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Invasive fungal infections (IFI) are reportedly increasing in many countries, especially candidemia and invasive aspergillosis (IA) among immunocompromised patients (1-4). Conversely, a decline of AIDS-associated Pneumocystis jirovecii pneumonia (Pjp) and [...]

Zygomycoses are severe angioinvasive infections caused by common filamentous fungi, the zygomycetes. These ubiquitous opportunistic fungi can cause infections with high lethality in immunocompromised or diabetic patients. Whatever the route [...]

We assessed the quantitative contribution of pig farming to antimicrobial resistance in the commensal flora of pig farmers by comparing 113 healthy pig farmers from the major French porcine production [...]

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest [...]

To the Editor: Legionellosis is a pneumonia caused by inhalation of Legionella spp. in aerosol water particles. Legionellapneumophila is responsible for [approximately equal to] 90% of cases; serogroup 1 alone [...]

Abstract Background Few data are available on prescriber adherence to tuberculosis (TB) treatment guidelines. In particular, excessively long treatment carries a risk of avoidable adverse effects and represents a waste of healthcare resources. We examined factors potentially associated with excessively long treatment. Methods We reviewed the medical records of patients diagnosed with TB in 2004 in the eastern Paris region. Sociodemographic and clinical factors associated with excessively long treatment were identified by logistic regression analyses. Based on contemporary guidelines, excessively long treatment was defined as more than 6 months of a four-drug regimen for thoracic TB with full sensitive strains, and more than 12 months for patients with extrathoracic TB. Results Analyses concerned 478 patients with a median age of 36.0 ± 13.5 years, of whom 48% were living in precarious conditions (i.e. poor living conditions and/or no health insurance), 80% were born abroad, and 17% were HIV-seropositive. TB was restricted to the chest in 279 patients (isolated pulmonary, pleuropulmonary, and isolated pleural TB in 245, 13, and 21 patients, respectively), exclusively extrathoracic in 115 patients, and mixed in the remaining 84 patients. Treatment was prescribed by a chest specialist in 211 cases (44.1%) and 295 patients (61.7%) were managed in a single institution. The treatment duration complied with contemporary guidelines in 316 cases (66.1%) and was excessively long in 162 cases (33.9%). The median duration of excessively long treatment was 313 days (IQR: 272-412). In multivariate analysis, isolated thoracic TB, previous TB, HIV infection, a prescriber other than a chest specialist, and management in more than one healthcare center during treatment were independently associated with excessively lengthy treatment. Conclusion One-third of TB patients received excessively long treatment, reflecting inadequate awareness of management guidelines or unwillingness to implement them.

The aim was to estimate the effect of reported history of smallpox vaccination prior to 1980 on clinical expression of mpox. We included all confirmed mpox cases identified by the national mpox surveillance system in France between May and July 2022. Cases tested positive for monkeypox virus or orthopoxviruses by PCR. Cases were interviewed by phone using a questionnaire documenting demographics, symptoms and exposures. To estimate the effect of smallpox vaccination on the presence of marked mpox symptoms (association of fever, lymphadenopathy and extensive mucocutaneous lesions), we estimated prevalence ratios (PRs) and 95% CIs using Poisson regression models with robust standard errors. There were 1888 confirmed mpox cases with date of symptom onset between 7 May and 31 July 2022. Overall, 7% (93/1394) presented marked mpox symptoms. Among patients who provided information about their vaccination status, 14% (207/1469) reported smallpox vaccination prior to 1980. The proportion of cases with marked symptoms was 2% (3/170) among those reporting smallpox vaccination prior to 1980 and 8% (76/974) among those who reported no vaccination. The proportion of marked symptoms was four times lower among cases reporting previous smallpox vaccination than in cases reporting no vaccination (PR, 0.24; 95% CI: 0.08–0.76). There was no evidence of an effect of smallpox vaccination on development of complications (PR, 0.65; 95% CI: 0.35–1.22) or hospitalization due to mpox (PR, 0.64; 95% CI: 0.23–1.80). Our results suggest that smallpox vaccination during childhood attenuated the clinical expression of monkeypox virus infection, but there was no evidence of an effect on complications or hospitalization. [ABSTRACT FROM AUTHOR]

Background: During 2020-2021, in the context of increasing SARS-CoV-2 transmission in the general population, French authorities made the decision to keep schools open and set up massive screening campaigns for students. Here, we describe the impact of this strategy on the circulation of SARS-COV-2 among children and adolescents during this period., Methods: We analyzed SARS-COV-2 surveillance data provided by the French National Public Health Agency for the 2020-2021 school year along with the results of school-based screening campaigns implemented by the Ministry of National Education., Results: The proportion of 0-17-year-olds among confirmed cases and tested individuals increased throughout the school year, with children and adolescents reaching a maximum of 24 % of confirmed cases in 2021 week (W) 22. During the first semester of 2021 (W3-W22), >2.6 million tests were performed in schools, with a positivity rate of 0.32 % among students. Considering only symptomatic cases, higher incidence rates occurred among children and adolescents during the 2021 wave from W9 to W17 compared with that in 2020 from W40 to W48. The incidence rate did not significantly change following the school closure periods., Conclusion: The higher contribution of children and adolescents to viral circulation during the 2020-2021 school year seems more related to the emergence of the alpha variant than to France's decision to keep schools open. Considering the negative impact of school closures on children's mental health, these results support the decision to keep schools open when accompanied by appropriate control measures., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Masson SAS.)

BackgroundLocally-acquired mpox cases were rarely reported outside Africa until May 2022, when locally-acquired-mpox cases occurred in various European countries.AimWe describe the mpox epidemic in France, including demographic and behavioural changes among a subset of cases, during its course.MethodsData were retrieved from the enhanced national surveillance system until 30 September 2022. Laboratory-confirmed cases tested positive for monkeypox virus or orthopoxviruses by PCR; non-laboratory-confirmed cases had clinical symptoms and an epidemiological link to a laboratory-confirmed case. A subset of ≥ 15-year-old male cases, notified until 1 August, was interviewed for epidemiological, clinical and sexual behaviour information. Association of symptom-onset month with quantitative outcomes was evaluated by t- or Wilcoxon tests, and with binary outcomes, by Pearson's chi-squared or Fisher exact tests.ResultsA total of 4,856 mpox cases were notified, mostly in Île-de-France region (62%; 3,025/4,855). Cases aged ≥ 15 years were predominantly male (97%; 4,668/4,812), with 37 years (range: 15-81) as mean age. Between May and July, among the subset interviewed, mpox cases increased in regions other than Île-de-France, and mean age rose from 35 (range: 21-64) to 38 years (range: 16-75; p = 0.007). Proportions of cases attending men-who-have-sex-with-men (MSM) meeting venues declined from 60% (55/91) to 46% (164/359; p = 0.012); median number of sexual partners decreased from four (interquartile range (IQR): 1-10) to two (IQR: 1-4; p < 0.001).ConclusionChanges in cases' characteristics during the epidemic, could reflect virus spread from people who were more to less behaviourally vulnerable to mpox between May and July, or MSM reducing numbers of sexual partners as recommended.

International comparisons of COVID-19 incidence rates have helped gain insights into the characteristics of the disease, benchmark disease impact, shape public health measures and inform potential travel restrictions and border control measures. However, these comparisons may be biased by differences in COVID-19 surveillance systems and approaches to reporting in each country. To better understand these differences and their impact on incidence comparisons, we collected data on surveillance systems from six European countries: Belgium, England, France, Italy, Romania and Sweden. Data collected included: target testing populations, access to testing, case definitions, data entry and management and statistical approaches to incidence calculation. Average testing, incidence and contextual data were also collected. Data represented the surveillance systems as they were in mid-May 2021. Overall, important differences between surveillance systems were detected. Results showed wide variations in testing rates, access to free testing and the types of tests recorded in national databases, which may substantially limit incidence comparability. By systematically including testing information when comparing incidence rates, these comparisons may be greatly improved. New indicators incorporating testing or existing indicators such as death or hospitalisation will be important to improving international comparisons.

Replacement of fluconazole by echinocandins as the first-line therapy for yeast-related fungemia could have an impact on both the mortality rate and the epidemiology of yeast species responsible for candidemia. We analyzed the individual clinical and microbiological data collected through the active surveillance program on yeast fungemia (YEASTS program, 2004-2016, Paris area, France) within 14 University Hospitals. The cohort included 3,092 patients [male:female ratio: 1.56; median age 61.0 years (IQR: 23.8)]. The mean mortality rate within 30 days was 38.5% (1,103/2,868) and significantly higher in intensive care units (690/1,358, 50.8%) than outside (413/1,510, 27.4%, p < 0.0001) without significant change over time. The yeast species distribution [ Candida albicans ( n = 1,614, 48.0%), Candida glabrata ( n = 607, 18.1%), Candida parapsilosis ( n = 390, 11.6%), Candida tropicalis ( n = 299, 8.9%), Candida krusei ( n = 96, 2.9%), rare species ( n = 357, 10.6%)], minimal inhibitory concentration distribution, and the distribution between the patient populations (hematological malignancies, solid tumors, without malignancy) did not change either while the proportion of patients ≥60-years increased from 48.7% (91/187) in 2004 to 56.8% (133/234) in 2017 ( p = 0.0002). Fluconazole as first-line therapy dramatically decreased (64.4% in 2004 to 27.7% in 2017, p < 0.0001) with a corresponding increase in echinocandins (11.6% in 2004 to 57.8% in 2017, p < 0.0001). Survival rates did not differ according to the first antifungal therapy. The progressive replacement of fluconazole by echinocandins as the first-line antifungal therapy was not associated with change in global mortality, regardless of species involved and antifungal susceptibility profiles. Other factors remain to be uncovered to improve the prognosis of yeast fungemia., Competing Interests: SB has received travel grant from Pfizer in 2018 and has served on scientific advisory board for Gilead until 2018. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bretagne, Desnos-Ollivier, Sitbon, Lortholary, Che, Dromer and Participants of the YEASTS.)

The emergence of a viral disease most often results from an imbalance in the interaction between the infectious agent, the host and the environment. After the introduction phase of a viral disease in a territory or a given population and once the first chains of transmission occur, the spread of the disease or its sustainability are possible if the control measures are not implemented or are not sufficiently effective. If it is difficult to anticipate the occurrence and introduction of an emerging viral disease, the following three key elements must be strengthened to limit its impact: (1) anticipation and preparation; (2) research and (3) monitoring and surveillance. Finally, to guarantee that the measures taken are relevant and acceptable to the population, a multidisciplinary approach must be systematically relied upon and re-evaluated on a prospective basis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Health surveillance is a reactive process, with no real hindsight for dealing with signals and alerts. It may fail to detect more radical changes with a major medium-term or long-term impact on public health. To increase proactivity, the French Institute for Public Health Surveillance has opted for a prospective monitoring approach.Methods: Several steps were necessary: 1) Identification of public health determinants. 2) Identification of key variables based on a combination of determinants. Variables were classified into three groups (health event trigger factors, dissemination factors and response factors) and were submitted to future development assumptions. 3) Identification, in each of the three groups, of micro-scenarios derived from variable trends. 4) Identification of macro-scenarios, each built from the three micro-scenarios for each of the three groups. 5) Identification of issues for the future of public health.Results: The exercise identified 22 key variables, 17 micro-scenarios and 5 macro-scenarios. The topics retained relate to issues on social and territorial health inequalities, health burden, individual and collective responsibilities in terms of health, ethical aspects, emerging phenomena, ‘Big data’, data mining, new health technologies, interlocking of analysis scales.Conclusions: The approach presented here guides the programming of activities of a health safety agency, particularly for monitoring and surveillance. By describing possible future scenarios, health surveillance can help decision-makers to influence the context towards one or more favourable futures.

It is difficult to estimate the increase of the incidence of mucormycosis at a country level because of the low number of studies in general population. This article analyzes and completes the initial data of a previous study carried out between 1997 and 2006 by covering the period 1997-2010 and by integrating a detailed study of the risk factors, confirming the existence of a real increase of incidence of mucormycosis linked with the increasing number of the persons at risk., (© 2013 médecine/sciences – Inserm / SRMS.)

Tuberculosis is one of the leading causes of infectious disease worldwide, with an estimate of more than 8 million new cases each year. Tuberculosis notification rates have been decreasing since 2002, but some countries, in Asia and sub-Saharan Africa, are still particularly affected. HIV co-infection and the emergence of resistant strains warrant further efforts to improve tuberculosis control worldwide. France is considered as a low incidence country but important disparities between populations and territories exist. Thus, the elderly, those living in large cities or in socio-economic deprived condition and persons born in high-endemic countries are mostly affected. The national tuberculosis program was launched in 2007, aiming at reducing these disparities.

The French public health institute is responsible for promoting and coordinating threats the detection and assessment of health risks, and for suggesting possible responses. Transmissible diseases affecting both human and animal health are the focus of surveillance networks. Early detection of potential infectious threats is based on the screening of "alert signals" identified through routine surveillance networks and other systems. The quality and accuracy of these signals is first verified, before assessing, through a multidisciplinary approach, the risk of introduction and dissemination. This article examines specific cases illustrating the process of detection, risk analysis and response, with respect to infectious threats that are endemic in tropical regions and have the potential to be imported into metropolitan France. For both novel pathogens and exotic diseases--which, not being endemic in France, are less well known--the analysis and response process must regularly be adapted to the latest epidemiological, clinical and biological findings, taking interactions between the pathogen, host, and environment into consideration. The need to improve reaction times and risk assessment is also discussed.

Tuberculosis is still a concern in France, especially in the Paris region and among people originating from highly endemic countries. In 2003, 6098 cases of tuberculosis were notified in France (10.2 per 100000). The patients' median age was 42 years, and 61% of patients were male. Most cases involved pulmonary tuberculosis (71.7%), but there were also 113 cases of tubercular meningitis (1.9%). Among documented cases, 43.9% were of foreign origin and 47.8% of patients were born abroad. The incidence among people born in France declined year on year until 2003, but has increased in the last two years in the 0- to 14-year age group. At the same time the incidence of tuberculosis has been increasing among young people born in sub-Saharan Africa, and the number of cases due to multidrug-resistant strains is also increasing. Official guidelines have been updated in order to improve the prevention and control of tuberculosis. Enhanced surveillance and appropriately funded public health initiatives are needed to reinforce the fight against tuberculosis in France.