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Background In malaria endemic areas, identifying spatio-temporal hotspots is becoming an important element of innovative control strategies targeting transmission bottlenecks. The aim of this work was to describe the spatio-temporal variation of malaria hotspots in central Senegal and to identify the meteorological, environmental, and preventive factors that influence this variation. Methods This study analysed the weekly incidence of malaria cases recorded from 2008 to 2012 in 575 villages of central Senegal (total population approximately 500,000) as part of a trial of seasonal malaria chemoprevention (SMC). Data on weekly rainfall and annual vegetation types were obtained for each village through remote sensing. The time series of weekly malaria incidence for the entire study area was divided into periods of high and low transmission using change-point analysis. Malaria hotspots were detected during each transmission period with the SaTScan method. The effects of rainfall, vegetation type, and SMC intervention on the spatio-temporal variation of malaria hotspots were assessed using a General Additive Mixed Model. Results The malaria incidence for the entire area varied between 0 and 115.34 cases/100,000 person weeks during the study period. During high transmission periods, the cumulative malaria incidence rate varied between 7.53 and 38.1 cases/100,000 person-weeks, and the number of hotspot villages varied between 62 and 147. During low transmission periods, the cumulative malaria incidence rate varied between 0.83 and 2.73 cases/100,000 person-weeks, and the number of hotspot villages varied between 10 and 43. Villages with SMC were less likely to be hotspots (OR = 0.48, IC95%: 0.33–0.68). The association between rainfall and hotspot status was non-linear and depended on both vegetation type and amount of rainfall. The association between village location in the study area and hotspot status was also shown. Conclusion In our study, malaria hotspots varied over space and time according to a combination of meteorological, environmental, and preventive factors. By taking into consideration the environmental and meteorological characteristics common to all hotspots, monitoring of these factors could lead targeted public health interventions at the local level. Moreover, spatial hotspots and foci of malaria persisting during LTPs need to be further addressed. Trial registration The data used in this work were obtained from a clinical trial registered on July 10, 2008 at www.clinicaltrials.gov under NCT00712374.

Background In the context of environmentally influenced communicable diseases, proximity to environmental sources results in spatial heterogeneity of risk, which is sometimes difficult to measure in the field. Most prevention trials use randomization to achieve comparability between groups, thus failing to account for heterogeneity. This study aimed to determine under what conditions spatial heterogeneity biases the results of randomized prevention trials, and to compare different approaches to modeling this heterogeneity. Methods Using the example of a malaria prevention trial, simulations were performed to quantify the impact of spatial heterogeneity and to compare different models. Simulated scenarios combined variation in baseline risk, a continuous protective factor (age), a non-related factor (sex), and a binary protective factor (preventive treatment). Simulated spatial heterogeneity scenarios combined variation in breeding site density and effect, location, and population density. The performances of the following five statistical models were assessed: a non-spatial Cox Proportional Hazard (Cox-PH) model and four models accounting for spatial heterogeneity—i.e., a Data-Generating Model, a Generalized Additive Model (GAM), and two Stochastic Partial Differential Equation (SPDE) models, one modeling survival time and the other the number of events. Using a Bayesian approach, we estimated the SPDE models with an Integrated Nested Laplace Approximation algorithm. For each factor (age, sex, treatment), model performances were assessed by quantifying parameter estimation biases, mean square errors, confidence interval coverage rates (CRs), and significance rates. The four models were applied to data from a malaria transmission blocking vaccine candidate. Results The level of baseline risk did not affect our estimates. However, with a high breeding site density and a strong breeding site effect, the Cox-PH and GAM models underestimated the age and treatment effects (but not the sex effect) with a low CR. When population density was low, the Cox-SPDE model slightly overestimated the effect of related factors (age, treatment). The two SPDE models corrected the impact of spatial heterogeneity, thus providing the best estimates. Conclusion Our results show that when spatial heterogeneity is important but not measured, randomization alone cannot achieve comparability between groups. In such cases, prevention trials should model spatial heterogeneity with an adapted method. Trial registration The dataset used for the application example was extracted from Vaccine Trial #NCT02334462 (ClinicalTrials.gov registry). Electronic supplementary material The online version of this article (10.1186/s12874-019-0759-z) contains supplementary material, which is available to authorized users.

Background In October 2010, Haiti was struck by a large-scale cholera epidemic. The Haitian government, UNICEF and other international partners launched an unprecedented nationwide alert-response strategy in July 2013. Coordinated NGOs recruited local rapid response mobile teams to conduct case-area targeted interventions (CATIs), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. An innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. Our study aimed to describe and evaluate the exhaustiveness, intensity and quality of the CATIs in response to cholera alerts in Haiti between July 2013 and June 2017. Methodology/principal findings We analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified CATIs. The odds of CATI response during the same week (exhaustiveness) and the number of complete CATIs in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. CATIs were carried out significantly more often in response to red alerts (adjusted odds ratio (aOR) [95%-confidence interval, 95%-CI], 2.52 [2.22–2.87]) compared with orange alerts. Significantly more complete CATIs were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (aIR), 1.85 [1.73–1.99]). Over the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (aOR, 1.43 [1.38–1.48] per semester) as well as the intensity and quality (aIR, 1.23 [1.2–1.25] per semester) of CATI responses, independently of funds available for the strategy. The odds of launching a CATI response significantly decreased with increased rainfall (aOR, 0.99 [0.97–1] per each accumulated cm). Response interventions were significantly heterogeneous between NGOs, communes and departments. Conclusions/significance The implementation of a nationwide case-area targeted rapid response strategy to control cholera in Haiti was feasible albeit with certain obstacles. Such feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in Haiti and in other affected countries., Author summary Cholera is a potentially deadly diarrheal disease caused by toxin-secreting strains of Vibrio cholerae. The bacterium can trigger severe epidemics in countries with limited access to potable water and sanitation. Hygiene promotion, proper sanitation and improved access to safe drinking water are essential to control cholera. However, very few reports have described and evaluated the implementation of such activities in the field. Since October 2010, Haiti has been affected by one of the most severe cholera epidemics of the past few decades. In this report, we describe and evaluate the implementation of the original nationwide case-area targeted interventions (CATIs) response strategy, which was launched in July 2013 after years of insufficient response coordination and diminishing efforts to control cholera outbreaks in affected communities. Rapid implementation of education sessions, household decontamination, soap distribution and water chlorination in affected communities proved challenging but possible, even in a mountainous and decentralized country such as Haiti with tens of thousands of suspected cholera cases per year. Evaluation of the impact of the CATI-based strategy on the cholera epidemic is underway. Together with other components of a multi-sectoral approach, this rapid response strategy appears to be critical to eventually eliminate cholera in Haiti.

Cholera has affected Haiti with damping waves of outbreaks since October 2010. However, mechanisms behind disease persistence during lull periods remain poorly understood. By mid 2014, cholera transmission seemed to only persist in the northern part of Haiti. Meanwhile, cholera appeared nearly extinct in the capital, Port-au-Prince, where it eventually exploded in September 2014. This study aimed to determine whether this outbreak was caused by local undetected cases or by re-importation of the disease from the north. Applying an integrated approach between November 2013 and November 2014, we assessed the temporal and spatial dynamics of cholera using routine surveillance data and performed population genetics analyses of 178 Vibrio cholerae O1 clinical isolates. The results suggest that the northern part of the country exhibited a persisting metapopulation pattern with roaming oligoclonal outbreaks that could not be effectively controlled. Conversely, undetected and unaddressed autochthonous low-grade transmission persisted in the Port-au-Prince area, which may have been the source of the acute outbreak in late-2014. Cholera genotyping is a simple but powerful tool to adapt control strategies based on epidemic specificities. In Haiti, these data have already yielded significant progress in cholera surveillance, which is a key component of the strategy to eventually eliminate cholera.

SummaryThe aim of the present study was to develop a method for multiscale analysis of non-stationary and non-periodic epidemic time series. Indeed, the epidemiologists may need to know the features, at different resolutions, of short duration outbreaks that did not exhibit periodic cycles. Among of the large number of wavelets, we have developed a continuous wavelet that shows an analogous shape to the Haar wavelet, and leads to precise time localization. We applied the wavelet transform to the cholera epidemic, which began in October 2010 in Haiti. We determined the wavelet spectra of both the cholera case toll and rainfall time series, from September 01, 2010, to November 20, 2012 (812 days). The relationship between case toll and rainfall was analyzed using cross-wavelet spectra at different lags. Cholera case toll scalogram highlighted four epidemic bursts. Cross-wavelet analysis highlighted an absence of relationship between the first epidemic burst and rainfall, but a clear relationship between the following epidemic bursts and rainfall after a 3 to 8 day lag.

International audience; Allergic fungal sinusitis (AFS) is a subgroup within noninvasive fungal chronic rhinosinusites. Its paraclinical diagnosis is based on a « gold standard »: rhinosinusitis evolving for at least 12 weeks or persisting on CT scan, allergic mucin seen during surgery, identification of Charcot‐Leyden crystals or eosinophils aggregates in pathology, fungal hyphae on direct examination or culture.Our objective was to search for clinical, radiological, biological, immunological and mycological criteria permitting AFS preoperative diagnosis, within a population operated on for CRS.

SummaryThe aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case–control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of odd-ratio exceeding one (Pr) >85% or

With limited resources and spatio-temporal heterogeneity of malaria in developing countries, it is still difficult to assess the real impact of socioeconomic and environmental factors in order to set up targeted campaigns against malaria at an accurate scale. Our goal was to detect malaria hotspots in rural area and assess the extent to which household socioeconomic status and meteorological recordings may explain the occurrence and evolution of these hotspots., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction L’objectif de cet essai clinique randomise etait de determiner si l’utilisation d’imagerie peroperatoire par autofluorescence (AF) pendant la thyroidectomie totale (TT) pouvaient ameliorer la preservation et ameliorer la fonction postoperatoire des parathyroides. Methode Au total, 245 patients (sur 529 eligibles) ont ete randomises, de septembre 2016 a octobre 2018, dans trois hopitaux francais, pour avoir soit une TT assistee par AF (TT + AF) soit une TT classique (controle). Les patients porteurs de pathologie parathyroidiennes preexistantes ont ete exclus. L’objectif principal etait le taux d’hypocalcemie postoperatoire (calcium corrige Resultats Dans l’ensemble, 241 patients ont ete analyses (âge moyen de 53,6 ans (DS 13,6 ans) ; 79,3 % de femmes) : 121 dans le groupe TT + AF et 120 dans le groupe controle. Le taux d’hypocalcemie postoperatoire transitoire etait de 9 % dans le groupe TT + AF et de 22 % dans le groupe controle (p = 0,0068). Il n’y a pas eu de difference significative pour l’hypocalcemie permanente : 0 % (groupe TT + AF) contre 1,6 % (groupe controle). Moins de patients ont eu une autotransplantation parathyroidienne dans le groupe TT + AF que dans le groupe controle : respectivement 4 (3,3 %) contre 16 (13,3 %, p = 0,009). La resection parathyroidienne par inadvertance etait significativement moindre dans le groupe TT + AF que dans le groupe controle : respectivement 3 (2,5 %) contre14 (11,7 %), p = 0,006. Conclusions L’utilisation de l’AF pour l’identification parathyroidienne pendant la thyroidectomie peut permettre d’ameliorer la preservation des parathyroides et de leur fonction postoperatoire.

Introduction Dans les zones ou le paludisme est endemique, l’identification des hotspots spatio-temporels est devenue un element important des strategies de lutte ciblee. Cependant peu d’etudes se sont interessees aux caracteristiques de leur variation spatio-temporelle. L’objectif de ce travail etait de decrire la variation spatio-temporelle des hotspots du paludisme et d’identifier les facteurs meteorologiques, environnementaux et preventifs associes a cette variation. Methodes Cette etude a ete realisee sur 575 villages (environ 500 000 habitants) au Centre-Ouest du Senegal de janvier 2008 a decembre 2012. Cette zone a ete l’objet d’un essai clinique sur la chimio-prevention saisonniere (CPS) du paludisme. Les taux d’incidence hebdomadaire de chaque village ont ete determines en rapportant les cas de paludisme cliniques confirmes par test de diagnostic rapide issus de cet essai clinique aux populations annuelles. Les cumuls hebdomadaires des precipitations et le type de vegetation annuel ont ete obtenus pour chaque village a partir de la teledetection. La serie temporelle de l’incidence hebdomadaire du paludisme de l’ensemble de la zone d’etude a ete divisee en periodes de transmission avec la methode d’identification des points de changement (« Change point analysis »). Ensuite les villages hotspots de paludisme ont ete detectes pour chaque periode de transmission avec la methode de balayage de Kulldorf (SaTScan). Pour finir, les effets des precipitations, du type de vegetation et de l’intervention de la CPS sur la variation spatio-temporelle des hotspots entre les periodes de transmission du paludisme ont ete evalues a l’aide d’un modele additif generalise mixte (GAMM). Resultats Le taux d’incidence hebdomadaire de la zone d’etude variait entre 0 et 115 cas/100 000 personne-semaines. L’analyse a donne cinq periodes de basse transmission (LTP) et cinq periodes de haute transmission (HTP). Durant les periodes de haute transmission l’incidence variait entre 7,5 et 38 cas/100 000 personne-semaines et le nombre de villages hotspots entre 62 et 147, tandis que celle des periodes de basse transmission etait entre 0,8 et 2,7, et le nombre de villages hotspots entre 10 et 43. L’analyse a montre aussi que la CPS du paludisme diminuait le risque hotspots d’un village (OR = 0,48, IC95 % : 0,33–0,68). L’analyse a mis en exergue que l’effet de la pluie sur le risque hotspot d’un village dependait du type de vegetation. Un seuil a partir duquel la pluie devenait un facteur de risque a ete mis en evidence selon chaque type de vegetation. Pour finir, le risque hotspot dependant de la localisation geographique des villages sur l’ensemble de la periode etudiee a ete estime. Conclusion Dans notre etude, les villages hotspots du paludisme variaient dans l’espace et dans le temps en fonction d’une combinaison de facteurs meteorologiques, environnementaux et preventifs. La CPS etait un facteur protecteur et la pluie un facteur de risque a partir d’un seuil dependant du type de vegetation. Cette etude a montre l’importance de comprendre la dynamique du paludisme a travers de petites echelles spatiales (villages, postes de sante, etc.) et d’adapter les strategies de luttes dans un contexte epidemiologique local.

Introduction En Amazonie, Plasmodium vivax (Pv) est devenu l’espece majoritaire des infections palustres. Il est essentiel de bien comprendre les profils epidemiologiques de ces infections, reviviscences et recurrences afin de mieux guider les programmes de controle. L’objectif de ce travail est de decrire les facteurs de risque d’infection a Pv et leurs profils de reviviscences. Materiels et methodes Une cohorte de 1566 habitants de 13 des 16 quartiers de Saint Georges de l’Oyapock, commune situe sur la frontiere avec le Bresil, a ete suivie sur plus de 10 ans (2007–2018). Les cas symptomatiques d’infection ont ete detectes par Test de Diagnostic Rapide et/ou Frottis Goutte Epaisse. Les infections recurrentes a Pv ont ete definies comme un test positif survenu apres 90 jours au moins apres un test diagnostique et un traitement antipaludeen. Afin de discriminer les reviviscences probables, celles-ci ete definies comme un test positif survenu dans les 7 jours apres un test et un traitement a Pv et avant 90 jours d’une nouvelle infection, selon les resultats d’un travail deja realise et publie sur cette zone. Une regression logistique a ete faite afin de connaitre les facteurs associes aux infections a Pv. Des courbes de Kaplan–Meir ont ete realisees afin de determiner les intervalles des reviviscences par groupe d’âge. Resultats Sur la periode d’etude, l’incidence cumulee de nouvelles infections palustre etait de 36,3 % (n = 569/1566, dont 443 Pv et 126 infections a Plasmodium falciparum-Pf-) sur un total de 335 personnes. Dans 7,9 % des cas les infections etaient recurrentes (n = 123, 106 Pv, 24 Pf et 7 infections mixtes Pv/Pf) et dans 6,4 % (n = 101) il existait des reviviscences a Pv. Les facteurs associes aux infections a Pv en analyse multivariee etaient le fait d’appartenir a une ethnie amerindienne, un nombre eleve d’habitants dans le meme foyer et le haut niveau scolaire. L’intervalle moyen entre la premiere infection et la premiere reviviscence etait de 39,7 jours [36,7–42,7]. Cet intervalle augmentait significativement avec le nombre de reviviscences (p Conclusion Les personnes presentant des infections recurrentes et des reviviscences jouent un role important dans le maintien de la transmission de paludisme. L’acces et la delivrance rapide de traitement par primaquine notamment chez les enfants et les amerindiens doit etre centrale dans les programmes de controle du paludisme a Pv en Guyane afin d’en reduire la dynamique de transmission.

International audience; We read the article entitled "Effect of Artemisia annua and Artemisia afra tea infusions on schistosomiasis in a large clinical trial" by Munyangi et al. with great interest. This trial was presumably designed as a phase III clinical trial with a randomized, controlled, double-blind study that aimed to demonstrate the superiority of A. annua and A. afra plant-based infusions over praziquantel for the treatment of schistoso-miasis. We would like to offer a critical analysis of this trial, as we believe there are several crucial issues regarding its scientific background, design , and statistical methods. These concerns question the scientific validity of the results while raising critical issues regarding ethical aspects. At first, backgrounds should be précised. We agree with the authors that the use of artemisinin-based combination therapies is a promising alternative for treating schistosomiasis as already suggested in a meta-analysis of 24 randomized trials where the cure rate of oral artesunate (alone or combined with various anti-parasitic agents) was compared with that of praziquantel for schistosomiasis (Villar et al., 2012). Nevertheless, in a sub-analysis of this meta-analysis, artesunate alone (4 mg/kg/day for 3 days) was clearly less effective than praziquantel (40 mg/kg once) (odds ratio = 0.27, 95% confidence interval (CI): 0.13-0.53). The crude cure rates were 33% and 61.5% in the artesunate and praziquantel groups, respectively. On another hand, artemisinin derivatives are reportedly efficient against the juvenile form of the parasite (schistosomulae), but not against adults or eggs as reported in experimental models (Sabah et al., 1986). This may explain the pro-phylactic effect of artemisinin derivatives on the disease, but the effect on adults or eggs is less convincing. Indeed, the efficacy of artemether on worm reduction was above 70% for schistosomulae aged 14-28 days, but decreased for older parasites. Taken together these experimental and clinical data do not seem sufficient to support such an approach. Moreover A. afra does not contain significant artemisinin, and A. annua contains a very low and variable level of this molecule as detailed by the authors in their article. Thus, the use of an Artemisia-based infusion in a phase III clinical trial does not seem to be supported by sufficient data to be considered as a valid alternative to praziquantel. Secondly, regarding the study protocol, the motivations for the exclusion criteria are unclear. Patients over 60 years-old and pregnant women were excluded. The authors did include school-aged children over the age of six years but did not explain how Artemisia infusion was given. Did the children receive the same treatment as the adults? Was the quantity of the infusion reduced? Praziquantel was prescribed at an unusual dosage of 60 mg/kg/day for 3 days. Most guidelines, including those from the WHO, recommend 40 mg/kg in a single dose, even for preschool-aged children (Colley et al., 2014; Coulibaly et al., 2017).

IntroductionIn many studies, covariates are not always fully observed because of missing data process. Usually, subjects with missing data are excluded from the analysis but the number of covariates can be greater than the size of the sample when the number of removed subjects is high. Subjective selection or imputation procedures are used but this leads to biased or powerless models.The aim of our study was to develop a method based on the selection of the nearest covariate to the centroid of a homogeneous cluster of covariates. We applied this method to a forensic medicine data set to estimate the age of aborted fetuses.AnalysisMethodsWe measured 46 biometric covariates on 50 aborted fetuses. But the covariates were complete for only 18 fetuses.First, to obtain homogeneous clusters of covariates we used a hierarchical cluster analysis.Second, for each obtained cluster we selected the nearest covariate to the centroid of the cluster, maximizing the sum of correlations (the centroid criterion).Third, with the covariate selected this way, the sample size was sufficient to compute a classical linear regression model.We have shown the almost sure convergence of the centroid criterion and simulations were performed to build its empirical distribution.We compared our method to a subjective deletion method, two simple imputation methods and to the multiple imputation method.ResultsThe hierarchical cluster analysis built 2 clusters of covariates and 6 remaining covariates. After the selection of the nearest covariate to the centroid of each cluster, we computed a stepwise linear regression model. The model was adequate (R2=90.02%) and the cross-validation showed low prediction errors (2.23 10−3).The empirical distribution of the criterion provided empirical mean (31.91) and median (32.07) close to the theoretical value (32.03).The comparisons showed that deletion and simple imputation methods provided models of inferior quality than the multiple imputation method and the centroid method.ConclusionWhen the number of continuous covariates is greater than the sample size because of missing process, the usual procedures are biased. Our selection procedure based on the centroid criterion is a valid alternative to compose a set of predictors.

BackgroundIn central Senegal malaria incidences have declined in recent years in response to scaling-up of control measures, but now remains stable, making elimination improbable. Additional control measures are needed to reduce transmission.MethodsBy using a meta-population mathematical model, we evaluated chemotherapy interventions targeting stable malaria hotspots, using a differential equation framework and incorporating human mobility, and fitted to weekly malaria incidences from 45 villages, over 5 years. Three simulated approaches for selecting intervention targets were compared: a) villages with at least one malaria case during the low transmission season of the previous year; b) villages ranked highest in terms of incidence during the high transmission season of the previous year; c) villages ranked based on the degree of connectivity with adjacent populations.ResultsOur mathematical modeling, taking into account human mobility, showed that the intervention strategies targeting hotspots should be effective in reducing malaria incidence in both treated and untreated areas.ConclusionsMathematical simulations showed that targeted interventions allow increasing malaria elimination potential.

Summary Background Potentially untreatable Plasmodium falciparum malaria threatens the Greater Mekong subregion. A previous series of pilot projects in Myanmar, Laos, Cambodia, and Vietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the reservoir of P falciparum and interrupts transmission. We examined the effects of a scaled-up programme of this strategy in four townships of eastern Myanmar on the incidence of P falciparum malaria. Methods The programme was implemented in the four townships of Myawaddy, Kawkareik, Hlaingbwe, and Hpapun in Kayin state, Myanmar. Increased access to early diagnosis and treatment of malaria was provided to all villages through community-based malaria posts equipped with rapid diagnostic tests, and treatment with artemether–lumefantrine plus single low-dose primaquine. Villages were identified as malarial hotspots (operationally defined as >40% malaria, of which 20% was P falciparum ) with surveys using ultrasensitive quantitative PCR either randomly or targeted at villages where the incidence of clinical cases of P falciparum malaria remained high (ie, >100 cases per 1000 individuals per year) despite a functioning malaria post. During each survey, a 2 mL sample of venous blood was obtained from randomly selected adults. Hotspots received targeted mass drug administration with dihydroartemisinin–piperaquine plus single-dose primaquine once per month for 3 consecutive months in addition to the malaria posts. The main outcome was the change in village incidence of clinical P falciparum malaria, quantified using a multivariate, generalised, additive multilevel model. Malaria prevalence was measured in the hotspots 12 months after mass drug administration. Findings Between May 1, 2014, and April 30, 2017, 1222 malarial posts were opened, providing early diagnosis and treatment to an estimated 365 000 individuals. Incidence of P falciparum malaria decreased by 60 to 98% in the four townships. 272 prevalence surveys were undertaken and 69 hotspot villages were identified. By April 2017, 50 hotspots were treated with mass drug administration. Hotspot villages had a three times higher incidence of P falciparum at malarial posts than neighbouring villages (adjusted incidence rate ratio [IRR] 2·7, 95% CI 1·8–4·4). Early diagnosis and treatment was associated with a significant decrease in P falciparum incidence in hotspots (IRR 0·82, 95% CI 0·76–0·88 per quarter) and in other villages (0·75, 0·73–0·78 per quarter). Mass drug administration was associated with a five-times decrease in P falciparum incidence within hotspot villages (IRR 0·19, 95% CI 0·13–0·26). By April, 2017, 965 villages (79%) of 1222 corresponding to 104 village tracts were free from P falciparum malaria for at least 6 months. The prevalence of wild-type genotype for K13 molecular markers of artemisinin resistance was stable over the three years (39%; 249/631). Interpretation Providing early diagnosis and effective treatment substantially decreased village-level incidence of artemisinin-resistant P falciparum malaria in hard-to-reach, politically sensitive regions of eastern Myanmar. Targeted mass drug administration significantly reduced malaria incidence in hotspots. If these activities could proceed in all contiguous endemic areas in addition to standard control programmes already implemented, there is a possibility of subnational elimination of P falciparum . Funding The Bill & Melinda Gates Foundation, the Regional Artemisinin Initiative (Global Fund against AIDS, Tuberculosis and Malaria), and the Wellcome Trust.

Introduction Le rapport hebdomadaire de surveillance epidemiologique du Burkina Faso agrege les donnees de 11 maladies transmissibles, ainsi que les donnees de deces maternels et neonataux. Initialement papier, il a ete informatise sous forme d’un formulaire electronique mobile capable d’alimenter directement l’entrepot de donnees national (ENDOS-BF). Ce projet denomme « initiative de Baskuy » a ete experimente dans le district sanitaire de Baskuy en 2013 et a ete etendu en 2015 a deux autres districts sanitaires du pays (Kongoussi et Gourcy). L’organisation pyramidale basee sur les missions et les entites a ete transformee en une organisation plus en reseau, axee sur le processus de partage de donnees. Nous avons realise une etude d’evaluation de cette configuration avec toutes les parties prenantes. Methode Nous avons evalue ce dispositif aupres : – des infirmiers chefs de postes de toutes les 87 structures sanitaires (SS) publiques des trois districts sanitaires (DS) ; – des medecins-chefs et des gestionnaires de donnees de ces trois districts ; – des trois gestionnaires de donnees des directions regionales de la sante (DRS) de ces DS ; – et dans trois directions centrales (DC) du ministere de la sante (MS) qui sont les utilisatrices de la plateforme. L’enquete a ete realisee de fevrier a avril 2016. L’ensemble des questions portaient sur l’utilisation du dispositif tout au long de l’annee 2015. Nous avons adopte le modele de l’outil « Tool for Assessing Level of Information » (TALI) developpe par « Health Information Systems Project » d’Afrique du Sud. Cet outil est structure en trois paliers : le fonctionnement du systeme d’information, l’analyse de l’information, et l’utilisation de l’information. Nous avons adopte les etapes d’evaluation des systemes d’information medicale utilisees par Ann Fruhling et Stacie Petter. Une echelle de Likert a sept options de choix a ete utilisee pour la majorite des items du questionnaire. Une question ouverte de satisfaction cloturait les items de chaque palier. Resultats Pour le fonctionnement correct du dispositif, il y avait « rarement » ou « jamais » : une transmission des donnees en dehors des delais ; un defaut de couverture du reseau ; une transmission incomplete des donnees ; ou une absence de transmission de donnees dans une semaine. Dans 73,6 % des structures sanitaires, il y avait une absence de feedback. L’information etait souvent analysee et discutee au niveau des DS. Les courbes de tendances des tableaux de bord dont tous les acteurs avaient acces ont permis aux trois DRS et aux trois DC d’identifier les alertes epidemiologies de meningites et de rougeole. Les indicateurs etaient « toujours » utilises pour l’elaboration des plans d’actions au niveau des DS, mais « jamais » utilises au niveau des DRS et des trois DC. La majorite (54 %) des SS avaient souhaite un acces aux informations des autres SS a travers l’application mobile. Des formations continues avaient ete demandees par 37 % des structures. Certains agents des SS (14 %) avaient exprime un besoin d’une plus grande implication des DS, des DRS et du MS. Conclusion Les resultats de cette etude ont montre que le dispositif de surveillance par la telephonie mobile au Burkina a permis d’identifier des alertes epidemiologiques. L’insuffisance d’implication des premiers acteurs constitue un frein pour ameliorer la transmission des donnees dans les delais et le suivi du fonctionnement correct des dispositifs mobiles.

BackgroundA massive cholera epidemic struck Haiti on October 2010. As part of the national cholera elimination plan, the Haitian government, UNICEF and other international partners launched a nationwide alert-response strategy from July 2013. This strategy established a coordinated methodology to rapidly target cholera-affected communities with WaSH (water sanitation and hygiene) response interventions conducted by field mobile teams. An innovative red-orange-green alert system was established, based on routine surveillance data, to weekly monitor the epidemic.Methodology/Principal findingsWe used cholera consolidated surveillance databases, alert records and details of 31,306 response interventions notified by WaSH mobile teams to describe and assess the implementation of this approach between July 2013 and June 2017. Response to red and orange alerts was heterogeneous across the country, but significantly improved throughout the study period so that 75% of red and orange alerts were responded within the same epidemiological week during the 1st semester of 2017. Numbers of persons educated about cholera, houses decontaminated by chlorine spraying, households which received water chlorination tablets and water sources that were chlorinated during the same week as cholera alerts significantly increased. Alerts appeared to be an interesting and simple indicator to monitor the dynamic of the epidemic and assess the implementation of response activities.Conclusions/SignificanceThe implementation of a nationwide alert-response strategy against cholera in Haiti was feasible albeit with certain obstacles. Its cost was less than USD 8 million per year. Continuing this strategy seems essential to eventually defeat cholera in Haiti while ambitious long-term water and sanitation projects are conducted in vulnerable areas. It constitutes a core element of the current national plan for cholera elimination of the Haitian Government.

International audience; Biliary obstruction secondary to colorectal cancer liver metastases is associated with a poor prognosis especially when chemotherapy cannot be re-started. The aim of this study was to determine the survival after biliary drainage and the associated prognostic factors.METHODS:Patients from two French centers were included retrospectively after first biliary endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography drainage for biliary obstruction secondary to liver metastases of colorectal cancer, occurring during chemotherapy.RESULTS:The final analysis included 69 patients. Overall median survival was 115 days. In univariate analysis, a previous liver surgery, technical and functional success of drainage and restarted chemotherapy were significantly associated with an improved survival. Chemotherapy was restarted after a median of 27 days. When drainage was efficient, survival improved from 33 to 262days (p

In the present study, binocular vision properties were modeled using a single elementary wavelet. Opponent responses (ON-OFF) appeared in the first stages of the neural coding in the retina. This property was assumed to build an adequate wavelet showing a positive part (On) and a negative part (OFF). We have examined the experimental orientation and position disparity given by Bishop. We assumed that the theoretical position disparity was given by a combination of two wavelets for a given orientation disparity β. A change in β implied a change in the magnitude of one of the wavelets and consequently a change in the wavelets combination. There was a close match between the theoretical and experimental position disparity curves according to the changes in orientation disparity.

Malaria transmission is highly heterogeneous through time and space, and mapping of this heterogeneity is necessary to better understand local dynamics. New targeted policies are needed as numerous countries have placed malaria elimination on their public health agenda for 2030. In this context, developing national health information systems and collecting information at sufficiently precise scales (at least at the ‘week’ and ‘village’ scales), is of strategic importance. In a recent study, Macharia et al. relied on extensive prevalence survey data to develop malaria risk maps for Kenya, including uncertainty assessments specifically designed to support decision-making by the National Malaria Control Program. Targeting local persistent transmission or epidemiologic changes is necessary to maintain efficient control, but also to deploy sustainable elimination strategies against identified transmission bottlenecks such as the reservoir of subpatent infections. Such decision-making tools are paramount to allocate resources based on sound scientific evidence and public health priorities. Please see related article: https://malariajournal.biomedcentral.com/articles/10.1186/s12936-018-2489-9 .

Background - Case-area targeted interventions (CATIs) conducted by rapid response teams are recommended by the Global Task Force on Cholera Control (GTFCC) to contain cholera outbreaks. They may include various combinations of water, sanitation, and hygiene measures, prophylactic antibiotics, and/or oral cholera vaccine. However, their effectiveness has never been established in a real-world setting. Haiti has implemented CATIs as a national coordinated strategy against cholera since July 2013. Methods - We thus conducted a quasi-experimental study from January 2015 to December 2017 in the Centre department of Haiti. Using case and stool cultures records, together with daily CATI reports of mobile teams, we identified and characterized cholera outbreaks at the locality scale, and then studied the outcome of outbreaks according to the response promptness. First, we compared the number of cases from the 4th day of outbreak between classes of time to the first complete CATI using generalized linear mixed models. Second, we compared the duration of outbreaks using Cox models for Andersen-Gill counting process. CATI effectiveness estimates were adjusted for potential confounders. Findings - We identified 456 cholera outbreaks across 290 different localities, including 176 responded to by at least one complete CATI. Compared to a first complete CATI >7 days after outbreak onset, a first complete CATI ≤1 day reduced accumulated cases by 74% (58 to 84), and outbreak duration by 64% (42 to 78). Interpretation - These results strongly suggest that a coordinated CATI strategy was significantly effective in mitigating and shortening cholera outbreaks in Haiti. Further research is required to confirm such findings, to study the respective effectiveness of each CATI component, to economically evaluate CATI efficiency and to better position CATI with other cholera control tools in a multi-sectoral approach. Funding - United Nations Children's Fund (UNICEF)-Haiti and Assistance Publique - Hopitaux de Marseille (APHM). Declaration of Interest: Authors working for the United Nations Children's Fund, Haiti (UNICEF-Haiti): SB, GB UNICEF-Haiti worked with the Haitian Ministry of Health and Population (MSPP) to implement the CATI response strategy against cholera in Haiti. For this, UNICEF-Haiti received funds from ECHO (European Commission Humanitarian Office), DFID (UK Government's Department for International Development) and CERF (Central Emergency Response Funds of United Nations). These three institutions had no involvement in study design, collection analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication. Authors working for Assistance Publique – Hopitaux de Marseille (APHM): JG, SR, RP (until 2017) Authors working for Assistance Publique – Hopitaux de Paris (AP-HP): RP (since 2017) AP-HP, a French university-hospital, has been mandated by the Haitian Ministry of Health and UNICEF-Haiti, and granted by UNICEF-Haiti, to provide the CATI response strategy against cholera with prospective epidemiological analyses and evaluations. Authors working for Ministry of Public Health and Population (MSPP): EM, JB, PD To implement the CATI response strategy against cholera in Haiti, MSPP has received material and financial support from UNICEF-Haiti. This study aimed to present and assess this strategy. Author with 335 no competing interest: MP Ethical Approval: The study protocol received authorization #1718-24 from the National Bioethics Committee of Haiti MSPP

International audience; During 2004–2014, the Democratic Republic of the Congo (DRC) declared 54% of plague cases worldwide. Using national data, we characterized the epidemiology of human plague in DRC for this period. All 4,630 suspected human plague cases and 349 deaths recorded in DRC came from Orientale Province. Pneumonic plague cases (8.8% of total) occurred during 2 major outbreaks in mining camps in the equatorial forest, and some limited outbreaks occurred in the Ituri highlands. Epidemics originated in 5 health zones clustered in Ituri, where sporadic bubonic cases were recorded throughout every year. Classification and regression tree characterized this cluster by the dominance of ecosystem 40 (mountain tropical climate). In conclusion, a small, stable, endemic focus of plague in the highlands of the Ituri tropical region persisted, acting as a source of outbreaks in DRC.

Resume Objectif Les complications infectieuses sont frequentes dans les suites des arrets cardio-respiratoires (ACR) extrahospitaliers reanimes. Les pneumonies precoces en sont les plus frequentes. Cette etude cherche a caracteriser les facteurs de risque, la microbiologie ainsi que l’impact pronostique de ces pneumonies. Materiel et methode Il s’agit d’une etude de cohorte retrospective. Tous les patients successivement admis en reanimation pour ACR dans une periode de 36 mois ont ete inclus. Tous les patients ayant un ACR intrahospitalier, decedes dans les 48 premieres heures ou avec une pneumonie a l’admission, etaient secondairement exclus. Le diagnostic de pneumonie etait porte a partir des elements suivants : foyer radiologique thoracique associant une hypoxemie sans participation hemodynamique ou prelevements bacteriologiques positifs. Resultats Sur 160 patients admis pour ACR, 79 ont ete inclus. Au total, 60 (76 %) patients ont developpe une pneumonie precoce. La documentation microbiologique retrouvait un microbiote proche de celui des pneumonies communautaires avec S taphylococcus aureus (27 %), Streptococcus pneumoniae (19 %) et Haemophilus influenzae (16,2 %). L’analyse univariee retrouvait la presence d’un etat de choc a l’admission comme facteur de risque predictif de la survenue d’une pneumonie precoce (OR = 2,64 ; IC 95 % = [1,02 ; 9,82] ; p = 0,05). L’analyse multivariee mettait en evidence la pneumonie precoce comme facteur de risque independant d’allongement de la duree de ventilation mecanique pour les patients atteints de pneumonie precoce (OR = 1,64 ; IC 95 % = [1,12 ; 2,57] ; p = 0,017). La consequence etait une augmentation significative de la duree de ventilation mecanique (5,98 ; DS = 1,02 versus 4,31 ; SD = 1,27 j ; p = 0,044) et d’hospitalisation en reanimation (8,25 ; DS = 1,66 versus 7,15 ; SD = 5,1 j ; p = 0,019) sans influence sur la mortalite ( p = 0,94). Conclusion La pneumonie precoce est une complication frequente de l’ACR extrahospitalier reanime. Sa microbiologie est proche de celle des pneumonies aigues communautaires. Ses consequences pronostiques impliquent une prise en charge diagnostique et therapeutique attentive.

ObjectThe purpose of this study was to establish the safety and efficacy of repeat Gamma Knife surgery (GKS) for recurrent trigeminal neuralgia (TN).MethodsUsing the prospective database of TN patients treated with GKS in Timone University Hospital (Marseille, France), data were analyzed for 737 patients undergoing GKS for TN Type 1 from July 1992 to November 2010. Among the 497 patients with initial pain cessation, 34.4% (157/456 with ≥ 1-year follow-up) experienced at least 1 recurrence. Thirteen patients (1.8%) were considered for a second GKS, proposed only if the patients had good and prolonged initial pain cessation after the first GKS, with no other treatment alternative at the moment of recurrence. As for the first GKS, a single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4–14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 90 Gy (range 70–90 Gy) was delivered. Data for 9 patients with at least 1-year followup were analyzed. A systematic review of literature was also performed, and results are compared with those of the Marseille study.ResultsThe median time to retreatment in the Marseille study was 72 months (range 12–125 months) and in the literature it was 17 months (range 3–146 months). In the Marseille study, the median follow-up period was 33.9 months (range 12–96 months), and 8 of 9 patients (88.9%) had initial pain cessation with a median of 6.5 days (range 1–180 days). The actuarial rate for new hypesthesia was 33.3% at 6 months and 50% at 1 year, which remained stable for 7 years. The actuarial probabilities of maintaining pain relief without medication at 6 months and 1 year were 100% and 75%, respectively, and remained stable for 7 years. The systematic review analyzed 20 peer-reviewed studies reporting outcomes for repeat GKS for recurrent TN, with a total of 626 patients. Both the selection of the cases for retreatment and the way of reporting outcomes vary widely among studies, with a median rate for initial pain cessation of 88% (range 60%–100%) and for new hypesthesia of 33% (range 11%–80%).ConclusionsResults from the Marseille study raise the question of surgical alternatives after failed GKS for TN. The rates of initial pain cessation and recurrence seem comparable to, or even better than, those of the first GKS, according to different studies, but toxicity is much higher, both in the Marseille study and in the published data. Neither the Marseille study data nor literature data answer the 3 cardinal questions regarding repeat radiosurgery in recurrent TN: which patients to retreat, which target is optimal, and which dose to use.

International audience; Introduction: Particulate matter, nitrogen dioxide (NO2) and ozone are recognized as the three pollutants that most significantly affect human health. Asthma is a multifactorial disease. However, the place of residence has rarely been investigated. We compared the impact of air pollution, measured near patients' homes, on emergency department (ED) visits for asthma or trauma (controls) within the Provence-Alpes Cote-d'Azur region. Methods: Variables were selected using classification and regression trees on asthmatic and control population, 3-99 years, visiting ED from January 1 to December 31, 2013. Then in a nested case control study, randomization was based on the day of ED visit and on defined age groups. Pollution, meteorological, pollens and viral data measured that day were linked to the patient's ZIP code. Results: A total of 794,884 visits were reported including 6250 for asthma and 278,192 for trauma. Factors associated with an excess risk of emergency visit for asthma included short-term exposure to NO2, female gender, high viral load and a combination of low temperature and high humidity. Conclusion: Short-term exposures to high NO2 concentrations, as assessed close to the homes of the patients, were significantly associated with asthma-related ED visits in children and adults. (c) 2017 Elsevier Ltd. All rights reserved.

International audience; These authors contributed equally to this work. Abstract. In areas of seasonal malaria transmission, the incidence rate of malaria infection is presumed to be near zero at the end of the dry season. Asymptomatic individuals may constitute a major parasite reservoir during this time. We conducted a longitudinal analysis of the spatio-temporal distribution of clinical malaria and asymptomatic parasitemia over time in a Malian town to highlight these malaria transmission dynamics. For a cohort of 300 rural children followed over 2009–2014, periodicity and phase shift between malaria and rainfall were determined by spectral analysis. Spatial risk clusters of clinical episodes or carriage were identified. A nested-case-control study was conducted to assess the parasite carriage factors. Malaria infection persisted over the entire year with seasonal peaks. High transmission periods began 2–3 months after the rains began. A cluster with a low risk of clinical malaria in the town center persisted in high and low transmission periods. Throughout 2009–2014, cluster locations did not vary from year to year. Asymptomatic and gametocyte carriage were persistent, even during low transmission periods. For high transmission periods, the ratio of asymptomatic to clinical cases was approximately 0.5, but was five times higher during low transmission periods. Clinical episodes at previous high transmission periods were a protective factor for asymptomatic carriage, but carrying parasites without symptoms at a previous high transmission period was a risk factor for asymptomatic carriage. Stable malaria transmission was associated with sustained asymptomatic carriage during dry seasons. Control strategies should target persistent low-level parasitemia clusters to interrupt transmission.

Introduction Gonaives, in the Artibonite region, is one of the most affected areas by the cholera epidemic in Haiti. Five years on, the epidemic persists and further information is needed to guide water and sanitation strategies for cholera elimination. Methods The number of cholera cases, socio-economic and environmental characteristics of Gonaives city neighbourhoods were included in an unsupervised classification approach and a general additive model was used to estimate standardized incidence ratios, adjusted on locations. Results Five classes of neighbourhoods were identified in Gonaives. Three classes were defined as high-risk in comparison with the area with the lowest incidence ratio: coastal flood-prone poor neighbourhoods (Class 5) with frequent open defecation and wide access to a shallow water table (Standardised Incidence Ratio - SIR of 3.15 IC95%[1.41; 7.04]); a coastal trade area (Class 3) with good access to a brackish and shallow water table likely contaminated by numerous latrines (SIR of 2.5 IC95%[1.05; 5.95]); and the hillside poor residential neighbourhoods (Class 4) with poor water availability and frequent open defecation (SIR = 3.2 IC95%[1.25; 8.18]). Conclusion Water and sanitation prevention strategies should not be homogenous. Within an urban area, prevention strategies should be planned according to the specific socio-environmental and geographical context of each neighbourhood.

International audience; BACKGROUND:In the field of epidemiological surveillance, no systematic literature review appears to exist of implemented projects using cellular phone technology.METHOD:We performed a systematic literature review using the Pubmed and Scopus databases to retrieve articles published up to December 2015. We analyzed information reported in these publications according to the mobile health (mHealth) evidence reporting and assessment (mERA) checklist, and complemented this work with specific items related to epidemiology, in order to clarify the types of results reported and summarized in this context.RESULTS:Thirty-three articles were selected and reviewed. Each article was related to a different project. Two mERA items were systematically and fully reported, while two others were never reported. Three projects were deployed in very specific zones. Most of the projects were implemented in Africa. Infectious diseases were the elements most monitored. Most projects were based on daily data collection and SMS transmission. Economic assessment was limited to SMS, mobile phone, and implementation costs.DISCUSSION-CONCLUSION:Although suitable for epidemiologic surveillance, the mERA checklist needs further interpretation. The technical and transmission modes of cellular phone use varied greatly from one study to another. No evaluation of the interoperability capabilities of cellular phones with other applications or sub-systems was possible.

IntroductionSeasonal influenza vaccination (SIV) is recommended for people with diabetes, but its effectiveness has not been demonstrated. All of the available studies are observational and marred with the healthy vaccine bias, that is, bias resulting from the generally better health behaviours practised by people who choose to be vaccinated against influenza, compared with those who do not. This protocol is intended to study the effectiveness of SIV in people with treated diabetes and simultaneously to control for bias.Methods and analysesThis case-control study is nested in a historical cohort and is designed to study vaccine effectiveness (VE) assessed by morbidity, mortality and anti-infective drug use. The cohort will comprise a representative sample of health insurance beneficiaries in France and will cover 10 consecutive epidemic seasons. It will include all patients reimbursed three separate times for drugs to treat diabetes. The first study of VE will use reasons for hospitalisation as the primary end point, and the second with the use of neuraminidase inhibitors and of antibiotics as the end points. A case will be defined as any person in the cohort reaching any end point at a given date. The case patient will be matched with the largest possible number of controls (individuals not reaching the end point by this date) according to the propensity score method with an optimal calliper width. A conditional logistic model will be used to estimate ORs to take into account both the matching and the repetition of measurements. The model will be applied separately during and outside of epidemic periods to estimate the residual confounding.Ethics and disseminationThe study has been approved by the French Commission on Individual Data Protection and Public Liberties (ref: AT/CPZ/SVT/JB/DP/CR05222O). The study's findings will be published in peer-reviewed journals and disseminated at international conferences and through social media.

International audience; In an interesting Personal View, Lucy Parker and colleagues1 reported the difficulties regarding implementation of a reactive oral cholera vaccination (OCV) campaign during the 2015 cholera epidemic in Juba, South Sudan.1 They support the choice to address the global shortage of vaccines by providing just one dose to twice the number of people. However, the epidemic curve provided by Parker and colleagues suggests that the South Sudan epidemic was not hugely affected by this campaign. Indeed, the basic reproductive number (R0), which we calculated as previously described2 using data extracted from this curve with the Plot Digitizer tool and R software, using the R0 package, was not reduced after the campaign was finally launched on July 31, 2015; the R0 was already less than 1 between the first peak on June 28 and the start of the OCV campaign (0·94 [95% CI 0·92–0·95]), only 0·72 (0·66–0·78) between the second peak on July 19 and the start of OCV, and still 0·92 (0·90–0·94) from the start of OCV until the last confirmed case on Sept 12, 2015.Several complementary factors might explain such a disappointing effect. First, vaccine effectiveness of this one-dose campaign could have been lower than the 87·3% (95% CI 70·2 – 100) calculated in a case-cohort observational study by the same group of authors.3 Efficacy of one-dose OCV was estimated to be about 40% (95% CI 11–60) in a double-blind placebo-controlled clinical trial.4 Using the WHO screening method5 with provided data, we calculated that 36% of cholera cases were expected to occur in vaccinated individuals in Juba. The observed proportion was only 6%,3 which suggests biases that the authors could not address despite their efforts to do so. Second, one-dose OCV did not generate any obvious herd immunity, even in the area targeted by mass vaccination, where coverage reached 64%;3 surprisingly, vaccine effectiveness tended to be much higher there (97%) than in the non-mass-vaccinated area (66% with 19% coverage),3 and the calculated cholera attack rate among non-vaccinees was two times higher than in the non-mass-vaccinated area (2·5 vs 1·3 cases per 10 000 inhabitants). 3 Finally, this late campaign probably provided little additional protection to a population in which adaptations to water sanitation and hygiene (WaSH) behaviour—rather than acquired immunity—were probably already reducing cholera transmission.This insightful cholera vaccination field report shows that WaSH activities must remain the cornerstone of cholera control and elimination strategies, even if they are difficult to implement. Reactive vaccination campaigns might help, provided they are promptly rolled out and include two doses as originally recommended.

Introduction En epidemiologie, il est frequent d’etudier des variables fonctionnelles pour lesquelles les observations sont realisees de facon discrete (courbe de croissance, ECG, etc.). C’est le cas des series temporelles d’incidences. L’etude des dynamiques epidemiques doit prendre en compte cette nature fonctionnelle, en estimant et analysant les fonctions a l’origine des observations plutot qu’en analysant les donnees individuelles elle-meme. L’objectif de notre travail etait de rechercher des profils epidemiques en tenant compte de la nature fonctionnelle des series temporelles d’incidences pour optimiser les actions de lutte ciblees. Methodes L’analyse a porte sur le nombre de cas de paludisme hebdomadaire et la population annuelle de 620 villages du Senegal de janvier 2008 a decembre 2012. Les 620 fonctions continues d’incidences ont ete estimees en utilisant une base de Fourier, tenant compte de leur periodicite annuelle. Les profils epidemiques ont ete obtenus par classification hierarchique ascendante sur ces fonctions utilisant la distance euclidienne adaptee aux donnees fonctionnelles Eq. (1) et la methode de Ward. Les rapports d’incidences associes a chaque profil ont ete estimes a l’aide d’un modele additif generalise. Resultats La classification des courbes d’incidences a permis d’obtenir trois profils epidemiques de paludisme : un profil d’incidences basses (taux d’incidence : 4 cas/100 000 habitants semaine) avec des durees epidemiques restreinte (duree moyenne : 22 semaines) et pas de cas entre les epidemies annuelles, un profil d’incidences hautes (186 cas/100 000 habitants semaine) avec des durees epidemiques importantes (33 semaines) et toujours des cas persistants, et entre les deux, un profil intermediaire (25 cas/100 000 habitants semaine) avec une duree epidemique moyenne de 24 semaines. Malgre un aspect spatialement tres disperse, les villages du profil « bas » etaient majoritairement au nord de la zone d’etude, ceux du profil « haut » majoritairement au sud et ceux du profil « intermediaire » presents aussi bien au nord qu’au sud. Par rapport au profil intermediaire, le rapport standardise d’incidence du profil bas etait de 0,17 (IC95 % [0,15 ; 0,19], p Conclusion L’analyse realisee a permis de prendre en compte le caractere fonctionnel des courbes epidemiques indiquant ainsi trois dynamiques temporelles differentes du paludisme.

Background Even if rainfall and temperature are factors classically associated to malaria, little is known about other meteorological factors, their variability and combinations related to malaria, in association with river height variations. Furthermore, in suburban area, urbanization and growing population density should be assessed in relation to these environmental factors. The aim of this study was to assess the impact of combined environmental, meteorological and hydrological factors on malaria incidence through time in the context of urbanization. Methods Population observational data were prospectively collected. Clinical malaria was defined as the presence of parasites in addition to clinical symptoms. Meteorological and hydrological factors were measured daily. For each factors variation indices were estimated. Urbanization was yearly estimated assessing satellite imaging and field investigations. Principal component analysis was used for dimension reduction and factors combination. Lags between malaria incidences and the main components were assessed by cross-correlation functions. Generalized additive model was used to assess relative impact of different environmental components, taking into account lags, and modelling non-linear relationships. Change-point analysis was used to determine transmission periods within years. Results Malaria incidences were dominated by annual periodicity and varied through time without modification of the dynamic, with no impact of the urbanization. The main meteorological factor associated with malaria was a combination of evaporation, humidity and rainfall, with a lag of 3 months. The relationship between combined temperature factors showed a linear impact until reaching high temperatures limiting malaria incidence, with a lag 3.25 months. Height and variation of the river were related to malaria incidence (respectively 6 week lag and no lag). Conclusions The study emphasizes no decreasing trend of malaria incidence despite accurate access to care and control strategies in accordance to international recommendations. Furthermore, no decreasing trend was showed despite the urbanization of the area. Malaria transmission remain increase 3 months after the beginning of the dry season. Addition to evaporation versus humidity/rainfall, nonlinear relationship for temperature and river height and variations have to be taken into account when implementing malaria control programmes.

Background The reliability of spatial statistics is often put into question because real spatial variations may not be found, especially in heterogeneous areas. Our objective was to compare empirically different cluster detection methods. We assessed their ability to find spatial clusters of cancer cases and evaluated the impact of the socioeconomic status (e.g., the Townsend index) on cancer incidence. Methods Moran’s I, the empirical Bayes index (EBI), and Potthoff-Whittinghill test were used to investigate the general clustering. The local cluster detection methods were: i) the spatial oblique decision tree (SpODT); ii) the spatial scan statistic of Kulldorff (SaTScan); and, iii) the hierarchical Bayesian spatial modeling (HBSM) in a univariate and multivariate setting. These methods were used with and without introducing the Townsend index of socioeconomic deprivation known to be related to the distribution of cancer incidence. Incidence data stemmed from the Cancer Registry of Isère and were limited to prostate, lung, colon-rectum, and bladder cancers diagnosed between 1999 and 2007 in men only. Results The study found a spatial heterogeneity (p 1.2). The multivariate HBSM found a spatial correlation between lung and bladder cancers (r = 0.6). Conclusions In spatial analysis of cancer incidence, SpODT and HBSM may be used not only for cluster detection but also for searching for confounding or etiological factors in small areas. Moreover, the multivariate HBSM offers a flexible and meaningful modeling of spatial variations; it shows plausible previously unknown associations between various cancers. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0228-x) contains supplementary material, which is available to authorized users.

Introduction Contre les epidemies de cholera, autorites sanitaires et ONGs mettent frequemment en oeuvre des interventions de reponse rapides et ciblees sur les zones de provenance des cas. Des equipes mobiles multidisciplinaires sensibilisent les familles sur les mesures de prevention, distribuent savons et produits de traitement de l’eau, proposent parfois une antibioprophylaxie aux sujets contacts, voire une vaccination reactive contre le cholera. L’efficacite de ces reponses rapides et ciblees n’a cependant jamais ete evaluee, et les grandes organisations internationales n’en recommandent l’usage que de maniere discrete. Depuis mi-2013, les autorites Haitiennes, UNICEF et leurs partenaires mettent malgre tout en oeuvre une strategie de reponse rapide a tous les cas de cholera, offrant une opportunite unique d’evaluation de ces interventions. Materiels et methodes Nous avons conduit une etude quasi-experimentale entre janvier 2015 et decembre 2017 dans le departement du Centre d’Haiti. A partir des details de 10 428 cas, de 509 coprocultures positives pour Vibrio cholerae O1 et de 3887 rapports d’interventions rapides, nous avons identifie des flambees de cholera a l’echelles des localites, puis caracterise la severite de leur demarrage, leur reponse recue, ainsi que leur evolution. Nous avons ensuite compare le nombre de cas enregistres par flambee en fonction de la promptitude ou de l’intensite des interventions de reponse grâce a des modeles lineaires generalises a effet mixte. Puis nous avons compare la duree des flambees en fonction de la promptitude ou de l’intensite des interventions de reponse grâce a des modeles de Cox pour evenements repetes. Resultats Nous avons identifie 456 flambees de cholera dans 290 localites. Par comparaison avec une premiere intervention conduite > 7 jours apres le debut de la flambee, une premiere intervention conduite ≤ 1 jours apres reduisait significativement le nombre de cas enregistres de 74 % (58–84) et la duree de 64 % (42–78). Par rapport a un nombre d’interventions par semaine Conclusion Ces resultats suggerent fortement qu’une strategie d’interventions de reponse rapides et ciblees est efficace pour attenuer et raccourcir les flambees de cholera en Haiti. Ils soutiennent une meilleure integration de cette methode dans la « boite a outils » de lutte contre les epidemies de cholera.

International audience; Dog bites are a serious public health concern. Besides injuries and the adverse psychological impacts, dog bites can be complicated by infections including rabies, which has the highest case-fatality rate of all infectious diseases. 1 The last case of human rabies acquired in mainland France was reported in 1924 and the last case of fox rabies in 1998. However, rabid dogs are repeatedly imported into France by travelers, with the majority originating from Morocco after having been transported through Spain by car. 2–6 The decision to prescribe rabies vaccine and/or rabies immunoglobulin to patients injured by dogs depends on the origin of the animal. Over-prescription of rabies post-exposure prophylaxis (PEP) has been questioned in France. 7 In Marseille, efforts to minimize over-prescription of the vaccination for rabies PEP has been conducted, by delaying the initiation of rabies treatment in injuries involving an apparently healthy dog that can be kept under observation. 8 However, significant numbers of rabies PEP vaccinations are still given to injured patients due to the high proportion of dogs that cannot be kept under observation. In this context, interventions aimed at reducing the number of dog bites are critical. The reduction of dog-related injuries by educational interventions has shown some success in children, 9,10 although this has been contradicted. 11 As a first step towards the possible implementation of such a strategy in Marseille, we conducted a preliminary survey to describe the epidemiology of dog-related injuries requiring rabies PEP in the city. 2. Materials and methods From 2007 to 2010, epidemiological data on dog-related injuries and associated rabies PEP treatment were prospectively collected from patients attending the Marseille rabies treatment center (RTC) using standardized forms. At the Marseille RTC, Background: Dog bites are a serious public health concern. Besides injuries and the adverse psychological impacts, dog bites can be complicated by infections including rabies, which has the highest case-fatality rate of all infectious diseases. Methods: Dog-associated injuries occurring in the city of Marseille, France were investigated in 245 individuals among patients presenting to the rabies treatment center over a 4-year period. Results: Male patients were more likely to report dog bites compared to female patients (66.5% vs. 33.5%; odds ratio 2.25, 95% confidence interval 1.72–2.93). The mean age of injured patients was 32 years (range 1–85 years). Children and young adults under 30 years of age were more than four times more likely to report dog bites compared to others. Most cases occurred outdoors (73.0%) – in public areas (38.0%) – and involved animals of unknown owners in 56.3% of the cases. Only 28.2% of dogs were available for observation. Most patients (63.7%) received complete rabies post-exposure prophylaxis. The distribution of dog bites in the city was not homogeneous and the incidence of bites was significantly higher in some areas. Eleven percent of patients declared having been bitten by dogs whose owner was a street beggar, and a clustered distribution was evidenced for these cases in one area of the city. Conclusions: Programs offering low-cost rabies vaccination and veterinary care to pets belonging to the group of street beggars should be considered. Such programs may be implemented in other large cities in France and Europe where street beggars are frequently seen. ß

International audience; Introduction Given the new therapeutic options in acromeg-aly, it seemed important to evaluate the outcome of operated acromegalic patients today. Objective To analyse the characteristics and short-and long-term surgical outcome of patients who underwent transsphenoi-dal surgery for a growth hormone (GH)-secreting adenoma in our centre and to determine predictive factors of remission. Design and patients This retrospective 10-year study included 115 newly diagnosed acromegalic patients operated on at Timone University Hospital, Marseille, France, between 1997 and 2007. Measurements Initial and long-term outcomes were evaluated using stringent and current remission criteria, associating GH nadir after oral glucose tolerance test

Object The goal of this study was to establish whether clear patterns of initial pain freedom could be identified when treating patients with classic trigeminal neuralgia (TN) by using Gamma Knife surgery (GKS). The authors compared hypesthesia and pain recurrence rates to see if statistically significant differences could be found. Methods Between July 1992 and November 2010, 737 patients presenting with TN underwent GKS and prospective evaluation at Timone University Hospital in Marseille, France. In this study the authors analyzed the cases of 497 of these patients, who participated in follow-up longer than 1 year, did not have megadolichobasilar artery– or multiple sclerosis–related TN, and underwent GKS only once; in other words, the focus was on cases of classic TN with a single radiosurgical treatment. Radiosurgery was performed with a Leksell Gamma Knife (model B, C, or Perfexion) using both MR and CT imaging targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.8 mm (range 4.5–14 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range 70–90 Gy) was delivered. Using empirical methods and assisted by a chart with clear cut-off periods of pain free distribution, the authors were able to divide patients who experienced freedom from pain into 3 separate groups: patients who became pain free within the first 48 hours post-GKS; those who became pain free between 48 hours and 30 days post-GKS; and those who became pain free more than 30 days after GKS. Results The median age in the 497 patients was 68.3 years (range 28.1–93.2 years). The median follow-up period was 43.75 months (range 12–174.41 months). Four hundred fifty-four patients (91.34%) were initially pain free within a median time of 10 days (range 1–459 days) after GKS. One hundred sixty-nine patients (37.2%) became pain free within the first 48 hours (Group PF≤ 48 hours), 194 patients (42.8%) between posttreatment Day 3 and Day 30 (Group PF(>48 hours, ≤ 30 days)), and 91 patients (20%) after 30 days post-GKS (Group PF>30 days). Differences in postoperative hypesthesia were found: in Group PF≤ 48 hours 18 patients (13.7%) developed postoperative hypesthesia, compared with 30 patients (19%) in Group PF(>48 hours, ≤ 30 days) and 22 patients (30.6%) in Group PF>30 days (p = 0.014). One hundred fifty-seven patients (34.4%) who initially became free from pain experienced a recurrence of pain with a median delay of 24 months (range 0.62–150.06 months). There were no statistically significant differences between the patient groups with respect to pain recurrence: 66 patients (39%) in Group PF≤ 48 hours experienced pain recurrence, compared with 71 patients (36.6%) in Group PF(>48 hours, ≤ 30 days) and 27 patients (29.7%) in Group PF>30 days (p = 0.515). Conclusions A substantial number of patients (169 cases, 37.2%) became pain free within the first 48 hours. The rate of hypesthesia was higher in patients who became pain free more than 30 days after GKS, with a statistically significant difference between patient groups (p = 0.014).

Background Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications. Objective The purpose of this study was to determine whether prasugrel would be more effective than clopidogrel in reducing procedural events in patients with an unruptured aneurysm treated endovascularly with coils and stent. Materials and methods Two hundred consecutive patients with intracranial aneurysms were treated using coiling and stenting procedures. The first 100 patients were administered a dual antiplatelet of aspirin and clopidogrel, while the remaining 100 patients were administered a dual antiplatelet of aspirin and prasugrel. In each group data were collected on procedural and periprocedural haemorrhagic and ischaemic complications. Results Aneurysmal occlusion and haemorrhagic complications rates were identical in both groups. The number of thromboembolic events observed in the two groups of our study did not differ significantly, but the prasugrel group included more wide-neck aneurysms and more flow-diverted stents. Moreover, complications in the prasugrel group were more benign, explaining the significant difference in clinical outcomes between the two groups on Day 30. Conclusions Prasugrel reduces the clinical consequences of thromboembolic complications of endovascular treatment with stenting and coiling of unruptured intracranial aneurysms.

International audience; Tropheryma whipplei was detected in preliminary studies in faeces of young children with diarrhoea and also in faeces of asymptomatic persons, not only in Europe but also in Africa. In this study, the link between this bacterium and the presence of acute diarrhoea was evaluated in a large group of children. From December 2009 to January 2013, rectal swabs collected from 3796 children in the emergency departments of university hospitals in Marseille, France, were analysed: 555 children (245 female and 310 male, from 6 days to 6 years old) with acute diarrhoea defined as at least three loose stools per day for

International audience; We conducted a prospective study to assess the value of the use of infrared thermal cameras in detecting fevers in both patients and healthcare workers between May 2015 and February 2016 in a university hospital center in Southern France.

International audience; In 1998, a cholera epidemic in east Africa reached the Comoros Islands, an archipelago in the Mozambique Channel that had not reported a cholera case for more than 20 years. In just a little over 1 year (between January 1998 and March 1999), Grande Comore, the largest island in the Union of the Comoros, reported 7,851 cases of cholera, about 3% of the population. Using case reports and field observations during the medical response, we describe the epidemiology of the 1998–1999 cholera epidemic in Grande Comore. Outbreaks of infectious diseases on islands provide a unique opportunity to study transmission dynamics in a nearly closed population, and they may serve as stepping-stones for human pathogens to cross unpopulated expanses of ocean.

International audience; Purposes The purpose of this study was to retrospectively study embryonal tumors with multilayered rosettes (ETMR), a rare new entity that gathers ETAN-TR (embryonal tumor with abundant neuropil and true rosettes), ependymoblastomas, and medulloepitheliomas, in order to improve their descriptions and try to better define therapeutic modalities. Methods: Patients with ETMR, ETAN-TR, ependymoblastoma, and medulloepithelioma treated in SFCE centres (Société Française de lutte contre les Cancers et les leucémies de l'Enfant et de l'adolescent) since 2000 were collected. Data were retrieved from clinical charts.Results: Thirty-eight patients were included in the analysis. Seventeen had an ETAN-TR, 13 had a medulloepithelioma, and 8 had an ETMR. No ependymoblastoma was included. The median age at diagnosis was 31 months (range, 2.8–141 months). The predominant tumor location was supratentorial (66 %); 18.4 % patients had metastatic lesion. LIN28A expression was positive in 11/11 patients. Amplification of the locus 19q13.42 was positive in 10/12 patients. Thirty patients were treated according to the primitive neuroectodermal tumors of high risk (PNET-HR) protocol. The median time of follow-up was 0.9 years (range 0.1 to 15.3 years). The 1-year event-free survival (EFS) and overall survival (OS) were, respectively, 36 % CI 95 % (23–55) and 45 % CI 95 % (31–64). On multivariate analysis, complete surgical resection, radiotherapy, and high-dose chemotherapy were associated with a better overall survival with a relative risk of, respectively, 7.9 CI 95 % (2.6–23.5) p < 0.0002, 41.8 CI 95 % (9.4–186) p < 0.0001, and 3.5 CI 95 % (1.3–9.5) p = 0.012.Conclusion: Prognosis of ETMR remains dismal despite multimodal therapy. LIN28A immunostaining and 19q13.42 amplification should be systematically done to secure the diagnosis. Complete surgical resection, radiotherapy, and high-dose chemotherapy are associated with better outcome.

Background: Radiosurgery is one of the neurosurgical alternatives for intractable trigeminal neuralgia (TN). Objective: Although acceptable short-/mid-term outcomes have been reported, long-term results have not been well documented. Methods: We report the long-term results in 130 patients who underwent radiosurgery for classical TN and were subsequently monitored through at least 7 years (median = 9.9, range = 7-14.5) of follow-up. Results: The median age was 66.5 years. A total of 122 patients (93.8%) became pain free (median delay = 15 days) after the radiosurgery procedure (Barrow Neurological Institute, BNI class I-IIIa). The probability of remaining pain free without medication at 3, 5, 7 and 10 years was 77.9, 73.8, 68 and 51.5%, respectively. Fifty-six patients (45.9%) who were initially pain free experienced recurrent pain (median delay = 73.1 months). However, at 10 years, of the initial 130 patients, 67.7% were free of any recurrence requiring new surgery (BNI class I-IIIa). The new hypesthesia rate was 20.8% (median delay of onset = 12 months), and only 1 patient (0.8%) reported very bothersome hypesthesia. Conclusions: The long-term results were comparable to those from our general series (recently published), and the high probability of long-lasting pain relief and rarity of consequential complications of radiosurgery may suggest it as a first- and/or second-line treatment for classical, drug-resistant TN.

International audience; Many ailments can be linked to exposure to indoor airborne fungus. However, obtaining a precise measurement of airborne fungal levels is complicated partly due to indoor air fluctuations and non-standardized techniques. Electrostatic dust collector (EDC) sampling devices have been used to measure a wide range of airborne analytes, including endotoxins, allergens, β-glucans, and microbial DNA in various indoor environments. In contrast, viable mold contamination has only been assessed in highly contaminated environments such as farms and archive buildings. This study aimed to assess the use of EDCs, compared with repeated air-impactor measurements, to assess airborne viable fungal flora in moderately contaminated indoor environments. Indoor airborne fungal flora was cultured from EDCs and daily air-impaction samples collected in an office building and a daycare center. The quantitative fungal measurements obtained using a single EDC significantly correlated with the cumulative measurement of nine daily air impactions. Both methods enabled the assessment of fungal exposure, although a few differences were observed between the detected fungal species and the relative quantity of each species. EDCs were also used over a 32-month period to monitor indoor airborne fungal flora in a hospital office building, which enabled us to assess the impact of outdoor events (e.g. ground excavations) on the fungal flora levels on the indoor environment. In conclusion , EDC-based measurements provided a relatively accurate profile of the viable airborne flora present during a sampling period. In particular, EDCs provided a more representative assessment of fungal levels compared with single air-impactor sampling. The EDC technique is also simpler than performing repetitive air-impaction measures over the course of several consecutive days. EDC is a versatile tool for collecting airborne samples and was efficient for measuring mold levels in indoor environments.

Background Dermatophytosis, and particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. To describe the epidemiology of dermatophytosis in distinct eco-climatic zones, three cross-sectional surveys were conducted in public primary schools located in the Sahelian, Sudanian and Sudano-Guinean eco-climatic zones in Mali. Principal Findings Among 590 children (average age 9.7 years) the overall clinical prevalence of tinea capitis was 39.3%. Tinea capitis prevalence was 59.5% in the Sudano-Guinean zone, 41.6% in the Sudanian zone and 17% in the Sahelian eco-climatic zone. Microsporum audouinii was isolated primarily from large and/or microsporic lesions. Trichophyton soudanense was primarily isolated from trichophytic lesions. Based on the multivariate analysis, tinea capitis was independently associated with male gender (OR = 2.51, 95%CI [1.74–3.61], P, Author Summary Dermatophytosis, and particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood. To describe the epidemiology of dermatophytosis in distinct eco-climatic zones, three cross-sectional surveys were conducted in public primary schools located in the Sahelian, Sudanian and Sudano-Guinean eco-climatic zones in Mali. Among 590 children (average age 9.7 years) the overall clinical prevalence of tinea capitis was 39.3%. Tinea capitis prevalence was 59.5% in the Sudano-Guinean zone, 41.6% in the Sudanian zone and 17% in the Sahelian eco-climatic zone. Microsporum audouinii was isolated primarily from large and/or microsporic lesions. Trichophyton soudanense was primarily isolated from trichophytic lesions. Based on the multivariate analysis, tinea capitis was independently associated with male gender (OR = 2.51, 95%CI [1.74–3.61], P

International audience; Ivermectin and doxycycline have been found to be independently effective in killing body lice. In this study, 450 body lice were artificially fed on a Parafilm TM membrane with human blood associated with antibiotics (doxycycline, erythromycin, rifampicin and azithromycin) alone and in combination with ivermectin. Fluorescence in situ hybridisation and spectral deconvolution were performed to evaluate bacterial transcriptional activity following antibiotic intake by the lice. In the first series, a lethal effect of antibiotics on lice was observed compared with the control group at 18 days (log-rank test, P ≤ 10 −3), with a significant difference between groups in the production of nits (P = 0.019, Kruskal–Wallis test). A high lethal effect of ivermectin alone (50 ng/mL) was observed compared with the control group (log-rank test, P ≤ 10 −3). Fluorescence of bacteriocytes in lice treated with 20 ␮g/mL doxycycline was lower than in untreated lice (P < 0.0001, Kruskal–Wallis test). In the second series with antibiotic–ivermectin combinations , a synergistic lethal effect on treated lice (log-rank test, P < 10 −6) was observed compared with the control group at 18 days, associated with a significant decrease in the production of nits (P ≤ 0.001, Kruskal–Wallis test). Additionally, survival of lice in the combination treatment groups compared with ivermectin alone was significant (log-rank test, P = 0.0008). These data demonstrate that the synergistic effect of combinations of antibiotics and ivermectin could be used to achieve complete eradication of lice and to avoid selection of a resistant louse population.

OBJECT Gamma Knife surgery (GKS) is one of the surgical alternatives for the treatment of drug-resistant trigeminal neuralgia (TN). This study aims to evaluate the safety and efficacy of GKS in a large population of patients with TN with very long-term clinical follow-up. METHODS Between July 1992 and November 2010, 737 patients presenting with TN were treated using GKS. Data were collected prospectively and were further retrospectively evaluated at Timone University Hospital. The frequency and severity of pain, as well as trigeminal nerve function, were evaluated before GKS and regularly thereafter. Radiosurgery using the Gamma Knife (model B, C, 4C, or Perfexion) was performed with the help of both MR and CT targeting. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4–14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 85 Gy (range 70–90 Gy) was prescribed. RESULTS The safety and efficacy are reported for 497 patients with medically refractory classical TN who were never previously treated by GKS and had a follow-up of at least 1 year. The median age in this series was 68.3 years (range 28.1–93.2 years). The median follow-up period was 43.8 months (range 12–174.4 months). Overall, 456 patients (91.75%) were initially pain free in a median time of 10 days (range 1–180 days). Their actuarial probabilities of remaining pain free without medication at 3, 5, 7, and 10 years were 71.8%, 64.9%, 59.7%, and 45.3%, respectively. One hundred fifty-seven patients (34.4%) who were initially pain free experienced at least 1 recurrence, with a median delay of onset of 24 months (range 0.6–150.1 months). However, the actuarial rate of maintaining pain relief without further surgery was 67.8% at 10 years. The hypesthesia actuarial rate at 5 years was 20.4% and at 7 years reached 21.1%, but remained stable until 14 years with a median delay of onset of 12 months (range 1–65 months). Very bothersome facial hypesthesia was reported in only 3 patients (0.6%). CONCLUSIONS Retrogasserian GKS proved to be safe and effective in the long term and in a very large number of patients. Even if the probability of long-lasting effects may be modest compared with microvascular decompression, the rarity of complications prompts discussion of using GKS as the pragmatic surgical first- or second-intention alternative for classical TN. However, a randomized trial, or at least a case-matched control study, would be required to compare with microvascular decompression.

International audience; Background: Few studies have focused on the social inequalities associated with environmental noise despite its significant potential health effects. This study analysed the associations between area socioeconomic status (SES) and potential residential exposure to road traffic noise at a small-area level in Marseilles, second largest city in France. Methods: We calculated two potential road noise exposure indicators (PNEI) at the census block level (for 24-h and night periods), with the noise propagation prediction model CadnaA. We built a deprivation index from census data to estimate SES at the census block level. Locally estimated scatterplot smoothing diagrams described the associations between this index and PNEIs. Since the extent to which coefficient values vary between standard regression models and spatial methods are sensitive to the specific spatial model, we analysed these associations further with various regression models controlling for spatial autocorrelation and conducted sensitivity analyses with different spatial weight matrices. Results: We observed a non-linear relation between the PNEIs and the deprivation index: exposure levels were highest in the intermediate categories. All the spatial models led to a better fit and more or less pronounced reductions of the regression coefficients; the shape of the relations nonetheless remained the same. Conclusion: Finding the highest noise exposure in midlevel deprivation areas was unexpected, given the general literature on environmental inequalities. It highlights the need to study the diversity of the patterns of environmental inequalities across various economic, social and cultural contexts. Comparative studies of environmental inequalities are needed, between regions and countries, for noise and other pollutants.

Classical models of epidemics by Ross and McKendrick have to be revisited in order to take into account the demography (fecundity, mortality and migration) both of host and vector populations and also the diffusion and mutation of infectious agents. The classical models are supposing the populations involved in the infectious disease to be constant during the epidemic wave, but the presently observed pandemics show that the duration of their spread during months or years imposes to take into account the host and vector population changes, and also the transient or permanent migration and diffusion of hosts (susceptible or infected), as well as those of vectors and infectious agents. One example is presented concerning the malaria in Mali.