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Côte d'Ivoire's status as a polio-free country requires high quality surveillance of acute flaccid paralysis. Our study aims to determine the prevalence of non-poliovirus enteroviruses found in the surveillance of Acute Flaccid Paralysis (AFP) in Côte d'Ivoire and to study their distribution according to individual characteristics and associated factors.We conducted an exhaustive descriptive and analytical cross-sectional retrospective study on 3597 cases of acute flaccid paralysis notified in the context of surveillance of AFP from 2007 to 2016 in Côte d'Ivoire.The mean annual rate of non-poliovirus enterovirus over the period was 11.3% over the study period with extremes of 9.2% and 15.9%. The absence of fever at the onset of illness and early age were factors associated with the occurrence of acute flaccid paralysis due to non-poliovirus enterovirus.Our study found a downward trend in non-poliovirus enteroviruses detected in AFP surveillance in Côte d'Ivoire, and identified the absence of fever and the age of the subject as being the factors associated with their occurrence. It is therefore necessary to type all cases of non-poliovirus enteroviruses detected in AFP surveillance to assess the risks of vaccine-derived polioviruses.

The global initiative for poliomyelitis eradication can only remain relevant if survey systems are regularly assessed. In order to identify shortcomings and to propose improvement, the data collection and transmission during case investigation were assessed in the Banfora health district in Burkina Faso.The survey targeted six (6) primary health centres, the district laboratory and the national laboratory, all involved in the poliomyelitis surveillance system. Data from registers, forms documenting suspected cases, stool sample forms and weekly reports were collected by means of a data grid. Data from actors involved in the poliomyelitis case investigation system were collected by means of an individual questionnaire.The reactivity of investigating suspected cases was satisfactory with a median alert questionnaire notification time of 18 hours. The completeness of the reporting system was satisfactory. Nevertheless, the promptness of data management by primary heath centres and the national laboratory remained unsatisfactory. Evaluation of data management revealed logistic and organization shortcomings.The overall efficacy of the poliomyelitis surveillance could be improved by using management tools for laboratory supplies, collecting data related to the homes of suspected cases and implementing a cold chain maintenance plan.

The mangrove area on the Guinea littoral constitutes a favourable habitat for transmission of Trypanosoma brucei gambiens, the parasite causing sleeping sickness also called Human African Trypanosmosis (HAT), due the simultaneous presence of the vector (tsetse flies) and the human hosts. In order to assess the influence of the sea tides on the densities of Glossina palpalis gambiensis (Gpg), major vector of HAT in the mangrove, entomological surveys were performed using two transects, according to tides coefficient (great and small) and tide daily fluctuations (high and low). On each transect, 12 biconical traps were deployed through the mangrove to the continent. In total, up to 612 Gpg were caught, giving a density of 2.13 flies/trap/day (f/t/d). Highest captures were recorded during small tides and more tsetse were caught during the dry season than in the wet season. There were significant differences between captures when considering the different biotopes, and highest tsetse densities were recorded at the junction of the river and the channel of the mangrove (6.17±5.24); and in the channels of mangrove (3.50±3.76), during high tides of small coefficients. The results of this study may be used to improve vector control methods.

Postdonation information is the knowledge of information about the donor or his donation, occurring after it, which challenges quality or safety of the blood products stemming from this or other donations. Classical hemovigilance sub-processes concerning donors or recipients adverse events do not cover this topic. France is just about to make it official as a fourth sub-process. Less formal management of postdonation information is already set up for more than ten years. French data of the year 2013 are presented, including the regional notification level and the national reporting one. A significant level of heterogeneity is observed as for other hemovigilance sub-processes. It is mainly due to subjective rather than objective differences in risk appreciation. A real consensual work is expected about it in the future.

Although notification of post-transfusion hemosiderosis is mandatory since 1994 among the French hemovigilance network, it is so far largely under reported.We screened 42,443 patients hospitalized for blood diseases in France in 2009 and 2010 and determined which patients had received more than 20 PRC. Among them, we selected those having at least one measure of serum ferritin, and subsequently those which ferritin was greater than or equal to 1000 ng/mL.Three thousand eight hundred and twelve patients (9%) received more than 20 PRC, 1935 (4.5%) had a ferritin assay, which was increased in 1216 patients (2.9%). Eight hundred and eighty-one patients underwent an hemovigilance report form. Forty-nine percent had low-risk myelodysplasia or acute leukemia, 7% hemoglobinopathies. Hemosiderosis was asymptomatic for 680 patients (77%), serious 188 (88%) and life-threatening for 11 (1%). Two patients died of terminal heart failure. The most severe hemosiderosis (≥ grade 2) were low-risk myelodysplasia and idiopathic aplastic anemia. Ninety-two percent of thalassemia patients and 46% of sickle cell anemia patients received an iron chelator. For low-risk myelodysplastic syndromes and idiopathic aplastic anemia, 228 of the 317 patients whose treatment is known and who could benefit from iron chelation (72%) have not received it.These results encourage seeking optimal transmission of information (over 20 CGR) to the clinician, and prolonging hemovigilance action towards a more comprehensive statement of post-transfusion hemochromatosis.

Dengue fever is the most widespread distributed vector borne viral disease. It is transmitted through the bites of Aedes aegypti and Aedes albopictus mosquitoes. With the expansion of Aedes albopictus and increasing travel exchange, it is no longer limited to the tropical zone and transmission has been documented in temperate areas. In mainland France, where Aedes albopictus has been present and disseminating since 2004, 2 episodes of autochthonous transmission occurred in 2010 and in 2013. Control measures against dengue and chikungunya, which shares the same vector, are implemented every year since 2006, in the areas where the vector is present. They aim at preventing or limiting local transmission of these diseases. They are based on epidemiological and entomological surveillance and vector control measures. The diagnosis of dengue, and chikungunya should be considered in case of suggestive symptoms in patients returning from an area of virus circulation. It should also be considered for patients living or having stayed in areas of mainland France where Aedes albopictus is present, during its activity period from May 1 to November 30. The prevention and control system, including vector control measures and the notification of cases to the local health authority should be known, as the risk of autochthonous transmission increases every year.

Burkina Faso is a sub-saharan African country completely included in the meningococcal meningitis belt. The western part of the country suffered from many meningococcal A epidemics, in spite of reactive collective campaigns with polysaccharide A vaccine. On 6th December 2010, Burkina Faso was the first African country to conduct a collective vaccination campaign of all the 1-29 years old population with a new conjugated meningococcal Avaccine (MenAfriVac™). Before this campaign, in Western Burkina (4,064,928 inhabitants, 27.5% of total population), a rehearsal of the staff of all peripheral medical laboratories has been conducted, with delivery of laboratory equipment, reactants, and possibility to transfer CSF specimens at the central level to confirm bacteriologic species in cause by latex, culture and PCR analysis. For this campaign, an administrative coverage of 100.3% was reached. A nearly complete disappearance of meningitis due to meningococcus A was recorded, but an increase of cases due to meningococcus X, W135. With the increase of quality of surveillance, and MenAfriVac™ vaccination showed its beneficial effect on meningococcus A meningitis. If we want however to impact on the number of recorded acute bacteriological meningitis, we will have to use multi-antigenic, if possible conjugated, meningococcal vaccines against locally circulating meningococcal species, the number of pneumococcal meningitis being contained by the recent inclusion in EPI of a 13-valent conjugated pneumococcal vaccine.

In Senegal, where HIV prevalence is less than 1% and stigma remains important, 40% of marriages are polygamic. The purpose of this article is to describe and analyze the motivations, benefits and constraints related to HIV disclosure, and to explore specific situations related to polygamy. Data were collected through qualitative research based on in-depth repeated interviews on the experience of antiretroviral therapy and its social effects, conducted over a period of 10 years with people on antiretroviral treatment and their caregivers. Health professionals encourage people to disclose their HIV status, especially in certain circumstances such as preventing mother-to-child transmission of HIV. Nevertheless they are aware of the social risks for some patients, particularly women. Some health workers insist on disclosure, while others do not interfere with women who do not disclose to their partner, while highlighting their ethical dilemma. Interviews trace the changing attitudes of caregivers regarding disclosure. The majority of married women begin by sharing their HIV status with their mother, waiting for her to confirm that the contamination is not due to immoral behavior and to participate in implementing a strategy to maintain secrecy. In polygamous households, women try to disclose to their partner, keeping the secret beyond the couple. Some women fear disclosure by their husbands to co-spouses, whose attitudes can be very diverse: some stories relate collective rejection from the household; sometimes disclosure is made in a progressive way following the hierarchy of positions of each person in the household; another person reported the solidarity shown by her co-spouses who kept her HIV status a secret outside the household. The article shows the diversity of situations and their dynamics regarding both disclosure practices and their social effects.

Since its creation in 1993, hemovigilance has an important place for blood safety. The part concerning donors, as the name suggests, targeted on improvement of donor's safety covers in fact the two points of the transfusion chain with serious adverse events in donor, epidemiologic survey for recipients and post-donation information on the two sides. Organized management and close collaboration between the actors of the transfusion chain are necessary to ensure the effectiveness of the system.

Burkina Faso achieved the leprosy elimination as a public health problem but this benefit was being lost. So, the National Program for Fighting against Leprosy has defined a strategy to reverse this situation. The aim of this survey was to evaluate the performance of the national program in the execution of this strategy in the region of "Hauts Bassins" (Burkina Faso) from 2005 to 2009.The survey was led through the five sanitary districts of the region. It consisted in interview with the mean actors of leprosy control program and the analysis of the data notified on the leprosy cases, in order to estimate the progression of the key indicators of detection and follow-up care for patients having leprosy.During the survey period, 248 cases of leprosy were recorded including 236 new cases and 12 relapses. The prevalence of leprosy was 0.28 per 100 000 inhabitants in 2009. The detection rate decreased from 3.77 per 100 000 in 2005 to 2.75 per 100 000 in 2009. Among the 236 new cases of leprosy, 194 (82.2 %) were multibacillary form (MB). MB patients proportion increased from 69,3 % in 2005 to 91.1 % in 2009. The proportion of children was on average 3.8 %, the one of female cases 38.9 %. Newly diagnosed cases with grade 2 disabilities moved up from 21.4 % in 2005 to 42.2 % in 2009. The completion of cure rate was globally 88.26 %. The losts from follow-up among the patients who started multi-drug therapy were 7.14 %.The aim of the leprosy elimination as a public health problem is achieved but some challenges may be taken up, particularly in the organization of leprosy detection by the heath structures.

This article presents recent data and trends on the epidemiology, clinical presentation and microbiology of tuberculosis in France during 2010.In 2009, a total of 5759 cases were notified in France, representing a rate of 8.2 cases per 100,000. The notification rate was below 10 per 100,000 in all French regions, except in Île-de-France and French Guyana. Notification rates were higher in some population groups such as people born abroad, especially those born in Sub-Saharan Africa, and those recently arrived in France, as well as in homeless people. Pulmonary tuberculosis accounted for 72% of notified cases, 49% of which were contagious (positive direct examination of sputum, positive culture). PERSPECTIVES-CONCLUSIONS: Except in 2007 and 2008 the incidence of tuberculosis (TB) has fallen consistently in France for the last 20 years and this was again the case in 2009. These results support the maintenance of a vigilant approach to the control of the disease and call for the enhancement of public health activities in population groups at higher risk of the disease.

In France, one of the main components of the tuberculosis control program is contact investigation around all tuberculosis cases. For this purpose, all cases of tuberculosis are to be reported to the health authorities (Centre de lutte antituberculeuse) within 48 hours of diagnosis. The Centre then conducts an initial patient interview within three days of the report in order to establish a list of contacts requiring evaluation. Given that a delay in action may play a role in the continued disease transmission, it appeared necessary to study more precisely this subject in a French area with a high annual new case rate, the Seine-Saint-Denis.A descriptive and retrospective study included all tuberculosis cases reported and received between April and June 2008. The two periods were statistically analyzed with socio-demographic, clinical-biological and investigations data.For the 148 cases reported during this period, a first interview was required for 123. The average time period between initiation of anti-tuberculosis therapy and reception of the report was 11.08 days. The overly long delay could be explained in part by the inappropriate use of the notification form (45.5%) designed for non-urgent collection of epidemiological data, and in part by the underuse of telephone reporting (8.1%). The first interview was not performed for 19 cases and the average time between reception of the notification and the patient interview was 6.58 days. Having the patient's phone number appeared essential to meet the deadline (odds ratio: 5.3; 95% confidence interval [1.7-16.9]). Few interviews were made in person. Shortage in financial and human resources and the delayed case reporting could be part of the explanations. Deadlines were met much better for cases of pleuro-pulmonary tuberculosis compared with other localizations, for reporting (39.2% versus 13.5%, p0.01) and for the first interview (48.8% versus 28.6%, p=0.03).This study reports some risk factors associated with delayed action and highlights the need for improved reporting of tuberculosis cases and contact investigations.

Transfusion transmitted bacterial infection is an adverse reaction occurring in a patient during blood transfusion and due to the presence of bacteria in the blood component. For each transfusion transmitted bacterial infection suspicion, clinical and biological investigations should allow to either affirm the accountability of the transfused product in the occurrence of the infection (accountability score 4) or exclude it (accountability score 0). However, among 60,175 adverse reaction sheets extracted from the French e-FIT database (AFSSAPS), 143 are classified as transfusion transmitted bacterial infection diagnosis and 97 of them show a score of accountability 2 (possible). This study aims to analyze these 97 adverse reaction sheets and search for the reasons that led the haemovigilance network actors not to refine the degree of accountability in line with an exclusion or a confirmation of transfusion origin.During collective reading sessions, each adverse reaction sheet among the 97 extracted was re-analyzed with an accountability criteria grid, built beforehand, and proposed in the technical guide sheet for transfusion transmitted bacterial infection (e-Fit AFSSAPS).Among the 97 analyzed adverse reaction sheets with a score accountability of 2: 12.4 % were considered as "non-analysable"; 54% were reclassified in another diagnosis category: non haemolytic febrile reaction (n=12), unknown diagnosis (n=17); patient infection before transfusion (n=23); blood component's "smear" (n=9); retrograde contamination of blood component (n=5). Finally, only 18.5% adverse reaction sheets (n=18) were maintained with a true diagnosis of transfusion transmitted bacterial infection an accountability score of 2. These cases were in agreement with those described in number 2, 3 or 4 in the annex sheet "Fiche Technique TTBI". 70% of adverse reaction sheets reclassified under another diagnosis as transfusion transmitted bacterial infection had been declared between 2000 and 2004. In order to improve transfusion transmitted bacterial infection suspicions diagnosis approach and to guide the French haemovigilance network in the investigations following a transfusion transmitted bacterial infection suspicion, the group propose recommendations after each adverse reaction sheets category analysis.The improvement measures taken as part of the French haemovigilance declaration framework allowed to perfect the data quality of transfusion transmitted bacterial infection. Progresses are still to be made to improve clinical and biological declaration, in order to precise the accountability of a blood component in the occurrence of an adverse transfusion transmitted bacterial infection effect. Tracking transfusion transmitted bacterial infection notifications by a group of experts at the national level is still recommended.

Non-tuberculous mycobacteria (NTM) infections usually occur in immunocompromised patients but also in immunocompetent patients following invasive procedures, especially for esthetic purposes. Since 2001, 20 episodes (57 cases) of NTM infections, seven of which (43 cases) were related to esthetic care, have been reported to the regional infection control coordinating centers (RICCC), the local health authorities (LHA), and the national institute for public health surveillance. Four notifications (40 cases) were related to non-surgical procedures performed by general practitioners in private settings: mesotherapy, carboxytherapy, and sclerosis of microvaricosities. The three other notifications (three cases) concerned surgical procedures-lifting and mammary prosthesis. Practice evaluations performed by the RICCC and LHA for five notifications showed deficiency of standard hygiene precautions and tap water misuse for injection equipment cleaning, or skin disinfection. Microbiological investigations (national reference center for mycobacteria) demonstrated the similarity of patient and environmental strains: in one episode (16 cases after mesotherapy), M. chelonae isolated from tap water was similar to those isolated from 11 cases. Healthcare-associated NTM infections are rare but have a potentially severe outcome. These cases stress the need of healthcare-associated infection notifications in outpatient settings.

International audience; Meningococcal meningitis remains a periodical threat in the African meningitis belt. The countries concerned, such as Burkina Faso, provided guidelines for its surveillance, diagnosis, treatment, and prevention during outbreaks. The objective of this study is to assess the quality of the surveillance system and case management during an outbreak in Fada N'Gourma district. A retrospective study of the meningitis outbreak in 2007 was conducted by literature review and interviews of health caretakers across 27 health centers (CSPS) and three units in the regional hospital in the district.We reported all data available about surveillance and case management, and then we compared it with the guidelines of the Ministry of Health. The case definition and notification forms were available in all centers and units. During the outbreak, 861 cases were recorded, but only 89% was notified at the upper level and 87% of notification forms were available. The age is marked on all the forms, while the interval between the onset of symptoms and consultation is noted only in 90.7%. The forms were distributed weekly at the district level. Cerebrospinal fluid (CSF) Gram coloration was performed for a limited number of cases (150/349 samples, 42.9%); it showed Gram-negative diplococcus in 86%. Culture was performed for a limited number of patients (7 cases). According to the results of a central level laboratory study, the outbreak was due to Group A Neisseria meningitidis. The case management guidelines were available in all the centers and units which were supervised during the outbreak. Anti-biotherapy was appropriate in 93.6% of the cases. A shortage of antibiotics (free prepositioning) was observed in 7 centers (23.3%). The mortality rate was 3.5%. This assessment shows an under-notification of cases, despite the existence of a surveillance system and supervision, a weak laboratory contribution in germ identification, appropriate case management, and shortage of antibiotics during the outbreak. Management of a meningitis outbreak may become more efficient by improving the notification, the laboratory's capabilities, and the availability of drugs.

A number of international databases are well-known and useful tools for professionals in blood transfusion. The advent of national hemovigilance registries and an international focus on transfusion practice and transfusion safety has led individuals and organisations to collect and compare data. This has led to the development of internationally useful indicators, for instance figures for the numbers of red cell products transfused per 1000 in the population. An international database of hemovigilance data (surveillance database for transfusion associated adverse reactions and events [STARE]) is currently being developed by the International Hemovigilance Network. In the pilot phase, it is seen that differences exist between the rates of adverse reactions and events. Factors such as the working method and definitions in use in the countries must be taken into account and efforts made to increase uniformity of the data. The remaining variability might then generate hypotheses of areas or types of increased risk, which would need to be further investigated in specific projects.

One of the objectives of the surveillance systems implemented by the French National Institute for Public Health Surveillance is to detect communicable diseases and to reduce their impact. For emerging infections, the detection and risk analysis pose specific challenges due to lack of documented criteria for the event. The surveillance systems detect a variety of events, or "signals" which represent a potential risk, such as a novel germ, a pathogen which may disseminate in a non-endemic area, or an abnormal number of cases for a well-known disease. These signals are first verified and analyzed, then classified as: potential public health threat, event to follow-up, or absence of threat. Through various examples, we illustrate the method and criteria which are used to analyze and classify these events considered to be emerging. The examples highlight the importance of host characteristics and exposure in groups at particular risk, such as professionals in veterinarian services, health care workers, travelers, immunodepressed patients, etc. The described method should allow us to identify future needs in terms of surveillance and to improve timeliness, quality of expertise, and feedback information regarding the public health risk posed by events which are insufficiently documented.

The vector for dengue fever and chikungunya, Aedes albopictus, was recently identified in Southeastern France, although the usual vector for dengue fever is Aedes aegypti, raising the possibility of cases occurring among the local population via viraemic individuals returning from endemic areas. Dengue fever is usually transmitted by Aedes aegypti. It is due to an arbovirus-flavivirus of which four different serotypes are known: Den 1 to 4. Each serotype is responsible for specific prolonged immunity but no cross-reactivity exists between serotypes. Clinically, the onset is abrupt with frontal headache, retro-orbital pain, myalgia, joint pain, prostration and, in many cases, a macular rash usually sparing the face and extremities. Haemorrhagic signs may occur, such as petechiae, purpura, epistaxis or bleeding gingivae. Two severe forms of dengue fever, particularly among children below 3 years of age, include dengue haemorrhagic fever (DHF) and DHF with shock (dengue shock syndrome). If a case is suspected in metropolitan France, the diagnosis should be systematically confirmed by positive specific IgM, RT-PCR or viral isolation. Treatment of dengue fever, whether in its uncomplicated form or with hemorrhagic manifestations or shock, remains symptomatic. There is no specific anti-viral treatment. A case should be notified to allow French health authorities to take the appropriate measures for vector control.

Listeria monocytogenes is a bacterium widely spread in the environment. Its persistence in industrial environment leads to food product contamination from the raw materials and constitutes a recurrent problem in food processing industry despite the use of cold chain procedures. L. monocytogenes is a foodborne pathogen causing severe and life-threatening infections that evolve mainly under sporadic mode, even if epidemics sometimes occur. Listeriosis causes mainly septicemia, central nervous system infections (meningitis and meningoencephalitis) and abortions. Listeriosis occurs primarily at risk groups of population like elderly people, pregnant women, neonates and patients with underlying diseases or impaired cellular immunity. In France, the epidemiological surveillance of listeriosis is based on two complementary approaches: the mandatory notification and the microbiological characterization by the National Reference Centre for Listeria of L. monocytogenes strains isolated from patients. The joined efforts of government and food producers have led to decrease significantly the incidence of listeriosis in France since 20 years and the number of epidemics. However, the recent observation of increasing number of listeriosis cases in most of the industrialised countries calls up to the attentiveness to reconsider the current rules and to reinforce the epidemiological surveillance of listeriosis in a context where susceptible people including the elderly are in increasing number.

Nosocomial infections have long been neglected in Sub-Saharan Africa, even though their prevalence is higher than in developed countries. Recently, however, this major public health problem has been the focus of a growing number of recommendations not only from the World Health Organization but also from some national health ministries. Because of the numerous limitations especially in financial resources in these regions, priority must be given to the implementation of simple and cost-effective measures. Accordingly the greatest efforts must be devoted to educating healthcare workers and patients about the importance of handwashing, eliminating unnecessary injections and transfusions, performing the latter acts in aseptic conditions, isolating patients with communicable diseases, handling waste products safely, and using antimicrobials properly. Amid the daunting health issues facing Sub-Saharan Africa, implementing these inexpensive measures that could save the lives of thousands of patients and healthcare workers appears easy. However it will require a cultural revolution. The keys to success will be changing the organizational culture, developing a commitment to prevention and evaluating performance regularly.

Surveillance of invasive meningococcal diseases (IMD) is based on mandatory reporting. Evaluation of the exhaustivity of the surveillance with capture-recapture analysis can correct for underreporting.To evaluate IMD incidence in children in Northern France from 2 databases and to determine the usefulness of the regional hospital reporting database for correcting mandatory reported data.Regional study of IMD incidence in children under 18 years of age, between the years 2002 and 2005, by a secondary analysis of 2 databases: the regional hospital reporting database administered by the Department of Medical Information (DIM) and the mandatory reporting health authorities database (DDASS). The corrected incidence of IMD was determined using a capture-recapture method.Three hundred and eleven cases of IMD were reported in at least 1 database. Of the 233 patients identified in the DIM database, 23 were not reported in the DDASS database, but 78 retrieved in the DDASS database were missed by the DIM. Database exhaustivity varied between years from 70 to 75% for the DIM and from 83 to 99% for the DDASS database. The corrected incidence of IMD varied from 6.9 to 9.4/100,000 children between 2002 and 2005. IMD incidence of children less than 1 year of age reached 44.5/100,000 in 2005. IMD attributable to serogroup B were predominant (56%).In this study, the DIM database provided a useful independent correction of mandatory reporting, although it remained insufficient. A high IMD incidence in children was identified in Northern France, especially in children less than 1 year of age.

An active case search for neonatal tetanus (NNT) was conducted in October 2005 in the Kayes region of Mali, in 35 health care facilities that had reported no cases to public health authorities between May and September 2005. Review of records and interviews with health care staff identified four physician-diagnosed clinical cases of NNT. This finding indicates that under-reporting of NNT occurs not only because cases are not seen by trained health care providers, but also because these professionals fail to report diagnosed cases.

Biovigilance is defined as the surveillance of therapeutic use in man of organs, tissues and cells. Four years after the implementation of the French biovigilance system, a first analysis of data collected has been performed by Afssaps. Quantitatively, with the exception of 2004, the first year of implementation, the average number of annual notifications reaches 166. Taking into account the total number of human applications, it has to be noted that events and adverse reactions notified and involving tissues are rather low compared to those involving organs and cells. From a qualitative point of view, this analysis allows to identify different categories of events and adverse reactions with the corresponding number of notifications for each of them. This descriptive analysis should constitute for the French National Commission of Biovigilance the starting point of a reflection aiming at improving both exhaustiveness and quality of notifications in order to facilitate further analysis of data collected. This improvement should aim first at identifying more precisely the categories of events and adverse reactions to be notified or not in biovigilance. It should also allow updating the notification form. Before completion of his first three-year mandate, the National Commission of Biovigilance should be able to set up all the necessary tools of the biovigilance network and to make them available and understandable by all the stakeholders.

This article presents results on cases of tuberculosis disease notified in France in 2005 by mandatory notification. In 2005, a total of 5,374 cases were notified in France, representing a rate of 8.9 cases per 100,000. The notification rate per 100,000 was below 10 in all French regions, except the Ile-de-France and French Guyana (with respective rates of 19.7/10(5) and 44.0/10(5)). Notification rates were higher in some population groups such as people born abroad (41.5/10(5)), especially those born in sub-Saharan Africa (160/10(5)), and those recently (2 years) arrived in France (251/10(5)), in homeless people (214/10(5)), and in persons aged 80 years and over (21.7/10(5)). Pulmonary tuberculosis accounted for 73% of notified cases, 79% of which were contagious (positive direct examination of sputum, positive culture). Results from the notification of tuberculosis disease in 2005 indicate a continuing decrease of incidence in France. However, the high incidence in some population groups requires adapting public health actions to the needs of population groups more exposed to tuberculosis.

The National Notifiable Diseases Working Group performed a ranking of 48 communicable diseases to assist with determining priorities for national surveillance. The WG offers six specific recommendations relating to the addition or deletion of communicable diseases from the list of nationally notifiable diseases.1. Clostridium difficile-associated diarrhea, paralytic shellfish poisoning, and invasive listeriosis are recommended for addition to the Nationally Notifiable Disease List. 2. New proposals for diseases not recommended for national notification include hepatitis E, HTLV-1, and HTLV-2. 3. Dengue virus infection should be deleted from the Nationally Notifiable Disease List. (Dengue hemorrhagic fever should continue to be reported.) 4. Classic Creutzfeld-Jacob disease ranked well below the threshold for inclusion; however, it should be retained on the list because surveillance of classic CJD is key to effective surveillance of new variant disease and because consulted provinces and territories strongly favoured its retention. 5. Several diseases that ranked near the borderline for reporting should be retained on the list as follows: a. a. brucellosis, because although it does not rank highly on the basis of its endemic pattern it is a category B biological warfare agent; b. laboratory-confirmed influenza because it forms part of a functional and working surveillance approach; c group B streptococcal infection because alternative hospital-based surveillance systems do not yet capture a significant proportion fo cases. 6. Transfusion-transmitted infections were unrankable by the current system. 7. The approach to reporting dengue hemorrhagic fever, plague, West Nile virus infections, and other viral hemorrhagic fevers should be made congruent with the approach for other notifiable diseases (see Discussion). 8. The feasibility and utility of national reporting for communicable diseases that have very high incidence and low severity (e.g. chickenpox, norovirus) should be carefully considered, especially when it leads to little or no case-by-case data reported by health authorities. The WG recommends that these diseases be placed under surveillance but that case-by-case reporting not be required at the national level. Alternative approaches to tracking trends could include enumerating outbreaks in the case of norovirus or the use of sentinel surveillance, laboratory surveillance, or physician billing events in the case of varicella.

Since 1987, in France, Legionella infection is a notifiable disease. Notification should be transmitted by the clinician to the referent public health physician in the Direction départementale des Affaires sanitaires et sociales. Criteria for certain and probable cases have been defined. From this level, nationwide information is centralised in the institut de veille sanitaire. The public health physician is responsible for the inquiry in the health care facility or community setting and for action taking as appropriate. After isolation, Legionella strains are further studied in the Centre national de référence in Lyon. This center is also responsible for typing of environmental strains. In 2002, the incidence of notified legionellosis was 1,7 per 100,000 inhabitants and the mortality rate of 13%. Median age was 61 years and the sex-ratio M/F of 2.9. Only 39 cases were nosocomial. Very few cases have been observed in children, almost all in immunocompromised patients. Legionellosis is of exceptional occurrence in neonates, but the lethality is high. Treatment guidelines have been published in France only for adult patients.

A measles outbreak occurred in Geneva between March and July 2003. An investigation was conducted to determine its magnitude, identify predominant modes of transmission, and assess disease outcome.In Switzerland, measles notification has been mandatory for physicians since 1999 and laboratories since 1988. All cases were investigated and followed up by interviewing physicians using a standardized questionnaire. Viral genotype was determined for 4 cases using a saliva specimen processed at the Robert Koch Institute, Berlin. Geographic distribution of cases and vaccination coverage were compared.Overall, 54 cases were notified. Fifty-three cases were between 10 and 19 years of age. Ninety-four percent (n = 46) of 49 cases with known vaccination status were not vaccinated and none were fully immunized (2 doses). Measles complications occurred among 19% (n = 7) of the 36 patients with follow up information: pneumonia (n = 4, combined with pericarditis and hepatitis in one case) and bronchitis (n = 3). Three persons were hospitalized. No complication was reported among 3 persons partially vaccinated (1 dose). The virus belonged to genotypes D8 and D5. Five separate clusters of related cases included 74% of all cases. Transmission mainly occurred within families (43% of all cases) and school (28%). Two of the most affected areas had measles vaccination coverage well below the cantonal average.Low vaccination coverage combined with clusters of unvaccinated household contributed to continued virus circulation and represents a threat to the canton of Geneva as new outbreaks of measles may reoccur.

An epidemiological investigation (Ministry of Health/Institut Pasteur de Madagascar (IPM)) was conducted in July 2002, in two districts of a same province (Fianarantsoa: Fianarantsoa II and Ikongo) considering the high frequency of deaths linked with acute respiratory infection (ARI). Morbidity and mortality data was collected in the Centre de Santé de Base (CSB) which gave the alert (village of Sahafata, district Fianarantsoa II). Analysis of monthly activity reports (MAR) allowed calculation of incidence rates of ARI/pneumonia in Fianarantsoa province. Virological data was based on the analysis of nasopharyngeal samples collected during the investigations. Clinical symptoms and homogeneity of laboratory results are consistent with an origin of these epidemics being related to the circulation of an influenza virus A subtype H3N2. Attack rates were very high. CFR was significantly higher in individuals of less than 1 year and more than 65 years. This data was confirmed by posterior investigations of teams from MoH/WHO. Surprisingly, this large epidemic was due to a known influenza virus that previously circulated in countries of northern hemisphere (the year before) and even in Antananarivo weeks before. Different hypothesis could be proposed to explain such phenomenon: great restriction of exchanges between different geographical zones, nutritional status....The epidemic episodes of acute respiratory infections in Madagascar in July 2002 were due to an influenza virus A subtype H3N2 without any genotypic or phenotypic features. Various factors, could explain the importance of the epidemic and particular high lethality found in some age groups. This epidemic illustrates the relative incapacity for a developing country, to face and manage a flu epidemic caused by a classical influenza virus.

The objectives of the investigation are double. Not only must the sick patients be identified and treated to stop the transmission chain since they could be sources of infection, but recently infected patients must also be identified and offered treatment for tuberculosis-infection if necessary. The goal of this step is to prevent their infection from evolving rapidly to tuberculosis-disease. Moreover, in a community, it is necessary to evaluate the risk of transmission and to identify the possible factors favoring this transmission in order to set up preventive measures. When a case of tuberculosis-disease or infection is diagnosed, the risk of BK transmission and individual risk factors of the people living close to the detected patient must be assessed. When a case of recent tuberculosis-infection is diagnosed the source patient must be looked for.

The traveler faces two types of specific risks for tuberculosis: that of a possible contagion through the unexpected contact with an infected person during a commercial flight (the available studies dealing mostly with cases of transmission during flights, the chapter will deal mainly with this question) and that of a possible contamination during a stay in a country with strong prevalence of TB. The ventilation in airliners is designed to limit movements of air to the front or the back of the aircraft. Moreover, studies have shown that the transmission of M. tuberculosis from passenger to passenger was observed only within the same cabin. Consequently, it is usually admitted that only passengers sitting next to the patient (3 rows ahead and behind, and 3 seats on the right and on the left of the infected passenger, depending on the aircraft's seat set-up) as well as the members of crew working in this same cabin must be warned of the potential risk a posteriori. The recommendations which follow are to be considered all the more carefully that the duration of stay is long, that the country or the geographical area is more at the risk (for example urban environment in a highly endemic zone), that the traveler is more fragile (infants and elderly people, immunodepression, etc.) and that activities during the stay will be more at risk.

The current importance of animal diseases, and their emergence or re-emergence, show that surveillance is crucial for defining suitable control measures. Surveillance systems rely on networks of different people, whose activities include collecting, transmitting, analysing and disseminating disease information. These activities can be distributed among both the public and private sectors. However, nowadays it is essential to clearly define the different roles of the public and private sectors. In Africa, where budget cuts for state Veterinary Services over a number of years have promoted the growth of private veterinary medicine, the tasks of public officials (veterinarians, technicians, etc.) and private sector workers (veterinarians, livestock farmers) must be clearly determined and harmonised. This article presents and comments upon a number of different experiments that various sub-Saharan African countries have conducted in this field.

L'importance actuelle des maladies animales, leur émergence ou réémergence montrent que la surveillance est indispensable pour que soient définies des mesures de lutte adaptées. Les systèmes de surveillance s'appuient sur différents types d'acteurs organisés en réseau et qui ont pour activités de collecter, transmettre, analyser et diffuser les informations sanitaires. Ces activités peuvent être réparties entre les acteurs du secteur public et ceux du secteur privé. Cependant, la spécification des mandats et attributions de chacun est aujourd'hui essentielle. Ainsi, en Afrique, où la réduction des budgets consacrés aux Services vétérinaires de l'État a suscité depuis quelques années le développement de la médecine vétérinaire privée, les positionnements et rôles des agents de l'État (vétérinaires, techniciens, etc.) par rapport aux acteurs du secteur privé (vétérinaires, éleveurs) demandent à être précisément définis et harmonisés. Diverses expériences dans ce domaine, menées par divers pays d'Afrique subsaharienne, sont ici présentées et commentées.

Since July 26, 2001, the external reporting to the regional office of health and social affairs (Direction départementale des affaires sanitaires et sociales--Ddass) and the coordination centre (Comité de lutte contre les infections nosocomiales--Cclin) for the fight against nosocomial infections (NI) is mandatory. However, the modalities of internal reporting to the Clin are unknown.We performed a retrospective analysis of 108 cases of NI reported over 23 months in 4 medical-surgical departments (MSD) with 14 to 35 NI reported/MSD. The distribution of the bacteria responsible was compared with that of the local epidemiological state (chi2 test). A correlation analysis was performed between the number of NI reported in each MSD and the structural characteristics and activity index of these MSD (Spearmann's correlation test).The NI were predominantly infections related to a catheter (43), lower respiratory tract (25) and infection of the site of surgery (19). Ninety were documented biologically, among which 10 implied multi-resistant bacteria. Ninety-four NI were associated with the prescription of an antibiotic. Compared with the local epidemiological state, the NI reported generally implied multi-resistant bacteria (p=0.009). The other microbiological data had little implication. In each of the MSD, the number of cases reported was independent of: the global activity, the number of interventions, the mean duration of hospitalisation, the number of beds, the number of clinicians, the number of new patients managed and the chemotherapy outpatient activity. Conversely, there was a strong correlation between the global consumption of antibiotics (r=0.78), and the number of the Clin members in each MSD DMC (r=0.82).In each MSD, the internal reporting of NI relies on the discovery of multi-resistant bacteria, but above all on the implication of those involved in the fight against nosocomial infections.