Couverture Vaccinale contre le virus de l’hépatite B au sein du personnel d’un centre Hospitalier Universitaire à Abidjan

Introduction: Le personnel des hôpitaux est une population à risque viral B. la prévention primaire par la vaccination contre le virus de l’hépatite B est efficace. Peu de données existent sur cette prévention en milieu hospitalier ivoirien. Le but de notre étude était d’évaluer la couverture vaccinale contre le VHB et les facteurs associés à cette vaccination au sein du personnel du CHU de Cocody Méthode: Nous avons réalisé une étude transversale analytique allant du 1er Juillet au 31 Décembre 2016 incluant tout le personnel du CHU de Cocody. Tous ceux absent pendant toute la durée de l’étude ou ayant refusé d’y participer ou chez qui une difficulté technique était notée au cours de l’analyse au laboratoire était exclu de l’étude. Des variables sociodémographiques, anamnestiques et biologiques étaient colligés sur une fiche d’enquête pré établie. La vaccination anti virale B était complète lorsque le sujet avait reçu les trois doses du vaccin. Résultats: Sur les 1479 agents du CHU de Cocody, 867 avaient été inclus soit un taux de participation de 58,6%. L’âge moyen était de 41,2 ±9,4 ans, la médiane de 40 ans (18 à 66 ans). Le sex ratio était de 0,82. Un accident d’exposition au sang était déclaré par 18,5% de sujet. L’AgHBs était positif chez 7,2% de cas. Dans 33,4% des cas les sujets affirmaient avoir reçus au moins une dose de vaccin contre le VHB. Un dépistage pré vaccinal était réalisé dans 17,6% des cas. Les sujets incomplètement vaccinés avaient reçu leur dernière dose avant un an, de 1 à 5 ans et plus de 5 ans dans respectivement 23,8%, 32,0% et 44,3% des cas. Les facteurs associés de façon indépendante à une vaccination complète étaient le statut matrimonial marié (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) et la profession médicale (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: La vaccination est un acte peu réalisé par le personnel du CHU de Cocody. Celle-ci était meilleure chez le personnel marié et médical. Mots clés: personnel hospitalier ; vaccination ; hépatite virale B ; Abidjan- côte d’ivoire English Title: Vaccination coverage against viral hepatitis B Abidjan teatching hospital English Abstract Introduction: Hospital staff is a risk population for viral hepatitis B. The primary prevention by anti-viral B vaccination is effective. There is few data about that prevention in Ivorian hospital environment. Method: We made a prospective cross-sectional study from the 1st of July to the 31st of December 2016, including all CHU de Cocody regularly assigned agent. All those who were absent throughout the duration of the study or refused to participate or in whom a technical difficulty was noted during laboratory analysis were excluded. Sociodemographic, anamnestic and biologic data were collected on a pre-established survey sheet. The anti-viral B vaccination was complete when the person had received three doses of the vaccine. Results: Among the 1479 agents of the CHU de Cocody, 867 was included, giving a participation rate of 58.6%. The middle age was 41.2± 9.4 years, the median was 40 years (18 to 66 years). The sex ratio was 0.82. Average professional seniority was 11.2 ± 9.7 years. Married agents (45.8%) and paramedics (45.9%) was relatively the most numerous. 91.5% of the hospital workers had already heard about viral hepatitis B. 70% of them were directly exposed to human organics fluids. A blood exposure accident was reported by 18.5% of hospital agents. Paramedical staff represented the majority. Positive HBs antigen was found in 7.2% of our study population. The agents claiming to have received at least one dose of anti-viral B vaccine numbered 290 (33.4%). A pre-vaccination screening had been achieved in 17.6 % of them. Respectively 29 (23.8%), 39 (32%) and 54 (44.3%) among the incompletely vaccinated agents have had their last dose before one year old, between 1 and 5 years old and after 5 years old. Independently associated factors with a complete vaccination was married marital status (Odds ratio 2, 21, IC95% [1,42-3,46] ; p=0,0001) and the medical profession (odds ratio 3, 47, IC95% [2,09-5,75]; p<0,0001). Conclusion: Vaccination coverage is poor in CHU de Cocody regularly assigned agents.It was better among married agents and medical staff. Keywords: Hospital staff; vaccination; viral hepatitis B, Abidjan-ivory- cos

Adénocarcinome du bulbe. A propos d’un cas observé au centre hospitalier et universitaire de Cocody, Abidjan-Côte d’Ivoire

L’adénocarcinome du bulbe est une affection rare ; le plus souvent sporadique mais des facteurs de risque ont été identifiés. Sa manifestation clinique est peu spécifique faisant errer et retarder le diagnostic précoce malgré les progrès radiologique et endoscopique. Nous rapportons le cas d’un adénocarcinome bulbaire avec métastase hépatique chez un patient de 62 ans cirrhotique connu sous tenofovir 300mg. Ce cas clinique souligne l’intérêt des biopsies duodénales devant toute lésion suspecte. Mots clés : Duodénum-Bulbe-Adénocarcinome-Histologie-Endoscopie English Title: Adenocarcinoma of the bulb: A case report in the universityteachinghospital of cocody (Abidjan Côte d’Ivoire) English Abstract The adenocarcinoma of the bulb is a rare affection; most often sporadic but risk factors have been identified. Its clinical manifestation is not very specific, causing maunder and delayed diagnosis despite radiological and endoscopic progress. We report the case of a bulbar adenocarcinoma with hepatic metastasis in a cirrhotic 62-year-old patient under tenofovir 300mg. This clinical case underlines the interest of biopsy in front of any duodenal lesions. Keywords: Duodenum-Bulb- Adenocarcinoma-Histology-Endoscop

Efficacy of 4 quadruple therapy to eradicate Helicobacter pylori in the real life

Background: The effectiveness of rate of eradication Helicobacter pylori is unknown in Côte d'Ivoire in daily practice. Objectives : The aim ofour study was to assess the effectiveness of 4 quadruple therapies Materials and Methods : This was a retrospective multi center study carriedout in Abidjan. The medical records of naive patients over 18 years old treated with quadruple therapy [sequential (Q s), concomitant 10 (Qc10) or14 days (Qc14) or bismuth based therapy (Qb)]confirmed histologically on gastric biopsies were included. All had a histologic al check for theeradication of H pylori at least 4 weeks after the en d of treatment. The quadruple th erapy eradication rate has been determined. Results : Onehundred and seventy files were included. The overall eradication rate was 60.6% [53.3% 67.9% 95% CI]. It was 55.6% for Qs (30/54, [42.3%68.9% 95% CI]), 80% for Qc10 (8/10, [55.2% 100% 95% CI ]]), 58.3% for Qc14 (49/84, [47,756%, 68,844% 95% CI]) and 72.7% for Qb (16/22,[54,084%, 91,316% 95% CI]). The patients of the 4 protocols were comparable for age (p = 0.054); gender (p = 0.157); reason p = 0.173) andendoscopy result (p = 0.244); intensit y of antral (p = 0.542) and fundic (p = 0.744) H pylori infection in histology; frequency of side effects (p =0.131) and adherence to therapy (p = 0.564). Conclusion s : T he eradication rate of H pylori in daily practice was not optimal regardless of thequa druple therapy regimen used. A study of the resistance of H pylori to different antibiotics is necessary

Evolution of hepatocellular carcinoma epidemiology in Côte d’Ivoire

International audienceIntroduction: Hepatocellular carcinoma is a major concern for Public health in West Africa. In Côte d'Ivoire, the bulk of our knowledge stems from studies conducted decades ago. Our aim was, thus, to assess whether the epidemiological features of this tumor changed recently.Methods: Records from 863 patients diagnosed between 2007 and 2014 were analyzed.Results: We observed major drifts concerning hepatocellular carcinoma with regards to the 1970-1980 period. Age at presentation is substantially delayed (49.4±14.1 years) whereas sex ratio decreased substantially (M:F=2.6). Patients seropositive for hepatitis B surface antigen and anti-hepatitis C virus represented 65% and 25% of cases whereas alcohol intake was reported in 36%. AFP level was above 400ng/mL in 36% of cases and tumors were already multinodular and/or metastatic at diagnosis in 77% and 26% of patients. Geographical and anthropological variations were observed with excesses of female cases affecting regions (Lagunes) or linguisitic groups (Kru). North-Mande speakers were more often identified as nonBnonC than others.Discussion: Ivorian epidemiology of hepatocellular carcinoma was reshaped during the last decades. These changes, most likely due to the spread of hepatitis C virus, resulted in an older and feminized population of patients. We fear that the current and future prevalence of anti-HCV cases might thwart the expected benefits of anti-hepatitis B immunization. Appropriate measures should be taken to prevent further transmission of hepatitis C in the country