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PurposeThe border between the State of Amapa, Brazil, and French Guiana is mostly primary forest. In the Oyapock basin, socioeconomic circumstances have fueled sex work, gold mining and the circulation of sexually transmitted infections. Given the lack of comprehensive data on this border area, we describe the different sexually transmitted infections along the Brazil/French Guiana border and the testing and care activity.MethodsWe conducted a review of the available scientific and technical literature on sexually transmitted infections in this complex border area. Temporal trends were graphed and for Human Immunodeficiency Virus (HIV) we estimated incidence using the European Center for prevention and Disease Control modeling tool.ResultsUntil 2019, 26 of the 46 HIV-infected patients followed and treated in Saint Georges de l'Oyapock were residing on the Brazilian side in Oiapoque. Virological suppression was only achieved for 75% of treated patients; but dropped to 62% during the COVID-19 epidemic. In 2019, cooperation efforts allowed HIV care in Oiapoque, resulting in the transfer of Brazilian patients previously followed on the French side and a substantial increase in the number of patients followed in Oiapoque. The average yearly HIV serological testing activity at the health center in Saint Georges was 16 tests per 100 inhabitants per year; in Camopi it was 12.2 per 100 inhabitants. Modeling estimated the number of persons living with HIV around 170 persons, corresponding to a prevalence of 0.54% and about 40 undiagnosed infections. The model also suggested that there were about 12 new infections per year in Saint Georges and Oiapoque, representing an HIV incidence rate of 3.8 cases per 10,000 per year. HPV prevalence in Saint Georges ranges between 25 and 30% and between 35 and 40% in Camopi. Testing activity for other sexually transmitted infections markedly increased in the past 5 years; the introduction of PCR for chlamydiasis and gonorrhea also had a substantial impact on the number of diagnoses.ConclusionsThe ongoing cooperation between multiple partners on both sides of the border has led to remarkable progress in primary prevention, in testing efforts, in treatment and retention on both sides of the border. In a region with intense health professional turnover, nurturing cooperation and providing accurate assessments of the burden of sexually transmitted infections is essential to tackle a problem that is shared on both sides of the border.

Additional file 4: Details of scores calculation

Additional file 5: KAP before (N=420) and after (N=381) Malakit intervention (%)

Additional file 3: Post-survey questionnaire

Additional file 2: Participants training tools

Additional file 1: Information, education and communication tools and content

Additional file 7: Sensitivity analysis

OBJECTIVE: We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. STUDY DESIGN: A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. RESULTS: Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30 kg/m(2) (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. CONCLUSION: Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

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Aim: This study aims to identify the epidemiological and social characteristics of the diabetic population in French Guiana. Background: The prevalence of diabetes is very high in the French overseas departments. French Guiana is, however, a very atypical territory, closer in the epidemiological field to Latin America than European and French standards. Objective: To perform a descriptive analysis of variables related to renouncing medical care, social parameters, and use of healthcare services Methods: A two-stage random sample of 1390 individuals aged 30 to 75 years was surveyed by telephone, and screening was initially done for diabetic versus non-diabetic individuals. Logistic regression was fitted on the sample to adjust for potential confounding factors. A Kaplan-Meier analysis showed the risk of diabetes as a function of the age of onset. Results: The prevalence rate of diabetes was 9.3%, particularly among women, for whom 20% had a history of gestational diabetes. Excess weight and obesity were found in 60% of people with diabetes. The diabetic individuals in French Guiana were younger than those in mainland France, and 30% of people with diabetes were on insulin. They often reported sleep problems, and their health status was described as poor. People with diabetes did not regularly consult a doctor and were very rarely followed up by a specialist. Conclusions: The prevalence rate of diabetes and obesity in French Guiana was one of the highest among the French territories, with specific vulnerabilities requiring to be addressed by local health policies.

Additional file 1. supplementary data on the methods and outcomes of the secondary objectives of the study.

Additional file 1. Contextual differences between countries involves in the Malakit project. The malaria and gold mining context of French Guiana, Suriname and Brazil are described here.

Additional file 10. Training posters. The drawings used by the facilitators to train the Malakit participants.

Additional file 6. Malakit training course. Content of the training.

Additional file 7. Tools and contents for facilitator training. The different tools and their content used to train the facilitators in their tasks.

Additional file 5. Treatment pocket of the malakit. Picture of the Treatment pocket heads (illustrated instructions) and tails.

Additional file 4. RDT pocket of the malakit. Picture of the RDT pocket heads (illustrated instructions) and tails.

Centre Hospitalier de Cayenne. Centre d Investigation Clinique Antilles. Guyane, Cayenne. Centre Hospitalier de Cayenne. Centre d Investigation Clinique Antilles. Guyane, Cayenne. Asociaci?n de Salud Integral. Cl?nica Familiar "Luis Angel Garc?a". Guatemala. Asociaci?n de Salud Integral. Cl?nica Familiar "Luis Angel Garc?a". Guatemala. Asociaci?n de Salud Integral. Cl?nica Familiar "Luis Angel Garc?a". Guatemala. Universidad Rosario. School of Medicine and Health Sciences. Bogot? and Corporacion para Investigationnes Biologicas. Bogot?, Colombia. Universidad Rosario. School of Medicine and Health Sciences. Bogot? and Corporacion para Investigationnes Biologicas. Bogot?, Colombia Universidad Rosario. School of Medicine and Health Sciences. Bogot? and Corporacion para Investigationnes Biologicas. Bogot?, Colombia. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Funda??o Oswaldo Cruz. Instituto de Pesquisa Cl?nica Evandro Chagas. Laborat?rio de Micologia. Rio de Janeiro, RJ, Brazil. Federal University of Cear?. Fortaleza, CE, Brazil. Laborat?rio Central de Sa?de P?blica do Amap?. Macap?, AP, Brazil. Laborat?rio Central de Sa?de P?blica do Amap?. Macap?, AP, Brazil. Laborat?rio Central de Sa?de P?blica do Amap?. Macap?, AP, Brazil. Academic Hospital Paramaribo. Suriname. Diakonessenhuis. Utrecht, KE. Academic Hospital Paramaribo. Suriname. Academic Hospital Paramaribo. Suriname. Universit? de Guyane. Ecosyst?mes Amazoniens et Pathologie Tropicale. French Guiana. Universit? de Guyane. Ecosyst?mes Amazoniens et Pathologie Tropicale. French Guiana. Universit? de Guyane. Ecosyst?mes Amazoniens et Pathologie Tropicale. French Guiana. Centre Hospitalier de l Ouest Guyanais. Service de M?decine. French Guiana. Instituto Nacional de Higiene Rafael Rangel. Departamento de Micolog?a. Caracas, Venezuela. Instituto Nacional de Higiene Rafael Rangel. Departamento de Micolog?a. Caracas, Venezuela. INEI-ANLIS "Dr Carlos G. Malbran". Buenos Aires, Argentina. Funda??o Oswaldo Cruz. Instituto Le?nidas e Maria Deane. Rio de Janeiro, RJ, Brazil. Universit? de Guyane. Ecosyst?mes Amazoniens et Pathologie Tropicale. French Guiana. Universidad Rosario. School of Medicine and Health Sciences. Bogot? and Corporacion para Investigationnes Biologicas. Bogot?, Colombia.

Background Zoonotic pathogens respond to changes in host range and/or pathogen, vector and host ecology. Environmental changes (biodiversity, habitat changes, variability in climate), even at a local level, lead to variability in environmental pathogen dynamics and can facilitate their transmission from natural reservoirs to new susceptible hosts. Whilst the environmental dynamics of aquatic bacteria are directly linked to seasonal changes of their habitat they also rely on the ecological processes underpining their transmission. However data allowing the comparison of these ecological processes are lacking. Here we compared the environmental dynamics of generalist and vector-borne aquatic bacterial pathogens in the same unit of time and space, and across rural and urban habitats in French Guiana (South America). Principal findings Using Leptospira sp. and Mycobacterium ulcerans we performed an environmental survey that allowed the detection of both pathogens in urban vs. rural areas, and during rainy vs. dry weather conditions. All samples were subjected to qPCR amplifications of LipL32 (Leptospira sp.) and IS2404 and KR (M. ulcerans) genetic markers. We found (i) a greater presence of M. ulcerans in rural areas compared with Leptospira sp., (ii) that modified urban environments were more favourable to the establishment of both pathogens, (iii) that Leptospira sp. presence was enhanced during the rainy season and M. ulcerans during the dry period, and (iv) differences in the spatial distribution of both bacteria across urban sites, probably due to the mode of dissemination of each pathogen in the environment. Conclusions We propose that in French Guiana simplified and modified urban ecosystems might favour leptospirosis and Buruli ulcer emergence and transmission. Moreover, disease risk was also constrained by seasonality. We suggest that the prevention of aquatic bacterial disease emergence in impoverished urban areas of developing countries would benefit from seasonal diseases targeted surveys, which would maximise limited budgets from cash-strapped health agencies., Author summary Many emerging pathogens are zoonotic and transmit from their abiotic reservoir to wild animals, domesticated animals and humans. It is now well known that environmental changes lead to variability in their dynamics in the environment and contribute to changes in the infectious risk. Many aquatic bacteria are responsable for major public health concerns, and more importantly in developing countries where access to drinking-water and sanitation is often limited. Whilst their environmental dynamics are directly linked to seasonal changes of their habitat, they also rely on the ecological processes underpining their transmission, i.e. directly transmitted vs. vector-borne. However, few studies have compared such environmental dynamics despite the fact that it would help to better characterise the infectious risk in the environment, as well as to better monitor the emergence of infectious diseases. Our aim was to provide data on the prevalence of generalist vs. vector-borne aquatic bacterial pathogens in the environment that would further allow the comparison of their environmental dynamics in the same unit of time and space, and across rural and urban habitats. We showed that urbanization and seasonality are two important factors underlying Buruli ulcer and leptospirosis disease emergence in French Guiana (South America), and propose that the mode of transmission of such environmental pathogens might have a detrimental role in disseminating the infectious agent in the environment.

International audience; BACKGROUND:The preventive treatment of Plasmodium vivax relapse recommended by the World Health Organization is primaquine at a dose of 15 mg/day for 14 days, except for malaria cases from Asia and Oceania. Since 2006, CDC recommends the use of primaquine at 30 mg/day for 14 days. In France, all cases of malaria due to P. vivax are treated with 30 mg of primaquine. This systematically increased dosage needs to be evaluated according to epidemiological context. The aim of the study was to compare relapses after 14 days of primaquine at 15 or 30 mg/day.METHODS:All patients treated with primaquine after a vivax malaria episode in French Guiana, between 1 January, 2007 and 1 August, 2016, were studied. Based on the compulsory hospital pharmacy forms for primaquine delivery, adult patients who received 15 or 30 mg of primaquine during 14 days for hypnozoite eradication were included. The recommended dose was initially 15 mg and was changed to 30 mg in 2011. Vivax malaria recurrences within 2 months after primaquine treatment, and vivax malaria recurrences 2-6 months after primaquine in each treatment group were analysed using survival analysis at 2, 3 and 6 months.RESULTS:Out of 544 patients included, 283 received 15 mg/day and 261 received 30 mg/day of primaquine. At 2 and 3 months after primaquine treatment, the number of recurrences was 7 (2.5%) and 19 (7.3%), and 9 (3.4%) and 15 (5.3%), in the 15 and 30 mg groups (p = 0.51 respectively 0.35), respectively. Within 3 months, the median time to recurrence was 2.05 months in the 15 and 30 mg groups. At 6 months after primaquine treatment, the number of recurrences was 25 (8.8%) and 31 (11.9%) at 15 and 30 mg, respectively (p = 0.24). The median time to recurrence was 2.38 months at 15 mg/day and of 2.64 months at 30 mg/day.CONCLUSIONS:There were no significant differences between primaquine at 15 or 30 mg/day for 14 days in the prevention of P. vivax relapses at 2, 3 and 6 months after primaquine treatment in French Guiana

Table S1. Breakdown of risky behavior, comparison between the general population in French Guiana and the migrant population in French Guiana (DOCX 15 kb)

PRISMA checklist. (DOC 64 kb)

Search details for the PubMed database. (DOCX 12 kb)

Cutaneous Leishmaniasis (CL) is the most prevalent form of Leishmaniasis and is widely endemic in the Americas. Several species of Leishmania are responsible for CL, a severely neglected tropical disease and the treatment of CL vary according to the different species of Leishmania. We proposed to map the distribution of the Leishmania species reported in French Guiana (FG) using a biogeographic approach based on environmental predictors. We also measured species endemism i.e., the uniqueness of species to a defined geographic location. Our results show that the distribution patterns varied between Leishmania spp. and were spatially dependent on climatic covariates. The species distribution modelling of the eco-epidemiological spatial patterns of Leishmania spp. is the first to measure endemism based on bioclimatic factors in FG. The study also emphasizes the impact of tree cover loss and climate on the increasing distribution of L. (Viannia) braziliensis in the most anthropized regions. Detection of high-risk regions for the different between Leishmania spp. is essential for monitoring and active surveillance of the vector. As climate plays a major role in the spatial distribution of the vector and reservoir and the survival of the pathogen, climatic covariates should be included in the analysis and mapping of vector-borne diseases. This study underscores the significance of local land management and the urgency of considering the impact of climate change in the development of vector-borne disease management strategies at the global scale.

While general lockdowns have proven effective to control SARS-CoV-2 epidemics, they come with enormous costs for society. It is therefore essential to identify control strategies with lower social and economic impact. Here, we report and evaluate the control strategy implemented during a large SARS-CoV-2 epidemic in June-July 2020 in French Guiana that relied on curfews, targeted lockdowns, and other measures. We find that the combination of these interventions coincided with a reduction in the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was sufficient to avoid hospital saturation. We estimate that thanks to the young demographics, the risk of hospitalisation following infection was 0.3 times that of metropolitan France and that about 20% of the population was infected by July. Our model projections are consistent with a recent seroprevalence study. The study showcases how mathematical modelling can be used to support healthcare planning in a context of high uncertainty.

Additional file 1: Table S1. Datasets and statistical models used in the study. Table S2. Incidence of Leptospirosis and BU in the communes of French Guiana. The significant numbers are given in bold.

Additional file 2: Supplement S3. Graphical abstract of the main result of the malaria outbreak investigation, border area between French Guiana and Brazil, 2017

Funder: We acknowledge financial support from the Investissement d'Avenir program, the Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases program (Grant ANR-10-LABX-62-IBEID), Sante Publique France, the INCEPTION project (PIA/ANR-16-CONV-0005) and European Union V.E.O and RECOVER projects., While general lockdowns have proven effective to control SARS-CoV-2 epidemics, they come with enormous costs for society. It is therefore essential to identify control strategies with lower social and economic impact. Here, we report and evaluate the control strategy implemented during a large SARS-CoV-2 epidemic in June–July 2020 in French Guiana that relied on curfews, targeted lockdowns, and other measures. We find that the combination of these interventions coincided with a reduction in the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was sufficient to avoid hospital saturation. We estimate that thanks to the young demographics, the risk of hospitalisation following infection was 0.3 times that of metropolitan France and that about 20% of the population was infected by July. Our model projections are consistent with a recent seroprevalence study. The study showcases how mathematical modelling can be used to support healthcare planning in a context of high uncertainty.

Additional file 1: Table S1. Datasets and statistical models used in the study. Table S2. Incidence of Leptospirosis and BU in the communes of French Guiana. The significant numbers are given in bold.

Additional file 1: Supplement S1. Distribution of G6PD deficiency according to the WHO definition of French Guianese participants. Supplement S2. Results of clusters for selected localities in the cross-border region between French Guiana and Brazil, January 2017—January 2018. FUNAI: Fundação Nacional do Índio, Brazil; SIVEP—Malária: Sistema de Vigilância Epidemiológica da Malária, Brazil; CDPS: Delocalized Centers for Prevention and Care, Cayenne Hospital, French Guiana; BR: Brazil; GF: French Guiana

Additional file 2: Supplement S3. Graphical abstract of the main result of the malaria outbreak investigation, border area between French Guiana and Brazil, 2017

Additional file 1: Supplement S1. Distribution of G6PD deficiency according to the WHO definition of French Guianese participants. Supplement S2. Results of clusters for selected localities in the cross-border region between French Guiana and Brazil, January 2017—January 2018. FUNAI: Fundação Nacional do Índio, Brazil; SIVEP—Malária: Sistema de Vigilância Epidemiológica da Malária, Brazil; CDPS: Delocalized Centers for Prevention and Care, Cayenne Hospital, French Guiana; BR: Brazil; GF: French Guiana

Background Women are at risk of severe adverse pregnancy outcomes attributable to Plasmodium spp. infection in malaria-endemic areas. Malaria control efforts since 2000 have aimed to reduce this burden of disease. Methods We used data from the Malaria Atlas Project and WorldPop to calculate global pregnancies at-risk of Plasmodium spp. infection. We categorised pregnancies as occurring in areas of stable and unstable P. falciparum and P. vivax transmission. We further stratified stable endemicity as hypo-endemic, meso-endemic, hyper-endemic, or holo-endemic, and estimated pregnancies at risk in 2000, 2005, 2010, 2015, 2017, and 2020. Findings In 2020, globally 120.4M pregnancies were at risk of P. falciparum, two-thirds (81.0M, 67.3%) were in areas of stable transmission; 85 2M pregnancies were at risk of P. vivax, 93.9% (80.0M) were in areas of stable transmission. An estimated 64.6M pregnancies were in areas with both P. falciparum and P. vivax transmission. The number of pregnancies at risk of each of P. falciparum and P. vivax worldwide decreased between 2000 and 2020, with the exception of sub-Saharan Africa, where the total number of pregnancies at risk of P. falciparum increased from 37 3M in 2000 to 52 4M in 2020. Interpretation Historic investments in malaria control have reduced the number of women at risk of malaria in pregnancy in all endemic regions except sub-Saharan Africa. Population growth in Africa has outpaced reductions in malaria prevalence. Interventions that reduce the risk of malaria in pregnancy are needed as much today as ever.

Background: Influenza has been shown to increase the risk for severe bacterial infection, in the tropics the seasonality of influenza epidemics is less marked, and this may not be the case. Dengue is often followed by prolonged asthenia and some physicians hypothesized increased susceptibility to infections based on anecdotal observations. Design and Methods: Time series of influenza and dengue surveillance were confronted bacterial sepsis admissions to test the hypotheses. Monthly surveillance data on influenza and dengue and aggregated sepsis data in Cayenne hospital were matched between 24/10/2007 and 27/09/2016. An ARIMA (1,0,1) model was used. Results The series of the number of monthly cases of sepsis was positively associated with the monthly number of cases of influenza at time t (β=0.001, p=0.0359). Forecasts were imperfectly correlated with sepsis since influenza is not the only risk factor for sepsis. None of the ARIMA models showed a significant link between the dengue series and the sepsis series. Conclusions: There was thus no link between dengue epidemics and sepsis, but it was estimated that for every 1,000 cases of flu there was one additional case of sepsis. In this tropical setting, influenza was highly seasonal, and improved vaccination coverage could have benefits on sepsis. Significance for public health Simultaneous infections may have complex consequences ranging from synergistic, neutral or antagonistic. Dengue fever and influenza cause repeated epidemics and may have consequences on the host’s immune response. Hypothesizing that an infection by dengue or influenza could increase the risk of bacterial infection we showed that there was no relation between dengue and sepsis, but that there was a relation between influenza and sepsis. Despite the tropical setting of French Guiana, the highly seasonal pattern of influenza suggests the vaccine reimbursement window should be extended.