Tularemia : situation in france, issues and public health risk

This is a retrospective study on natural foci of tularemia in animals as well as human cases reported in France between 1999 and 2004. Since 1999, approximately 20 to 60 animals foci of infection in hares are detected every year in 19 to 34 French departments. Human cases often occur in areas where animal foci have erupted, but not always. There are several reasons explaining the presence of this disease on French territory, its underestimation in animals, and probably in man, and its durability. The disease is generally poorly recognised, except amongst shooters who are aware of its existence. Several clinical forms are known in man, sometimes with severe symptoms. The diagnosis of tularemia can be difficult due to its non-specific clinical features. Tularemia is mostly described in hares but other species can be also affected, serving as reservoirs for the infection and sometimes acting as vectors as well. The animal population tested for tularemia should be widened to include other wild species, as well as some of our domestic animals. In man, this diagnosis should be considered in people presenting certain clinical signs. A background on epidemiological data is given. In addition, as Francisella tularensis is one of the bioterrorism agents, it is essential that clinicians and biologists recognise this bacteria and are aware of its dangers. Tularemia was removed from the list of Legally Contagious Disease in veterinary medicine in 1996. It has become a notifiable disease in human medicine in 2002.Il s’agit d’une étude rétrospective de foyers animaux de la tularémie et des cas de contamination humaine recensés en France entre 1999 et 2004. Depuis 1999, environ 20 à 60 foyers sont identifiés chaque année chez des lièvres, dans 19 à 34 départements français. Les cas humains se déclarent souvent dans les régions où sont détectés les cas animaux, mais pas toujours. Plusieurs raisons sont à l’origine de la présence de la maladie sur le territoire, de sa sous-estimation chez les animaux, et vraisemblablement aussi chez l’homme, et de sa pérennité. La maladie est généralement mal connue, sauf chez les chasseurs qui en sont informés. Elle se présente sous de multiples formes chez l’homme et peut occasionner des troubles assez graves. Le diagnostic clinique peut être difficile, à cause des symptômes relativement peu spécifiques. Le lièvre n’est pas la seule espèce animale en cause, il n’est qu’un révélateur d’un foyer de la maladie. Plusieurs autres espèces y sont sensibles et constituent des réservoirs d’infection, certaines jouant également un rôle de vecteur. Il faudrait élargir la recherche de la tularémie à d’autres espèces de la faune sauvage, mais aussi à certaines espèces domestiques. Chez l’homme, cette maladie potentiellement grave devrait faire l’objet d’une recherche systématique face à certains symptômes cliniques. Plusieurs facteurs épidémiologiques sont rappelés. Par ailleurs, Francisella tularensis faisant partie des agents du bioterrorisme, il est essentiel que les cliniciens et les biologistes apprennent à reconnaître cette bactérie et exercent une certaine vigilance. La tularémie ne fait plus partie des Maladies Légalement Contagieuses en médecine vétérinaire depuis 1996. Elle est à déclaration obligatoire en santé humaine depuis 2002

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Impact on disease mortality of clinical, biological, and virological characteristics at hospital admission and overtime in COVID‐19 patients

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