Introduction of SARS in France, March–April, 2003

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France

L’éradication des maladies infectieuses : l’exemple de la poliomyélite

L’éradication constitue le but ultime des différentes stratégies de lutte contre les maladies infectieuses. Après un rappel des différences entre un programme visant au contrôle, à l’élimination ou à l’éradication d’une maladie, est exposé ici l’exemple du programme d’éradication de la poliomyélite. Les raisons ayant motivé la priorité donnée à cette maladie, les différentes stratégies retenues pour mener à bien ce programme d’éradication, ainsi que les résultats obtenus sont développés. Avec le continent américain et le Pacifique oriental certifiés exempts de poliovirus sauvage, et l’absence de cas dans la région Europe de l’OMS depuis 1998, l’éradication semble proche. Toutefois, plusieurs questions se posent : s’assurer de l’absence de circulation prolongée de poliovirus vaccinal comportant un risque de récupération de virulence, d’un confinement efficace des poliovirus au laboratoire et d’une stratégie adaptée d’arrêt de la vaccination

Complete Genome Sequence of a Wild-Type Measles Virus Isolated during a 2016 Winter Outbreak in a Refugee Settlement in Calais, France

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Two-dose measles vaccine effectiveness remains high over time: A French observational study, 2017–2019

International audienceBackground: From 2008 to 2019, France has experienced a resurgence of measles epidemics. Surveillance data have shown that the proportion of cases vaccinated with two doses of measles-containing vaccine (MCV) increased with age, raising concerns about the duration of vaccine protection. Our objectives were to investigate age-stratified vaccine effectiveness (VE) for the second dose of MCV (MCV2) and to quantify protection levels over time. Methods: We analyzed data on measles cases aged 2-31 years, reported via mandatory notification to the French measles surveillance system from October 2017 to September 2019. We estimated an age-stratified VE for MCV2 using the screening method, which compares the vaccination status of cases with that of the general population. We improved this method by accounting for natural immunity, exploring four scenarios with four possible levels of natural immunity in the population. In addition, we quantified the decay rate of protection over time, by fitting an exponential decay model among individuals vaccinated in early life. Results: In the baseline analysis (absence of natural immunity), VE estimates were high in all age groups and decreased with age, from 99.6 % (95 % confidence interval: 99.3-99.8) in 2-5 years old to 91.4 % (85.1-95.0) in 26-31 years old. Accounting for natural immunity increased VE in the older age group to 93.2-99.2 % depending on the scenario. We estimated that VE was slowly decreasing over time, with an exponential decay rate of 0.0022/year (0.0017-0.0028), leading to VE of 96.7 % (96.0-97.4) 16 years after MCV2 vaccination. This decline was most compatible with scenario 2, a scenario of 4.4 % naturally immunized, non-vaccinated individuals in the 26-31 years old. Conclusion: Our study confirms the continued high effectiveness of two doses of MCV with only slight degradation, decades after immunization. These findings support the importance of achieving a very high vaccination coverage with 2 doses of MCV

Prolonged Maternal Shedding and Maternal-fetal Transmission of Measles Virus

International audienceProlonged measles virus detection in maternal saliva and blood was evidenced in 6 pregnant women. Maternal-fetal transmission was evidenced in 2 of 4 infants who were asymptomatic at birth, 21–24 weeks after maternal infection. Whereas peripartum congenital measles is severe, asymptomatic measles virus vertical transmission can occur earlier in pregnancy

Molecular epidemiology and clinical characteristics of hepatitis B identified through the French mandatory notification system.

BACKGROUND & AIMS: Strains responsible for acute hepatitis B infections (AHB) in France have not been characterized. This study was first designed to analyze the molecular epidemiology of AHB and second to describe the differences between AHB and chronic hepatitis B (CHB) exacerbations. METHODS: This prospective study was based on the French mandatory notification system for AHB. 147 samples corresponding to declared cases were shipped to a central laboratory for classification as AHB or CHB according to the level of anti-HBc IgM and anti-HBc avidity. RESULTS: Based on biological marker values and file examination, 75 cases (59%) were classified as AHB. Independently of the acute or chronic status, genotype A (57%), D (22%) and E (14%) were the most prevalent and no phylogenetic clustering was observed among HBV sequences (n=68). Precore or basal core-promoter variants were not particularly associated with disease severity but were more prevalent in CHB. No antiviral resistant strains or immune-escape HBsAg was observed. HBV viral loads in AHB or CHB were comparable but with opposite distributions. ALT levels reached 10 times the upper normal value in 94% of AHB but only in 24% of CHB. CONCLUSIONS: After rigorous classification, no major difference at the genetic level was found between HBV strains isolated from AHB and CHB. Absence of potentially deleterious variant detection is reassuring. When based upon HBsAg and anti-HBc IgM determination, AHB notification may falsely include more than 40% CHB, leading to an important risk of bias in national surveillance programs of AHB

Dépistage des maladies infectieuses en cours de grossesse, résultats de l’enquête Elfe en maternités, France métropolitaine, 2011

Introduction : en France, plusieurs infections susceptibles d'avoir un retentissement materno-foetal font l'objet d'un dépistage prénatal. L'objectif de cet article était d'étudier la réalisation des dépistages prénataux et leurs déterminants pour les maladies infectieuses suivantes : toxoplasmose, syphilis, hépatite B (dépistages obligatoires), infections à VIH (dépistage obligatoirement proposé) et à cytomégalovirus (CMV, dépistage non recommandé). Méthodes : les données de l'Étude longitudinale française depuis l'enfance (Elfe), recueillies en maternités en 2011, ont été utilisées. Elles portaient sur 18 022 mères âgées d'au moins 18 ans ayant accouché dans 320 maternités publiques et privées de France métropolitaine tirées au sort. Les données concernant les dépistages infectieux ont été renseignées à partir du dossier médical (toxoplasmose, syphilis, hépatite B et CMV) ou lors d'un entretien avec la mère (VIH). Les facteurs associés à la réalisation de ces dépistages ont été étudiés par analyses uni- et multivariées. Résultats : l'absence de dépistage concernait entre 2,8% et 2,9% des femmes pour la toxoplasmose (en raison d'une immunité déjà connue pour 97,5% d'entre elles), entre 2,6% et 2,8% pour la syphilis et entre 2,2% et 2,3% pour l'hépatite B selon que l'on exclut ou non les valeurs manquantes. Concernant le VIH, 10,2% à 11,0% des femmes ont déclaré ne pas avoir été dépistées. Les principaux facteurs associés à l'absence de dépistage de ces infections étaient le fait d'habiter hors Île-de-France et d'avoir déjà au moins un enfant. Le dépistage du CMV a été réalisé pour 24,6% des femmes pour lesquelles l'information était disponible. Conclusion : bien que très fréquemment réalisés, les dépistages prénataux obligatoires de l'hépatite B et de la syphilis ne le sont pas encore suffisamment. Les résultats suggèrent aussi un défaut d'information des femmes concernant le dépistage prénatal du VIH. Ils montrent enfin une pratique assez répandue du dépistage du CMV, qui n'est pourtant pas recommandé

La rougeole en France

Entre janvier 2008 et mai 2012, plus de 22 000 cas de rougeole ont été déclarés en France. L’incidence la plus élevée a été observée chez les enfants de moins de un an, et plus de 50 % des cas ont été déclarés chez de jeunes adultes. Près de 5 000 patients ont été hospitalisés, dont 1 023 atteints de pneumonie, 27 d’encéphalite/myélite ; 10 patients sont décédés. Cette situation résulte d’une couverture vaccinale insuffisante, hétérogène, avec constitution progressive d’un réservoir de sujets réceptifs permettant la circulation du virus. Si la couverture avec deux doses de vaccin a augmenté pour les enfants, améliorer celle des jeunes adultes demeure un objectif majeur pour éliminer la maladie et, en particulier, pour pouvoir protéger les populations vulnérables ne pouvant être vaccinées (enfants de moins d’un an, patients immunodéprimés, femmes enceintes)

Measles Elimination Efforts and 2008–2011 Outbreak, France

Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of>20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80 % of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met. In 1983, measles vaccination was introduced into the immunization schedule for toddlers in France; the combined measles-mumps-rubella vaccine (MMR) has been used since 1986. A second MMR dose was added in 1996. Until 2004, recommendation were that the first dose (MMR1) be administered at 12 months of age and the second (MMR2) at 3–6 years of age. A catch-up schedule with 1 dose of MMR was also recommended for unvaccinated children 6–13 years of age. To meet the World Health Organization (WHO) European Region’s goals for measles elimination, a national plan was implemented in 2005. It included bringing forward the administration of MMR2 to a child’s second year of life in addition to expanding catch-up to includ

True Measles Cases Undetected by Reverse Transcription-PCR (RT-PCR): Effect of Genetic Variability on Assay Sensitivity Needs To Be Regularly Surveyed

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