Le chikungunya : une arbovirose ré-émergente (Thèse d'exercice de Pharmacie)

Currently reemergence in the world, chikungunya virus is an arbovirus causing the occurrence of epidemics in countries not previously affected. Mainly transmitted to humans by mosquitoes Aedes albopictus and Aedes aegypti this arbovirus concerned by its development. The possible mutations of the virus, different genotypes, climate change, the political context (war, globalization ...) and reservoirs of viruses difficult to identify are all factors making the control very complicated of viral dissemination. Paradoxically this development, despite the lack of treatment and vaccine, chikungunya disease is becoming better understood. This overall progress of knowledge is one of optimism for the future. However currently, individual and collective prevention remains the most effective way to fight against the spread of the virus. Therefore, vector control is the major asset of this taken into preventive care. As the first contact the pharmacist has a major role to play in prevention

Les arboviroses tropicales émergentes en France (dengue et chikungunya) : étude du rôle du pharmacien d'officine dans la lutte anti-vectorielle (Thèse d'exercice de Pharmacie)

En 2005, l’épidémie de chikungunya qui a sévi sur l’île de la Réunion a marqué les esprits. Depuis, avec l’arrivée d’un moustique pouvant être le vecteur de cette maladie en France ; Aedes albopictus, la problématique s’est élargie. Venu initialement d’Italie, ce moustique se propage en effet le long du littoral méditerranéen français et peut véhiculer les virus de la dengue et du chikungunya pour les transmettre à l’homme. Pour éviter l’émergence de ces arboviroses, il faut donc lutter contre le moustique tigre sous deux aspects : l’aspect de la nuisance mais aussi et surtout, l’aspect de sa capacité et de sa compétence vectorielle. Les différents messages de la lutte anti-vectorielle peuvent apparaître ambigus et leur utilité est parfois remise en question. Ainsi, le pharmacien est un acteur de santé incontournable, sollicité par les populations des régions endémiques pour disposer de plus d’informations et savoir comment se protéger contre Aedes albopictus. Une étude a donc été réalisée pour réaliser un état des lieux des connaissances des pharmaciens d’officine dans ce domaine, dans la ville de Marseille. Or, les enseignements tirés de cette enquête ont été la mise en évidence des lacunes pouvant porter préjudice à la bonne information et donc éducation communautaire. Un plan d’actions est donc proposé pour améliorer la prise en charge

Natural Haemophilus influenzae type b capsular polysaccharide antibodies in 412 infants and children from West Africa (Burkina-Faso) and France: a cross-sectional serosurvey.

Prior to possible introduction of large-scale vaccination programmes, an estimation and comparison of naturally acquired immunity against Haemophilus influenzae type b (Hib) was carried out in two populations of age-stratified infants and children (from birth to 14 years old) in Burkina-Faso (West Africa) (n = 206) and France (n = 206). Hib capsular polysaccharide antibodies were detected by an ELISA method. The difference in the percentages of minimum protective levels for the two populations were not significant (0.15 microg/ml) for newborns (0-1 month) but became significant as early as 2 to 3 months of age (p < 0.01) when lower levels were found among infants from Burkina-Faso. Subsequently, the percentages in both countries remained low until 11 months of age and showed no significant differences. For children between 12 and 35 months, the results > or = 0.15 microg/ml were significantly higher in France (p < or = 0.05). From 36 months, the percentage of minimum seropositivity increased in Burkina-Faso, so that the difference was no longer significant. In each country, the percentage of children with the minimum protective level varied significantly (p < or = 0.05) according to age (0-47 months). None of the children from Burkina-Faso or France had antibody levels > 1.0 microg/ml before one year of age. Thereafter, only 9.51% of French children in the 12- to 17-month age stratum and 19.2% over 4 years of age had antibody levels > 1.0 microg/ml. There were no non-detectable results for children over 4 years of age, and the means for natural detectable Hib CP antibodies were > 0.15 microg/ml for both populations. Hib invasive infections depend on climate, socioeconomic status and ethnic and genetic factors. In Burkina-Faso, the large number of infants and children under 4 years of age susceptible to Hib infections suggests that large scale vaccination programmes are needed soon after birth. However, it would first be necessary to evaluate such factors as the frequency of Hib diseases in this population

Development of RT-semi-nested PCR for detection of hepatitis A virus in stool in epidemic conditions.

The purpose of this study was to determine the efficiency of semi-nested PCR in detecting hepatitis A virus (HAV) RNA. During a 2-year period (1990-1991), HAV RNA was searched for in shellfish from the French Brittany coasts using cRNA and vRNA probes. In January 1992, at the time of a hepatitis A outbreak, 28 stool samples were collected from infected patients (18 adults, 10 children) with anti-HAV IgM. Four samples from subjects with negative HAV serology were used as negative controls. Nucleic acid amplification (reverse-transcription-semi-nested PCR) was performed to detect HAV in stool. HAV RNA was purified by phenol-chloroform extraction and converted to cDNA using reverse transcriptase (Mu-MLV). After amplification, PCR products were visualized on an ethidium-bromide-stained gel and confirmed by hybridization with a specific digoxigenin-labelled oligoprobe. Samples were also studied by molecular hybridization with cRNA and vRNA probes. After onset of the illness, HAV RNA was detected over a longer time period by semi-nested PCR (16/28) than by hybridization (0/28). Even though biological diagnosis of hepatitis A will continue to rely on the detection of anti-HAV IgM, PCR should be useful in certain clinical cases (diagnosis of relapse) and for epidemiological and environmental monitoring of viruses