Regional spread of an atypical ESBL-producing Escherichia coli ST131H89 clone among different human and environmental reservoirs in Western Switzerland

We describe the inter-regional spread of a novel ESBL-producing Escherichia coli subclone (ST131H89) in long-term care facility residents, general population, and environmental water sources in Western Switzerland between 2017 and 2020. The study highlights the importance of molecular surveillance for tracking emerging antibiotic-resistant pathogens in healthcare and community settings

Preventive strategies against cytomegalovirus and incidence of α-herpesvirus infections in olid-organ transplant recipients: A nationwide cohort study.

We assessed the impact of antiviral preventive strategies on the incidence of herpes-simplex virus (HSV) and varicella-zoster virus (VZV) infections in a nationwide cohort of transplant recipients. Risk factors for the development of HSV/VZV infection were assessed by Cox PH regression. We included 2781 patients (56% kidney, 20% liver, 10% lung, 7.3% heart, 6.7% others). Overall, 1264 (45%) patients received antiviral prophylaxis [(val)ganciclovir (n=1126) or (val)acyclovir (n=138)]. Incidences for HSV and VZV infections were 28.9 and 12.1 cases per 1000 person-years, respectively. Incidence of HSV/VZV infections at 1-year post-transplant was 4.6% (95% CI 3.5-5.8) in patients receiving antiviral prophylaxis vs. 12.3% (95% CI 10.7-14) in patients without prophylaxis; this was particularly observed for HSV infections: 3% (95% CI 2.2-4) vs. 9.8% (95% CI 8.4-11.4), respectively. A lower rate of HSV/VZV infections was also seen in donor or recipient CMV-positive patients receiving (val)ganciclovir prophylaxis as compared to a preemptive approach. Female gender (HR 1.663, p=0.001), HSV seropositivity (HR 5.198, p<0.001), previous episodes of rejection (HR 1.95, p=0.004), and use of a preemptive approach (HR 2.841, p=0.017) were significantly associated with a higher risk for HSV infection. While HSV/VZV infections were common after transplantation, antiviral prophylaxis significantly reduced symptomatic HSV infections. This article is protected by copyright. All rights reserved

Determinants of geographic inequalities in HPV vaccination in the most populated region of France.

BACKGROUND:In France, there are recommendations and reimbursements for human papillomavirus (HPV) vaccination but no HPV vaccination programs. Therefore, vaccination is largely determined by parents' initiative, which can lead to inequalities. The objective of this study was to determine the factors associated with poorer vaccination coverage rates in the most populated region of France. METHODS:The data of this study were obtained from the National Health Insurance between 2011 and 2013. Correlations between vaccination initiation rate (at least 1 dose reimbursed) and socio-demographic/cultural factors were assessed using Pearson's product-moment correlation coefficient. Multivariate analyses were performed using logistic regression. RESULTS:In total, 121,636 girls received at least one HPV vaccine dose. The vaccination rate for girls born from 1996 to 1999 was 18.7%. Disparities in vaccination coverage rates were observed between the 8 departments of the region, ranging from 12.9% to 22.6%. At the department level, unemployment, proportion of immigrants and foreigners, and coverage by CMU health insurance ("Couverture Maladie Universelle", a health insurance plan for those who are not otherwise covered through business or employment and who have a low income) were significantly inversely correlated with vaccination rates, whereas urban residence, medical density, income and use of medical services were not related to coverage. In the multivariate model, only the percentage of foreigners remained independently associated with lower vaccination coverage. At the individual level, the use of medical services was a strong driver of HPV vaccination initiation. CONCLUSION:We observed geographic disparities in HPV vaccination initiation coverage. Even if no clear factor was identified as a vaccination determinant, we observed a failure of vaccination only based on parents' initiative. Therefore, an organized policy on HPV vaccination, such as school-based programs, can help improve coverage rates

Vaccination rates according to the 8 departments of the Ile-de-France region, France.

<p>Vaccination rates according to the 8 departments of the Ile-de-France region, France.</p

Vaccination scheme for CMU recipient’s girls and non-CMU recipient’s girls.

<p>a: Rates of CMU recipients in the vaccinated population (at least one dose, dark grey) and general population (light grey). b: Percentage of vaccinated girls reimbursed for 1, 2, and 3 or more doses in 2012 and 2013 with first dose reimbursed in 2012, in CMU recipients (up) and non-CMU recipients (down).</p

Determinants of geographic inequalities in HPV vaccination in the most populated region of France - Fig 4

<p>Correlations between the vaccination rate (initiation) in each of the 8 departments and the medical density (a), urbanization rate (b), average incomes per capita (c), unemployment rate (d), percentage of immigrants (e), percentage of foreigners (f), average CMU recipient rates (g) and median amount of medical consumption from 2011 to 2013 (h). Each dot corresponds to a department. a. <i>Data from the French National Medical Council (7)</i>. <i>b</i>. <i>Data from the SENAT (8)</i>. <i>c</i>. <i>Data from INSEE (9)</i>. <i>d</i>. <i>Data from INSEE (10)</i>. <i>e</i>. <i>Data from INSEE (11)</i>. <i>f</i>. <i>Data from INSEE (12)</i>. <i>g</i>. <i>Date from CMU (13)</i>. <i>h</i>. <i>Data from our database</i>.</p

Bouffées de chaleur et cancer du sein avec récepteurs hormonaux positifs : mécanismes et prise en charge

International audienceBreast cancer is the most frequently diagnosed cancer in women and the first cause of cancer death in France. Among the different subtypes of breast cancer, the predominant form is characterized by positive hormone receptors (more than 70% of breast cancers). Hormone therapy thus plays a key role in the strategy of management of these cancers both in adjuvant and metastatic situations. The two types of adjuvant hormone therapy used are selective estrogen receptor modulators and aromatase inhibitors. Fulvestrant, an anti-estrogen, is used alone or in combination with other molecules in metastatic situations. Hot flashes are one of the symptoms most frequently reported by patients under hormone therapy. Hormone replacement therapy, which is currently the most effective treatment for hot flashes, is contraindicated in patients with a personal history of breast cancer. Various therapeutic classes of drugs have been tested in this indication but without real efficacy in the various studies carried out to date, and moreover associated with non-negligible side effects. The recent discovery of the implication of the kisspeptin system located at the hypothalamic level in the mechanism of genesis of hot flashes opens the way to possible new symptomatic treatments for hot flashes. Neurokinin 3 receptor antagonists have shown encouraging preliminary results in postmenopausal cancer-free patients and could be considered in patients in hormonal therapy for breast cancer. Broader additional studies are needed to confirm these initial results

Les récepteurs aux androgènes dans le cancer du sein : expression, valeur et perspectives thérapeutiques

International audienceTriple-negative (TN) breast cancer are characterized by lack of estrogen receptor (OR) and progesterone receptor (PR) expression, and the absence of overexpression of human epidermal growth factor receptor 2 (HER2). It is a heterogeneous group of tumors with a more pejorative prognosis than other subtypes of breast cancer. Androgen receptors (AR) are nuclear receptors whose expression varies from 80 to 85% of primary breast cancers and 60 to 75% of metastatic cancers. Among the TN breast cancers, the luminal androgen receptor (LAR) subtype expresses AR more frequently, up to 53% of the cases. AR are associated with lower tumor size, histological grade, Ki67, and lymph node involvement. The results of recent clinical trials evaluating anti-androgen therapies in locally advanced or metastatic TN breast cancer are promising. Many new therapies are tested, including enzalutamide or abiraterone acetate, and numerous therapeutic combinations including PI3K/AKT/mTOR inhibitors or CDK inhibitors. These therapies would allow an alternative treatment of patients with TN breast cancer for which there is often a therapeutic impasse

Age impact on human papillomavirus vaccination in France in 2014: A study from the National Health Insurance Database

International audienceSummaryIntroduction Human papillomavirus (HPV) is the main cause of cervical cancer. In France, since March 2007, HPV vaccination has been recommended for girls aged 14, in addition to a catch-up program for girls aged 15 to 23. In October 2012, the target population was changed to 11- to 14-year-old girls. The main objective of the present study was to evaluate the impact of the recommendation change on HPV vaccination coverage and compliance. Methods We conducted a descriptive study of the Échantillon Généraliste des Bénéficiaires (EGB), which is a random 1/97 permanent sample from the French National Health Insurance Database. We focused our analyses on girls aged 11 to 17 years who were covered by the main insurance scheme (which covers 77% of the French population). Results We included 16,195 girls in this analysis. At the last update of the database (06/15/2014), 42% of 17-year-old girls had been vaccinated, with more than 50% of them having been vaccinated at age 14. Between January 2012 and June 2014, patients were reimbursed for a total of 7698 doses of the HPV vaccine. During the first trimester of 2013, the number of vaccinated 11- to 13-year-old girls increased, growing by more than 20-fold between the last trimester of 2012 (n = 8) and the last trimester of 2013 (n = 178). Less than 60% of the vaccinated patients received 3 injections. Discussion Implementation of the new recommendations was rapid but had only a slight impact on vaccination coverage