent diagnosis of several cases of hepatitis A among homosexual men in Paris. An investigation into these cases was carried out by the InVS, in collaboration with REZO 85 and the tropical and infectious diseases unit at Rothschild hospital, Paris.

Utilisation du virus de la variole comme arme biologique : place de la vaccination en France

Abstract: Le Ministere Francais de la Sante a, dans le cadre de son plan de lutte contre le bioterrorisme, demande a l'Institut de Veille Sanitaire d'evaluer le risque epidemique en cas d'introduction du virus de la variole et de proposer des recommandations concernant d'eventuelles strategies vaccinales a mettre en œuvre. Une evaluation de la balance benefice/risque de differents scenarios de vaccination, incluant la vaccination de l'ensemble de la population francaise, a ete realisee pour differents niveaux d'intensite de la menace d'action terroriste. A l'issue de cette analyse, il apparait que, dans la situation actuelle, aucune action de vaccination n'apparait justifiee. Meme en cas de menace averee, la vaccination des personnels de soins les plus exposes et surtout celle des sujets contacts des cas devront constituer les strategies prioritaires.

Politiques nationales de prévention de la résistance aux antibiotiques – la situation de 17 pays européens fin 2000

Abstract: Une enquete menee parmi les Pays Membres de l’Union Europeenne et la Norvege montre que seul deux d'entre eux ne disposaient pas, en decembre 2000, d’une surveillance nationale des microorganismes resistants aux antibiotiques. En Italie, en Irlande et en Ecosse, ces systemes ont ete mis en place tres recemment (respectivement 1998, 1999 et 1999). Par ailleurs, a l’exception de l’Irlande et de l’Ecosse, ils disposent tous d’un systeme national de surveillance de la consommation des antibiotiques, l’Autriche, l’Italie et le Luxembourg depuis l’annee 2000. Plusieurs de ces systemes ont donc ete mis en place apres la publication des recommandations de la conference europeenne " La Menace Microbienne " qui s’est tenue a Copenhague en septembre 1998. De plus, un certain nombre d’autres mesures ont ete prises depuis : campagne d’education du public en Angleterre et au Pays de Galles, Irlande ou France, mise en place de comites specifiquement charges de la surveillance de la consommation en Italie ou de la prevention de la resistance en Belgique ou en Irlande, publications de recommandations sur le bon usage des antibiotiques en Autriche et en Finlande, etc.

Vaccine preventable diseases: a regional surveillance can help improve data comparability between countries.

Abstract: The way that surveillance of a given disease is undertaken in European countries varies greatly. Each study that has been undertaken on this subject so far has come to this conclusion, the variation between countries being related to many factors among which the organisation of the health care delivery plays a major role. This rule applies to vaccine preventable diseases and vaccine coverage surveillance as this Eurosurveillance issue shows. However, as the surveys undertaken for measles and pertussis indicate, there is a lot of common information gathered by each EU member state for both diseases. Therefore the definition of a minimal data set of pertinent variables common to most countries may be defined and is a way to initiate common EU data base. Whether this will be enough to effectively monitor timeliness and to compare the incidence in countries with different immunisation strategies and coverage needs to be further evaluated.