Implementation of the One Health approach to fight arbovirus infections in the Mediterranean and Black Sea Region: Assessing integrated surveillance in Serbia, Tunisia and Georgia

Background In the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter-sectoral collaboration; however, no standardized methodology exists to study One Health surveillance. Methods We designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter-sectoral integration. Results Serbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea-Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case. Discussion The three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter-sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized

Metabolic Syndrome according to Three Definitions in Hammam-Sousse Sahloul Heart Study: A City Based Tunisian Study

Objectives. Metabolic syndrome (MetS) is a major risk factor of CVD. The aim of the present study is to determine the prevalence of the MetS, its components, and its different profiles according to NCEP-ATP III 2001, IDF 2005, and JIS 2009 definitions in Hammam-Sousse Sahloul Heart Study (HSHS). Study Design. The study involved 1121 participants (364 men and 757 women; sex-ratio  =  0.48; mean age  =  47.49 ± 16.24 years) living in Hammam Sousse city, located in the east of Tunisia. Methods. Anthropometric parameters, blood pressure, lipids levels, glycemia, insulinemia, and body mass index were measured. Statistical analyses were performed by SPSS16.0. Results. The percentage of participants who had MetS defined according to NCEP ATP III, IDF 2005, and JIS 2009 definitions was respectively, 29.5%, 38.4%, and 39.6%. With regard to gender, the prevalence of MetS is higher in men than in women according to IDF 2005 definition (38.5% men versus 38.3% women, P=0.961) and according to JIS 2009 definition (41.8% men versus 38.6% women, P=0.307), whereas, according to NCEP ATP III definition, the prevalence of MetS is higher in women than in men (30% versus 28.6%, P=0.627). The prevalence of MetS increased with increasing age according to the three definitions (P<0.001) and peaked in the oldest age group (≥70 years) according to IDF 2005 and JIS 2009. Furthermore, a significant difference in the prevalence of MetS components according to gender was observed. Indeed, the abdominal obesity is the most frequent MetS compound in women group, but hypertension and low HDL-C are the most frequent in men. In addition, according to the three definitions, the most frequent MetS profile in our study is “higher waist circumference, hypertension, and low HDL-C.” Conclusion. The high prevalence of MetS is a serious public health problem in Hammam-Sousse Sahloul community. Higher waist circumference, hypertension, and low HDL-C were the most frequent profile in our study

Effect of mutations in LDLR and PCSK9 genes on phenotypic variability in Tunisian familial hypercholesterolemia patients

International audienceBackground: Autosomal dominant hypercholesterolemia (ADH) is commonly caused by mutations in the low-density lipoprotein (LDL) receptor gene (LDLR), in the apolipoprotein B-100 gene (APOB), or in the proprotein convertase subtilisin kexine 9 gene (PCSK9). ADH subjects carrying a mutation in LDLR present highly variable plasma LDL-cholesterol (LDL-C). This variability might be due to environmental factors or the effect of some modifying genes such as PCSK9 and APOE. Aims: We investigated the molecular basis of thirteen Tunisian ADH families and attempted to determine the impact of PCSK9 and APOE gene variations on LDL-cholesterol levels and on the variable phenotypic expression of the disease. Methods and results: Fifty six subjects were screened for mutations in the LDLR gene through direct sequencing. The causative mutation was found to segregate with the disease in each family and a new frameshift mutation, p.Met767CysfsX21, was identified in one family. The distribution of total-and LDL-cholesterol levels, adjusted for age and gender, among homozygous and heterozygous ADH patients varied widely. Within seven families, nine subjects presented low LDL-cholesterol levels despite carrying a mutation in the LDLR gene. To identify the molecular actors underlying this phenotypic variability, the PCSK9 gene was screened using direct sequencing and/or enzymatic restriction analysis, and the apo E genotypes were determined. A new missense variation (p.Pro174Ser) in the PCSK9 gene was identified and characterized as a new putative loss-of-function mutation. Conclusion: Genetic variations in PCSK9 and APOE genes could explain only part of the variability observed in the phenotypic expression in Tunisian ADH patients carrying mutations in the LDLR gene. Other genetic variants and environmental factors very probably act to fully explain this phenotypic variability