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• In-hospital coronavirus disease 2019 clusters onset were correlated to coronavirus disease 2019 community incidence. • Preventive measures were not fully applicable due to several specific determinants. • These determinants were patient—(eg, dementia), and ward-associated factors (eg, shared rooms). • Adapting hospital environment and care organization is needed to avoid cluster onset. A total of 92 coronavirus disease 2019 clusters involving 1,156 individuals (729 patients and 427 healthcare workers) occurred in Lyon University Hospital between September 1, 2020 and March 31, 2021, mostly on medical and geriatric wards. The number of clusters was closely correlated to the trend in coronavirus disease 2019 community incidence over time; in-hospital clusters did not persist when community incidence decreased. Recommended preventive measures were not fully applicable due to specific ward-associated determinants and patient characteristics. [ABSTRACT FROM AUTHOR]

A survey was undertaken to evaluate the level of computerization in intensive care units (ICUs) within a French network dedicated to the surveillance of healthcare-associated infections, antimicrobial use (AMU) and antimicrobial resistance (AMR) in ICUs (REA-REZO). Ninety-eight ICUs responded, and patient records were computerized in 57%, antimicrobial prescriptions were computerized in 59% and AMR epidemiology was computerized in 72%. AMU and AMR feedback was provided to the ICU itself for 77% and 65% of ICUs, respectively, and feedback was provided to the national surveillance for 79% and 65% of ICUs, respectively. This study suggests that the level of computerization in ICUs requires further improvement. [ABSTRACT FROM AUTHOR]

• The burden of hospital-acquired influenza (HAI) is not fully understood. • Having an underlying disease is an important characteristic of hospitalized ILI. • HAI occurred at a rate of 1 in 13 with influenza-like-illness (ILI) in hospital. • The incidence of HAI was highest in the geriatric ward and increased over time. • HAI rates approximate those reported for hospital-acquired Clostridium difficile. Hospital-acquired influenza potentially leads to significant morbidity and mortality in already vulnerable patients, but its overall burden is not fully understood. We undertook this study to estimate the incidence and trends of hospital-acquired laboratory-confirmed influenza among adults, and to compare clinical characteristics between hospital-acquired and community-acquired influenza cases. This was a prospective surveillance study over 11 years of adults with influenza-like-illness (ILI) hospitalized in surgery, medicine and geriatric wards in a tertiary acute-care hospital in Lyon, France. Nasal swabs were systematically collected from those with ILI and tested for influenza by reverse transcriptase-polymerase chain reaction at the national influenza reference laboratory (Lyon, France). Influenza was laboratory confirmed at a rate of 1 in 13 patients who developed ILI during their hospitalization. Having an underlying disease was an important characteristic of hospital-acquired ILI cases. Cardiovascular disease was the most frequent underlying condition in both influenza-positive and influenza-negative patients. Complications were more frequent for influenza-positive than influenza-negative patients. The influenza incidence rate was highest in the geriatric ward and increased over the study period. Hospital-acquired influenza poses a significant risk to already vulnerable patients. Longitudinal surveillance data are essential to support better recognition and monitoring of viral infections in hospitals. [ABSTRACT FROM AUTHOR]

• Ventilator-associated pneumonia (VAP) in adults intensive care units ICUs. • Restricted risk factors for multidrug-resistant microorganisms (MDROs) infection. • Decrease of the percentage of MDROs involved in VAP over year. • 23.9% of MDROs involved in VAP starting 2 days after ICU admission. • Increase of the percentage of MDROs involved in VAP after 10 days in ICUs. The aim of this study was to describe the proportion of multidrug-resistant microorganisms (MDROs) involved in ventilator-associated pneumonia (VAP) as the first hospital-acquired infection in 536 adults with restricted risk factors for MDRO-related infection. We found a significant decrease in the percentage of MDROs involved in VAP between 2003 and 2016 and this percentage increased when VAP occurred after day 10. [ABSTRACT FROM AUTHOR]

Background Mandatory notification of health care–associated (HA) infections, including influenza-like illness (ILI) outbreaks, has been implemented in France since 2001. In 2012, the system moved to online electronic notification of HA infections (e-SIN). The objectives of this study are to describe ILI outbreak notifications to Santé publique France (SPF), the French national public health agency, and to evaluate the impact of notification dematerialization. Methods All notifications of HA ILI outbreaks between July 2001 and June 2015 were included. Notifications before and after e-SIN implementation were compared regarding notification delay and information exhaustiveness. Results Overall, 506 HA ILI outbreaks were reported, accounting for 7,861 patients and health care professionals. Median delay between occurrence of the first case and notification was, respectively, 32 and 13 days before and after e-SIN utilization ( P  < .001). Information exhaustiveness was improved by electronic notification regarding HA status (8.5% of missing data before and 2.3% after e-SIN, P  = .003), hypotheses of cause (25.4% of missing data before vs 8.0% after e-SIN, P  < .001), and level of event control (23.7% of missing data before vs 7.5% after e-SIN, P  < .001). Conclusions HA influenza notifications, including HA ILI or influenza, to health authorities are essential to guide decisional instances and health care practices. Electronic notifications have improved the timeliness and quality of information transmitted. [ABSTRACT FROM AUTHOR]

Background Hospital-acquired infections (HAIs) in intensive care units (ICUs) are associated with increased length of stay (LOS). The objective of this study was to graphically describe by heat mapping LOS of patients hospitalized in ICUs related to the occurrence of HAI and severity at admission measured by the Simplified Acute Physiological Score II (SAPSII). Methods Adult patients hospitalized in ICUs of Lyon University Hospitals (France) were included in an active standardized surveillance study of HAI from January 1, 1995-December 31, 2012. Surveillance included adult patients aged ≥18 years hospitalized ≥2 days. Patient follow-up ended at ICU discharge or death. LOS was calculated in days from differences between dates of entry and discharge from ICUs. HAIs recorded were pneumonia, bacteremia, and urinary tract infection. The heat map was designed with a spreadsheet software. Results A total of 34,694 patients were analyzed. Among infected patients, 72.3% had 1 infected site (IS), 23% had 2 ISs, and 4.7% had 3 ISs. Median LOS was 24 days in infected patients (20.4 days among patients with 1 IS, 34.2 days among patients with 2 ISs, and 45.3 days among patients with 3 ISs) and 5 days in noninfected patients ( P  < .001). Two groups of multi-infected patients with long LOSs were identified with the heat map. Conclusions The heat map facilitated easy-to-implement semi-quantitative visualization of increasing LOS through the SAPSIIs and number of ISs. [ABSTRACT FROM AUTHOR]

Background Patterns of contacts between health care workers and patients during seasonal epidemics are unknown. Our study objective was to compare the number and duration of contacts between health care workers and patients during a nonepidemic period versus a community influenza epidemic, and to identify supercontactors. Methods Our observational study was conducted in a short-stay geriatric unit of a university hospital. Contacts between individuals were recorded by active radio frequency identification devices. Contact patterns were compared between 2 periods according to contact number and duration. Each care period lasted 5 days in the nonepidemic and influenza epidemic periods. Results The study included 21 medical doctors, 43 nurses, and 56 patients. In total, 3,200 contacts (61.4%; 152,700 seconds) were recorded during the nonepidemic period, with 2,013 contacts (38.6%; 92,740 seconds) in the epidemic period ( P  = .007). More cumulative contacts occurred during the nonepidemic period between nurses and patients (n = 2,638 [82%] vs n = 1,599 [79%]), but not between patients (n = 56 [18%] vs n = 414 [21%]). Contact duration between nurses and patients lasted longer during the nonepidemic period ( P  = .04). During the epidemic period, 6 nurses (15%) considered to be supercontactors accounted for 44.3% of the total number of contacts with patients. Conclusion The pattern of contacts between individuals differed according to the presence or not of the community influenza peak that might have influenced the risk of nosocomial influenza. [ABSTRACT FROM AUTHOR]

Summary: Background & aims: Parenteral nutrition is known as a high-risk factor for central venous catheter-related bloodstream infection (CVC-RBSI) in cancer patients. Owing to ethical and technical problems, the studies in the literature have nonrandomized designs and are therefore often confounded by biases. We performed a propensity score analysis to estimate the effect of parenteral nutrition on CVC-RBSI in digestive cancer patients who underwent chemotherapy. Methods: Data were collected prospectively. A logistic regression model was used to calculate a propensity score, which was the probability of receiving parenteral nutrition. Kaplan–Meier survival and Cox regression model were used to estimate the effect of the parenteral nutrition on CVC-RBSI after adjustment for the propensity score. Results: Before the propensity score analysis, the differences between patients with (n = 113) and without (n = 312) parenteral nutrition were identified including: male gender, body weight, weight loss, performance status, location of primary cancer, FOLFIRI, and previous long-term corticotherapy. After propensity score stratification, all of the covariates were balanced within each stratum. After adjustment, patients with parenteral nutrition were at a higher risk for CVC-RBSI. Conclusion: By using the propensity score analysis, this study confirmed that parenteral nutrition was an independent risk factor for CVC-RBSI in digestive cancer patients. [Copyright &y& Elsevier]

Abstract: Despite years of public health effort to increase vaccine uptake among populations recommended for influenza vaccination, immunization rates remain low among patients and healthcare workers (HCWs). The objective of this study was to report on influenza vaccination coverage of patients and HCWs for the same time period in 4 wards of a university hospital. A prospective cross-sectional study was conducted among patients and HCWs between December 11, 2006 and April 15, 2007 and individual factors associated with being vaccinated against influenza were assessed. Results indicated that older patients were significantly more vaccinated than younger patients. Physicians and residents were more likely to be vaccinated that the rest of staff, with possible differences between wards. Immunization of HCWs is a major issue in infection control in hospitals and long-term care facilities. However, the impact of influenza vaccination among HCWs in reducing hospital-acquired influenza and patient morbidity needs to be explored further. [Copyright &y& Elsevier]

Background: Central venous access port–related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. Methods: This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. Results: A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. Conclusions: In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies. [Copyright &y& Elsevier]

With no vaccines or specific treatments, non-pharmaceutical interventions are the only tools for controlling the human-to-human transmission of the COVID-19 disease, which appeared in Wuhan, China last December and has spread globally since. Here we describe and compare the first-wave mitigation strategies and epidemiology of five Asia-Pacific countries that responded rapidly to the epidemic. From January to April 2020, mitigation measures and epidemiological data for Singapore, South Korea, Japan, Taiwan, Hong Kong were screened from official local government websites and a review of investigational studies was conducted. Daily case reports and mitigation measures information were extracted. Epidemiological estimates were calculated and compared between countries. All five countries combined measures, focusing on contact tracing, testing, isolation efforts and healthcare management. Epidemiological data varied temporally and geographically: incubation period ranged 3.9–7.1 days, effective reproduction number at time t (Rt) ranged 0.48–1.5, with intensive care admissions 1–3% of hospitalised patients, and case fatality rates were 0.1–3%. Extrinsic estimates to the virus were lower than global estimates. Implemented mitigation strategies in these countries allowed a rapid and successful control or delay of the first COVID-19 pandemic wave. These are valuable examples to inform subsequent waves. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To compare risk factors of early- (E) and late-onset (L) ventilator-associated pneumonia (VAP). Materials and Methods: An epidemiological survey based on a nosocomial infection surveillance program of 11 intensive care units (ICUs) of university teaching hospitals in Lyon, France, was conducted. A total of 7236 consecutive ventilated patients, older than 18 years and hospitalized in ICUs for at least 48 hours, were studied between 1996 and 2002. Data during ICU stay, patient-dependent risk factors, device exposure, nosocomial infections occurrence, and outcome were collected. The cutoff point definition between E-VAP (≤6 days) and L-VAP (>six days) was based on the daily hazard rate of VAP. Results: The VAP incidence rate was 13.1%, 356 (37.6%) E-VAP (within 6 days of admission) and 590 (62.4%) L-VAP were reported. Independent risk factor for E-VAP vs L-VAP was surgical diagnostic category (odds ratio [OR], 1.49 [95% confidence interval, 1.07-2.07]), whereas independent risk factors for L-VAP vs E-VAP were older age (OR, 1.01 [1.01-1.02]), high Simplified Acute Physiology Score II (OR, 1.01 [1.00-1.02]), infection on admission (OR=2.22 [1.61-3.03]), another nosocomial infection before VAP (OR, 5.88 [3.33-11.11]), and exposure to central venous catheter before VAP (OR, 4.76 [1.04-20.00]). Conclusions: E-VAP and L-VAP have different risk factors, highlighting the need for developing specific preventive measures. [Copyright &y& Elsevier]

Summary: Background & aims: Renal impairment is a documented complication in long-term parenteral nutrition (LTPN) patients. However, the aetiologies have remained elusive. The aim of this study was to evaluate the impact of parenteral nutrition, digestive status, and hydration level on renal function in LTPN patients. Methods: In a prospective study of 40 LTPN patients, renal function and hydration level were assessed by measurement of inulin and creatinine clearances, plasma creatinine, urea, aldosterone and renin and urinary sodium/potassium ratio. Patients were assigned to one of two groups according to their inulin clearance (normal=Group 1, 20% decrease or more=Group 2). Results: Of the patients, 52.5% (21/40) had a decrease in glomerular filtration rate (−38±15%), with age taken into consideration. Patient characteristics, parenteral nutrition composition or duration and intestinal status were not different between the two groups. Urologic or nephrologic diseases were more frequent in Group 2 patients. Moreover, in Group 2 patients, a urinary sodium/potassium excretion ratio of less than 1 in 8/21 patients and plasma renin (316±298 vs. 86±53% of normal value) and aldosterone (291±464 vs. 58±36pmol/l) that were significantly higher than in Group 1 patients suggested a hypovolemic component. Conclusion: Decreased renal function is frequent (52.5%) in LTPN patients. A volemic component was associated in more than 70% of them. An elevation of serum creatinine or an inversion of the urinary Na/K ratio requires an evaluation of hydration equilibration and an oral rehydration and a modification in parenteral nutrition formulation. [Copyright &y& Elsevier]

Abstract: Objectives. – To compare outpatients treated with conventional nonsteroidal antiinflammatory drugs (NSAIDs) versus cyclooxygenase-2 (COX2) inhibitors in June 2002 in the Ain district of France. Patients and methods. – A cross-sectional study was done in the 14,216 patients older than 19 years of age who were identified in the universal health insurance database as having received therapy with conventional NSAIDs or COX2 inhibitors. A logistic regression model was built to identify factors associated with the type of antiinflammatory agent. Results. – COX2 inhibitor therapy was noted in 17% of patients. Factors significantly associated with COX2 inhibitor therapy were older age and concomitant use of symptomatic slow-acting drugs for osteoarthritis, disease-modifying antirheumatic drugs, anticoagulants, antiplatelet agents, diuretics, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists. Patients taking COX2 inhibitor therapy were significantly less likely to be taking concomitant gastroprotective therapy, compared to patients on conventional NSAIDs. Conclusions. – The powerful advertisement campaigns that surrounded the introduction of COX2 inhibitors rapidly affected practice patterns regarding the prescription of antiinflammatory drugs. The study reported here showed a significantly greater likelihood of receiving COX2 inhibitors in older patients taking multiple medications, a population known to be at increased risk for drug-induced cardiovascular events. Evidence obtained after the present study established that COX2 inhibitors carry a risk of cardiovascular side effects. Rofecoxib has been removed from the market, and new recommendations have been issued regarding other COX2 inhibitors. [Copyright &y& Elsevier]

Résumé: Objectifs. – Décrire et comparer les caractéristiques des patients, ayant reçu un anti-inflammatoire non stéroïdien (AINS) classique ou un coxib, dans le département de l''Ain, en juin 2002. Patients et méthodes. – Une étude transversale a été réalisée chez 14 216 patients de plus de 19 ans qui ont reçu un AINS. Les patients ont été identifiés dans la base de données de l''assurance maladie (projet MIAM) grâce au codage des médicaments. Une régression logistique a été utilisée pour identifier les variables associées aux prescriptions. Résultats. – On dénombrait 17 % de patients traités par coxib. Les patients ayant reçu un coxib étaient plus âgés que les patients traités par un AINS classique, avaient plus souvent un antiarthrosique, un traitement de fond des rhumatismes inflammatoires, un anticoagulant, un antiagrégant, un diurétique, un inhibiteur de l''enzyme de conversion ou un antagoniste de l''angiotensine II associé. Les patients ayant reçu un coxib avaient moins souvent un antiulcéreux associé que les patients ayant reçu un AINS classique. Conclusions. – La présentation des coxibs, peut-être trop favorable au moment de leur mise sur le marché, a eu un retentissement sur la prescription des AINS. Cela est bien montré chez les sujets âgés polymédicamentés à qui les coxibs sont significativement plus prescrits alors que justement cette population est aujourd''hui reconnue comme la plus à risque de présenter des complications cardiovasculaires induites. Depuis la réalisation de cette étude, en raison de la mise en évidence d''effets indésirables cardiovasculaires, le rofécoxib a été retiré du marché et les coxibs ont fait l''objet de mesures de précaution. [Copyright 2005 Elsevier]

Intensive care unit patients exposed to multiple devices but free of hospital-acquired infection (HAI) until discharge were identified through a surveillance network of HAIs in Lyon, France, between 2003 and 2011. Multiexposed patients were defined according to the tenth deciles of length of stay and exposures to invasive devices. Overall, 982 (5.0%) multiexposed patients were identified; 154 (15.7%) remained uninfected. Multiexposed infected patients differed from noninfected patients regarding length of exposures and mortality. [ABSTRACT FROM AUTHOR]

The risk of nosocomial influenza-like illness (noso-ILI) compared with that of community-acquired ILI was calculated during 3 influenza seasons (2004-2007) at a 1100-bed university hospital with a total of 21,519 hospitalized patients. Outbreaks of noso-ILI occurred in each season, although a protective effect against noso-ILI was also identified for other wards. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination has proven to be effective in preventing severe cases, reducing viral load, and transmissibility. The aim of this study was to evaluate the impact of vaccination 11 months after implementation on epidemiological indicators and the effective reproduction number in one French region. We plotted four indicators with vaccination coverage as the explaining variable and estimated the impact of vaccination using the reduction rates in infections and hospital admissions. A reduction of 98% in COVID-19-related hospitalisation 11 months after the vaccine campaign began in January 2021 has been reported while vaccine coverage increased over time. Those results do not make it possible to postulate a causal relationship but do support the effect of vaccination against multiple variants of concern. Non-pharmaceutical measures remain necessary to attain complete epidemic control. Open epidemiological data should be considered to monitor vaccine effectiveness wherever possible. [ABSTRACT FROM AUTHOR]

Introduction Les Aspergillus sont des champignons filamenteux responsables d’aspergillose invasive (AI) chez les patients immunodéprimés. Ce risque est augmenté en période de travaux. Des études récentes ont rapporté l’émergence mondiale de la résistance aux azolés chez des souches d’ A. fumigatus . En Europe, la possibilité d’une acquisition environnementale de la résistance aux azolés a été suggérée par la détection d’isolats résistants aux azolés chez des patients naïfs. L’objectif de cette étude est d’évaluer la susceptibilité aux azolés d’isolats d’ A. fumigatus retrouvés chez des patients et dans l’air d’un hôpital universitaire français durant une période d‘un an dans un contexte de travaux majeurs de déconstruction. Matériel et méthode Entre janvier et décembre 2015, un pavillon central (6000 m 2 ) de notre hôpital a été entièrement démoli sans arrêt de l’activité de soins. Pendant cette période, une investigation épidémiologique des cas d’AI basée sur les critères European Organization for Research and Treatment of Cancer (EORTC) a été systématiquement réalisée et des prélèvements de l’air intérieur ( n = 2141) et extérieur ( n = 1744) ont été conduits. Les isolats d’ A. fumigatus ont été identifiés par examen micro- et macroscopique, thermotolérance et séquençage du gène de la β -tubuline. La susceptibilité des isolats d’ A. fumigatus à l’itraconazole (ITZ), voriconazole (VCZ) a été évaluée par des bandelettes Etest (Biomerieux ® ) sur un milieu RPMI-1640 supplémenté avec 2 % de glucose (Biomerieux ® ). La concentration minimale inhibitrice (CMIs) a été déterminée visuellement au point d’inhibition de croissance à 4 h d’incubation à 37 °C. Résultats Au total 393 isolats d’ A. fumigatus ont été conservés, (381 isolats provenant de l’air et 12 isolats cliniques). Les isolats environnementaux incluaient 153 isolats provenant de l’intérieur, et 228 isolats de l’extérieur. Les souches cliniques ont été collectées chez 10 patients présentant une AI nosocomiale probable ( n = 2) ou possible ( n = 2), une aspergillose non invasive localisée ( n = 1) ou une colonisation respiratoire ( n = 5). Tous les isolats étaient sensibles aux azolés. La CMI moyenne du VCZ observée était de 0,099 μg/mL [0,023–0,5] pour les isolats environnementaux et de 0,112 μg/mL [0,094 à 0,19] pour les isolats cliniques. Pour l’ITZ, la CMI moyenne était de 0,425 μg/mL [0,032 à 1] pour les isolats environnementaux, et de 0,424 μg/mL [0,19 à 0,5] pour les isolats cliniques. Les CMIs des isolats environnementaux extérieurs et intérieurs n’étaient pas significativement différentes pour l’ITZ ( p > 0,3) et le VCZ ( p > 0,9). De même, aucune différence significative entre les isolats environnementaux et cliniques n’a été retrouvée pour l’ITZ ( p > 0,9) et le VCZ ( p > 0,1). Conclusions Les isolats d’ A. fumigatus environnementaux et cliniques retrouvés au sein de notre établissement hospitalier ne présentent pas de résistance aux azolés. Cependant, face au risque accru pour les patients d’être infectés par une souche d’emblée résistante aux azolés, il paraît intéressant d’effectuer un suivi régulier de l’écologie environnementale des souches d’ A. fumigatus. [ABSTRACT FROM AUTHOR]

• Hospital-acquired influenza (HAI) can lead to significant morbidity and mortality. • Knowledge on the impact of vaccination on HAI in hospitalized patients is limited. • The study reported 60 % reduction in the risk of HAI in vaccinated patients. • HAI can be better controlled by vaccinating patients at risk of hospitalization. Literature is limited on the impact of patient vaccination on the risk of hospital-acquired influenza (HAI). This test negative case-control study nested in a surveillance program aimed at evaluating the effectiveness of influenza vaccination in reducing the risk of HAI in hospitalized patients during 15 influenza seasons (2004–05 to 2019–20). HAI cases were those who developed influenza like illness (ILI) symptoms at least 72 h after hospitalization and had a positive reverse transcriptase-polymerase chain reaction (RT-PCR). Controls were those with ILI symptoms and a negative RT-PCR test. A nasal swab as well as socio-demographic, clinical data and information on influenza vaccination were collected. Of the 296 patients included, 67 were confirmed HAI cases. Influenza vaccine coverage was significantly higher among controls compared to HAI cases (p = 0.002). The risk of HAI was reduced by almost 60 % in vaccinated patients. A better control of HAI can be achieved by vaccinating hospitalized patients. [ABSTRACT FROM AUTHOR]

• The outbreak of COVID-19 in South Kivu raised concern about increased morbidity and mortality. • Little or no use of face masks was noted in at least half of the streets observed. • The number of suspected cases of COVID-19 increased six-fold. • The estimated mortality rate increased at least four-fold by the end of 2020 compared with the first wave. • The excess mortality in South Kivu is extremely concerning. The outbreak of coronavirus disease 2019 (COVID-19) in South Kivu, Democratic Republic of Congo raised concerns regarding additional morbidity and mortality. Updating these indicators before a second wave is essential in order to prepare for additional help. From mid-May to mid-December 2020, weekly surveys were undertaken in sampled streets from 10 health areas to quantify the use of barrier measures, and interview pedestrians about sickness and deaths in their households. Crude death rates (CDRs) were estimated. Minimal use or no use of face masks was observed in at least half of the streets. From May to December 2020, the number of suspected cases of COVID-19 increased six-fold (P < 0.05). Of deaths within 30 days preceding the interviews, 20% were considered to be related to COVID-19. The monthly CDRs at the beginning and end of the study were approximately 5 and 25 per 1000 population, respectively (P < 0.05); that is, annual CDRs of 60 and 260 per 1000 population, respectively. Thus, during the first wave, the estimated mortality rate increased by 50% compared with previous years, and increased at least four-fold by the end of 2020. Despite possible overestimations, the excess mortality in South Kivu is extremely concerning. This crisis calls for a rapid response and increased humanitarian assistance. [ABSTRACT FROM AUTHOR]

• Vaccination is a key determinant for the prevention of infectious diseases. • Participants known HZ but were not aware of the existence of the vaccine. • 69% of participants agreed to be vaccinated if they had risk factors. • The lack of knowledge is a major issue regarding prevention by vaccines. The aim of the study was to evaluate the acceptability and to describe the perception of vaccination against herpes zoster (HZ) for outpatients and hospitalized patients in Lyon, France, aged 65 years and over. An observational study was based on a questionnaire completed from a face-to-face interview from January 2018 to March 2019. Volunteer outpatients who attended private medical laboratories or who were hospitalized in the geriatric department, or who were at the ambulatory medical clinic for a consultation were asked to participate. A total of 907 individuals were interviewed, with a mean age of 75.8 years. A large majority 87.6% (795) knew about HZ and 68.9% (625) would agree to be vaccinated against HZ if they had risk factors. The participants had knowledge of HZ as a disease but vaccine awareness is still lacking among the general public. [ABSTRACT FROM AUTHOR]

• Knowledge of the incubation period is essential for the SARS-CoV-2 case definition. • The mean incubation period was 6.38 days 95% CI (5.79; 6.97); range 2.33–17.60 days. • A real time meta-analysis, called the InCoVid-Lyon, is proposed A valid measurement of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incubation period is needed for case definitions and for adapting appropriate isolation measures but is challenging in an emergency context. Our objective was to systematically review recent literature reporting estimates of the distribution of the incubation period of SARS-CoV-2 and describe the distribution and its variability and dispersion through a meta-analysis. A systematic review was carried out on studies published from 1 January 2020 to 10 January 2021 reporting the SARS-CoV-2 incubation period. Individual mean and standard deviation were used to produce the pooled estimate. Sources of heterogeneity were explored by age, gender and study design using a meta-regression. In total, 99 studies were eligible for analysis in our meta-analysis. The pooled estimate of the mean incubation period across the studies was 6.38 days, 95% CI (5.79; 6.97). Calculation of the mean incubation period will help with the identification of time of exposure, however, determinants of its variations/range might be explored for potential links with the clinical outcome or pathogenic steps at the early stage of infection. A real-time meta-analysis, named the InCoVid Lyon, is proposed following this initial analysis. [ABSTRACT FROM AUTHOR]

Quantify the effects of characteristics of nursing homes and their surroundings on the spread of COVID-19 outbreaks and assess the changes in resident protection between the first 2 waves (March 1 to July 31 and August 1 to December 31, 2020). An observational study was carried out on data on COVID-19 outbreaks extracted from a database that monitored the spread of the virus in nursing homes. The study concerned all 937 nursing homes with >10 beds in Auvergne-Rhône-Alpes region, France. The rate of nursing homes with at least 1 outbreak and the cumulative number of deaths were modeled for each wave. During the second (vs the first wave), the proportion of nursing homes that reported at least 1 outbreak was higher (70% vs 56%) and the cumulative number of deaths more than twofold (3348 vs 1590). The outbreak rate was significantly lower in public hospital–associated nursing homes than in private for-profit ones. During the second wave, it was lower in public and private not-for-profit nursing homes than in private for-profit ones. During the first wave, the probability of outbreak and the mean number of deaths increased with the number of beds (P <.001). During the second wave, the probability of outbreak remained stable in >80-bed institutions and, under proportionality assumption, the mean number of deaths was less than expected in >100-bed institutions. The outbreak rate and the cumulative number of deaths increased significantly with the increase in the incidence of hospitalization for COVID-19 in the surrounding populations. The outbreak in the nursing homes was stronger during the second than the first wave despite better preparedness and higher availabilities of tests and protective equipment. Solutions for insufficient staffing, inadequate rooming, and suboptimal functioning should be found before future epidemics. [ABSTRACT FROM AUTHOR]

Introduction Vaccination is an effective and proven method of preventing infectious diseases. However, uptake has not been optimal with available vaccines partly due to vaccination hesitancy. Various public health approaches have adressed vaccination hesitancy. Serious video games involving vaccination may represent an innovative public health approach. The aim of this study was to identify, describe, and review existing serious video games on vaccination. Method A systematic review was performed. Various databases were used to find data on vaccination-related serious video games published from January 1st 2000 to May 15th 2015. Data including featured medical and vaccination content, publication characteristics and games classification were collected for each identified serious game. Results Sixteen serious video games involved in vaccination were identified. All games were developed in high-income countries between 2003 and 2014. The majority of games were available online and were sponsored by educational/health institutions. All games were free of charge to users. Edugame was the most prevalent serious game subcategory. Twelve games were infectious disease-specific and the majority concerned influenza. The main objective of the games was disease control with a collective perspective. Utilization data was available for two games. Two games were formally evaluated. Discussion The use of serious video games for vaccination is an innovative tool for public health. Evaluation of vaccination related serious video games should be encouraged to demonstrate their efficacy and utility. [ABSTRACT FROM AUTHOR]

Background Influenza is an important cause of serious illness and death, particularly in elderly and high-risk groups. Objectives Aim of this study was to identify factors associated with poor outcomes among adults hospitalized in France for laboratory-confirmed seasonal influenza. Study design Patients hospitalized for influenza were identified in a prospective, multicenter study carried out in French hospitals during three consecutive influenza seasons (2012–2015). Influenza virus infection was confirmed by reverse transcription polymerase chain reaction. Sociodemographic and clinical variables were compared according to the virus type and subtype. Risk factors for complications, intensive care unit (ICU) admission and death were analyzed by backward stepwise logistic regression. Results The study population consisted of 566 patients, of whom 56% were older than 65 years and 82% had underlying chronic illnesses. Type A influenza viruses infected 422 patients (75%), including subtype H3N2 in 239 patients (57%). The prior vaccine coverage rate was 38%. Complications occurred in 255 patients (45%), consisting mainly of pneumonia (n = 143, 30%) and respiratory failure (n = 116, 20%). Eighty-three patients (15%) were admitted to an ICU, and the in-hospital mortality rate was 4% (n = 21). Sixty-six patients (12%) received oseltamivir. Age over 65 years was the only identified risk factor for complications. Risk factors for ICU admission were an absence of vaccination, no oseltamivir administration before admission, pre-existing chronic respiratory disease, and current smoking. Age over 65 years and ICU admission were risk factors for death. Conclusions Older individuals and patients with underlying conditions are most at risk of influenza complications. Vaccination and early oseltamivir administration, both of which are recommended for these patients, appear to reduce ICU admissions. [ABSTRACT FROM AUTHOR]

Background Several vaccines are recommended in HIV-infected patients due to an increased risk of vaccine-preventable infections, severe forms of the disease, or shared transmission routes. Few data are available regarding vaccination coverage and its determinants in this population. Methods A cross-sectional study was performed in HIV-infected patients included in a hospital-based cohort in 2011. Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), seasonal and A(H1N1)2009 pandemic influenza, and invasive pneumococcal diseases (IPD) were recorded. Factors associated with vaccination were assessed by multivariate logistic regression. Results 2467 patients were included (median age 47 years; male gender 71.5%; men having sex with men (MSM) 43.9%; CDC stage C 24.3%; HBV and/or hepatitis C virus co-infection 14.4%). Median duration of HIV infection was 10 years and 93.1% of patients received combination antiretroviral therapy. At baseline, the median CD4 count was 527 cells/mm³ and HIV viral load was <50 copies/mL in 83.3% of cases. Vaccination coverage for HBV, HAV, seasonal influenza, A(H1N1)2009 pandemic influenza, and IPD were 61.9%, 47.4%, 30.9, 48.3%, and 64.6%, respectively. Factors independently associated with vaccination were a younger (HBV) or an older age (influenza), male gender (HBV, HAV), MSM (HBV), CD4 count >200/mm³ and HIV-RNA <50 copies/mL (IPD, influenza), longer duration of HIV infection (IPD, influenza), and follow-up by an experienced physician (HBV, IPD). Conclusions Vaccination coverage remained insufficient for all vaccine-preventable infections investigated in this study. Determinants for vaccination were largely not evidence-based, and efforts should be focused on improving physicians' knowledge about guidelines. [ABSTRACT FROM AUTHOR]

Highlights: [•] Hepatitis B infection and vaccination in pregnant women of Mayotte were described. [•] High prevalence of HBV infection and low HBV vaccination rate was found. [•] Lower education and HBV endemic birthplace were associated with a low vaccination rate. [•] History of STIs and condom use were associated with higher and lower risk of HBV infection respectively. [•] Identification of socio-demographic and behavioral factors may help to offer adapted actions for pregnant women in Mayotte. [Copyright &y& Elsevier]

Abstract: The aim of this study was to estimate influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza among hospitalized patients. A case–control investigation was based on the prospective surveillance of influenza-like illness (ILI) during five flu seasons. We compared influenza-positive cases and influenza-negative controls. Unadjusted overall IVE was 62% (95% confidence interval 24% to 81%). We found that IVE was lower during the 2004–05 flu season (11%; 95% CI −232% to 76%) when the vaccine and circulating viruses were mismatched. Expansion of the study to other hospitals could provide IVE estimates earlier in the season, for different age groups and emerging virus strains. [Copyright &y& Elsevier]

Background & Aims: Nodular regenerative hyperplasia (NRH) leading to non-cirrhotic portal hypertension has been described in HIV-infected patients and has been linked to didanosine. The relation between NRH and other antiretrovirals remains unclear. Methods: A case-control study was performed in 13 patients with NRH and 78 controls matched for time of inclusion, baseline CD4, and duration of follow-up. Univariate and multivariate conditional logistic regression analyses were performed. Results: Control patients and patients with NRH were similar at baseline regarding demographics and biological data with the exception of older age for patients with NRH (43.9 vs. 33.5years, p =0.044). At the time of NRH diagnosis, cases had a lower CD4 count (327 vs. 468/mm3, p =0.013), a similar CD4 percentage (24 vs. 26.2%, p =0.7), a lower platelet count (169 vs. 228 giga/L, p =0.003) and a higher AST level (33 vs. 26IU/L, p =0.001) than controls. Univariate analysis demonstrated that patients with NRH had been exposed longer than controls to didanosine, stavudine, tenofovir, didanosine+stavudine, and didanosine+tenofovir. The age at baseline [OR 2.2 (1.0–5.0) per 10years, p =0.053] and didanosine+stavudine cumulative exposure [OR 3.7 (1.4–10.2) per year, p =0.011] were independently associated with NRH. The age at baseline [OR 2.3 (1.0–5.3) per 10years, p =0.045], cumulative exposure to didanosine [OR 1.4 (1.1–1.9) per year, p =0.023] and to tenofovir [OR 1.7 (1.0–2.8) per year, p =0.04] were independently associated with NRH when didanosine+stavudine exposure was excluded from the model. Conclusions: NRH in HIV-infected patients seems strongly related to age and the cumulative exposure to didanosine+stavudine, didanosine, and stavudine. [Copyright &y& Elsevier]