Low Clinical Burden of 2009 Pandemic Influenza A (H1N1) Infection during Pregnancy on the Island of La Réunion

BACKGROUND: Pregnant women have been identified as a group at risk, both for respiratory complications than for the admissions to the Intensive Care Unit (ICU) during the 2009 H1N1 influenza pandemic (pdm). The purpose of this prospective register-based cohort-study was to characterize the clinical virulence of the pdm (H1N1/09)v during pregnancy in La Réunion. METHODS/PRINCIPAL FINDINGS: Over a twelve-week pdm wave (13 July to 3 October 2009), 294 pregnant women presented with an influenza-like illness (ILI) to one of the three maternity departments of the South Reunion area, Indian Ocean. Out of these, 278 were checked by RT-PCR for influenza viruses (157 positive and 121 negative, of whom, 141 with pdm flu and 132 with ILIs of non pdm origin, 5 untyped). The median body temperature was higher in women experiencing pdm flu than in those with non pdm ILI (38.9 degrees C versus 38.3 degrees C, P<0.0001), without evidence linked to circulating viremia. Oseltamivir was given for 86% of pdm flu cases in a median time inferior than 48 hrs (range 0-7 days). The hospitalization rate for pdm flu was of 60% and not associated with underlying conditions. Six viral pneumonia and fourteen asthma attacks were observed among 84 hospitalized pdm flu cases, of whom, only one led to the ICU for an acute lung injury. No maternal death occurred during the pdm wave. None adverse pregnancy outcome was associated with pdm flu. No congenital birth defect, nor early-onset neonatal influenza infection was attributable to pdm flu exposure. CONCLUSIONS/SIGNIFICANCE: This report mitigates substantially the presumed severity of pandemic H1N1/09 influenza infection during pregnancy. The reasons for which the clinical burden of H1N1/09 influenza virus may differ worldwide raise questions about a differential local viral-strain effect and public health preparedness, notably in timely access to special care and antiviral treatments

Risk Factors for Early and Late Onset Preeclampsia in Reunion Island: Multivariate Analysis of Singleton and Twin Pregnancies. A 20-Year Population-Based Cohort of 2120 Preeclampsia Cases

Objectives: To develop a multivariate model for risk factors specific to early onset preeclampsia (EOP) and late onset preeclampsia (LOP) in our entire population (singleton and twin pregnancies). Material and methods: 20 year-observational population-based historical cohort study (2001–2020). All consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity ward. A standardized validated epidemiological perinatal database was used. Results: During the 20-year period, there were 81,834 pregnancies and 83,497 infants born, 1232 dichorionic and 350 monochorionic twin pregnancies. There were 2120 cases of preeclampsia, of which 2001 were preeclamptic singleton pregnancies and 119 twin pregnancies (incidence 7.5% in twin pregnancies vs. 2.5% singletons, OR 3.0, p &lt; 0.001). Independent risk factors for EOP and LOP in a multivariate model (controlling for the two major confounders: maternal ages—both risks for EOP and LOP, and maternal pre-pregnancy BMI—specific risk factor for LOP) were: history of preeclampsia (adjusted OR (aOR) 11.7 for EOP, 7.8 for LOP, p &lt; 0.0001), chronic hypertension (aOR 7.3 for EOP, 3.9 for LOP, p &lt; 0.0001), history of perinatal death (aOR 2.2 for EOP, p &lt; 0.0001 and 1.48 for LOP, p = 0.007), primipaternity (aOR 3.0 for EOP and 3.6 for LOP, p = 0.001), dizygotic twin pregnancies (aOR 3.7 for EOP, p &lt; 0.0001 and 2.1 for LOP, p = 0.003), monozygotic twin pregnancies (aOR 3.98 for EOP, p = 0.003 and non-significant (NS) for LOP), ovulation induction (aOR 5.6 for EOP, p = 0.004 and NS for LOP), and in vitro fertilization (aOR 2.8 for EOP, p = 0.05 and NS for LOP). Specific to LOP and NS for EOP: renal diseases (aOR for LOP 2.9, p = 0.007) and gestational diabetes mellitus (aOR 1.2, p = 0.04). Conclusions: Maternal ages over 35 years, chronic hypertension, history of preeclampsia, ovulation induction, in vitro fertilizations, history of perinatal deaths and twin pregnancy (in our experience, especially mono zygotic twin pregnancies) are significant risk factors for EOP. New paternity is an independent factor for both EOP and LOP

Antibody kinetics in infants exposed to Chikungunya virus infection during pregnancy reveals absence of congenital infection

International audienceTo search for serological evidence of congenital infection in apparently healthy neonates born to women infected with the Chikungunya virus (CHIKV) during pregnancy, monitoring for CHIKV-specific antibodies was performed within the CHIMERE cohort study (Reunion island, 2006-2008). CHIKV-specific antibody kinetics showed no evidence of asymptomatic congenital infection as neonates were tested negative for CHIKV-specific IgM antibodies at birth and 368 infants with CHIKV-specific IgG antibodies seroreversed completely (mean seroreversion time: 7.7 months). Seroreversion time of transplacental CHIKV IgG antibodies was inversely correlated with the stage of pregnancy at which exposure took place and end-term small for gestational infants seroreversed earlier

Mise en place d'une surveillance spatialisée des malformations congénitales à La Réunion : choix méthodologiques

International audienceIntroduction – The Registry of Congenital Malformations (CM) in Reunion Island (REMACOR) oversees the surveillance of CM for public health and research purposes. This surveillance consists of the exhaustive collec- tion of cases, and temporal analysis of CM. Since 2013, REMACOR has retrospectively geolocalized the data to allow their spatial analysis and the detection of health signals the methodology of which is presented hereunder.Materials and methods – Each case is geolocated according to the mother’s address, using the reference address databases. Birth-related prevalence is then calculated by aggregating cases according to the different administrative scales. The choice of the suitable scale is determined using a Poisson test that estimates the minimum number of births required to perform the analysis in a statistically signi cant manner, and then a compromise between this representativeness of information, data completeness and spatial resolution.Results – 95% of the cases could be geolocalized. Different cluster detection methods are used to identify the most affected areas. Finally, clusters detected at different scales are nally intersected to calculate an index of belonging to 1, 2 or 3 scales.Discussion and conclusion – The spatialized database set up now allows REMACOR to consider the spatial heterogeneity of the distribution of the most frequent CM in order to inform public health stakeholders.Introduction: Le Registre des malformations congénitales de La Réunion (Remacor) assure la surveillance de ces pathologies à des fins de santé publique et de recherche. Cette surveillance consiste en un recueil exhaustif des cas et en l'analyse temporelle de leur survenue. Afin de permettre leur analyse spatiale et la détection de signaux sanitaires, le Remacor a géocodé rétroactivement les données et mis en place une surveillance spatialisée, dont les choix méthodologiques sont présentés ici.Matériel et méthodes: Chaque cas est géolocalisé conformément à l'adresse de la mère. Les prévalences relatives aux naissances sont ensuite calculées par agrégation des cas selon les différentes échelles administratives. Le choix de l'échelle est déterminé à l'aide d'un test de Poisson qui permet d'estimer le nombre de naissances minimum nécessaire pour réaliser l'analyse de manière statistiquement significative, puis d'un compromis entre cette significativité de l'information, la complétude des données et la résolution spatiale.Résultats: Il a été possible de géolocaliser 95% des cas. Différentes méthodes de détection d'agrégats de cas ont été utilisées afin de repérer les zones les plus touchées. Enfin, les agrégats détectés à différentes échelles ont été intersectés pour calculer un indice d'appartenance à 1, 2 ou 3 échelles.Discussion et conclusion: La base de données spatialisée mise en place permet aujourd'hui au Remacor de prendre en compte l'hétérogénéité spatiale de la distribution des malformations congénitales les plus fréquentes pour informer les acteurs de la santé publique

A prospective study evaluating congenital CMV infection in Mayotte and La Reunion Islands (France)

International audienceOBJECTIVES Congenital cytomegalovirus infection (cCMV) affects around 3400 newborns each year in France, of whom 700 will develop sequelae, primarily sensorineural hearing loss. Our objectives were (1) to evaluate incidence of cCMV in two French departments located in the Indian Ocean: Mayotte and La Reunion, and (2) evaluate interest and feasibility/acceptability of universal screening of cCMV at birth. MATERIAL AND METHODS We implemented a universal neonatal CMV screening in Mayotte during 7 months in 2019 and in La Reunion during one month in March 2020. Saliva swabs were collected in the first three days of life, and tested for CMV DNA by PCR. A short survey allowed evaluating whether this screening is acceptable and feasible. RESULTS: A total of 1026 newborns were screened: 854 in Mayotte and 172 in La Reunion. In Mayotte, cCMV incidence was evaluated at a minimum of 1.6 % (95 % CI 0.94-2.81). In La Reunion, cCMV incidence was evaluated at a minimum of 1.2 % (95 % CI -0.20-4.57). All cCMV infants were born to mothers with non-primary CMV infection. Only 0.7 % parents refused the screening. CONCLUSIONS cCMV incidence in Mayotte and La Reunion is higher than in metropolitan France. This diagnosis should not be overlooked, especially since the time dedicated to screening and its feeling by the parents seem to be acceptable

Study population.

<p>− : seronegative for CHIKV-specific IgM and IgG antibodies ; + : seropositive for CHIKV-specific IgG antibodies; M24: 24^th month, end of follow-up ; Unexposed - Uninfected and Exposed - Uninfected children were pooled as the Uninfected group (grey lozenge) and compared with Exposed - infected children as the Infected group (white lozenge) for RBL (Revised Brunet-Lézine) performance.</p

Children characteristics related to perinatal mother-to-child Chikungunya virus infection, CHIMERE cohort, Reunion Island, 2008.

<p>Data are means, standard errors, numbers and percentages. <i>P</i> values are given for Kruskal-Wallis and Fisher exact tests comparing the three groups.</p>†<p>This propensity score is derived from maternal population (see table 2 of ref. <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002996#pntd.0002996-Fritel1" target="_blank">[12]</a>) assigning positive or negative points to rounded-value beta coefficients associated with categories of maternal origin, education, marital status, parity and body mass index;</p>‡<p>gestational age <37 weeks;</p>#<p><10^th percentile of AUDIPOG network growth charts;</p><p>*corrected for 24 months postnatal age.</p