Diagnostic performance of the WHO definition of probable dengue within the first 5 days of symptoms on Reunion Island.

The relevance of the World Health Organization (WHO) criteria for defining probable dengue had not yet been evaluated in the context of dengue endemicity on Reunion Island. The objective of this retrospective diagnostic study was to evaluate the diagnostic performance of the 2009 WHO definition of probable dengue and to propose an improvement thereof. From the medical database, we retrieved the data of subjects admitted to the emergency department of the University Hospital of Reunion Island in 2019 with suspected dengue fever (DF) within a maximum of 5 days post symptom onset, and whose diagnosis was confirmed by a Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The intrinsic characteristics of probable dengue definitions were reported in terms of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), using RT-PCR as the gold standard. Of the 1,181 subjects who exhibited a positive RT-PCR, 652 (55%) were classified as probable dengue. The WHO definition of probable dengue yielded a sensitivity of 64% (95%CI 60-67%), a specificity of 57% (95%CI 52-61%), a LR+ of 1.49 (95%CI 1.33-1.67), and a LR- of 0.63 (95%CI 0.56-0.72). The sensitivity and LR- for diagnosing and ruling out probable dengue could be improved by the addition of lymphopenia on admission (74% [95%CI: 71-78%] and 0.54 [95%CI: 0.46-0.63] respectively), at the cost of slight reductions of specificity and LR+ (48% [95%CI: 44-53%] and 1.42 [95%CI: 1.29-1.57], respectively). In the absence of, or when rapid diagnostic testing is unreliable, the use of the improved 2009 WHO definition of probable dengue could facilitate the identification of subjects who require further RT-PCR testing, which should encourage the development of patient management, while also optimizing the count and quarantine of cases, and guiding disease control

Effect of Replacement of As by Ge and Sb on the Photo-Response under Near Infrared Femtosecond Laser Irradiation in As-based Sulfide Glasses

Bulk glasses having the compositions As42S58, As36Sb6S58, and As36Ge6S58 have been irradiated at 800 nm using a femtosecond-pulsed laser to determine the relationship between composition and photo-response. Localized variation in the glass volume (photo-expansion) has been determined through interferometric measurements of surface exposures, whereas induced refractive index change (photo-darkening) was determined from the diffraction efficiency of subsurface direct-written phase gratings. To understand the compositional dependence of the photo-response, the linear and nonlinear optical properties and structure of the unexposed glasses have been compared. The ablation threshold is shown to be controlled by variation of the nonlinear absorption, related to shifts of the absorption band gap with exchange of As by Ge or Sb. Changes in the unexposed network structure show that partial replacement of As by Ge or Sb induces an increased number of As–As bonding defects in the glass, particularly in the form of As4S4 molecular units which become polymerized into the network, impacting the photo-modification process. The Ge was found to induce an increase in the ablation threshold, and enhance both photo-darkening and photo-expansion effects, whereas Sb was shown to decrease ablation threshold and inhibit photo-darkening while enhancing photo-expansion

Local management of anogenital warts in non-immunocompromised adults : a systematic review with meta-analyses, pooled analysis and network meta-analysis of randomized controlled trials

Contexte: Il existe plusieurs traitements pour les condylomes ano-génitaux externes (CAE) cependant, aucune hiérarchie de traitement claire, n'est mentionnée dans les dernières recommandations. Objectifs: Comparer l'efficacité des traitements topiques et des traitements ablatifs pour la prise en charge des CAE. Méthodes: Tous les essais cliniques comparatifs et randomisés (ECR) de 12 bibliothèques numériques comparant des adultes immunocompétents avec des CAE ayant reçu au moins un traitement administré par le médecin ou auto appliqué par le patient ont été inclus. L’évaluation du risque de biais a suivi les recommandations Cochrane. Le critère d'évaluation de l'étude était la réponse lésionnelle complète (RLC) après évaluation du traitement. Des méta-analyses, des analyses poolées puis une méta-analyse réseau ont été réalisées. Résultats: Soixante-dix ECR (9 931 patients) ont été inclus. Tous les ECR, sauf quatre présentaient un risque élevé de biais. Méta-analyse en réseau: les traitements les plus efficaces comparativement au placebo étaient la chirurgie (RR 10,54 ; IC95% 4,53-24,52), une combinaison de traitement ablatif et d’imiquimod (RR 7,52 ; IC95% 4,53-24,52) et l'électrochirurgie (RR 7,10 ; IC95% 3,47-14,53). Les valeurs de SUCRA confirmaient la supériorité de la chirurgie (90,9%), d’une combinaison d’un traitement ablatif avec de l’imiquimod (79,8%) et de l'électrochirurgie (77,1%). Les TAP les plus efficaces étaient la podophyllotoxine 0,5 % solution (63,5%) et la podophyllotoxine à 0,5 % crème (62,2%). Conclusions: La majorité des ECR inclus sont à faible niveau de preuve. La chirurgie et l'électrochirurgie semblent être supérieures aux autres traitements.Background: While several treatments exist for anogenital warts (AGWs), no clear treatment hierarchy is mentioned in the latest guidelines. Objectives: To compare the efficacy of topical treatments and ablative procedures for the management of AGWs. Methods: Twelve electronic databases were systematically searched. All randomized controlled trials (RCTs) comparing immunocompetent adults with AGWs who received at least 1 provider-administered or patient-administered treatment in at least 1 parallel group were included. Risk of bias assessment followed the Cochrane Handbook. Study endpoints were clearance, recurrence, side effects (SE) and complete lesion response (CLR) after treatment assessment. Meta-analyses, pooled analysis then network meta-analysis were performed. Results: Seventy RCTs (9,931 patients) were included. All but 4 RCTs had a high risk of bias. In network meta-analysis (only CLR assessment): a network geometry was constructed based on 49 of the 70 RCTs. The most efficacious treatments compared to placebo were surgery (RR 10.54; CI95% 4.53-24.52), association of ablative therapy and imiquimod (RR 7.52; CI95% 4.53-24.52), and electrosurgery (RR 7.10; CI95% 3.47-14.53). SUCRA values confirmed the superiority of surgery (90.9%), association of ablative therapy and imiquimod (79.8%), and electrosurgery (77.1%). The most efficacious patient-administered treatments were podophyllotoxin 0.5% solution (63.5%) and podophyllotoxin 0.5% cream (62.2%). Conclusions: Most included RCTs have low-level evidence. Surgery and electrosurgery seem to be superior to other treatments. Combined therapy should be more evaluated in future RCT

Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial

BackgroundOn Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. ObjectiveThe main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. MethodsThis study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a “health bus”). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. ResultsRecruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. ConclusionsIn this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. Trial RegistrationClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221 International Registered Report Identifier (IRRID)DERR1-10.2196/3569

PROM SSCOL—Impact of a Papillomavirus Vaccination Promotion Program in Middle Schools to Raise the Vaccinal Coverage on Reunion Island

Introduction: On Reunion Island, cervical cancer is the third most common cause of cancer in women. Primary prevention is based on the HPV vaccination, yet coverage rate is low (8.1%). The objective of the study was to evaluate the impact of a health promotion program on the proportion of middle school girls who have completed the HPV vaccination schedule. Material and methods: In this prospective, controlled intervention study of superiority, 12 classes were randomly selected in an intervention school where the promotion program took place, and in a control school where no specific intervention was planned. The program combined: information to students during school classes, information to parents by letter and phone calls, information to general practitioners by letter and video conference call, and the free school-based vaccination (in a “health bus” parked in the schoolyard) with the nonavalent HPV vaccine. Results: In the intervention group, the completion was achieved for 26 girls, which was significantly higher than in the control group (three girls, p −3). The initiated vaccination was also higher in the intervention group (31 girls vs. 6 girls in the control group, p −3). The same results were obtained for the boys as for the full or partial scheme (seven boys vs. 0, p = 0.01; 16 boys vs. 1, p −3, respectively). Conclusions: Implementing a health promotion program and offering the free, school-based vaccination raised the vaccination coverage. These results are promising and may be a stepping stone to expanding this program to the whole Reunion Island and hopefully someday decrease the burden of cervical cancer

Early diagnosis of dengue: Diagnostic utility of the SD BIOLINE Dengue Duo rapid test in Reunion Island.

BackgroundIn Reunion Island, dengue outbreaks have been occurring since 2018. The healthcare facilities are facing the problem of managing a massive influx of patients and a growing care burden. The aim of this study was to evaluate the performance of the SD Bioline Dengue Duo rapid diagnostic test in adults consulting at an emergency department during the 2019 epidemic.Methodology/principal findingsThis retrospective study of diagnostic accuracy included patients over 18 years old, suspected of dengue, who were admitted to emergency units of the University Hospital of Reunion between the 1st of January and 30th of June, 2019, and were tested for dengue fever with the SD Bioline Dengue Duo rapid diagnostic test and reverse transcriptase polymerase chain reaction. Over the study period, 2099 patients were screened retrospectively. Of them, 671 patients matched the inclusion criteria. The overall rapid diagnostic test performance was 42% for sensitivity and 15% for specificity. The non-structural 1 antigen component had a good specificity of 82% but a low sensitivity of 12%. The immunoglobulin M component had a sensitivity of 28% and a specificity of 33%. Sensitivities were slightly improved beyond the 5th day of illness compared to the early stage for all components, but only the non-structural 1 antigen component had a better specificity of 91%. Furthermore, predictive values were low and post-test probabilities never improved pre-test probabilities in our setting.Conclusions/significanceThese results suggest that the SD Bioline Dengue Duo RDT did not achieve sufficient performance levels to rule in, or discard, an early point of care dengue diagnosis in the emergency department during the 2019 epidemic in Reunion

Scabies incidence and association with skin and soft tissue infection in Loyalty Islands Province, New Caledonia : A 15-year retrospective observational study using electronic health records

International audienceScabies is a known public health problem in the Pacific region. This study aimed to determine the importance of scabies and associated skin infections in the Loyalty Island Province (LIP) of New Caledonia (20,000 inhabitants). The provincial electronic medical database was searched for all cases of scabies and skin infection that occurred in the LIP population between 2004 and 2018. To evaluate the impact of scabies on skin infections, we measured the decrease in the number of skin infections in children <5 years one year after scabies treatment.Over the study period, the average number of scabies cases occurring each year was 6 per 100 inhabitants. In children <1 year, this number was 18 per 100 inhabitants. We found that 80% of children aged 15 years had experienced at least one episode of scabies. We also observed a fourfold decrease in the number of skin infections in children <5 years 1 year after treatment. Scabies was more frequent (+30%) in winter