Direct impact of COVID-19 by estimating disability-adjusted life years at national level in France in 2020

Background: The World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on March 11, 2020. The standardized approach of disability-adjusted life years (DALYs) allows for quantifying the combined impact of morbidity and mortality of diseases and injuries. The main objective of this study was to estimate the direct impact of COVID-19 in France in 2020, using DALYs to combine the population health impact of infection fatalities, acute symptomatic infections and their post-acute consequences, in 28 days (baseline) up to 140 days, following the initial infection. Methods: National mortality, COVID-19 screening, and hospital admission data were used to calculate DALYs based on the European Burden of Disease Network consensus disease model. Scenario analyses were performed by varying the number of symptomatic cases and duration of symptoms up to a maximum of 140 days, defining COVID-19 deaths using the underlying, and associated, cause of death. Results: In 2020, the estimated DALYs due to COVID-19 in France were 990 710 (1472 per 100 000), with 99% of burden due to mortality (982 531 years of life lost, YLL) and 1% due to morbidity (8179 years lived with disability, YLD), following the initial infection. The contribution of YLD reached 375%, assuming the duration of 140 days of post-acute consequences of COVID-19. Post-acute consequences contributed to 49% of the total morbidity burden. The contribution of YLD due to acute symptomatic infections among people younger than 70 years was higher (67%) than among people aged 70 years and above (33%). YLL among people aged 70 years and above, contributed to 74% of the total YLL. Conclusions: COVID-19 had a substantial impact on population health in France in 2020. The majority of population health loss was due to mortality. Men had higher population health loss due to COVID-19 than women. Post-acute consequences of COVID-19 had a large contribution to the YLD component of the disease burden, even when we assume the shortest duration of 28 days, long COVID burden is large. Further research is recommended to assess the impact of health inequalities associated with these estimates

Increased risk of miscarriage among women experiencing physical or sexual intimate partner violence during pregnancy in Guatemala City, Guatemala: cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Violence against women by their male intimate partners (IPV) during pregnancy may lead to negative pregnancy outcomes. We examined the role of IPV as a potential risk factor for miscarriage in Guatemala. Our objectives were: (1) To describe the magnitude and pattern of verbal, physical and sexual violence by male intimate partners in the last 12 months (IPV) in a sample of pregnant Guatemalans; (2) To evaluate the influence of physical or sexual IPV on miscarriage as a pregnancy outcome.</p> <p>Methods</p> <p>All pregnant women reporting to the maternity of a major tertiary care public hospital in Guatemala City from June 1st to September 30th, 2006 were invited to participate in this cross-sectional study. The admitting physician assessed occurrence of miscarriage, defined as involuntary pregnancy loss up to and including 28 weeks gestation. Data on IPV, social and demographic characteristics, risk behaviours, and medical history were collected by interviewer-administered questionnaire. Laboratory testing was performed for HIV and syphilis. The relationship between IPV and miscarriage was assessed through multivariable logistic regression.</p> <p>Results</p> <p>IPV affected 18% of the 1897 pregnant Guatemalan women aged 15-47 in this sample. Verbal IPV was most common (16%), followed by physical (10%) and sexual (3%) victimisation. Different forms of IPV were often co-prevalent. Miscarriage was experienced by 10% of the sample (<it>n </it>= 190). After adjustment for potentially confounding factors, physical or sexual victimisation by a male intimate partner in the last 12 months was significantly associated with miscarriage (ORadj 1.1 to 2.8). Results were robust under a range of analytic assumptions.</p> <p>Conclusions</p> <p>Physical and sexual IPV is associated with miscarriage in this Guatemalan facility-based sample. Results cohere well with findings from population-based surveys. IPV should be recognised as a potential cause of miscarriage. Reproductive health services should be used to screen for spousal violence and link to assistance.</p

Modèles pour l'estimation de l'incidence de l'infection par le VIH en France à partir des données de surveillance VIH et SIDA

L'incidence de l'infection par le VIH, définie comme le nombre de sujets nouvellement infectés par le VIH au cours du temps, est le seul indicateur permettant réellement d'appréhender la dynamique de l'épidémie du VIH/SIDA. Sa connaissance permet de prévoir les conséquences démographiques de l'épidémie et les besoins futurs de prise en charge, mais également d'évaluer l'efficacité des programmes de prévention. Jusqu'à très récemment, l'idée de base pour estimer l'incidence de l'infection par le VIH a été d'utiliser la méthode de rétro-calcul à partir des données de l'incidence du SIDA et de la connaissance de la distribution de la durée d'incubation du SIDA. L'avènement, à partir de 1996, de nouvelles combinaisons thérapeutiques très efficaces contre le VIH a contribué à modifier la durée d'incubation du SIDA et, par conséquent, à augmenter la difficulté d'utilisation de la méthode de rétro-calcul sous sa forme classique. Plus récemment, l'idée d'intégrer des informations sur les dates de diagnostic VIH a permis d'améliorer la précision des estimations. La plupart des pays occidentaux ont mis en place depuis quelques années un système de surveillance de l'infection à VIH. En France, la notification obligatoire des nouveaux diagnostics d'infection VIH, couplée à la surveillance virologique permettant de distinguer les contaminations récentes des plus anciennes a été mise en place en mars 2003. L'objectif de ce travail de thèse est de développer de nouvelles méthodes d'estimation de l'incidence de l'infection par le VIH capables de combiner les données de surveillance des diagnostics VIH et SIDA et d'utiliser les marqueurs sérologiques recueillis dans la surveillance virologique dans le but de mieux saisir l'évolution de l'épidémie dans les périodes les plus récentes.The knowledge of the dynamics of the HIV/AIDS epidemic is crucial for planning current and future health care needs. The HIV incidence, i.e. the number of new HIV infections over time, determines the trajectory and the extent of the epidemic but is difficult to measure. The backcalculation method has been widely developed and used to estimate the past pattern of HIV infections and to project future incidence of AIDS from information on the incubation period distribution and AIDS incidence data. In recent years the incubation period from HIV infection to AIDS has changed dramatically due to increased use of antiretroviral therapy, which lengthens the time from HIV infection to the development of AIDS. Therefore, it has become more difficult to use AIDS diagnosis as the basis for back-calculation. More recently, the idea of integrating information on the dates of HIV diagnosis has improved the precision of estimates. In recent years, most western countries have set up a system for monitoring HIV infection. In France, the mandatory reporting of newly diagnosed HIV infection, coupled with virological surveillance to distinguish recent infections from older, was introduced in March 2003. The goal of this PhD thesis is to develop new methods for estimating the HIV incidence able to combine data from monitoring HIV and AIDS diagnoses and use of serologic markers collected in the virological surveillance in order to better understand the evolution of the epidemic in the most recent periods

Modèles pour l'estimation de l'incidence de l'infection par le VIH en France à partir des données de surveillance VIH et SIDA

L'incidence de l'infection par le VIH, définie comme le nombre de sujets nouvellement infectés par le VIH au cours du temps, est le seul indicateur permettant réellement d'appréhender la dynamique de l'épidémie du VIH/SIDA. Sa connaissance permet de prévoir les conséquences démographiques de l'épidémie et les besoins futurs de prise en charge, mais également d'évaluer l'efficacité des programmes de prévention. Jusqu'à très récemment, l'idée de base pour estimer l'incidence de l'infection par le VIH a été d'utiliser la méthode de rétro-calcul à partir des données de l'incidence du SIDA et de la connaissance de la distribution de la durée d'incubation du SIDA. L'avènement, à partir de 1996, de nouvelles combinaisons thérapeutiques très efficaces contre le VIH a contribué à modifier la durée d'incubation du SIDA et, par conséquent, à augmenter la difficulté d'utilisation de la méthode de rétro-calcul sous sa forme classique. Plus récemment, l'idée d'intégrer des informations sur les dates de diagnostic VIH a permis d'améliorer la précision des estimations. La plupart des pays occidentaux ont mis en place depuis quelques années un système de surveillance de l'infection à VIH. En France, la notification obligatoire des nouveaux diagnostics d'infection VIH, couplée à la surveillance virologique permettant de distinguer les contaminations récentes des plus anciennes a été mise en place en mars 2003. L'objectif de ce travail de thèse est de développer de nouvelles méthodes d'estimation de l'incidence de l'infection par le VIH capables de combiner les données de surveillance des diagnostics VIH et SIDA et d'utiliser les marqueurs sérologiques recueillis dans la surveillance virologique dans le but de mieux saisir l'évolution de l'épidémie dans les périodes les plus récentes.The knowledge of the dynamics of the HIV/AIDS epidemic is crucial for planning current and future health care needs. The HIV incidence, i.e. the number of new HIV infections over time, determines the trajectory and the extent of the epidemic but is difficult to measure. The backcalculation method has been widely developed and used to estimate the past pattern of HIV infections and to project future incidence of AIDS from information on the incubation period distribution and AIDS incidence data. In recent years the incubation period from HIV infection to AIDS has changed dramatically due to increased use of antiretroviral therapy, which lengthens the time from HIV infection to the development of AIDS. Therefore, it has become more difficult to use AIDS diagnosis as the basis for back-calculation. More recently, the idea of integrating information on the dates of HIV diagnosis has improved the precision of estimates. In recent years, most western countries have set up a system for monitoring HIV infection. In France, the mandatory reporting of newly diagnosed HIV infection, coupled with virological surveillance to distinguish recent infections from older, was introduced in March 2003. The goal of this PhD thesis is to develop new methods for estimating the HIV incidence able to combine data from monitoring HIV and AIDS diagnoses and use of serologic markers collected in the virological surveillance in order to better understand the evolution of the epidemic in the most recent periods

Estimation de la distribution des temps d'infection par le VIH à partir des données longitudinales de marqueurs virologiques de séroconversion

International audienceDepuis les années 1990, de nombreux travaux portent sur l'étude de l'évolution des anticorps anti-VIH menant à des tests permettant de distinguer les infections récentes des infections déjà bien établies à partir d'un seul échantillon de sérum. L'incidence peut alors être estimée à partir de la relation entre la prévalence, l'incidence et la durée de l'infection récente ("période fenêtre"). Cependant, de récents travaux ont montré les limites de cette approche dues essentiellement à une grande variabilité de la "période fenêtre". Nous proposons une approche alternative qui consiste à estimer la distribution du temps d'infection basée sur la valeur des marqueurs virologiques au moment où l'infection est découverte pour la première fois. Dans un premier temps, un modèle pour l'évolution des marqueurs est spécifié et estimé à partir de mesures répétées de marqueurs virologiques de séroconversion. Les paramètres du modèle sont estimés à partir des données d'une cohorte de patients inclus pendant la primo-infection. Dans un second temps, nous utilisons ce modèle pour estimer la distribution des temps d'infection pour les sujets nouvellement diagnostiqués VIH+ et reportés dans le système de surveillance des diagnostics VIH en France

Monitoring the reproductive number of COVID-19 in France: Comparative estimates from three datasets

International audienceBackground: The effective reproduction number (R t ) quantifies the average number of secondary cases caused by one person with an infectious disease. Near-real-time monitoring of R t during an outbreak is a major indicator used to monitor changes in disease transmission and assess the effectiveness of interventions. The estimation of R t usually requires the identification of infected cases in the population, which can prove challenging with the available data, especially when asymptomatic people or with mild symptoms are not usually screened. The purpose of this study was to perform sensitivity analysis of R t estimates for COVID-19 surveillance in France based on three data sources with different sensitivities and specificities for identifying infected cases. Methods: We applied a statistical method developed by Cori et al. to estimate R t using (1) confirmed cases identified from positive virological tests in the population, (2) suspected cases recorded by a national network of emergency departments, and (3) COVID-19 hospital admissions recorded by a national administrative system to manage hospital organization. Results: R t estimates in France from May 27, 2020, to August 12, 2022, showed similar temporal trends regardless of the dataset. Estimates based on the daily number of confirmed cases provided an earlier signal than the two other sources, with an average lag of 3 and 6 days for estimates based on emergency department visits and hospital admissions, respectively. Conclusion: The COVID-19 experience confirmed that monitoring temporal changes in R t was a key indicator to help the public health authorities control the outbreak in real time. However, gaining access to data on all infected people in the population in order to estimate R t is not straightforward in practice. As this analysis has shown, the opportunity to use more readily available data to estimate R t trends, provided that it is highly correlated with the spread of infection, provides a practical solution for monitoring the COVID-19 pandemic and indeed any other epidemic

Antenatal HIV screening: results from the National Perinatal Survey, France, 2016

Background: Universal antenatal HIV screening programmes are an effective method of preventing mother-to-child transmission. Aims: To assess the coverage and yield of the French programme on a nationally representative sample of pregnant women, and predictive factors for being unscreened or missing information on the performance/ result of a HIV test. Methods: Data came from the medical records of women included in the cross-sectional 2016 French National Perinatal Survey. We calculated odds ratios (OR) to identify factors for being unscreened for HIV and for missing information by multivariable analyses. Results: Of 13,210 women, 12,782 (96.8%) were screened for HIV and 134 (i.o%) were not; information was missing for 294 (2.2%). HIV infection was newly diagnosed in 19/12,769 (0.15%) women screened. The OR for being unscreened was significantly higher in women in legally registered partnerships (OR: 1.3; 95% CI: 1.1-1.6), with 1-2 years of post-secondary schooling (OR: 1.6; 95% CI: 1.2-2.1), part-time employment (OR: 1.4; 95% CI: 1.1-1.8), inadequate antenatal care (OR: 1.9; 95% CI: 1.5-2.4) and receiving care from >1 provider (OR: 1.8; 95% CI: 1.1-2.8). The OR of missing information was higher in multiparous women (OR: 1.4; 95% CI: 1.2-1.5) and women cared for by general practitioners (OR: 1.4; 95% CI: 1.1-1.9). Conclusions: The French antenatal HIV screening programme is effective in detecting HIV among pregnant women. However, a few women are still not screened and awareness of the factors that predict this could contribute to improved screening levels

Emerging Shiga-toxin-producing Escherichia coli serogroup O80 associated hemolytic and uremic syndrome in France, 2013-2016: Differences with other serogroups.

To generate hypotheses on possible sources of Shiga toxin-producing Escherichia coli (STEC) serogroup O80 associated hemolytic-uremic syndrome (HUS), we explored differences in factors associated with STEC O80 associated HUS, compared with STEC O157 or STEC of other serogroups, in France during 2013-16. STEC was isolated from 153/521 (30%) reported HUS cases: 45 serogroup O80, 46 O157 and 62 other serogroups. Median ages were 1.1 years, 4.0 years and 1.8 years, respectively. O80 infected patients were less likely to report ground beef consumption (aOR [adjusted Odds Ratio] 0.14 95% CI [Confidence Interval] 0.02-0.80) or previous contact with a person with diarrhea or HUS (aOR 0.13 95%CI 0.02-0.78) than patients infected with STEC O157. They were also less likely to report previous contact with a person presenting with diarrhea/HUS than patients infected with other serogroups (aOR 0.13 95%CI 0.02-0.78). STEC O80 spread all over France among young children less exposed to known risk factors of O157 or other STEC infections, suggesting the existence of different reservoirs and transmission patterns

Risk of a blood donation contaminated with hepatitis E virus entering the blood supply before the implementation of universal RNA screening in France

International audienc