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La querelle du contagionisme qui aboutit, pendant plusieurs décennies au XIXe siècle, à la victoire d'une doctrine qui affirmait la non-contagiosité des grandes maladies épidémiques, a été racontée avec brio en 1948 par Erwin Ackerknecht. Son récit constitue un point de départ au rôle, maintenant reconnu, de l'idéologie en médecine. L'histoire sera reprise ainsi que l'interprétation donnée par Ackerknecht selon laquelle le succès de la doctrine provenait des convictions bourgeoises et libérales de ses partisans. Nous y ajouterons qu'il s'agissait d'une élite qui cultivait des intentions généreuses et qu'elle s'était coupée des gens ordinaires, dont les praticiens du terrain exerçant en province. L'exemple de l'épidémie récente de choléra en Haïti montre le risque toujours actuel d'une contamination de la médecine par l'idéologie et la politique ainsi que l'absolue nécessité de confronter les théories aux faits. With the title "Anticontagionism between 1821–1867", Erwin Ackerknecht's 1948 Fielding Garrison lecture to the American Association for the History of Medicine marked a milestone in the history of medicine by showing how medicine could be influenced by politics and ideology. His account tells of the quarrel, particularly lively in France, between supporters and opponents of contagionism, a quarrel which led to the official doctrine that major epidemic diseases were not contagious (this doctrine in the form of dogma was only abandoned at the end of the century thanks to the progress of medical knowledge). The order in which the Academy of Medicine reviewed the reports it had requested is important, from the first when Étienne Pariset was sent to Spain to study two epidemics of yellow fever and wrongly asserted the contagious nature of the infection (and this assertion was quickly challenged) to the second when it became aware of the unanimous anticontagionist reports of French doctors who had been working in Egypt on the victims of the plague epidemic of 1834–1835. The Academy, i.e. the elite of the profession, had forged an anticontagionist conviction which it asserted during the cholera epidemic of 1832 neglecting the contrary opinion of provincial practitioners. The anticontagionist dogma – and this is Ackerknecht's interpretation – came from the bourgeois and liberal convictions of its supporters. They considered contagionism to be a medieval doctrine which, in their view, neglected the lamentable living and housing conditions of the poorest, those who were the most numerous victims of the epidemics. Their liberal criticism also concerned the organisation of quarantines, which were considered inefficient and blocked trade. We would add that it was an elite with generous intentions and that it had cut itself off from ordinary people. The example of the recent epidemic of cholera in Haiti shows the ever-present risk of medical contamination by ideology and politics, and the absolute necessity of confronting theories with facts. [ABSTRACT FROM AUTHOR]

Résumé Les infections respiratoires basses demeurent dans le monde la principale cause de mortalité d'origine infectieuse. La grippe y est particulièrement impliquée, que ce soit intrinsèquement ou plus encore, en faisant le lit des infections et superinfections bactériennes. Elle est aussi responsable de la décompensation de nombreuses comorbidités, et favoriserait l'apparition de certains infarctus du myocarde et d'accidents vasculaires cérébraux. Plus que les thérapies antivirales dont l'impact reste limité, les mesures préventives chez les patients à risque, et tout particulièrement la vaccination, demeurent un enjeu majeur de santé publique. La grippe reste donc toujours un défi de tous les instants et à tous les niveaux, de la prévention vaccinale, à la reconnaissance des formes atypiques, en passant par la prise en charge précoce des complications bactériennes. Abstract Lower respiratory infections remain the deadliest communicable disease in the world. Influenza infections are particularly involved, whether intrinsically, or more frequently, by promoting bacterial infections and superinfections. The flu is also responsible for the decompensation of many comorbidities and could lead to some myocardial infarction and stroke. The effect of antiviral therapies is limited but preventives measures, such as vaccination, remain a major public health issue. The flu is a major challenge at all levels and all times, from vaccine prevention, to the recognition of atypical forms, and the early management of bacterial complications. [ABSTRACT FROM AUTHOR]

Objectives Viruses are recognized as important agents of gastroenteritis outbreaks in institutions caring for dependent people. We aimed to define norovirus (NoV) and rotavirus (RV) immunochromatographic tests (ICT) and reverse transcription-polymerase chain reaction (RT-PCR) used in gastroenteritis investigations. Methods Fourteen sites were monitored from 2010 to 2015, with 360 laboratory investigations. Twenty-two outbreaks and 44 sporadic case patients were investigated with ICTs (114 NoVs and 80 RVs) and RT-PCRs (114 NoVs and 52 RVs). Results ICTs were useful during outbreaks (identification of NoVs and RVs in respectively 76.5% and 75.0% of episodes) despite the NoV sensitivity limit (55.1%) and the four RV false positive results observed for 10 samples. Given the NoV ICT performance and the observed variations of the NoV and RV prevalence (between 20.0% and 5.0%), ICTs are not appropriate to identify sporadic gastroenteritis case patients. Positive predictive values < 60.0% were observed when the prevalence of RV and NoV was low (< 5.0%). NoV and RV RT-PCR indications are sporadic gastroenteritis case patients, negative NoV and RV ICT during outbreaks, control of positive RV ICT in cases of suspected NoV and RV co-circulation, patients with long symptom duration, and NoV genogroup and genotype identifications (infection control and epidemiological surveillance). Inclusion of patients with specific clinical symptoms is recommended irrespective of the technique. Conclusion On the basis of the ICT limits identified in this work, RT-PCR development seems essential to improve viral gastroenteritis investigations in institutions caring for dependent people. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objective: The survey was implemented to describe vaccination policies for healthcare professionals in French healthcare institutions. Methods: A cross-sectional survey based on questionnaires was sent to occupational physicians and chairpersons of hospital infection prevention and control committees (HIPC) of 38 institutions between November 2010 and January 2011. Results: Twenty-nine occupational physicians and 26 hospital infection prevention and control committees chairpersons (HIPC), from 30 institutions answered (response rate: 79%), 70% of the institutions were university hospitals. Overall, 76% of occupational physicians and 85% of HIPC chairpersons reported that information and awareness campaigns about vaccination recommendations for healthcare professionals were usually conducted in their establishment. Fifty-nine percent of occupational physicians and 31% of HIPC chairpersons reported that they were aware of the vaccine coverage rates of professionals in their institution. The occupational physicians reported that they suggested diphtheria, tetanus, polio, influenza, and acellular pertussis vaccination to all staff at their annual visit in 100%, 97%, and 62% of cases, respectively. Varicella and measles vaccinations were never suggested in 31% and 17% of cases, respectively. Among respondents, 55% of physicians reported that they had already managed a pertussis epidemic, and 42% a measles epidemic, and in both of these cases an awareness campaigns were usually conducted (93% and 96%). Conclusions: The vaccine coverage rates of healthcare professionals in French healthcare institutions remain insufficiently documented and could be improved. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: British colleagues have developed the Outbreak Reports and Intervention studies of Nosocomial Infection (Orion) guidelines with the aim to promote transparency of publications in the field of health-care associated infections and particularly for reports of outbreak investigation or intervention studies. The aim of this study was to translate the Orion criteria and to promote their use in France. Results: The Orion guidelines include a checklist of 22 commented items related to the title, abstract, introduction, methods, results, and discussion sections of a scientific article. Specific points for each item are developed to enhance its relevance. Conclusion: The use of Orion guidelines by authors and editors should be encouraged and should improve the quality of standards in research, intervention studies, and publications on nosocomial infections and health-care associated infections. [Copyright &y& Elsevier]

Abstract: Objective: Investigation of two successive autumnal outbreaks of typhoid fever that occurred in southeast Tunisia. Patients and methods: Salmonella typhi isolates collected from confirmed cases of typhoid fever during the two outbreaks occurred in autumn 2004 and 2005 and from healthy carriers were analyzed by antibiogram and pulsed-field gel electrophoresis (PFGE). Results: A total of 86 isolates of Salmonella enterica serovar Typhi (76 from blood culture or stool of patients involved in both outbreaks and 10 from stool of healthy carriers) were obtained. All isolates of S. typhi were fully sensitive to all antibiotics tested, particularly to co-trimoxazole and ciprofloxacin. All isolates of 2004 (39 from patients and 10 from healthy carriers) appeared to be genetically identical when digested with SpeI, AvrII and XbaI. XbaI digestion of 2005 outbreak isolates gave five different patterns with predominance of the 2004 outbreak pattern. Both outbreaks were concomitant with the season of “legmi”, fermented juice traditionally extracted from palm-tree. Conclusion: PFGE with XbaI was discriminatory and can be useful for epidemiological routine investigation of typhoid fever. Typing results suggests the monoclonality of 2004 outbreak and the multiclonality of the 2005 outbreak. The epidemic clone of S. typhi is able to persist for long period in a quiet state in the population and to give again a new outbreak, when the conditions become favorable. [Copyright &y& Elsevier]

Abstract: An outbreak (or epidemic) is a higher number of cases of a given disease in a given population and time interval. A timely investigation has for aim to identify the source and vehicle of the outbreak and provides unique opportunities to better understand its occurrence and the role of contributing risk factors to implement the most appropriate measures to control it and prevent further recurrences. The investigation of an outbreak is based on a multidisciplinary approach (clinical, epidemiological, environmental, and microbiological) with a descriptive and analytical (hypothesis testing) phase. In this article, we describe the methodological approach of a field outbreak investigation illustrated by examples taken from our experience. The investigation includes the following steps: establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place, and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community. The investigation of an outbreak is an evolving process: information gathered or conclusions made at a given stage must be fully used for following steps. The social, institutional, and political background associated with outbreaks usually makes their investigation complex and should be taken into account. The earlier the outbreak is detected and investigated in close relation with public health authorities, the greater will be the potential preventive impact of control measures. [Copyright &y& Elsevier]

Abstract: Skin cutting types of self-mutilation behaviours are more and more frequent among adolescents. Like eating disorders for the last decades, they could in future significantly contribute to the demand for psychiatric care. These behaviours reveal a relationship pathology and show border line features in the functioning of personalities from various psychological organisations. Within the hospital ward — the privileged observation field, where these behaviours can turn epidemic — they are part of a transference on the ward, and as such require an adequate answer from the medical staff. [Copyright &y& Elsevier]

Copyright of Revue Francaise des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Maladies infectieuses is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)