Chapitre 9 : Facteurs organisationnels locaux d’optimisation de la lutte contre la dengue

Introduction Maladie virale endémo-épidémique transmise par les moustiques du genre Aedes, la dengue est devenue une préoccupation majeure dans la Caraïbe depuis une vingtaine d’années. En effet, la première épidémie importante de dengue hémorragique à Cuba en 1981 a fait prendre conscience de la gravité d’une maladie considérée jusqu’alors comme bénigne. Dans les DFA, cette prise de conscience au niveau de la population n’est véritablement survenue qu’avec l’apparition des premiers cas locau..

Evolution de la sarcoïdose traitée et non traitée : étude rétrospective de 100 dossiers

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact of subsistence production on the management options to reduce the food exposure of the Martinican population to Chlordecone

International audienceChlordecone is an organochlorine insecticide used until 1993 in the banana plantations of the French Antilles. Recent surveys revealed itswide presence in the environment. This current paper focuses on the impact of different management options on the Martinican population’sfood exposure, taking into account that an appreciable part of the food consumed in Martinique corresponds to subsistence production.Food exposure is assessed through deterministic models. Consumption data derive from the ESCAL Survey on 1814 subjects aged 3 andover. Residues data come from the Monitoring Programs 2002–2004. Different scenarios are studied depending on whether the subjects liveon a soil-contaminated place or not and on their supply habits. The impact of various maximum limits is then analysed. The probability ofexceeding the chronic health-based guidance value (CHGV) of 0.5 lg/kg bw/day is, respectively, 20.9% (CI95th [6.2; 34.4]) and 15.6% (CI95th[9.6; 20.8]) for children and adults living in a soil-contaminated area and null for the remaining population. MLs below 300 lg/kg fw wouldreduce significantly the exposure but the probability of exceeding the CHGV remains statistically different from zero when only commercialisedproducts are taken into account. This study shows the supply habits may have significant impacts on food exposure to contaminants.It reveals that setting MLs, which can only be controlled on commercialised products, is not enough in such situations. Other managementoptions like consumption recommendations for self-produced foodstuffs are necessary to protect the Martinican consumer

La dengue dans les départements français d’Amérique

En progression rapide dans toutes les régions chaudes, la dengue ou « fièvre dengue » est la maladie à vecteur la plus répandue dans le monde. L’expansion de ses formes hémorragiques, qui peuvent être mortelles, est devenue particulièrement inquiétante, d’autant qu’en l’absence de vaccins ou de nouveaux traitements, l’unique moyen d’enrayer la maladie consiste à lutter contre le moustique vecteur. Il ressort des contributions réunies dans cette expertise collégiale qu’à côté des techniques de démoustication présentées en détail dans le volume, un travail en réseau est indispensable pour surveiller et prendre en charge cette pathologie. Il apparaît également nécessaire, ce qui n’est pas le plus facile, de convaincre les populations d’éliminer elles-mêmes les réserves d’eau (mares, flaques, récipients...) où le moustique se reproduit, une autre mesure essentielle proposée dans cette expertise.Dengue, or dengue fever, is the most widespread vector-borne disease on the planet and is spreading rapidly in all the world’s hot regions. The spread of its hemorrhagic forms, which can be fatal, is particularly worrying, especially as without a vaccine or a new treatment, the only way to halt the disease is to control the mosquito that carries it. From the papers that make up this report, it emerges that alongside the mosquito-control methods described by the authors, networking is essential for surveillance and medical care of dengue. The report also highlights the need to persuade the population (and this is not the easiest task) to take on themselves the essential work of eradicating pools, puddles and receptacles where water collects and mosquitoes can breed

Sargassum seaweed health menace in the Caribbean: clinical characteristics of a population exposed to hydrogen sulfide during the 2018 massive stranding

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An ecological and digital epidemiology analysis on the role of human behavior on the 2014 Chikungunya outbreak in Martinique

International audienceUnderstanding the spatio-temporal dynamics of endemic infections is of critical importance for a deeper understanding of pathogen transmission, and for the design of more efficient public health strategies. However, very few studies in this domain have focused on emerging infections, generating a gap of knowledge that hampers epidemiological response planning. Here, we analyze the case of a Chikungunya outbreak that occurred in Martinique in 2014. Using time series estimates from a network of sentinel practitioners covering the entire island, we first analyze the spatio-temporal dynamics and show that the largest city has served as the epicenter of this epidemic. We further show that the epidemic spread from there through two different propagation waves moving northwards and southwards, probably by individuals moving along the road network. We then develop a mathematical model to explore the drivers of the temporal dynamics of this mosquito-borne virus. Finally, we show that human behavior, inferred by a textual analysis of messages published on the social network Twitter, is required to explain the epidemiological dynamics over time. Overall, our results suggest that human behavior has been a key component of the outbreak propagation, and we argue that such results can lead to more efficient public health strategies specifically targeting the propagation process

Evaluating vector competence for Yellow fever in the Caribbean

Abstract The mosquito-borne disease, Yellow fever (YF), has been largely controlled via mass delivery of an effective vaccine and mosquito control interventions. However, there are warning signs that YF is re-emerging in both Sub-Saharan Africa and South America. Imported from Africa in slave ships, YF was responsible for devastating outbreaks in the Caribbean. In Martinique, the last YF outbreak was reported in 1908 and the mosquito Aedes aegypti was incriminated as the main vector. We evaluated the vector competence of fifteen Ae. aegypti populations for five YFV genotypes (Bolivia, Ghana, Nigeria, Sudan, and Uganda). Here we show that mosquito populations from the Caribbean and the Americas were able to transmit the five YFV genotypes, with YFV strains for Uganda and Bolivia having higher transmission success. We also observed that Ae. aegypti populations from Martinique were more susceptible to YFV infection than other populations from neighboring Caribbean islands, as well as North and South America. Our vector competence data suggest that the threat of re-emergence of YF in Martinique and the subsequent spread to Caribbean nations and beyond is plausible

Outbreak of Chikungunya in the French Caribbean Islands of Martinique and Guadeloupe: Findings from a Hospital-Based Surveillance System (2013–2015): OUTBREAK OF CHIKUNGUNYA IN THE FRENCH CARIBBEAN ISLANDS

International audienceChikungunya virus (CHIKV) emerged in the Caribbean island of Saint-Martin in December 2013. Weimplemented a hospital-based surveillance system to detect and describe CHIKV cases including severe forms of theinfection and deaths in the islands of Martinique and Guadeloupe. A case was defined as a patient with a CHIKV laboratoryconfirmation cared for in a public hospital for chikungunya for at least 24 hours, and a severe CHIKV case was defined as aCHIKV case presenting one or more organ failures. Sociodemographic, clinical, and laboratory data were collected andcases classified into severe or nonsevere based on medical records. From December 2013 to January 2015, a total of1,836 hospitalized cases were identified. Rate of hospital admissions for CHIKV infection was 60 per 10,000 suspectedclinical CHIKV cases and severity accounted for 12 per 10,000. A total of 74 deaths related to CHIKV infection occurred.Infants and elderly people were more frequently hospitalized compared with others and severity was more frequentlyreported in elderly subjects and subjects with underlying health condition. Fifteen neonatal infections consecutive tomother-to-child transmission were diagnosed, seven of which were severe. The most vulnerable groups of the population,such as the elderly, infants, individuals with comorbidities, and pregnant women, should remain the main targets of publichealth priorities

Zika emergence in the French Territories of America and description of first confirmed cases of Zika virus infection on Martinique, November 2015 to February 2016

International audienceFollowing of the emergence of Zika virus in Brazil in 2015, an epidemiological surveillance system was quickly implemented in the French overseas Territories of America (FTA) according to previous experience with dengue and chikungunya and has detected first cases of Zika. General practitioners and medical microbiologists were invited to report all clinically suspectedcases of Zika, laboratory investigations were systematically conducted (RT-PCR). On 18 December, the first autochthonous case of Zika virus infection was confirmed by RT-PCR on French Guiana and Martinique, indicating introduction of Zika virus inFTA. The viral circulation of Zika virus was then also confirmed on Guadeloupe and Saint-Martin. We report here early findings on 203 confirmed cases of Zika virus infection identified by RT-PCR or seroneutralisation on Martinique Island between 24 November 2015 and 20 January 2016. All cases were investigated. Common clinical signs were observed (maculopapularrash, arthralgia, fever, myalgia and conjunctival hyperaemia) among these patients, but the rash, the foundation of our case definition, may be absent in a significant proportion of patients (16%). These results are important for the implementation of a suspected case definition, the main tool for epidemiological surveillance, in territories that may be affected by ZIKV emergence, including Europe