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

A national cross-sectional study among drug-users in France: epidemiology of HCV and highlight on practical and statistical aspects of the design

<p>Abstract</p> <p>Background</p> <p>Epidemiology of HCV infection among drug users (DUs) has been widely studied. Prevalence and sociobehavioural data among DUs are therefore available in most countries but no study has taken into account in the sampling weights one important aspect of the way of life of DUs, namely that they can use one or more specialized services during the study period. In 2004–2005, we conducted a national seroepidemiologic survey of DUs, based on a random sampling design using the Generalised Weight Share Method (GWSM) and on blood testing.</p> <p>Methods</p> <p>A cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once in their life. We conducted a two stage random survey of DUs selected to represent the diversity of drug use. The fact that DUs can use more than one structure during the study period has an impact on their inclusion probabilities. To calculate a correct sampling weight, we used the GWSM. A sociobehavioral questionnaire was administered by interviewers. Selected DUs were asked to self-collect a fingerprick blood sample on blotting paper.</p> <p>Results</p> <p>Of all DUs selected, 1462 (75%) accepted to participate. HCV seroprevalence was 59.8% [95% CI: 50.7–68.3]. Of DUs under 30 years, 28% were HCV seropositive. Of HCV-infected DUs, 27% were unaware of their status. In the month prior to interview, 13% of DUs shared a syringe, 38% other injection parapharnelia and 81% shared a crack pipe. In multivariate analysis, factors independently associated with HCV seropositivity were age over 30, HIV seropositivity, having ever injected drugs, opiate substitution treatment (OST), crack use, and precarious housing.</p> <p>Conclusion</p> <p>This is the first time that blood testing combined to GWSM is applied to a DUs population, which improve the estimate of HCV prevalence. HCV seroprevalence is high, indeed by the youngest DUs. And a large proportion of DUs are not aware of their status. Our multivariate analysis identifies risk factors such as crack consumption and unstable housing.</p

Politique de réduction des risques : programmes d’échange de seringues

Dans de nombreux pays développés, les programmes d’échange de seringue (PES) sont un des éléments clefs de la politique de réduction des risques chez les usagers de drogues. La plupart des études sur les PES tendent à montrer qu’ils sont protecteurs vis-à-vis de la transmission du virus du sida (VIH) à condition d’être complétés par d’autres actions de réduction des risques. Leur efficacité sur la transmission du virus de l’hépatite C (VHC) semble beaucoup moins certaine. De plus, il apparaît que les jeunes usagers de drogues par injection (UDI), groupe à haut risque de contamination par le VIH et le VHC, ne fréquentent pas ou très peu les PES. En plus de maintenir un niveau d’accès suffisant aux seringues stériles, il est nécessaire de s’interroger sur la manière de toucher les jeunes usagers de drogues commençant à s’injecter des produits, en travaillant notamment sur leurs réseaux sociaux. Il faut également développer la prévention des pratiques sexuelles à risque, qui sont fortement associées aux pratiques à risque liées à l’injection. Enfin, il faut améliorer la qualité des évaluations de ces programmes.In several developed countries, needles exchange programs (NEPs) are a key preventive tool in harm reduction policy related to drug use. Many studies about NEP show it reduces HIV infections related to syringes sharing when part of others preventive actions. NEPs seem to have no impact on HCV transmission. Furthermore, young drug users, who are at high risk for HIV and HCV infections, are not attending NEPs very often. Trying to maintain high accessibility to sterile syringes, efforts must be stressed on hard-to-reach populations such as young injection drug users (IDU), focusing on their social network. Emphasis must also be put on prevention of unsafe sexual intercourse, often related to syringe sharing, which must be more prevented. Finally, design of assessment studies should be improved

Quelques idées à propos de la prévention

L'objectif de cet article est de réfléchir aux conditions d'efficacité des actions de prévention, en s'interrogeant sur leur limites et en proposant des approches renouvelées pour certaines d'entre elles. La plupart de ces actions se limitent à informer sur un mode rationnel et impersonnel, d'autres tentent de sensibiliser sur un mode émotionnel, comme sur les paquets de cigarettes qui "préviennent" le fumeur de ce qui l'attend. Mais, en l'absence d'intériorisation, les effets de ces messages risquent de s'estomper dans le temps. D'autres actions tablent sur l'approche répressive, qui peut avoir une certaine efficacité. Cependant, un seuil est toujours atteint, imposant le déploiement d'autres stratégies. Pour intégrer la dimension subjective des comportements, une piste pourrait être de s'inspirer des publicitaires pour s'adresser aux profondeurs de la personne. Mais cela, dans un tout autre but, puisque là où la publicité propose de l'objet, la prévention doit proposer du sujet