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International audience; Human behaviors are increasingly recognized to play a key role in the spread of infectious diseases. Although a set of social and cognitive determinants has been consistently found to affect the adoption of health protective behaviors aiming to control and prevent a variety of infections, little is currently known about the ecological drivers of these behaviors in epidemic settings. In this article, we took advantage of the outbreak of chikungunya, a reemerging mosquito-borne disease, that occurred in French Guiana in 2014-15 to test empirically the assumption proposed by Zielinski-Gutierrez and Hayden that the proximity of the disease and perceptions of the natural environment may considerably shape public response to an emerging health threat. To achieve this, a cross-sectional survey was conducted among high school students of the region ( = 1462) at an early stage of the epidemic. Surprisingly, spatial analysis of the collected data leads to counterintuitive results as the participants who lived in the most affected area expressed less concern about the disease and practiced preventive behaviors less frequently than did other participants. These paradoxical results may be attributed to the possible activation of risk denial processes which have previously been observed in the risk perception literature, and described by several social and psychological defensiveness theories.

International audience; Contexte et objectifs : La dengue est l’arbovirose la plus répandue dans le monde et sévit dans les zones tropicales et sub-tropicales du globe. Au cours des dernières années, l’épidémiologie de la dengue a fortement évolué dans les Amériques tendant vers une situation d’hyper-endémicité caractérisée par la co-circulation des quatre sérotypes du virus responsable et des épidémies plus fréquentes et plus intenses. Dans ce contexte, une surveillance hospitalière a été mise en place en Guyane afin d’étudier la sévérité des épidémies de dengue et les caractéristiques cliniques des patients hospitalisés.Méthode : De 2008 à 2013, un recueil quotidien des données cliniques et biologiques a été mis en place pour tous les cas de dengue hospitalisés. La classification établie par l’Organisation mondiale de la santé en 2009 a été appliquée de manière rétrospective, puis prospective à l’ensemble des cas. Le taux de sévérité a été calculé en rapportant le nombre de formes sévères au nombre de cas cliniquement évocateurs estimé par le dispositif de surveillance épidémiologique.Présentation des résultats : Sur les 1356 cas de dengue hospitalisés, 216 (16%) présentaient une dengue sans signes d’alerte, 926 (68%) présentaient une dengue avec des signes d’alerte et 214 (16%) présentaient une dengue classée sévère. Les taux de sévérité étaient similaires au cours des trois épidémies survenues durant la période d’étude (2009, 2010 et 2013) bien que le taux d’hospitalisation ait été plus élevé en 2013. La présence d’un épanchement pleural, d’un taux d’aminotransférases supérieur à 193UI/L et d’un taux de plaquettes inférieur à 75000 cellules/mm3 étaient associés à la sévérité de la dengue.Conclusion et interprétation des résultats : Cette étude a permis de fournir une description épidémiologique récente de la sévérité des épidémies de dengue en Guyane et a montré la pertinence de la nouvelle classification sur l’activité hospitalière.

National audience; Leptospirosis is a neglected disease which affects all tropical regions, particularly South America and the Caribbean. Its incidence and case-fatality rates are poorly known, and probably highly underestimated. In order to estimate the real incidence of leptospirosis in the French West Indies, an incidence study was performed in 2011 using the three prevailing available biological tests for diagnosis: Microscopic Agglutination Test (MAT), IgM ELISA and PCR. The study investigated inpatients as well as outpatients, and used active case ascertainment from data provided by a general practitioners’ sentinel network.The incidence of leptospirosis was estimated respectively at 69 and 61 annual cases per 100,000 inhabitants respectively in Guadeloupe and Martinique, representing an incidence 100 times higher than in Mainland France for the study period. The results also show that using PCR-real time for diagnosis has allowed identifying cases many more cases than that would not have been detected without having recourse to this test. It also contributes to early detection of the disease, reducing the risk of complications due to leptospirosis through the prescription of an antibiotic therapy.It has also been possible to describe the epidemiology of the disease in terms of severity, demographic characteristics and seasonal patterns. Besides, these results support the relevance of developing an integrated management strategy for surveillance, prevention and control of the disease in the French West Indies.; La leptospirose est l'une des maladies dites négligées des pays du Sud, en particulier en Amérique latine et dans la Caraïbe. Son incidence réelle et sa létalité sont incertaines, cette dernière étant probablement élevée. Afin d'estimer l'impact sanitaire réel de la maladie aux Antilles françaises, une étude d'incidence a été conduite en 2011, en mettant en oeuvre l'ensemble des outils diagnostiques aujourd'hui disponibles : le test de micro-agglutination (MAT), la sérologie Elisa IgM et la PCR. Cette étude a pris en compte non seulement les patients hospitalisés mais également, grâce aux réseaux de médecins généralistes sentinelles, les patients ambulatoires pris en charge par leur médecin traitant. L'incidence de la leptospirose a été estimée à 69 et 61 cas annuels pour 100 000 habitants, respectivement en Guadeloupe continentale et en Martinique, soit une incidence plus de 100 fois supérieure à celle de la métropole à la période de l'étude. Les résultats montrent également que l'accès au diagnostic par PCR conduit à un nombre de cas aux Antilles très largement supérieur à celui dénombré antérieurement ; il permet en outre de diagnostiquer la maladie en phase précoce, limitant le risque de complications de la leptospirose par la prescription d'un traitement antibiotique. L'épidémiologie de la maladie a pu être également décrite en termes de sévérité, de caractéristiques démographiques et de saisonnalité. Les résultats confirment la pertinence de la mise en place d'un système de surveillance épidémiologique à visée d'alerte, étroitement articulé avec une stratégie de prévention et de contrôle de la maladie.

International audience; BACKGROUND: Dengue fever is the most important arboviral infection that affects humans, particularly in tropical and subtropical regions. Here, we provide the first comprehensive overview of the severity of dengue epidemics in French Guiana. METHODOLOGY/PRINCIPAL FINDINGS: We monitored hospitalized cases between 2008 and 2013. Detailed clinical features and biological parameters were collected on a daily basis from all cases. Among the 1,356 cases, 216 (16%) were classified according to the WHO 2009 classification as dengue without warning signs (WS), 926 (68%) were classified as dengue with WS and 214 (16%) were classified as severe dengue. The severity rates were similar between the three major epidemics that occurred during the study period, whereas the hospitalization rate was highest in 2013. Fluid accumulation, aspartate aminotransferase (ASAT) counts>193 IU/L and platelet counts

Background Dengue fever epidemic dynamics are driven by complex interactions between hosts, vectors and viruses. Associations between climate and dengue have been studied around the world, but the results have shown that the impact of the climate can vary widely from one study site to another. In French Guiana, climate-based models are not available to assist in developing an early warning system. This study aims to evaluate the potential of using oceanic and atmospheric conditions to help predict dengue fever outbreaks in French Guiana. Methodology/Principal Findings Lagged correlations and composite analyses were performed to identify the climatic conditions that characterized a typical epidemic year and to define the best indices for predicting dengue fever outbreaks during the period 1991–2013. A logistic regression was then performed to build a forecast model. We demonstrate that a model based on summer Equatorial Pacific Ocean sea surface temperatures and Azores High sea-level pressure had predictive value and was able to predict 80% of the outbreaks while incorrectly predicting only 15% of the non-epidemic years. Predictions for 2014–2015 were consistent with the observed non-epidemic conditions, and an outbreak in early 2016 was predicted. Conclusions/Significance These findings indicate that outbreak resurgence can be modeled using a simple combination of climate indicators. This might be useful for anticipating public health actions to mitigate the effects of major outbreaks, particularly in areas where resources are limited and medical infrastructures are generally insufficient., Author Summary Climatic determinants are amongst the most frequently cited in studies aimed at understanding and explaining the dynamics of vector-borne infections, and dengue in particular. French Guiana, a French overseas territory in which the vector Aedes aegypti is well established, experiences an epidemic cycle of dengue with large and prolonged epidemics occurring approximately every 3 years. Dengue is one of the most prioritized infectious diseases, and it requires an intense mobilization of local public health authorities, health services, and health professional and vector control services. A specific surveillance, preparedness and response plan has been developed based upon these needs. Gaining an accurate understanding of the drivers of dengue transmission is required to develop a model to predict the risk of an epidemic and to plan activities aimed at controlling it. Here, we assessed the effects of climatic factors on dengue spread to develop a predictive model of the epidemics in French Guiana on a country-wide scale. The goal of the model is to anticipate and plan both preventive and control activities. Given climate conditions, the model predicts that a dengue epidemic is likely to occur in early 2016. These conditions, which are favorable for Aedes mosquito proliferation, could also enhance the diffusion of other arboviruses, such as the Zika virus, in northeastern South America.

Les regions de Guadeloupe, de Guyane et de la Martinique et les collectivites de Saint-Martin et Saint-Barthelemy ont deploye au niveau local un dispositif specifique pour surveiller l’emergence de la grippe A(H1N1) 2009. Apres une phase de confinement basee sur la detection et la gestion individuelle des cas, une surveillance a ete mise en place a l’echelle populationnelle, essentiellement basee sur les donnees des reseaux de medecins sentinelles et les confirmations virologiques. Tout comme l’ensemble des pays de la zone caraibe, les cinq territoires ont subi une epidemie liee au virus A(H1N1) 2009 ayant debute entre aout et septembre 2009. Malgre une dynamique similaire, ces vagues epidemiques ont presente des specificites en termes d’ampleur et de severite, avec un taux d’attaque variant de 28 a 70 pour 1 000 habitants et un taux d’hospitalisation de 4,3 a 10,3 pour 1 000 cas. Les outils de surveillance mis en place ont permis d’obtenir une vision globale et precise des caracteristiques de l’epidemie et semblent donc tout a fait adequats pour surveiller une eventuelle nouvelle vague epidemique. Certaines difficultes liees au contexte geographique ou sanitaire specifique des territoires concernes (complexite de l’acheminement des prelevements pour la surveillance virologique, survenue concomitante d’epidemies de dengue) sont apparues, et a l’inverse certaines specificites locales (presence de comites d’experts et de reseaux actifs de medecins sentinelles) ont facilite la surveillance et la gestion de l’episode.

Background Leptospirosis is a neglected zoonosis affecting mainly tropical and subtropical regions worldwide, particularly South America and the Caribbean. As in many other countries, under-reporting of cases was suspected in the French West Indies because of inadequate access to diagnostic tests for the general population. Methodology/Principal findings In order to estimate the real incidence of leptospirosis in Guadeloupe and Martinique, a study was performed in 2011 using the three prevailing available biological tests for diagnosis: Microscopic Agglutination Test (MAT), IgM ELISA and PCR. The study investigated inpatients and outpatients and used active case ascertainment from data provided by a general practitioners’ sentinel network. The epidemiology of the disease was also described in terms of severity and demographic characteristics. Leptospirosis incidence was estimated at 69.4 (95%CI 47.6–91.1) and 60.6 (95%CI 36.3–85.0) annual cases per 100 000 inhabitants in Guadeloupe and Martinique, respectively, which was 3 and 4 times higher than previous estimations. Conclusion/Significance Inclusion of PCR and IgM ELISA tests for diagnosis of leptospirosis resulted in improved sensitivity in comparison with MAT alone. Our results highlighted the substantial health burden of the disease in these two territories and the importance of access to appropriate laboratory tests. Based on our results, PCR and IgM ELISA tests have now been included in the list of tests reimbursed by the national system of social security insurance in France. Our results also underline the relevance of implementing an integrated strategy for the surveillance, prevention and control of leptospirosis in the French West Indies., Author Summary Leptospirosis is a common disease in tropical regions around the world. It is caused by a bacteria excreted in environmental waters by mammals, especially rodents, through their urine. Leptospirosis has symptoms similar to other tropical diseases, including dengue fever, and early laboratory diagnosis is crucial to provide both appropriate treatments for patients and rapid control measures when an outbreak occurs. In 2011, we undertook a study to determine the incidence of leptospirosis in two territories (Guadeloupe and Martinique) in the French West Indies by establishing a surveillance network and implementing new diagnostic assays in order to ensure an exhaustive diagnostic analysis. We concluded that leptospirosis was previously significantly under-reported in the French West Indies and we recommended: 1- access to these new diagnostic tests for the entire population for a better detection of leptospirosis patients and, 2- the implementation of an integrated surveillance, alert and prevention system for the disease in this region. Our findings had raised the awareness of this neglected disease in the French West Indies and, as another consequence; new diagnostic tests are now reimbursed by the social security insurance in France.

International audience; The Maroni basin, an isolated region delineating the border between Suriname and French Guiana has been affected by the human immunodeficiency virus (HIV) epidemic 10 years after coastal French Guiana. However, the rise in HIV prevalence was sharp, exceeding 1% within 10 years. The aim of the present study is to compare, using the first quantitative data from the general population in remote villages, the knowledge, attitudes, and behaviors regarding HIV between Maroon and Amerindian populations, the two most frequent populations living along the Maroni. Data were collected in 2012 using a structured questionnaire among a random sample of 896 individuals residing in the remote villages on the Maroni river. Proportions were compared between the Maroni and the coastal general population, and between Maroon and Amerindian populations. The present study shows significant differences between territories and between communities living on the Maroni river: the multiple sexual partnerships, more common among population living on the Maroni river, were more frequently reported in Maroons than in Amerindians. Condom use was more frequently reported among men on the Maroni river than on the coast, but these findings were reversed for women. Moreover, among people living on the Maroni river, condom use was more frequently reported among Maroons than among Amerindians. Regarding genital factors that may affect transmission, penile implant seemed to have no ethnic boundaries, steam baths seemed specific to Maroon women. The present results should help to improve community-based specific interventions.

International audience; Dengue is a public health concern across the globe, and an escalating problem in the Americas. As part of a wider programme (covering Latin America and South East Asia) to characterize the epidemiology of dengue in dengue endemic areas, we undertook a systematic literature review to assess epidemiological trends (incidence, timing and duration of outbreaks/epidemics, age and sex distribution, serotype distribution, seroprevalence and disease severity) for dengue across the French Territories of the Americas (FTA), in French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy between 2000 and 2012 (CRD42012002341: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002341). Of 413 relevant data sources identified, 45 were eligible for inclusion. A large proportion of the available data were from national surveillance reports, and 12 publications were from peer-reviewed journals. During the review period, 3-5 epidemics were identified in each of the island territories and French Guiana, and epidemics were often associated with a shift in the predominant circulating dengue virus serotype. Substantial gaps in epidemiological knowledge were identified. In particular, information regarding dengue virus genotype distribution, seroprevalence and age distribution of dengue were lacking. Additionally, much of the available data were from epidemic years; data from inter-epidemic periods were sparse. Nevertheless, the available epidemiological data showed that dengue is endemic across the FTA and suggest an evolution towards hyperendemicity, highlighting the need to continue the efforts with the existing surveillance programmes to assist in planning an effective vaccination programme once a dengue vaccine is deployed.

International audience; The Maroni basin, an isolated region which lies between Suriname and French Guiana, has been affected by the HIV epidemic 10 years after coastal French Guiana. However, the rise in HIV prevalence was sharp with a prevalence exceeding 1% within 10 years. Stigma and discrimination towards people living with HIV (PLWHIV) or "suspected to have HIV" is rampant as reported by health professionals or non-governmental organisations. The objective of this article is to present the first quantitative data from the general population of this region on stigma towards people living with HIV. Data were collected in 2012 by a structured questionnaire among a random sample of 896 individuals residing in remote villages on the Maroni River. Proportion comparisons between the Maroni sample and the sample from the general population on the coastline in 2011 were conducted. Simple and multivariate logistic regression models were used to predict stigmatising attitudes. For all situations involving PLWHIV, the proportion of negative attitudes was significantly higher on the Maroni than in coastal French Guiana (p < 0.001). Findings indicate that the different levels of knowledge, erroneous beliefs and poor situation (not having electricity in one's home; not having French health insurance) were associated with stigmatising attitudes. The present data could help both sides coordinate interventions both at the individual level by improving knowledge and at the community level to change norms in order to reduce stigma and discrimination aiming for increased impact.

Dengue is a public health concern across the globe, and an escalating problem in the Americas. As part of a wider programme (covering Latin America and South East Asia) to characterize the epidemiology of dengue in dengue endemic areas, we undertook a systematic literature review to assess epidemiological trends (incidence, timing and duration of outbreaks/epidemics, age and sex distribution, serotype distribution, seroprevalence and disease severity) for dengue across the French Territories of the Americas (FTA), in French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy between 2000 and 2012 (CRD42012002341: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42012002341). Of 413 relevant data sources identified, 45 were eligible for inclusion. A large proportion of the available data were from national surveillance reports, and 12 publications were from peer-reviewed journals. During the review period, 3–5 epidemics were identified in each of the island territories and French Guiana, and epidemics were often associated with a shift in the predominant circulating dengue virus serotype. Substantial gaps in epidemiological knowledge were identified. In particular, information regarding dengue virus genotype distribution, seroprevalence and age distribution of dengue were lacking. Additionally, much of the available data were from epidemic years; data from inter-epidemic periods were sparse. Nevertheless, the available epidemiological data showed that dengue is endemic across the FTA and suggest an evolution towards hyperendemicity, highlighting the need to continue the efforts with the existing surveillance programmes to assist in planning an effective vaccination programme once a dengue vaccine is deployed. Protocol registration PROSPERO CRD42012002341, Author Summary Dengue disease is a mosquito-borne viral illness and is a major health concern in the Americas. We conducted a literature analysis and review to describe the epidemiology of dengue in the French Territories of the Americas (FTA), comprising French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthélemy, to determine the impact of dengue on the population and to identify research priorities. We used well-defined methods to search for and identify relevant research conducted between 2000 and 2012. We identified an increase in the frequency, magnitude and severity of dengue epidemics across all the territories, an increase in the co-circulation of serotypes and the evolution to a hyperendemic state. Countries sharing geographical and environmental characteristics (e.g., Martinique and Guadeloupe, and Saint Barthélemy and Saint Martin) also shared characteristics in dengue epidemiology and its evolution, including timing of epidemics and circulating serotypes. Gaps in epidemiological knowledge provide several avenues for research, such as dengue virus genotype distribution, seroprevalence and age distribution of dengue cases. Epidemiological and virological surveillance of dengue in the FTA is evolving, and improved knowledge of the disease in these territories will improve anticipation of epidemics and aid implementation of control measures.

We applied sequential pattern extraction to identify the most important climatic factors related to dengue fever in French Guiana. Our findings suggest that the local climate has major effects on the occurrence of dengue epidemics in French Guiana and highlight the utility of the data mining approach to analyze disease surveillance data on a temporal and a spatial scale in relation to climatic, social and environmental variables. This study is a first step of a data mining project which will help to better understand and accurately predict temporal dynamics of dengue fever in French Guiana.

Objective To determine whether dengue epidemics are associated with an increase in adverse obstetrical outcomes. Methods Semi-ecological study combining individual data on obstetrical events from the perinatal registry and aggregated exposure data from the epidemiologic surveillance of dengue in Cayenne, French Guiana between 2004 and 2007. Results After adjustment for individual risk factors, analysis showed that an epidemic level of dengue transmission during the first trimester was associated with an increased risk of post-partum haemorrhage and preterm birth. The associated risks seemed to depend on the epidemic level. Conclusions Despite its limitations, this study suggests that dengue in the first trimester may be related to preterm birth and to post-partum bleeding, thus leading to specific hypotheses that should be tested in prospective studies. Objectif Determiner si les epidemies de dengue sont associees a une augmentation des resultats obstetricaux adverses. Methodes Etude semi-ecologique combinant les donnees individuelles sur les evenements obstetricaux du registre perinatal et les donnees d'exposition cumulees, provenant de la surveillance epidemiologique de la dengue a Cayenne, en Guyane francaise entre 2004 et 2007. Resultats Apres ajustement pour les facteurs de risque individuels, l'analyse a montre qu'un niveau epidemique de transmission de la dengue au cours du premier trimestre etait associe a un risque accru d'hemorragie postpartum et de prematurite. Les risques associes semblaient dependre de l'ampleur de l’epidemie. Conclusions Malgre ses limitations, la presente etude suggere que la dengue au cours du premier trimestre peut etre liee a la prematurite et a des saignements postpartum, ce qui conduit a des hypotheses specifiques qui devraient etre testees dans des etudes prospectives. Objetivo Determinar si las epidemias de dengue estan asociadas con un aumento en los resultados obstetricos adversos. Metodos Estudio semiecologico que combina datos individuales sobre eventos obstetricos desde el registro perinatal y datos agregados de exposicion de la vigilancia epidemiologica del dengue en Cayenne, Guayana Francesa entre 2004 y 2007. Resultados Despues de ajustar para factores de riesgo individuales, el analisis mostro que un nivel epidemico de transmision de dengue durante el primer trimestre estaba asociado con un aumento en el riesgo de hemorragias posparto y nacimientos prematuros. El riesgo asociado parece depender del nivel epidemico. Conclusiones A pesar de sus limitaciones, este estudio sugiere que el dengue, en el primer trimestre, podria estar relacionado con el nacimiento prematuro y el sangrado postparto, conllevando a la hipotesis especifica de que deberia evaluarse en estudios prospectivos.

Presented in part as an oral communication at the 10th Journées Nationales d’Infectiologie, Marseille, France, June 10-12, 2009.; International audience; On May 27, 2008, a patient died from rabies at the Cayenne Hospital in French Guiana. Postexposure prophylaxis vaccination was implemented for all health care workers exposed to this patient. Examining the management of such a rare risk reveals important factors in the education of personnel who may have contact with a patient with rabies, to permit appropriate risk assessment and reduce unnecessary postexposure prophylaxis, taking into account the risks and costs of adverse events.

International audience; Malaria is endemic in French Guiana. Plasmodium falciparum and Plasmodium vivax are the predominant species responsible and Anopheles darlingi is described as the major vector. In mid-August 2008, an increase in malaria incidence was observed in Saül. A retrospective cohort survey was performed. In vitro susceptibility profiles to antimalarials were determined on P. falciparum isolates. Collections of mosquitoes were organized. The malaria attack rate reached 70.6/100. The risk of malaria increased for people between 40 and 49 years of age, living in a house not subjected to a recent indoor residual insecticide spraying or staying overnight in the surrounding forest. All isolates were susceptible. Anopheles darlingi females and larvae were collected in the village suggesting a local transmission. Our results strongly support a role of illegal mining activities in the emergence of new foci of malaria. Therefore, public health authorities should define policies to fight malaria at a transborder level.

Background Until 2008, human rabies had never been reported in French Guiana. On 28 May 2008, the French National Reference Center for Rabies (Institut Pasteur, Paris) confirmed the rabies diagnosis, based on hemi-nested polymerase chain reaction on skin biopsy and saliva specimens from a Guianan, who had never travelled overseas and died in Cayenne after presenting clinically typical meningoencephalitis. Methodology/Principal Findings Molecular typing of the virus identified a Lyssavirus (Rabies virus species), closely related to those circulating in hematophagous bats (mainly Desmodus rotundus) in Latin America. A multidisciplinary Crisis Unit was activated. Its objectives were to implement an epidemiological investigation and a veterinary survey, to provide control measures and establish a communications program. The origin of the contamination was not formally established, but was probably linked to a bat bite based on the virus type isolated. After confirming exposure of 90 persons, they were vaccinated against rabies: 42 from the case's entourage and 48 healthcare workers. To handle that emergence and the local population's increased demand to be vaccinated, a specific communications program was established using several media: television, newspaper, radio. Conclusion/Significance This episode, occurring in the context of a Department far from continental France, strongly affected the local population, healthcare workers and authorities, and the management team faced intense pressure. This observation confirms that the risk of contracting rabies in French Guiana is real, with consequences for population educational program, control measures, medical diagnosis and post-exposure prophylaxis., Author Summary Until 2008, rabies had never been described within the French Guianan human population. Emergence of the first case in May 2008 in this French Overseas Department represented a public health event that markedly affected the local population, healthcare workers and public health authorities. The antirabies clinic of French Guiana, located at Institut Pasteur de la Guyane, had to reorganize its functioning to handle the dramatically increased demand for vaccination. A rigorous epidemiological investigation and a veterinary study were conducted to identify the contamination source, probably linked to a bat bite, and the exposed population. Communication was a key factor to controlling this episode and changing the local perception of this formerly neglected disease. Because similar clinical cases had previously been described, without having been diagnosed, medical practices must be adapted and the rabies virus should be sought more systematically in similarly presenting cases. Sharing this experience could be useful for other countries that might someday have to manage such an emergence.

The epidemiology of dengue fever in French Guiana is marked by a combination of permanent transmission of the virus in the whole country and the occurrence of regular epidemics. Since 2006, a multi data source surveillance system was implemented to monitor dengue fever patterns, to improve early detection of outbreaks and to allow a better provision of information to health authorities, in order to guide and evaluate prevention activities and control measures. This report illustrates the validity and the performances of the system. We describe the experience gained by such a surveillance system and outline remaining challenges. Future works will consist in the use of other data sources such as environmental factors in order to improve knowledge on virus transmission mechanisms and determine how to use them for outbreaks prediction.

Chlordecone is an organochlorine insecticide used until 1993 in the banana plantations of the French Antilles. Recent surveys revealed its wide presence in the environment. This current paper focuses on the impact of different management options on the Martinican population’s food exposure, taking into account that an appreciable part of the food consumed in Martinique corresponds to subsistence production. Food exposure is assessed through deterministic models. Consumption data derive from the ESCAL Survey on 1814 subjects aged 3 and over. Residues data come from the Monitoring Programs 2002–2004. Different scenarios are studied depending on whether the subjects live on a soil-contaminated place or not and on their supply habits. The impact of various maximum limits is then analysed. The probability of exceeding the chronic health-based guidance value (CHGV) of 0.5 μg/kg bw/day is, respectively, 20.9% (CI 95th [6.2; 34.4]) and 15.6% (CI 95th [9.6; 20.8]) for children and adults living in a soil-contaminated area and null for the remaining population. MLs below 300 μg/kg fw would reduce significantly the exposure but the probability of exceeding the CHGV remains statistically different from zero when only commercialised products are taken into account. This study shows the supply habits may have significant impacts on food exposure to contaminants. It reveals that setting MLs, which can only be controlled on commercialised products, is not enough in such situations. Other management options like consumption recommendations for self-produced foodstuffs are necessary to protect the Martinican consumer.

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National audience

Introduction Malaria is a notifiable disease in all European Union and European Economic Area countries except Belgium and France, where only autochthonous malaria is notifiable. Although morbidity caused by malaria has been assessed, little is known about mortality incidence. Objective Our aim was to estimate the number of imported malaria-related deaths in hospital in metropolitan France. Methods We matched individual deaths reported between 1 January 2005 and 31 December 2014 to the French National Reference Centre for malaria (FNRCm) with malaria-related deaths from two other sources: the French National Registry on medical causes of death and the French national hospital discharge database. A capture–recapture method with log-linear modelling was used. Age, sex and place of death stratification were applied to remove heterogeneity. Results The estimated malaria-related deaths in metropolitan France during the study period were 205 (95% confidence interval (CI): 191–219). The annual mean number of malaria-related deaths was estimated at 21 (95% CI: 19–22). The FNRCm malaria-related deaths surveillance had a 38% sensitivity (95% CI: 32–44). Among 161 in-hospital individual malaria-related deaths reported from three data sources, the sex ratio (male to female) was 2.6. Median age of the patients was 57 years, ranging from 1 to 89 years. Conclusion The pertinent finding of this report is that malaria-related death records were significantly less* complete than case records. Therefore, data comparison of imported malaria morbidity and mortality between countries should imperatively be assessed using standard indicators weighted according to the completeness of health surveillance systems.

French Guiana is located on the South American continent and is subject to a high epidemic potential, particularly of arboviral diseases. After a decade of hyper-endemic dengue fever until 2013, successive emergences of chikungunya and zika virus occurred between 2014 and 2016. French Guiana has adopted an integrated vector control and surveillance system, relying on population’s adherence. In the mean time, studies led at the Pasteur Institute of Cayenne revealed that (1) individual protective behaviours largely depend on risk perception, (2) this perception evolve during the epidemic process. In our over-mediatized "risk society", with media and social networks playing an increasing role as information transmitters, we may wonder how media coverage evolves during epidemics. In this report, we investigated media coverage of the recent chikungunya and zika outbreaks in French Guyana. Among websites and social networks (Facebook and Twitter) pages of eight general media outlets and four health authority agencies, we retrospectively collected all publications containing the keywords “chikungunya” and “zika” between June 2013 and March 2017 (N = 1730). The analysis of publications’ numbers compared to characteristic epidemic phases or events revealed that communication on outbreaks was mostly carried out at the very beginning ofthe outbreak and quickly dropped before the epidemic reached its peak. The notion of risk was identified as a determinant of communication, and our results raised implications for communication by health authorities during outbreak., La Guyane est un département français d’Amérique soumis à un fort potentiel épidémique, notamment en ce qui concerne les arboviroses. De fait, après une décennie d’hyper-endémicité de dengue jusque 2013, elle a du faire face à l’émergence successive d’une épidémie de chikungunya puis de zika entre 2014 et 2016. La Guyane s’est dotée d’un dispositif intégré de surveillance et de lutte anti vectorielle, adapté à sa situation et reposant sur l’adhésion des populations. Parallèlement, l’Institut Pasteur de Cayenne a mené des études révélant que les comportements de protection des individus étaient en grande partie basés sur la perception du risque, et que cette perception évoluait au cours du processus épidémique. Or dans une « société du risque4 » surmédiatisée, où les médias et les réseaux sociaux jouent un rôle grandissant de transmetteurs d’informations, il semble opportun de se demander comment la couverture médiatique évolue au cours des phénomènes épidémiques. Dans ce rapport, nous avons étudié la couverture médiatique des épidémies du chikungunya et de zika survenues en Guyane. A partir des sites web et des comptes sur les réseaux sociaux (Facebook et Twitter) de huit médias généralistes et de quatre autorités de santé, nous avons collecté rétrospectivement l’ensemble des publications comportant les mots-clés « chikungunya » et « zika » entre juin 2013 et mars 2017 (N = 1730). L’analyse comparative du nombre de publications par rapport aux phases ou événements épidémiques caractéristiques a mis en évidence que la communication sur les épidémies auprès du grand public était majoritairement réalisée en début d’épidémie, mais qu’elle diminuait très rapidement et avant même que le pic soit atteint. La notion du risque a été identifiée comme un déterminant de la communication en période d’émergence épidémique, et des implications possibles en matière de communication de la part des autorités en période épidémique ont été suggérées.

International audience; OBJECTIVE: To describe the methodology used for implementing a surveillance system specifically for influenza A(H1N1)pdm09 in the French West Indies and French Guiana during an outbreak of this new virus in 2009-2010, and to report its main results. METHODS: This was an observational descriptive study of confirmed and probable cases of influenza A(H1N1)pdm09 hospitalized for at least 24 hours in 23 July 2009-3 March 2010. Reverse transcription polymerase chain reaction was performed on nasopharyngeal swab samples according to the Centers for Disease Control and Prevention protocol. A probable case was defined as fever > 38ºC or aches or asthenia with respiratory symptoms (cough or dyspnea). All confirmed and probable hospitalized cases were reported, along with patient's age, sex, clinical condition at admission, place and length of hospitalization, antiviral treatment, underlying conditions, complications, and clinical evolution. A case was classified as severe if respiratory assistance or intensive care was required or if death resulted. RESULTS: A total of 331 confirmed and 16 probable cases were hospitalized, with a hospitalization rate ranging from 4.3 per 1 000 clinical cases in Saint Martin to 10.3 in French Guiana. Of these, 36 were severe, and subsequently, 10 were fatal. The median length of stay was 4 days for non-severe cases and 9 days for severe (P < 0.05). The mean patient age was 21 years, and severe cases were significantly older than non-severe (mean: 38 years versus 19 years, P < 0.05). Underlying conditions associated with a higher risk of severity were 65 years of age or more (RR = 7.5, 95%CI = 4.2-13.3), diabetes (RR = 3.7, 95%CI = 1.5-9.4), cardiac insufficiency (RR = 8.4, 95%CI = 5.2-13.6), and morbid obesity (RR = 4.4, 95%CI = 1.8-10.4). Patients who received antiviral treatment within 2 days of symptom onset had shorter hospital stays (mean: 4 days versus 6.5 days, P < 0.05), and the illness tended to become less severe (11.1% versus 19.0%, P = 0.13). CONCLUSIONS: Active research of hospitalized cases enabled almost exhaustive surveillance. The pandemic's hospitalization rates and lethality were more moderate than expected. Some previously known underlying conditions of severity were confirmed during this outbreak. Furthermore, these results show the validity of early antiviral treatment.