État des lieux de la prise en charge de l'interruption volontaire de grossesse à Mayotte

L'interruption volontaire de grossesse est une pratique courante dans les pays développés. Elle participe au contrôle des naissances et protège la bonne santé des femmes, quand elle est légalisée. Mayotte jouit d'une place particulière au sein de la République Française du fait de sa nouvelle départementalisation. Comment la mission de service publique garantissant l'accès à l'avortement est-elle assurée à Mayotte ? Nous cherchons à rendre compte de l'évolution et de l'état de la prise en charge de l'avortement à Mayotte, par rapport à son contexte global. Au sein de l'Unité Fonctionnelle d'Orthogénie, depuis le premier octobre 1993 jusqu'au trente et un décembre 2011, nous avons observé différents facteurs à Mayotte. En effet, le taux d'avortement a décuplé en près de vingt ans. L'utilisation de la méthode médicamenteuse a été multipliée par 20 après son introduction sur l'île en 2002. La majorité des femmes avortent entre 18 et 25 ans, soit 44% d'entre elles entre 2005 et 2009. Les avortements se font en moyenne au terme de 10 semaines d'aménorrhée et les interruption volontaire de grossesse tardives représentent 5% des avortements en 2007 et 2009. La part des femmes qui utilise l'avortement pour la première fois augmente plus que celle qui récidive en 2005 et 2007. Le pourcentage d'avortement moyen est plus élevé, à 10% en août, septembre et octobre entre 2003 et 2009. La situation globale de Mayotte, qui est isolée au milieu de la pauvreté environnante, rend difficile le maintien d'un accès à l'interruption volontaire de grossesse avec une qualité optimale. L'évolution favorable des indicateurs de santé montre un travail efficace. L'évolution de l'activité au sein de l'Unité Fonctionnelle d'Orthogénie montre une bonne adaptation à la demande croissante, aidée par le secteur médical libéral, malgré la pénurie médicale et l'afflux migratoire qui influence la gestion du système de soins mahorais. Une nouvelle stratégie au niveau de l'organisation des soins est à prévoir pour poursuivre l'effort accompli. Elle implique une plus grande intégration et coopération de Mayotte, et donc de la France, dans la région de l'Océan Indien.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Rôle des anticorps naturels et des IgA sécrétoires (SIgA) dans la transmission du VIH lors de l'allaitement

Le taux de transmission du Virus de l Immunodéficience Humaine (VIH) de la mère à l enfant est d environ 20% en absence de traitement antirétroviral et ce malgré une importante exposition répétée au virus présent dans le lait. Ce faible taux pourrait s expliquer par la présence, dans le lait, de facteurs capables de limiter la transmission du VIH. Nous avons isolé, dans le lait maternel, des anticorps naturels dirigés contre le CCR5 et le DC-SIGN, deux récepteurs ayant un rôle clé dans l infection par le VIH. Les anticorps anti-CCR5 et anti-DC-SIGN sont respectivement capables d inhiber l infection des cellules dendritiques et des macrophages par le VIH et le transfert du VIH aux lymphocytes T. Le lait maternel est une source abondante d IgA sécrétoires (SIgA), nous avons étudié l impact de cet apport en SIgA sur l infectabilité des macrophages muqueux par le VIH. Nos résultats montrent que les SIgA isolés du lait maternel étaient capables d inhiber fortement l infection des macrophagesPARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Maternal and congenital toxoplasmosis in Mayotte: Prevalence, incidence and management.

BackgroundToxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte.Methodology / principal findingsWe collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022-0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005-0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants.Conclusions / significanceThe seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring

Biological data, treatment and imaging information for infants born to women with confirmed toxoplasmosis, possible <i>Toxoplasma</i> infection or non-excluded primary infection.

Two sets of twins were born, one to a mother with confirmed toxoplasmosis and the other to a mother with non-excluded primary infection.</p

Demographic and management data for pregnant women with confirmed toxoplasmosis, possible <i>Toxoplasma</i> infection and non-excluded primary infection.

* Abnormalities related to congenital toxoplasmosis.</p

Classification of maternal toxoplasmosis with primary infection.

Classification according to the recommendations of the French National Reference Centre for Toxoplasmosis [9,18,19].</p

Diagnosis algorithm for congenital toxoplasmosis.

BackgroundToxoplasmosis is an infection caused by an intracellular protozoan, Toxoplasma gondii. It is usually asymptomatic, but toxoplasmosis acquired during pregnancy can cause congenital toxoplasmosis, potentially resulting in fetal damage. Epidemiological information is lacking for toxoplasmosis in Mayotte (a French overseas territory). We evaluated (1) the prevalence of maternal toxoplasmosis, (2) the incidence of maternal and congenital toxoplasmosis, and (3) the management of congenital toxoplasmosis in Mayotte.Methodology / Principal FindingsWe collected all the available data for toxoplasmosis serological screening during pregnancy and maternal and congenital cases of toxoplasmosis obtained between January 2017 and August 2019 at the central public laboratory of Mayotte (Mamoudzou). Using toxoplasmosis serological data from samples collected from 16,952 pregnant women we estimated the prevalence of toxoplasmosis in Mayotte at 67.19%. Minimum maternal toxoplasmosis incidence was estimated at 0.29% (49/16,952, 95% CI (0.0022–0.0038)), based on confirmed cases of maternal primary infection only. The estimated incidence of congenital toxoplasmosis was 0.09% (16/16,952, 95% CI (0.0005–0.0015). Missing data made it difficult to evaluate management, but follow-up was better for mothers with confirmed primary infection and their infants.Conclusions / SignificanceThe seroprevalence of toxoplasmosis among pregnant women and the incidence of toxoplasmosis are higher in Mayotte than in mainland France. There is a need to improve the antenatal toxoplasmosis screening and prevention programme, providing better information to physicians and the population, to improve management and epidemiological monitoring.</div

Management of newborns with confirmed congenital infection (CT).

*Abnormalities related to congenital toxoplasmosis. (Imaging abnormality: one case with small subependymal haemorrhages typical of toxoplasmosis (no calcification and no ventricular dilation) confirmed on check-up imaging and one case of persistent microcysts in the caudate nucleus).</p

Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: A time-series analysis in Paris region

Members of the Collégiale de Bactériologue – Virologie – Hygiène (CBVH)Guillaume Arlet, Laurence Armand Lefevre, Alexandra Aubry, Laurent Belec, Béatrice Bercot, Stéphane Bonacorsi, Vincent Calvez, Emmanuelle Cambau, Etienne Carbonnelle, Stéphane Chevaliez, Jean-Winoc Decousser, Constance Delaugerre, Diane Descamps, Florence Doucet-Populaire, Jean-Louis Gaillard, Antoine Garbarg-Chenon, Elyanne Gault, Jean-Louis Herrmann, Vincent Jarlier, Jérôme Le Goff, Jean-Christophe Lucet, Jean-Luc Mainardi, Anne-Geneviève Marcellin, Laurence Morand-Joubert, Xavier Nassif, Jean-Michel Pawlotsky, Jérôme Robert, Anne-Marie Roque Afonso, Martin Rottman, Christine Rouzioux, Flore Rozenberg, François Simon, Nicolas Veziris, David Skurnik, Jean-Ralph Zahar, Guilene Barnaud, Typhaine Billard Pomares, Gaëlle Cuzon, Dominique Decré, Alexandra Doloy, Jean-Luc Donay, Laurence Drieux-Rouzet, Isabelle Durand, Agnès Ferroni, Vincent Fihman, Nicolas Fortineau, Camille Gomart, Nathalie Grall, Christelle Guillet Caruba, Françoise Jaureguy, Valérie Lalande, Luce Landraud, Véronique Leflon, Patricia Mariani, Liliana Mihaila, Didier Moissenet, Latifa Noussair, Isabelle Podglajen, Isabelle Poilane, Hélène Poupet, Emilie Rondinaud, Valérie Sivadon Tardy, David Trystram, Charlotte Verdet, Emmanuelle Vigier, Sophie Vimont BillarantInternational audienceThe impact of the COVID-19 pandemic on bloodstream infections (BSIs) due to Streptococcus pneumoniae and Streptococcus pyogenes was assessed in 25 university hospitals of Paris. Monthly BSIs incidence rates that appeared stable in 2018 and 2019, decreased for the 2 pathogens during the 2 COVID-19 lockdown periods of 2020. Containment policies, including social distancing, masking and hand hygiene strengthening in both community and hospital settings are likely to reduce BSIs due to these pathogens

Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey

Background: Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. Methods: A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Results: Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Conclusions: Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and antiviral management procedures