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The current epidemiological situation of tuberculosis in France makes it necessary to re-assess the relevancy of the current BCG policy. It is close to the thresholds proposed internationally to consider the discontinuation of vaccination programs using BCG. Both the literature, specially experiences from European countries, and the analysis carried out on French data are in favour of an extremely limited impact of BCG revaccination of tuberculino-negative children. From these same sources, it can be anticipated that interruption of all BCG activities would result in an increase in tuberculosis incidence, affecting mainly high risks populations. The importance of this increase depends on the hypothesis made on BCG effectiveness. The National Technical Committees on Vaccination and Infectious Diseases have recommended in June 2002 the discontinuation of BCG revaccination and systematic tuberculin testing and should issued a definitive statement on November 2002. The decision regarding primo-vaccination needs, as a pre-requisite, a risk-benefit analysis taking into consideration adverse aspects of BCG vaccination, and an analysis of the feasibility and acceptability of various potential modifications in the population targeted by the BCG. [Copyright &y& Elsevier]

Background: Since the 1980s, Shiga toxin-producing Escherichia coli (STEC), especially E. coli O157:H7, has been an important cause of food borne disease in industrial countries. In France, as there was no routine screening for STEC in clinical laboratories, enhanced surveillance of hemolytic uremic syndrome (HUS) in children less than 15 years of age was established in 1996 to monitor trends in the incidence of STEC infections., Methods: The surveillance system was based on a voluntary national network of pediatricians of 31 pediatric nephrology units in public hospitals., Results: From 1996 to 2006, the mean annual incidence of HUS was 0.71 cases per 100,000 children less than 15 years of age and 1.87 cases per 100,000 children less than 5 years of age. STEC infections were confirmed in 66% of patients; STEC O157 was the most common serogroup identified in STEC-related HUS (83%). In this 11-year period, 96% of HUS cases were sporadic and only 2 outbreaks caused by STEC O157 and by a dual infection of STEC O26 and O80 were detected., Conclusions: An evaluation of the surveillance of pediatric HUS showed that it is a simple and useful system for monitoring trends in STEC infections in France. It provides the information needed to measure the impact of new and changing vehicles of STEC transmission, and evaluate the effectiveness of prevention measures.

Rationale: Contact tracing is an important component of tuberculosis (TB) control programs. Standardization of contact investigation protocols can make them more efficient., Objectives: To develop a model to select contact subjects for screening., Methods: We prospectively collected standardized data on 325 TB index cases and their 2,009 contacts. Factors that independently influenced the risk of TB infection were included in the model, which was then validated in a second prospective cohort of 88 cases of TB and their 618 contacts., Measurements and Main Results: A total of eight independent risk factors were identified (odds ratio; 95% confidence interval): age, with three subgroups: 6-14 years (3.6; 1.6-8.0); 15-29 years (3.7; 1.8-7.7); > or =30 years (4.1; 2.0-8.5); cavitation on the index case's chest radiograph (1.6; 1.1-2.2); an index case sputum smear with 100 or more acid-fast bacilli per field (1.8; 1.2-2.8); household contact at night (2.1; 1.3-3.2); first-degree family relationship with the index case (2.1; 1.3-3.3); active smoking by the contact (1.6; 1.1-2.4); free health care (2.0; 1.2-3.2); and birth in a country with TB incidence rate higher than 25 of 100,000 (2.2; 1.5-3.2). Predictive probabilities were chosen to ensure false-negative rates lower than estimated TB infection background. The number of contacts to be investigated was reduced by 26% while maintaining a false-negative rate of 8%., Conclusions: This study provides a standardized contact screening model which reduces resources required without negatively affecting disease control.

Background and Objectives: The majority of cases of tuberculosis occur among males, but the majority of cases with extrapulmonary tuberculosis (EPTB) occur among females. The aim of this study was to identify independent risk factors associated with EPTB., Methods: A multivariable logistic regression model was used. Eighteen thousand, six hundred seventeen cases of tuberculosis, notified through the French national mandatory network between 1 January 1997 through 31 December 2001, were included in the analysis. Because of multiple interactions, different multivariable models were built for each area of birth (Europe, North Africa, Sub-Saharan Africa, and Asia)., Results: Risk factors for EPTB vary according to area of birth. Women born in Asia or North Africa were at a higher risk of developing an EPTB than men. In Sub-Saharan Africa, age was associated with EPTB. Human immunodeficiency virus infection was an independent risk factor for EPTB in the European groups only with an OR of 2.48 (CI 99% 1.84-3.34)., Conclusion: This analysis contributes to a better understanding of host-related factors associated with EPTB. As clinical presentation of EPTB is extremely variable, the identification of groups at higher risk may help in the early detection of cases.

Objective: To estimate the incidence of culture-positive and culture-negative tuberculous meningitis (TBM) in France in 2000., Methods: Capture-recapture method using two unrelated sources of data: the tuberculosis (TB) mandatory notification system (MNTB), recording patients treated by anti-tuberculosis drugs, and a survey by the National Reference Centre (NRC) for mycobacterial drug resistance, recording culture-positive TBM., Results: Of 112 cases of TBM reported to the MNTB, 28 culture-positive and 34 culture-negative meningitis cases were validated (17 duplicates, 3 cases from outside France, 21 false notifications, and 9 lost records were excluded). The NRC recorded 31 culture-positive cases, including 21 known by the MNTB. When the capture-recapture method was applied to the reported culture-positive meningitis cases, the estimated number of meningitis cases was 41 and the incidence was 0.7 cases per million. Sensitivity was 75.6% for the NRC, 68.3% for the MNTB, and 92.7% for both systems together. When sensitivity of the MNTB for culture-positive cases was applied to culture-negative meningitis, the total estimated number of culture-negative meningitis cases was 50 and the incidence was 0.85 cases per million., Conclusion: TBM is underestimated in France. Capture-recapture analysis using different sources to better estimate its incidence is of great interest.

Introduction: The incidence of tuberculosis in France is stable at around 10 per 100,000 per year since 1997. However in the Ile-de-France (which includes Paris and its suburbs) high population density, social deprivation and large numbers of immigrants result in the region providing more than half of the total number of cases notified in France., Methods: Retrospective analysis using data from the mandatory notification forms of patients diagnosed in 2001., Results: The incidence of tuberculosis in 2001 was 27.2 cases per 100,000 in the Ile-de-France region and 48.4 per 100,000 in the Paris area. The incidence was particularly high amongst young immigrants, especially those from Sub-Saharian countries. Pulmonary tuberculosis was the most commonly observed disease form (72% of cases). HIV infection was documented in 7.5% of subjects. Local tuberculosis control services were asked to intervene in only 30% of overall cases, and in only 50% of pulmonary cases living in crowded housing., Conclusion: More resource is needed for the surveillance of tuberculosis and the implementation of public health initiatives in the Ile-de-France to strengthen the fight against tuberculosis.

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 university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription-polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22-23. Timely detection, isolation of probable case-patients, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.

Clusters of travel associated legionnaires' disease warrant urgent attention, and are detected by the French national surveillance system and the European network EWGLINET. Between September 2001 and August 2003, 37 clusters were identified in French tourist accommodation: 27 hotels and 10 campsites. The number of clinical cases per cluster was as follows: 30 clusters of 2 cases (81%), 6 clusters of 3 cases (16%) and one cluster of 4 cases (3%), a total of 82 cases. The local health authorities performed environmental investigations for 36 of the 37 clusters. Among the 36 clusters investigated, water samples were collected for 35. At 16 (46%) sites, Legionella pneumophila was found at a level of more than 103 cfu/litre. In all of the accommodation where risk assessment was found to be inadequate- control measures were implemented immediately. Six hotels were closed immediately following cluster alerts. Comparison of clinical and environmental isolates by pulsed field gel electrophoresis (PFGE) was possible in 3 clusters and identical genomic profiles of the isolates were found in all. During this two year period of surveillance, we found that on many sites there has been a risk of exposure to Legionella. This reinforces the importance of the European surveillance network and the timely notifications of all the cases to EWGLINET.

An analysis of 691 French clinical Legionella isolates showed that the endemic L. pneumophila serogroup 1 strain Paris was responsible for 12.2% of all cases of legionellosis and had a specific pulsed-field gel electrophoresis pattern. We also demonstrated the presence of this endemic clone throughout Europe.

Tuberculosis in France is still a topical question. The national incidence rate was 11.2 cases per 100,000 population in 2000 and has been stable since 1997. The situation is particularly worrying in the Ile-de-France region where the incidence is twice the national rate. It reaches 50 cases per 100,000 in Paris. The proportion of cases with human immunodeficiency virus infection has decreased, but the tuberculosis cases rates are 8 times higher in foreigners, especially in young adults. Social deprivation and migration from countries with high tuberculosis incidence contribute to this situation. Targeting public health initiatives with appropriate fundings should be implemented to combat tuberculosis.

In France, two sources of data, the mandatory notification and the laboratory network EPIBAC, allow the health authorities to follow the incidence of bacterial meningitis (BM) and to assess the relative frequency of the micro-organisms responsible for such infection. In 1999, more than 1,000 cases of BM were notified in France. The more common micro-organisms were: Streptococcus pneumoniae 46%, Neisseria meningitidis 32% and Streptococcus agalactiae(or Streptococcus B) 11%. Listeria monocytogenes and Haemophilus influenzae accounted for 6% and 5% of the cases respectively. In 1999, the incidence per 100,000 inhabitants of meningitis due to pneumococci (0.81), to streptococci B (0.19) and tuberculosis meningitis (0.17) were stable since 1995. The incidence rate of meningitis due to Listeria (0.10) and to H. influenzae (0.08) shows a regular decrease since 1992. The impact of preventive measures of meningitis due to Listeria and H. influenzae B has been clearly demonstrated through the dramatic decrease of meningitis due to these micro-organisms.

Data from a national network of paediatric nephrology departments in France suggest that the incidence of haemolytic uraemic syndrome (HUS) in 1998 was 0.7 cases per 100 000 children aged under 15 years and that cases occur sporadically. Six out of 85 cas

From 29 June to July 1998, four cases of legionnaires disease in British citizens were reported to the Reseau National de Sante Publique (RNSP) by the statutory notification system (declaration obligatoire (DO)) and by theEuropean Surveillance Scheme for

Arbitrarily primed PCR with three primers and pulsed-field gel electrophoresis were used to characterize a set of 75 clinical Legionella pneumophila serogroup 1 isolates, with no apparent epidemiological link, obtained from 24 hospitals in Paris, France, from 1987 to 1997. Unexpectedly, 25 clinical isolates from 15 hospitals had an identical profile (termed type A) by both methods. The same profile was subsequently found in 16 of 64 randomly selected environmental L. pneumophila serogroup 1 isolates from 15 different sites in the Paris area. There was no evidence of geographic clustering or a peak incidence of type A isolation. Type A has not been found in France outside the Paris area, suggesting that a particular type of L. pneumophila serogroup 1 is specifically present in the Paris water distribution network.

Right from the arrival of the displaced Karen people in Thailand, Médecins sans Frontières (MSF) identified malaria as the top priority problem. A program of patient care based on the coupled laboratory/dispensary was set up in April 1984. Immediately a system of surveillance of morbidity and mortality from malaria was set up. This study consisted of analysing data gathered over a period of five years. During this time, the displaced population increased from 9,000 to 20,000. Analysis of the trends shows a hyperendemic situation with an annual incidence rate of 1,067 per thousand in 1984. This figure was 600 per thousand in 1988. 1,500 blood smears were checked each month and the positive predictive value of clinical suspicion was 45% on average. Plasmodium falciparum represented 80% of infections. The malaria case fatality ratio over the course of the last two years of surveillance was 0.3%. Five years observation show that the fight against malaria in this region can be based on the development of curative services and laboratories.