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In November 2013, the first autochthonous cases of chikungunya virus (CHIKV) infection were identified in the territory of Saint-Martin in the French West Indies (1). Since that time, local transmission [...]

Abstract Background During the last decades, dengue viruses have spread throughout the Americas region, with an increase in the number of severe forms of dengue. The surveillance system in Guadeloupe (French West Indies) is currently operational for the detection of early outbreaks of dengue. The goal of the study was to improve this surveillance system by assessing a modelling tool to predict the occurrence of dengue epidemics few months ahead and thus to help an efficient dengue control. Methods The Box-Jenkins approach allowed us to fit a Seasonal Autoregressive Integrated Moving Average (SARIMA) model of dengue incidence from 2000 to 2006 using clinical suspected cases. Then, this model was used for calculating dengue incidence for the year 2007 compared with observed data, using three different approaches: 1 year-ahead, 3 months-ahead and 1 month-ahead. Finally, we assessed the impact of meteorological variables (rainfall, temperature and relative humidity) on the prediction of dengue incidence and outbreaks, incorporating them in the model fitting the best. Results The 3 months-ahead approach was the most appropriate for an effective and operational public health response, and the most accurate (Root Mean Square Error, RMSE = 0.85). Relative humidity at lag-7 weeks, minimum temperature at lag-5 weeks and average temperature at lag-11 weeks were variables the most positively correlated to dengue incidence in Guadeloupe, meanwhile rainfall was not. The predictive power of SARIMA models was enhanced by the inclusion of climatic variables as external regressors to forecast the year 2007. Temperature significantly affected the model for better dengue incidence forecasting (p-value = 0.03 for minimum temperature lag-5, p-value = 0.02 for average temperature lag-11) but not humidity. Minimum temperature at lag-5 weeks was the best climatic variable for predicting dengue outbreaks (RMSE = 0.72). Conclusion Temperature improves dengue outbreaks forecasts better than humidity and rainfall. SARIMA models using climatic data as independent variables could be easily incorporated into an early (3 months-ahead) and reliably monitoring system of dengue outbreaks. This approach which is practicable for a surveillance system has public health implications in helping the prediction of dengue epidemic and therefore the timely appropriate and efficient implementation of prevention activities.

Résumé: Dans le cadre du plan Ecophyto2, la Direction régionale de l'alimentation, l'agriculture et la forêt (Draaf) d'Occitanie a développé le projet « EXPO'PHYTO » qui vise à conduire, à l'échelle de petits territoires, une démarche collective et concertée de réduction de l'exposition aérienne aux produits phytopharmaceutiques. Pour tester la pertinence de cette approche, la Draaf souhaitait pouvoir la conduire sur quelques territoires où la réduction de l'exposition s'avérerait prioritaire par rapport à d'autres. Il a été décidé pour cela d'établir un classement des territoires d'Occitanie au regard de leur fardeau d'exposition potentielle. Deux indicateurs quantitatifs, pour les professionnels agricoles et la population générale respectivement, ont été construits à l'échelle cantonale en recourant à l'utilisation simultanée de matrices culture-exposition et de données de population et d'urbanisation. Les cantons ont ainsi pu être classés par valeur décroissante des indicateurs. Une analyse de sensibilité a été conduite afin de vérifier la robustesse des résultats. Celle-ci montre, pour chacune des deux populations, que certains cantons à prédominance viticole, restent classés dans les dix premiers parmi les 269 que compte l'Occitanie : cinq cantons pour la population professionnelle et trois cantons pour la population générale. Ces derniers sont également classés parmi les dix premiers pour la population professionnelle, quels que soient les paramètres de calcul utilisés. Bien que les pratiques d'usage des produits phytopharmaceutiques ne soient pas particulières dans ces cantons, ceux-ci présentent des caractéristiques d'assolement, de démographie et de répartition de l'habitat qui les rendent plus vulnérables en termes d'exposition potentielle. Par ailleurs, leur caractère viticole est cohérent avec les connaissances scientifiques récentes. La démarche retenue constitue un outil d'aide à la décision pour identifier les territoires prioritaires où mettre en place des actions de réduction de l'exposition aérienne aux produits phytopharmaceutiques, du point de vue des impacts potentiels sur leurs populations. As part of the Ecophyto2 plan, the Regional Administration of Food, Agriculture and Forestry (Draaf) of Occitania has developed the "EXPO'PHYTO" project. Its aim is to lead a collective and concerted approach in small communities to reduce airborne exposure to plant protection products (PPPs). To test the relevance and feasibility of this approach, Draaf wanted to be able to identify some areas where exposure reduction was a priority over others, by ranking the cantons of the Occitania region in order of their potential exposure burden. Two quantitative indicators, for agricultural professionals and the general population respectively, were constructed at cantonal scale level by combining the use of crop- exposure matrices with population data and urbanization level. The cantons could thus be classified by decreasing value of the indicators. A sensitivity analysis was conducted to verify the robustness of the results. This showed, for each of the two populations, that some predominantly wine-growing cantons remain in the top ten of the 269 listed in Occitania: five cantons for the occupationally exposed population and three cantons for the general population. These three also ranked among the top ten for the occupationally exposed population, regardless of the calculation parameters used. Practices in the use of PPPs are not specific to these cantons, but they have demographic and land-use characteristics that make them more vulnerable in terms of potential exposure. In addition, the presence of vineyards is consistent with recent scientific knowledge. The approach implemented is a decision-making tool to identify priority areas where is needed to reduce the population's airborne PPP exposure and its potential impacts. [ABSTRACT FROM AUTHOR]

Résumé: La lutte contre les risques sanitaires environnementaux, d'autant plus lorsqu'ils se cumulent à des inégalités sociales ou territoriales, constitue l'un des vecteurs d'actions primordiaux dans la politique de santé publique. Afin d'analyser les disparités environnementales en Occitanie, une typologie des territoires au niveau communal a été réalisée en 2017, à partir d'indicateurs de qualité de l'eau, de l'air, des sols et de l'habitat. Cette typologie a été construite à l'aide d'une classification ascendante hiérarchique (CAH), réalisée à partir des résultats d'une analyse des correspondances multiples (ACM) sur 10 indicateurs. Les données disponibles et mobilisables sur l'ensemble du territoire étaient relativement restreintes et la qualité moyenne des indicateurs utilisés constitue la principale limite de l'étude. Néanmoins, l'analyse a identifié six profils environnementaux de territoires qui, mis en perspective avec un indice de défavorisation sociale, ont permis de repérer des territoires socialement défavorisés où les risques environnementaux présents constituent un enjeu d'autant plus grand face aux inégalités sociales de santé. Combatting environmental health risks, especially those combined with social or regional inequalities, is one of the primary vectors of action in public health policy. To analyse the environmental disparities in Occitania, municipalities were classified in 2017 according to water, air, soil and housing quality indicators. A hierarchical clustering statistical method was performed with the multiple correspondence analysis (MCA) results of 10 indicators. The data available across the entire region and the modest quality of the indicators used constitute the main limitations of this study. Nevertheless, the analysis identified six environmental profiles of areas that, combined with a social deprivation index, revealed socially disadvantaged territories where the environmental risks are an even greater issue in view of the social inequalities in health. [ABSTRACT FROM AUTHOR]

During the past ten years, the islands of Guadeloupe (FrenchWest Indies) are facing dengue epidemics with increasing numbers of cases and fatal occurrences. The vector Aedes aegypti is submitted to intensive control, with little effect on mosquito populations. The hypothesis that important Ae. aegypti breeding sites are not controlled is investigated herein. For that purpose, the roof gutters of 123 houses were systematically investigated, and the percentage of gutters positive for Ae. aegypti varied from 17.2% to 37.5%, from humid to dry locations. In the dryer location, most of houses had no other breeding sites. The results show that roof gutters are becoming the most important Ae. aegypti breeding sites in some locations in Guadeloupe, with consequences on dengue transmission and vector control [ABSTRACT FROM AUTHOR]

Abstract: In the past few years many studies on air pollution and health based on time series have been carried out. Yet, this approach does not assess exposure to air pollution at an individual level but it is based on ambient concentrations measured by air quality monitoring networks. Questions on the estimates of exposure to pollutants have been raised, in particular the fact that background measuring stations only have been considered in the set up of pollution indicators. To assess the impact of exposure indicator characteristics on the results of time series analysis, two series (black smoke and sulfur dioxide, respectively) of exposure indicators to urban air pollution were set up taking into account a growing part of proximity measures (industrial sources) available in the studied urban area (Le Havre, France). For each pollutant, indicators distributions were almost similar, especially for black smoke. Whatever the pollutant, the most obvious heterogeneity could be observed between the 100% background indicator and the indicator including the arithmetic mean for all the stations (50% background stations and 50% proximity stations). Then the sensitivity of the associations between mortality and air pollution to these indicators was studied. These indicators did not show statistically significant differences in the estimated excess risk. Yet, confidence intervals were more statistically significant as the contribution of proximity stations was more substantial, in particular for SO2. To conclude, the use of proximity measurements did not influence dramatically on the mean estimates of the association between air pollution and mortality indicators in Le Havre. Therefore it does not seem relevant to include the data provided by the proximity stations in the urban exposure indicators within the context of the epidemiology monitoring system. [Copyright &y& Elsevier]

Introduction: Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter <10 μm (PM10>), nitrogen dioxide (NO2>) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998–2003 period. Methods: The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 μg/m3> increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting. Results: Daily number of hospitalizations for cardiovascular diseases was associated with PM10> levels (for a 10 μg/m3> increase, ERR=0.8%, 95% CI: [0.2, 1.5]), with NO2> (1.1%, [0.6, 1.6]) but not with ozone (0.1% [−0.2%, 0.5%]). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels. Discussion: Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution. [Copyright &y& Elsevier]