Real-Time Assessment of Health-Care Requirements During the Zika Virus Epidemic in Martinique.

The spread of Zika virus in the Americas has been associated with a surge in Guillain-Barré syndrome (GBS) cases. Given the severity of GBS, territories affected by Zika virus need to plan health-care resources to manage GBS patients. To inform such planning in Martinique, we analyzed Zika virus surveillance and GBS data from Martinique in real time with a modeling framework that captured dynamics of the Zika virus epidemic, the risk of GBS in Zika virus-infected persons, and the clinical management of GBS cases. We compared our estimates with those from the 2013-2014 Zika virus epidemic in French Polynesia. We were able to predict just a few weeks into the epidemic that, due to lower transmission potential and lower probability of developing GBS following infection in Martinique, the total number of GBS cases in Martinique would be substantially lower than suggested by simple extrapolations from French Polynesia. We correctly predicted that 8 intensive-care beds and 7 ventilators would be sufficient to treat GBS cases. This study showcased the contribution of modeling to inform local health-care planning during an outbreak. Timely studies that estimate the proportion of infected persons that seek care are needed to improve the predictive power of such approaches

Comités d'Experts des Maladies Infectieuses & Émergentes aux Antilles françaises

National audienc

Incidence and clinical characteristics of ciguatera fish poisoning in Guadeloupe (French West Indies) between 2013 and 2016: a retrospective cases-series

International audienc

Revising rates of asymptomatic Zika virus infection based on sentinel surveillance data from French Overseas Territories

French Polynesia and the French Territories of the Americas (FTAs) have experienced outbreaks of Zika virus (ZIKV) infection. These territories used similar sentinel syndromic surveillance to follow the epidemics. However, the surveillance system only takes into account consulting patients diagnosed with ZIKV disease, while non-consulting cases, as well as asymptomatic cases, are not taken into account. In the French territories under study, the ratio of consulting to non-consulting patients was found to likely be as low as 1/3 to 1/4, and rough estimates of the ZIKV asymptomatic infections indicated a lower rate than previously reported (i.e., not more than half). Keywords: Zika virus, Sentinel surveillance, Asymptomatic infections, Pacific islands, Caribbean region, Vector-borne infection

Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study

International audienceBackground: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016.Methods: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS.Results: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease.Conclusions: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases

Nirsevimab effectiveness against cases of respiratory syncytial virus bronchiolitis hospitalised in paediatric intensive care units in France, September 2023 -January 2024

International audienceIn September 2023, France was one of the first countries that started a national immunization campaign with nirsevimab, a new monoclonal antibody against respiratory syncytial virus (RSV). Using data from a network of paediatric intensive care units (PICUs), we aimed to estimate nirsevimab effectiveness against severe cases of RSV bronchiolitis in France. We conducted a case-control study based on the test-negative design and included 288 infants reported by 20 PICUs. We estimated nirsevimab effectiveness at 75.9% (48.5-88.7) in the main analysis and 80.6% (61.6-90.3) and 80.4% (61.7-89.9) in two sensitivity analyses. These real-world estimates confirmed the efficacy observed in clinical studies

Short-term health impact assessment after Irma in French islands

ObjectiveDescribe short-term health effects of the Hurricane using the syndromic surveillance system based on emergency departments, general practitioners and dispensaries in Saint-Martin and Saint-Barthélemy islands from September 11, 2017 to October 29, 2017.IntroductionIn Saint-Martin (31 949 inhabitants) and Saint-Barthélemy (9 625 inhabitants) islands in the French West Indies, the surveillance system is based on several data sources: (1) a syndromic surveillance system based on two emergency departments (ED) of Saint-Barthélemy (HL de Bruyn) and Saint-Martin (CH Fleming) and on mortality (SurSaUD® network [1])); (2) a network of sentinel general practitioners (GP’s) based on the voluntary participation of 10 GPs in Saint-Martin and 5 in Saint-Barthélemy; (3) the notifiable diseases surveillance system (31 notifiable diseases to individual case-specific form); (4) the regional surveillance systems of leptospirosis and arboviruses based on the biological cases reported by physicians and laboratories of two islands.On September 6, 2017, Hurricane Irma struck Saint-Martin and Saint-Barthélemy islands. Both islands were massively destroyed. This storm led to major material damages, such as power outages, disturbance of drinking water systems, road closures, destruction of medical structures and evacuation or relocation of residents.In this context, the usual monitoring system did not work and life conditions were difficult. The regional unit of French National Public Health Agency set up an epidemiological surveillance by sending epidemiologists in the field in order to collect data directly from ED physicians, GP’s and in dispensaries. Those data allowed to describe short-term health effects and to detect potential disease outbreaks in the aftermath of Hurricane Irma. This paper presents results of the specific syndromic surveillance.MethodsBefore Irma, ED data were collected daily directly from patients’ computerized medical files that were filled in during medical consultations at ED. Among the collected variables, the diagnosis was categorized according to the 10th revision of the International Classification of Diseases (ICD-10). This surveillance system was completed by aggregated data of Emergency Medical Services (EMS), also including medical diagnosis coded using the ICD10.Because of the sudden disruption in hospital departments due to hurricane, electronic transmission was stopped. To replace it, ED data collection turned temporary into paper-forms and several epidemiologists were sent in Saint-Martin and Saint-Barthélemy to collect data directly from the ED physicians. This system remained until the end of October when connections and data transmission were restored.Because of destruction of medical structures, dispensaries were opened in different strategic areas of the island, 3 in Saint-Martin and none in Saint-Barthélemy. General practitioners have progressively reopened their practice (8 GP’s in Saint-Martin and 5 in Saint-Barthélemy) and patient's data were collected and integrated into the surveillance system.Based on a literature review and former experience, the main pathologies identified for the health risk assessment were: (1) somatic pathologies directly or indirectly related to the hurricane (trauma, wounds, cuts, burns, secondary infection); (2) infectious diseases related to the lack of hygiene partly due to damaged water and electricity networks and unavailable health care structures (gastroenteritis, food infections, respiratory diseases, skin infections, tetanus and other pathologies that may occur in the longer term linked to the incubation period especially leptospirosis and hepatitis A); (3) chronic pathologies by discontinuity of care (renal insufficiency, diabetic, cardio-respiratory decompensation, etc.); (4) pathologies related to animal bites and mosquito bites (vector-borne diseases); (5) psychological and / or psychiatry disorders.Then in the French West Indies, from September 11 to October 29,2017, data were routinely analyzed to detect and follow-up various expected or unusual variations of one or more pathology of the above list.ResultsThe following week after Irma (2017-37), the weekly number of ED visits compared to the mean activity observed in normal situation has increased: 1225 ED visits vs. 313 in 2017-35 in Saint-Martin and 227 ED visits vs. 94 ED visits in 2017-35 in Saint-Barthélemy. ED activity has gradually decreased to finally return to a based-activity as observed before the hurricane at the end of October.From September 11 to October 29, 25% of recorded emergency consultations in Saint-Martin island were trauma, wounds, burns and cuts. As in Saint-Martin, 42% of emergency visits in Saint-Barthélemy were pathologies directly or indirectly related to the passage of Irma (trauma, wounds, etc). Others major causes of ED visits were for treatment renewal (diabetes, renal insufficiency, etc.) and gyneco-obstetric activity because general practitioners had stopped their activity.In dispensaries and general practitioners, the most common pathology was gastroenteritis (11% in Saint-Martin) over the entire period of surveillance. At the beginning of the surveillance, skin infections were the most frequently found (20%) in Saint-Martin and psychological disorders (3%) in Saint-Bartélemy, while at the end respiratory infections were the most frequent (6%) in both islands.No increase in visits for chronic diseases, food-borne diseases, acute respiratory or diarrhea illness were detected. No autochthonous confirmed cases of cholera, leptospirosis, vector-bone disease, hepatitis A or typhoid fever had been reported, due to the destruction of the laboratory.ConclusionsSyndromic surveillance in the French West Indies allowed the epidemiologists to assess rapidly the health impact of hurricane in Saint-Martin and Saint-Barthélemy.The well-established relations between French National Public Health Agency and local professionals of both affected islands allowed to temporary switch from an electronic into a paper-based data transmission without any interruption of data analysis.Although several cluster suspicions have been investigated (especially of gastroenteritis, scabies, etc), no massive outbreak was detected. Then even with a degraded system, syndromic surveillance allowed to reinsure authority of the absence of major health impact due to Irma.References1-Caserio- Schönemann C, Bousquet V, Fouillet A, Henry V. Le système de surveillance syndromique SurSaUD ®. Bull Epidemiol Hebd 2014 ;3-4 :38-44.

Outbreak of Chikungunya in the French Caribbean Islands of Martinique and Guadeloupe: Findings from a Hospital-Based Surveillance System (2013–2015): OUTBREAK OF CHIKUNGUNYA IN THE FRENCH CARIBBEAN ISLANDS

International audienceChikungunya virus (CHIKV) emerged in the Caribbean island of Saint-Martin in December 2013. Weimplemented a hospital-based surveillance system to detect and describe CHIKV cases including severe forms of theinfection and deaths in the islands of Martinique and Guadeloupe. A case was defined as a patient with a CHIKV laboratoryconfirmation cared for in a public hospital for chikungunya for at least 24 hours, and a severe CHIKV case was defined as aCHIKV case presenting one or more organ failures. Sociodemographic, clinical, and laboratory data were collected andcases classified into severe or nonsevere based on medical records. From December 2013 to January 2015, a total of1,836 hospitalized cases were identified. Rate of hospital admissions for CHIKV infection was 60 per 10,000 suspectedclinical CHIKV cases and severity accounted for 12 per 10,000. A total of 74 deaths related to CHIKV infection occurred.Infants and elderly people were more frequently hospitalized compared with others and severity was more frequentlyreported in elderly subjects and subjects with underlying health condition. Fifteen neonatal infections consecutive tomother-to-child transmission were diagnosed, seven of which were severe. The most vulnerable groups of the population,such as the elderly, infants, individuals with comorbidities, and pregnant women, should remain the main targets of publichealth priorities

Zika emergence in the French Territories of America and description of first confirmed cases of Zika virus infection on Martinique, November 2015 to February 2016

International audienceFollowing of the emergence of Zika virus in Brazil in 2015, an epidemiological surveillance system was quickly implemented in the French overseas Territories of America (FTA) according to previous experience with dengue and chikungunya and has detected first cases of Zika. General practitioners and medical microbiologists were invited to report all clinically suspectedcases of Zika, laboratory investigations were systematically conducted (RT-PCR). On 18 December, the first autochthonous case of Zika virus infection was confirmed by RT-PCR on French Guiana and Martinique, indicating introduction of Zika virus inFTA. The viral circulation of Zika virus was then also confirmed on Guadeloupe and Saint-Martin. We report here early findings on 203 confirmed cases of Zika virus infection identified by RT-PCR or seroneutralisation on Martinique Island between 24 November 2015 and 20 January 2016. All cases were investigated. Common clinical signs were observed (maculopapularrash, arthralgia, fever, myalgia and conjunctival hyperaemia) among these patients, but the rash, the foundation of our case definition, may be absent in a significant proportion of patients (16%). These results are important for the implementation of a suspected case definition, the main tool for epidemiological surveillance, in territories that may be affected by ZIKV emergence, including Europe