236 results on '"Desenclos JC"'
Search Results
2. Apport de la modélisation à la connaissance de la diffusion des maladies infectieuses et de leur prévention
- Author
-
Desenclos Jc
- Subjects
Epidemiology ,Public Health, Environmental and Occupational Health - Published
- 2006
3. [Untitled]
- Author
-
Desenclos Jc, George Papaevangelou, Schlumberger Mg, R. Ancelle-Park, and S. C. Richardson
- Subjects
Needle sharing ,medicine.medical_specialty ,Epidemiology ,business.industry ,Cross-sectional study ,virus diseases ,social sciences ,medicine.disease ,Rate ratio ,law.invention ,Surgery ,Condom ,Acquired immunodeficiency syndrome (AIDS) ,immune system diseases ,law ,mental disorders ,Medicine ,Serostatus ,business ,Demography ,HIV Seronegativity - Abstract
The objective of the study was to analyse the effect of knowledge of HIV serostatus on behaviours preventing the acquisition or transmission of HIV among European IDU, and to compare results with a previous similar study conducted 3 years before. Data were gathered in 1992-1993 during a retrospective multicentre cross-sectional study of IDU recruited in 11 European countries, in specialized centers and on the street. We compared, between groups with different HIV serological status (IDU who knew well before their HIV-positive serological status, IDU who knew their HIV-negative serostatus and IDU who did not know before their serological status), the respective proportions of IDU who reported that, during the six months prior to interview, (1) always used condoms, (2) never gave their used injecting equipment to other IDU, (3) always injected drugs safely. We only included IDU who had known their serological status for at least six months prior to interview. Results were compared to the similar survey conducted in 1990. From 2171 IDU recruited, data of 1334 IDU were included in the analysis. Compared with IDU who did not know their HIV serostatus, only IDU knowing their HIV-positive serostatus used condoms significantly more often (37% compared to 15%, rate ratio (RR): 2.4; 95% confidence interval (CI): 1.8-2.3) and never gave their used injecting equipment to other IDU (69% compared to 53%, RR: 1.3; 95% CI: 1.2-1.4). In comparison with the 1990 study, only condom use significantly improved and only for IDU who knew their HIV-negative serostatus (13% compared to 9%, RR: 1.6; 95% CI: 1.1-2.3). This study confirms among European IDU the relation between knowing own HIV serological status to preventive behaviours. However, there were only minor improvements between 1990 and 1992-1993, indicating that prevention of HIV transmission among IDU must be reinforced.
- Published
- 1999
4. Different transmission patterns in the early stages of the influenza A(H1N1) v pandemic: A comparative analysis of 12 European countries
- Author
-
Flasche, S, Hens, N, Boelle, Py, Mossong, J, van Ballegooijen WM, Nunes, B, Rizzo, C, Popovici, F, Santa-Olalla, P, Hruba, F, Parmakova, K, Baguelin, M, van Hoek AJ, Desenclos, Jc, Bernillon, P, Camara, Al, Wallinga, J, Asikainen, T, White, Pj, Edmunds, Wj, Arias, P, Avdicova, M, Bella, A, Bermingham, A, Carreira, M, Catarino, J, Cucuiu, R, Declich, S, Dias, C, Donker, T, Even, J, Fonteneau, L, Furtado, C, Gastellu-Etchegorry, M, Guiomar, R, Gutierrez, I, Hahne, Sj, van der Hoek, W, van den Kerkhof, H, Kremer, J, Koopmans, M, Kurchatova, A, Leon, L, van der Lubben MI, Ontanon, Sd, Meijer, A, Nogueira, P, Opp, M, Paixao, E, Pebody, R, Pistol, A, Van Ranst, M, Robesyn, E, Rota, Mc, Reichert, P, Salmaso, S, van der Sande MA, Schutte, M, Moros, Mjs, van Steenbergen, J, Vaux, S, and Weicherding, P
- Subjects
Male ,Extinction probability ,Epidemiology ,medicine.disease_cause ,Disease Outbreaks ,law.invention ,Influenza A Virus, H1N1 Subtype ,0302 clinical medicine ,Risk Factors ,law ,Pandemic ,Influenza A virus ,Swine-origin influenza A H1N1 virus ,030212 general & internal medicine ,Child ,Holidays ,0303 health sciences ,Schools ,Reverse Transcriptase Polymerase Chain Reaction ,Regression analysis ,Middle Aged ,humanities ,3. Good health ,Statistical models ,Europe ,Transmission (mechanics) ,Infectious Diseases ,Regression Analysis ,Seasons ,Adult ,Adolescent ,Doenças Evitáveis pela Vacinação ,Microbiology ,Young Adult ,03 medical and health sciences ,Age Distribution ,Mixing patterns ,Virology ,Influenza, Human ,medicine ,Humans ,Epidemiologia ,Social Behavior ,Weather ,Pandemics ,030304 developmental biology ,Absolute humidity ,Extinction ,business.industry ,Public Health, Environmental and Occupational Health ,Seasonality ,Estados de Saúde e de Doença ,medicine.disease ,Parasitology ,business ,Demography - Abstract
Following the emergence of a novel strain of influenza A(H1N1) in Mexico and the United States in April 2009, its epidemiology in Europe during the summer was limited to sporadic and localised outbreaks. Only the United Kingdom experienced widespread transmission declining with school holidays in late July. Using statistical modelling where applicable we explored the following causes that could explain this surprising difference in transmission dynamics: extinction by chance, differences in the susceptibility profile, age distribution of the imported cases, differences in contact patterns, mitigation strategies, school holidays and weather patterns. No single factor was able to explain the differences sufficiently. Hence an additive mixed model was used to model the country-specific weekly estimates of the effective reproductive number using the extinction probability, school holidays and weather patterns as explanatory variables. The average extinction probability, its trend and the trend in absolute humidity were found to be significantly negatively correlated with the effective reproduction number - although they could only explain about 3% of the variability in the model. By comparing the initial epidemiology of influenza A (H1N1) across different European countries, our analysis was able to uncover a possible role for the timing of importations (extinction probability), mixing patterns and the absolute humidity as underlying factors. However, much uncertainty remains. With better information on the role of these epidemiological factors, the control of influenza could be improved. UK Medical Research Council for Centre funding;European PCRD 7 (Flumodcont); Institute for the Promotion of Innovation by Science and Technology in Flanders (IWT), project number 060081 and by the IAP research network nr P6/03 of the Belgian Government (Belgian Science Policy)
- Published
- 2011
5. Knowledge of HIV serostatus and preventive behaviour among European injecting drug users
- Author
-
Desenclos Jc, Papaevangelou G, and Ancelle-Park R
- Subjects
medicine.medical_specialty ,biology ,Transmission (medicine) ,business.industry ,Immunology ,virus diseases ,Rate ratio ,medicine.disease ,biology.organism_classification ,Confidence interval ,Surgery ,law.invention ,Infectious Diseases ,Acquired immunodeficiency syndrome (AIDS) ,Condom ,immune system diseases ,law ,mental disorders ,Epidemiology ,medicine ,Immunology and Allergy ,Serostatus ,business ,Sida ,Demography - Abstract
Objective To study the effect of knowledge of HIV serostatus on behaviour for preventing the acquisition or transmission of HIV among European injecting drug users (IDU). Methods Data on behaviour and prior knowledge of HIV status were gathered during a multicentre cross-sectional survey of 200 European IDU recruited in 12 European countries in 1990. The respective proportions of IDU who (1) used condoms, (2) did not give their used injecting equipment to other IDU and (3) injected drugs safely (ether did not re-use other IDU's equipment or re-used it only after disinfection with bleach, alcohol or boiling water during the 6 months preceding interview were compared according to whether they knew their HIV serostatus for at least 6 months prior to interview. Results In comparison with IDU who had never been tested, IDU who knew that they were HIV-seropositive were more likely to always use condoms [rate ratio (RR) = 3.1; 95% confidence interval (CD, 2.3–4.2] and never gave their used equipment to other IDU (RR = 1.3; 95% Cl, 1.2–1.5), but did not differ with regard to safe injecting practices (RR = 1.0; 95% Cl, 0.9–1.1). Compared with IDU who had never been tested, IDU with a negative test tended to inject drugs safely more often (RR = 1.1; 95% Cl, 1.02–1.2). There was no significant difference in condom use (RR = 0.7; 95% Cl, 0.5–1.1). Conclusion These results indicate that the knowledge of HIV serostatus may help to reduce HIV transmission from HIV-positive IDU to others through safer injecting and sexual behaviour. However, for HIV-negative IDU safer injecting behaviour appears to be better accepted than safer sexual behaviour.
- Published
- 1993
6. A multistate outbreak of hepatitis A caused by the consumption of raw oysters
- Author
-
Harold S. Margolis, Robert A. Gunn, Michael H. Wilder, Karl C. Klontz, Desenclos Jc, and O. V. Nainan
- Subjects
Adult ,Male ,Oyster ,Veterinary medicine ,animal structures ,Adolescent ,Attack rate ,Enzyme-Linked Immunosorbent Assay ,Disease Outbreaks ,Dozen ,Foodborne Diseases ,Virus antigen ,biology.animal ,medicine ,Animals ,Humans ,Child ,Shellfish ,biology ,business.industry ,fungi ,Public Health, Environmental and Occupational Health ,food and beverages ,Outbreak ,Hepatitis A ,Middle Aged ,Bivalvia ,biology.organism_classification ,medicine.disease ,Ostreidae ,Case-Control Studies ,Florida ,Food Microbiology ,Female ,Water Microbiology ,business ,geographic locations ,Research Article - Abstract
BACKGROUND. In August 1988 we investigated a multistate outbreak of hepatitis A caused by Panama City, Florida, raw oysters. METHODS. Cases of hepatitis A (HA) with onset in July-August 1988 were identified among persons who ate seafoods harvested in the coastal waters of Panama City, Florida. We conducted a case-control study, using eating companions of case-patients, and calculated attack rate (AR) per 1000 dozen raw oysters served. Enzyme immunoassay (EIA) and a polymerase chain reaction (PCR) technique were performed on samples of raw shellfish obtained from Panama City coastal waters. RESULTS. Sixty-one case-patients were identified in five states: Alabama (23), Georgia (18), Florida (18), Tennessee (1), and Hawaii (1). We found an increased risk of HA for raw oyster eaters (odds ratio = 24.0; 95% confidence interval = 5.4-215.0; P less than .001). The AR of HA in seafood establishments was 1.9/1000 dozen raw oysters served. The EIA and PCR revealed HA virus antigen and nucleic acid in oysters from both unapproved and approved oyster beds, in confiscated illegally harvested oysters, and in scallops from an approved area. CONCLUSIONS. The monitoring of coastal waters and the enforcement of shellfish harvesting regulations were not adequate to protect raw oyster consumers. More emphasis should be placed on increasing public awareness of health hazards associated with eating raw shellfish.
- Published
- 1991
7. A large multi-pathogen waterborne community outbreak linked to faecal contamination of a groundwater system, France, 2000
- Author
-
Gallay, A, De Valk, H, Cournot, M, Ladeuil, B, Hemery, C, Castor, C, Bon, F, Megraud, F, Le Cann, Pierre, Desenclos, Jc, Gallay, A, De Valk, H, Cournot, M, Ladeuil, B, Hemery, C, Castor, C, Bon, F, Megraud, F, Le Cann, Pierre, and Desenclos, Jc
- Abstract
A large waterborne outbreak of infection that occurred during August 2000 in a local community in France was investigated initially via a rapid survey of visits to local physicians. A retrospective cohort study was then conducted on a random cluster sample of residents. Of 709 residents interviewed, 202 (28.5%) were definite cases (at least three liquid stools/day or vomiting) and 62 (8.7%) were probable cases (less than three liquid stools/day or abdominal pain). Those who had drunk tap water had a three-fold increased risk for illness (95% CI 2.4-4.0). The risk increased with the amount of water consumed (chi-square trend: p < 0.0001). Bacteriological analyses of stools were performed for 35 patients and virological analyses for 24 patients. Campylobacter coli, group A rotavirus and norovirus were detected in 31.5%, 71.0% and 21% of samples, respectively. An extensive environmental investigation concluded that a groundwater source to this community had probably been contaminated by agricultural run-off, and a failure in the chlorination system was identified. This is the first documented waterborne outbreak of infection involving human C. coli infections. A better understanding of the factors influencing campylobacter transmission between hosts is required.
- Published
- 2006
- Full Text
- View/download PDF
8. The challenge of hepatitis C surveillance in Europe
- Author
-
Desenclos Jc
- Subjects
medicine.medical_specialty ,Iatrogenic transmission ,High prevalence ,Intravenous drug ,Epidemiology ,Transmission (medicine) ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,MEDLINE ,Hepatitis C ,medicine.disease ,Virology ,Immunology ,medicine ,Intensive care medicine ,business - Abstract
Hepatitis C has become an important public health issue because of its high prevalence, severe liver complica-tions, ongoing transmission among intravenous drug users (IDUs), the risk of iatrogenic transmission and the availability of prevention measures and treatment.
- Published
- 2003
9. The raw oyster consumer--a risk taker? Use of the Behavioral Risk Factor Surveillance System
- Author
-
Roberts C, Wolfe Le, Desenclos Jc, Hoecherl Sa, Robert A. Gunn, and Karl C. Klontz
- Subjects
Adult ,Male ,Oyster ,Adolescent ,Epidemiology ,Age and sex ,law.invention ,Eating ,Risk-Taking ,law ,biology.animal ,Environmental health ,Prevalence ,Medicine ,Animals ,Humans ,Consumption (economics) ,biology ,Behavioral Risk Factor Surveillance System ,business.industry ,Driving While Intoxicated ,Middle Aged ,biology.organism_classification ,Chronic alcohol ,Ostreidae ,Transmission (mechanics) ,Socioeconomic Factors ,Female ,business - Abstract
We used the 1988 Behavioral Risk Factor Surveillance System in Florida to determine the prevalence of consumption of raw oysters, a vehicle implicated in the transmission of several pathogens. One-third of survey respondents reported ever eating raw oysters. The prevalence was higher for persons 18-49 years old and for males, and, when controlled for age and sex, for persons who reported being cigarette smokers or acute or chronic alcohol drinkers, and driving while intoxicated.
- Published
- 1991
10. Estimation épidémiologique de l’efficacité de la vaccination anticoquelucheuse au cours d’épidémies en collectivité
- Author
-
Baron, S, primary, Grimprel, E, additional, Daurat, G, additional, Cuisinet, C, additional, Ponge, A, additional, Haeghebaert, S, additional, Guiso, N, additional, Desenclos, JC, additional, and Drucker, J, additional
- Published
- 1997
- Full Text
- View/download PDF
11. Bilan de l'investigation de cinq épidémies communautaires de salmonellose, France, 1993–1994
- Author
-
Desenclos, JC, primary, Rebère, I, additional, Bouvet, P, additional, Benz-Lemoine, E, additional, Robain, M, additional, Bouvier, N, additional, Ponge, A, additional, Viannez-Gaide, AM, additional, Paoli, C, additional, Bleuzé, V, additional, Tran Quyet Chinh, E, additional, Grimont, F, additional, and Grimont, PAD, additional
- Published
- 1996
- Full Text
- View/download PDF
12. Sporadic community-acquired Legionnaires' disease in France: a 2-year national matched case-control study.
- Author
-
Che D, Campese C, Santa-Olalla P, Jacquier G, Bitar D, Bernillon P, Desenclos JC, Che, D, Campese, C, Santa-Olalla, P, Jacquier, G, Bitar, D, Bernillon, P, and Desenclos, J-C
- Abstract
Legionnaires' disease (LD) is an aetiology of community-acquired bacterial pneumonia in adults, with a high case-fatality ratio (CFR). We conducted a matched case-control study to identify risk factors for sporadic, community-acquired LD. Cases of sporadic, community-acquired and biologically confirmed LD, in metropolitan France from 1 September 2002 to 31 September 2004, were matched with a control subject according to age, sex, underlying illness and location of residence within 5 km. We performed a conditional logistic regression on various host-related factors and exposures. Analysis was done on 546 matched pairs. The CFR was 3.5%. Age ranged from 18-93 years (mean 57 years), with a 3.6 male:female sex ratio. Cases were more likely to have smoked with the documentation of a dose-effect relation, to have travelled with a stay in a hotel (OR 6.1, 95% CI 2.6-14.2), or to have used a wash-hand basin for personal hygiene (OR 3.5, 95% CI 1.6-7.7) than controls. Tobacco and travel have been previously described as risk factors for LD, but this is the first time that such a dose-effect for tobacco has been documented among sporadic cases. These findings will provide helpful knowledge about LD and help practitioners in identifying patients at high risk. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
13. Evaluation of the impact on human salmonellosis of control measures targeted to Salmonella Enteritidis and Typhimurium in poultry breeding using time-series analysis and intervention models in France.
- Author
-
Poirier E, Watier L, Espie E, Weill FX, De Valk H, Desenclos JC, Poirier, E, Watier, L, Espie, E, Weill, F-X, De Valk, H, and Desenclos, J-C
- Abstract
In France, salmonellosis is the main cause of foodborne bacterial infection with serotypes Enteritis (SE) and Typhimurium (ST) accounting for 70% of all cases. French authorities implemented a national control programme targeting SE and ST in poultry and eggs from October 1998 onwards. A 33% decrease in salmonellosis has been observed since implementation. We designed an evaluation of the impact of this control programme on SE and ST human infections in France. Using monthly Salmonella human isolate reports to the National Reference Centre we defined two intervention series (SE and ST) and one control series comprising serotypes not know to be associated with poultry or eggs. The series, from 1992 to 2003, were analysed using autoregressive moving average models (ARMA). To test the hypothesis of a reduction of SE and ST human cases >0 after the programme started and to estimate its size, we introduced an intervention model to the ARMA modelling. In contrast to the control series, we found an annual reduction of 555 (95% CI 148-964) SE and of 492 (95% CI 0-1092) ST human infections, representing respectively a 21% and 18% decrease. For SE, the decrease occurred sharply after implementation while for ST, it followed a progressive decrease that started early in 1998. Our study, suggests a true relation between the Salmonella control programme and the subsequent decrease observed for the two targeted serotypes. For ST, however, the decrease prior to the intervention may also reflect control measures implemented earlier by the cattle and milk industry. [ABSTRACT FROM AUTHOR]
- Published
- 2008
- Full Text
- View/download PDF
14. Association between indicators of cattle density and incidence of paediatric haemolytic-uraemic syndrome (HUS) in children under 15 years of age in France between 1996 and 2001: an ecological study.
- Author
-
Haus-Cheymol R, Espie E, Che D, Vaillant V, De Valk H, and Desenclos JC
- Published
- 2006
- Full Text
- View/download PDF
15. Correlates of cocaine use during methadone treatment: implications for screening and clinical management (ANRS Methaville study)
- Author
-
Marion Mora, Caroline Lions, Antoine Vilotitch, Patrizia Carrieri, Alain Morel, Bruno Spire, Fabienne Marcellin, Gwenaëlle Maradan, Perrine Roux, Laurent Michel, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Troubles du comportement alimentaire de l'adolescent (UMR_S 669), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Centre Pierre Nicole, Oppelia, The study received external funding from the French National Agency forResearch for Aids and Viral Hepatitis (ANRS) and from the French Ministry ofHealth., ANRS Methaville study group - Carrieri PM, Morel A, Michel L, Mora M, Roux P, Aubertin JF, Robinet S, Daulouede JP, Desenclos JC, Cohen J, Herszkowicz A, Paul C, Porteret I, Marie T, Bachellier J, Beauverie P, Couteron JP, Marty-Double C, Vray M, Baker R, Catania H, Gossop M, Haemmig R, Torrens M, Wodak A, Michel CL, Mora M, Roux P, Maradan G, Biemar J, Huguet S, Kurkdji P, Taieb C, Cohen J, Giovannini C, Kissikian MP, Desenclos JC, Job-Spira N, Dore V, Paul C, Porteret I, Richard N, Herszkowicz A, Prisse N, Olivet F, Arditti J., BMC, BMC, Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM - U912 INSERM - AMU - IRD ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ), Troubles du comportement alimentaire de l'adolescent ( UMR_S 669 ), and Université Paris-Sud - Paris 11 ( UP11 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )
- Subjects
Male ,Injection ,[SDV]Life Sciences [q-bio] ,030508 substance abuse ,Medicine (miscellaneous) ,law.invention ,Opioid dependence ,0302 clinical medicine ,Randomized controlled trial ,Cocaine ,law ,Behavior Therapy ,Risk Factors ,030212 general & internal medicine ,Longitudinal Studies ,media_common ,Depression ,Opiate Substitution Treatment ,3. Good health ,[SDV] Life Sciences [q-bio] ,Psychiatry and Mental health ,Crack Cocaine ,Female ,France ,Opiate ,0305 other medical science ,medicine.drug ,Adult ,Narcotics ,Methadone maintenance ,medicine.medical_specialty ,Maintenance ,03 medical and health sciences ,Cocaine-Related Disorders ,mental disorders ,medicine ,Attention deficit hyperactivity disorder ,media_common.cataloged_instance ,Humans ,ADHD ,European union ,Psychiatry ,[ SDV ] Life Sciences [q-bio] ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,medicine.disease ,Opioid-Related Disorders ,Clinical trial ,Socioeconomic Factors ,Attention Deficit Disorder with Hyperactivity ,Emergency medicine ,Self Report ,business ,Methadone - Abstract
International audience; AbstractBackgroundCocaine use is frequent in patients receiving methadone maintenance treatment (MMT) and can jeopardize their treatment response. Identifying clinical predictors of cocaine use during methadone treatment can potentially improve clinical management. We used longitudinal data from the ANRS Methaville trial both to describe self-reported occasional and regular cocaine use during MMT and to identify clinical predictors.MethodsWe selected 183 patients who had data on cocaine (or crack) use at months 0 (M0), M6, and/or M12, accounting for 483 visits. The outcome was “cocaine use” in three categories: “no,” “occasional,” and “regular” use. To identify factors associated with the outcome over time, we performed a mixed multinomial logistic regression.ResultsTime on methadone was significantly associated with a decrease in occasional but not in regular cocaine use from 14.7 % at M0 to 7.1 % at M12, and from 10.7 % at baseline to 6.5 % at M12, respectively. After multiple adjustments, opiate injection, individuals screening positive for attention deficit hyperactivity disorder (ADHD) symptoms, and those presenting depressive symptoms were more likely to regularly use cocaine.ConclusionsAlthough time on MMT had a positive impact on occasional cocaine use, it had no impact on regular cocaine use. Moreover, regular cocaine users were more likely to report opiate injection and to present ADHD and depressive symptoms. Early screening of these disorders and prompt tailored pharmacological and behavioral interventions can potentially reduce cocaine use and improve response to MMT.Trial registrationThe trial is registered with the French Agency of Pharmaceutical Products (AFSSAPS) under the number 2008-A0277-48, the European Union Drug Regulating Authorities Clinical Trials, number Eudract 2008-001338-28, the ClinicalTrials.gov Identifier: NCT00657397, and the International Standard Randomised Controlled Trial Number Register ISRCTN31125511.
- Published
- 2015
16. Past excessive alcohol consumption: a major determinant of severe liver disease among newly referred hepatitis C virus infected patients in hepatology reference centers, France, 2001.
- Author
-
Delarocque-Astagneau E, Roudot-Thoraval F, Campese C, Desenclos JC, and Hepatitis C Surveillance System Steering Committee
- Abstract
PURPOSE: Our study aimed to identify factors associated with the occurrence of severe liver disease in hepatitis C virus (HCV) positive patients at first referral to hepatology reference centers in France in 2001. METHODS: Patients reported through the national hospital-based hepatitis C surveillance system in 2001 were included. The definition of severe liver disease was based on clinical, biological, and morphological evaluation; cirrhosis (+/- complication) and primary liver cancer were classified as severe liver disease. Patient characteristics were compared for those with and without severe liver disease. RESULTS: Of the 3404 newly referred patients in the 26 participating centers, 391 (11.5%) had severe liver disease. Male gender (adjusted odds ratios [aOR]=1.4; 95% confidence interval [CI], 1.0-1.9), age over 39 years at referral (aOR=3.8; 95% CI, 2.7-5.3), past excessive alcohol consumption (aOR=2.6; 95% CI, 1.9-3.5), and HIV seropositivity (aOR=1.9; 95% CI, 1.1-3.3) were each independently associated with an increased risk of severe liver disease. In the subgroup of patients with known age at time of HCV exposure, age over 39 years at time of exposure (aOR=1.6; 95% CI, 1.1-2.4), duration of HCV infection over 15 years (aOR=2.6; 95% CI, 1.8-3.7), known HBs antigen positivity (aOR=2.4; 95% CI, 1.1-5.2), and past excessive alcohol consumption (aOR=2.7; 95% CI, 1.8-3.9) were each associated with increased risk of severe liver disease. CONCLUSIONS: Our findings underscore the important role of past excessive alcohol consumption on the development of severe liver disease for HCV patients. [ABSTRACT FROM AUTHOR]
- Published
- 2005
17. A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France.
- Author
-
Boudet-Berquier J, Demattei C, Guldner L, Gallay A, Manouvrier S, Botton J, Philippat C, Delva F, Bloch J, Semaille C, Odent S, Perthus I, Randrianaivo H, Babajko S, Barjat T, Beneteau C, Brennetot N, Garne E, Haddad G, Hocine M, Lacroix I, Leuraud K, Mench M, Morris J, Patrier S, Sartelet A, Verloes A, Bonaldi C, Le Barbier M, Gagnière B, Pépin P, Ollivier R, Bitoun M, King L, Guajardo-Villar A, Gomes E, Desenclos JC, Regnault N, and Benachi A
- Subjects
- Humans, France epidemiology, Female, Male, Cluster Analysis, Risk Factors, Upper Extremity, Spatio-Temporal Analysis, Child, Environmental Exposure adverse effects, Infant, Upper Extremity Deformities, Congenital
- Abstract
Introduction: Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas., Methods: The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use., Results: After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed., Discussion: Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred., (© 2024. Springer Nature B.V.)
- Published
- 2024
- Full Text
- View/download PDF
18. Surveillance system integration: reporting the results of a global multicountry survey.
- Author
-
Carter ED, Stewart DE, Rees EE, Bezuidenhoudt JE, Ng V, Lynes S, Desenclos JC, Pyone T, and Lee ACK
- Subjects
- Humans, Cross-Sectional Studies, Surveys and Questionnaires, Public Health Surveillance methods, Systems Integration, Global Health statistics & numerical data
- Abstract
Objectives: Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs)., Study Design: This was a cross-sectional survey of NPHIs., Methods: A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status., Results: Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability., Conclusions: Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
19. The state of integrated disease surveillance globally: synthesis report of a mixed methods study.
- Author
-
Lee ACK, Iversen BG, Lynes S, Desenclos JC, Bezuidenhoudt JE, Flodgren GM, and Pyone T
- Subjects
- Humans, Cross-Sectional Studies, Population Surveillance methods, COVID-19 epidemiology, Public Health, Global Health statistics & numerical data
- Abstract
Objectives: Disease surveillance is an essential public health function needed to prevent, detect, monitor and respond to health threats. Integrated disease surveillance (IDS) enhances its utility and has been advocated for decades by the World Health Organization. This study sought to examine the state of IDS implementation worldwide., Study Design: The study used a concurrent mixed methods approach consisting of a systematic scoping review of the literature on IDS, a survey of International Association of National Public Health Institutes (IANPHI) members and qualitative deep dive case studies in seven countries., Methods: This report collates, analyses and synthesises the findings from the three components. The scoping review consisted of a review of summarised evidence on IDS. Eight reviews and five primary studies were included. The cross-sectional survey was conducted of 110 IANPHI members representing ninety-five countries. Qualitative case studies were conducted in Malawi, Mozambique, Uganda, Pakistan, Canada, Sweden, and England, which involved thirty-four focus group discussions and forty-eight key informant interviews., Results: In the different countries, IDS is conceptualised differently and there are differing levels of maturity of IDS functions. Although the role of National Public Health Institutes has not been well defined in the IDS, they play a significant role in IDS in many countries. Fragmentation between sectors and resourcing (human and financial) issues were common. Good governance measures such as appropriate legislative and regulatory frameworks and roles and responsibilities for IDS were often unclear. The COVID-19 pandemic has strengthened some surveillance systems, often through leveraging existing respiratory surveillance systems. In some instances, improvements were seen only for COVID-19 related data but these changes were not sustained. Evaluation of IDS was also reported to be weak., Conclusions: Integration should be driven by a clear purpose and contextualised. Political commitment, clear governance, and resourcing are needed. Technology and the establishment of technical communities of practice may help. However, the complexity and cost of integration should not be under-estimated, and further economic and impact evaluations of IDS are needed., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
20. Seroprevalence for Borrelia burgdorferi sensu lato and tick-borne encephalitis virus antibodies and associated risk factors among forestry workers in northern France, 2019 to 2020.
- Author
-
Septfons A, Rigaud E, Bénézet L, Velay A, Zilliox L, Baldinger L, Gonzalez G, Figoni J, de Valk H, Deffontaines G, Desenclos JC, and Jaulhac B
- Subjects
- Animals, Humans, Seroepidemiologic Studies, Forestry, Cross-Sectional Studies, Antibodies, Bacterial, Antibodies, Viral, Risk Factors, France epidemiology, Borrelia burgdorferi, Lyme Disease epidemiology, Encephalitis Viruses, Tick-Borne, Tick-Borne Diseases epidemiology, Encephalitis, Tick-Borne epidemiology, Ticks, Bites and Stings
- Abstract
BackgroundLyme borreliosis (LB) is the most common tick-borne disease (TBD) in France. Forestry workers are at high risk of TBD because of frequent exposure to tick bites.AimWe aimed to estimate the seroprevalence of Borrelia burgdorferi sensu lato and tick-borne encephalitis virus (TBEV) antibodies among forestry workers in northern France. We compared seroprevalence by geographical area and assessed factors associated with seropositivity.MethodsBetween 2019 and 2020, we conducted a randomised cross-sectional seroprevalence survey. Borrelia burgdorferi sl seropositivity was defined as positive ELISA and positive or equivocal result in western blot. Seropositivity for TBEV was defined as positive result from two ELISA tests, confirmed by serum neutralisation. We calculated weighted seroprevalence and adjusted prevalence ratios to determine association between potential risk factors and seropositivity.ResultsA total of 1,778 forestry workers participated. Seroprevalence for B. burgdorferi sl was 15.5% (95% confidence interval (CI): 13.9-17.3), 3.5 times higher in the eastern regions than in the western and increased with seniority and with weekly time in a forest environment. Seroprevalence was 2.5 times higher in forestry workers reporting a tick bite during past years and reporting usually not removing ticks rapidly. Seroprevalence for TBEV was 0.14% (95% CI: 0.05-0.42).ConclusionWe assessed for the first time seroprevalence of B. burgdorferi sl and TBEV antibodies among forestry workers in northern France. These results will be used, together with data on LB and tick-borne encephalitis (TBE) incidence and on exposure to tick-bites, to target prevention programmes.
- Published
- 2023
- Full Text
- View/download PDF
21. Essential public health functions: the key to resilient health systems.
- Author
-
Squires N, Garfield R, Mohamed-Ahmed O, Iversen BG, Tegnell A, Fehr A, Koplan JP, Desenclos JC, and Viso AC
- Subjects
- Humans, Public Health
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2023
- Full Text
- View/download PDF
22. The Authors' Reply.
- Author
-
Carrat F, Desenclos JC, de Lamballerie X, and Zins M
- Published
- 2022
- Full Text
- View/download PDF
23. Estimating chikungunya virus transmission parameters and vector control effectiveness highlights key factors to mitigate arboviral disease outbreaks.
- Author
-
Jourdain F, de Valk H, Noël H, Paty MC, L'Ambert G, Franke F, Mouly D, Desenclos JC, and Roche B
- Subjects
- Animals, Disease Outbreaks prevention & control, Mosquito Vectors, Aedes, Arbovirus Infections epidemiology, Chikungunya Fever epidemiology, Chikungunya Fever prevention & control, Chikungunya virus
- Abstract
Background: Viruses transmitted by Aedes mosquitoes have greatly expanded their geographic range in recent decades. They are considered emerging public health threats throughout the world, including Europe. Therefore, public health authorities must be prepared by quantifying the potential magnitude of virus transmission and the effectiveness of interventions., Methodology: We developed a mathematical model with a vector-host structure for chikungunya virus transmission and estimated model parameters from epidemiological data of the two main autochthonous chikungunya virus transmission events that occurred in Southern France, in Montpellier (2014) and in Le Cannet-des-Maures (2017). We then performed simulations of the model using these estimates to forecast the magnitude of the foci of transmission as a function of the response delay and the moment of virus introduction., Conclusions: The results of the different simulations underline the relative importance of each variable and can be useful to stakeholders when designing context-based intervention strategies. The findings emphasize the importance of, and advocate for early detection of imported cases and timely biological confirmation of autochthonous cases to ensure timely vector control measures, supporting the implementation and the maintenance of sustainable surveillance systems., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2022
- Full Text
- View/download PDF
24. COVID-19 hotspots through clusters analysis in France (may-October 2020): where should we track the virus to mitigate the spread?
- Author
-
Spaccaferri G, Calba C, Vilain P, Garras L, Durand C, Pilorget C, Atiki N, Bernillon P, Bosc L, Fougère E, Hanon JB, Henry V, Huchet-Kervella C, Martel M, Pontiès V, Mouly D, Rolland du Roscoat E, Le Vu S, Desenclos JC, Laporte A, and Rolland P
- Subjects
- Communicable Disease Control, France epidemiology, Humans, SARS-CoV-2, COVID-19 epidemiology, Contact Tracing
- Abstract
Background: In France, the lifting of the lockdown implemented to control the COVID-19 first wave in 2020 was followed by a reinforced contact-tracing (CT) strategy for the early detection of cases and transmission chains. We developed a reporting system of clusters defined as at least three COVID-19 cases, within seven days and belonging to the same community or having participated in the same gathering, whether they know each other or not. The aim of this study was to describe the typology and criticality of clusters reported between the two lockdowns in France to guide future action prioritisation., Methods: In this study we describe the typology and criticality of COVID-19 clusters between the two lockdowns implemented in France (between May and end of October 2020). Clusters were registered in a national database named "MONIC" (MONItoring des Clusters), established in May 2020. This surveillance system identified the most affected communities in a timely manner. A level of criticality was defined for each cluster to take into consideration the risk of spreading within and outside the community of occurrence, and the health impact within the community. We compared the level of criticality according to the type of community in which the cluster occurred using Pearson's chi-square tests., Results: A total of 7236 clusters were reported over the study period, particularly in occupational environment (25.1%, n = 1813), elderly care structures (21.9%, n = 1586), and educational establishments (15.9%, n = 1154). We show a shift over time of the most affected communities in terms of number of clusters. Clusters reported in occupational environment and the personal sphere had increased during summer while clusters reported in educational environment increased after the start of the school year. This trend mirrors change of transmission pattern overtime according to social contacts. Among all reported clusters, 43.1% had a high level of criticality with significant differences between communities (p < 0.0001). A majority of clusters had a high level of criticality in elderly care structures (82.2%), in disability care centres (56.6%), and health care facilities (51.7%)., Conclusion: These results highlight the importance of targeting public health action based on timely sustained investigations, testing capacity and targeted awareness campaigns. The emergence of new SARS-CoV-2 variants strengthen these public health recommendations and the need for rapid and prioritise vaccination campaigns., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
25. Increased awareness and knowledge of Lyme Borreliosis and tick bite prevention among the general population in France: 2016 and 2019 health barometer survey.
- Author
-
Septfons A, Figoni J, Gautier A, Soullier N, de Valk H, and Desenclos JC
- Subjects
- France epidemiology, Humans, Surveys and Questionnaires, Lyme Disease epidemiology, Lyme Disease prevention & control, Tick Bites prevention & control, Tick-Borne Diseases
- Abstract
Background: Lyme borreliosis (LB) is the most frequent tick-borne disease in France. In the absence of a vaccine, LB prevention mainly relies on reducing tick bites. In 2016, the French Ministry of Health launched a national plan against tick-borne infections, including a prevention component. To evaluate the impact of this prevention strategy, we assessed knowledge and practices of tick bite prevention using the 2016 and 2019 national surveys on health attitudes and beliefs known as the French Health Barometer., Methods: The Health Barometer is a repeated nationwide phone survey conducted annually on a random sample aged 18 to 75 years living in mainland France. In 2016 and 2019, participants were asked, among others, about their exposure to ticks, their behavior and practices regarding tick bites, and their knowledge about LB and its prevention., Results: In 2019, 30% of the population reported a lifetime tick bite and 6% in the last year, an increase from 25% and 4%, respectively, in 2016 (p < 0.001). In 2019, 25% of the population felt exposed to tick bites compared to 23% in 2016 (p < 0.001). The proportion of participants who had heard about LB and who considered themselves well informed respectively increased from 66% and 29% in 2016 to 79% and 41% in 2019, (p < 0.001). In 2019 compared to 2016, a greater part of the French population applied protective measures against tick bites, particularly wearing protective clothing (74% vs 66%, p < 0.001) and regular tick checks and prompt tick removal after exposure (54% vs 47%, p < 0.001)., Conclusions: A substantial proportion of French residents are exposed to tick bites and apply protective measures. Our findings indicate a trend toward an increased knowledge and awareness of tick bites and LB between 2016 and 2019 in France. Our results can be used to target future information campaigns to specific age groups or at-risk areas in addition to the general population. However, we need to further study the barriers to the use of preventive measures., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
26. Evidence of early circulation of SARS-CoV-2 in France: findings from the population-based "CONSTANCES" cohort.
- Author
-
Carrat F, Figoni J, Henny J, Desenclos JC, Kab S, de Lamballerie X, and Zins M
- Subjects
- Adult, Aged, Cohort Studies, Female, France epidemiology, Humans, Male, Middle Aged, SARS-CoV-2, Young Adult, COVID-19 blood, COVID-19 epidemiology
- Abstract
Using serum samples routinely collected in 9144 adults from a French general population-based cohort, we identified 353 participants with a positive anti-SARS-CoV-2 IgG test, among whom 13 were sampled between November 2019 and January 2020 and were confirmed by neutralizing antibodies testing. Investigations in 11 of these participants revealed experience of symptoms possibly related to a SARS-CoV-2 infection or situations at risk of potential SARS-CoV-2 exposure. This suggests early circulation of SARS-CoV-2 in Europe.
- Published
- 2021
- Full Text
- View/download PDF
27. Early assessment of the impact of mitigation measures to control COVID-19 in 22 French metropolitan areas, October to November 2020.
- Author
-
Spaccaferri G, Larrieu S, Pouey J, Calba C, Benet T, Sommen C, Lévy-Bruhl D, Smaili S, Che D, Filleul L, Caserio-Schönemann C, Ait-El-Belghiti F, Haeghebaert S, Desenclos JC, Huiart L, Laporte A, and Rolland P
- Subjects
- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 transmission, Cities, Communicable Disease Control statistics & numerical data, France epidemiology, Hospitalization, Humans, Incidence, Time Factors, COVID-19 prevention & control, Communicable Disease Control methods, Pandemics, Physical Distancing, Quarantine legislation & jurisprudence, SARS-CoV-2, Urban Population statistics & numerical data
- Abstract
In France, measures including curfew and lockdown were implemented to control the COVID-19 pandemic second wave in 2020. This study descriptively assesses their possible effects, also relative to their timing. A considerable decrease in incidence of COVID-19 cases and hospital admissions was observed 7 to 10 days after mitigation measures were put in place, occurring earlier in metropolitan areas which had implemented these first. This temporal coincidence suggests the measures' positive impact, consistent with international experiences.
- Published
- 2020
- Full Text
- View/download PDF
28. Environmental and human health issues related to long-term contamination by chlordecone in the French Caribbean.
- Author
-
Benoit P, Cravedi JP, Desenclos JC, Mouvet C, Rychen G, and Samson M
- Subjects
- Caribbean Region, Humans, West Indies, Chlordecone analysis, Insecticides analysis
- Published
- 2020
- Full Text
- View/download PDF
29. From importation to autochthonous transmission: Drivers of chikungunya and dengue emergence in a temperate area.
- Author
-
Jourdain F, Roiz D, de Valk H, Noël H, L'Ambert G, Franke F, Paty MC, Guinard A, Desenclos JC, and Roche B
- Subjects
- Animals, Chikungunya Fever epidemiology, Dengue epidemiology, Female, France epidemiology, Humans, Male, Aedes growth & development, Chikungunya Fever transmission, Dengue transmission, Disease Transmission, Infectious, Mosquito Vectors growth & development
- Abstract
Background: The global spread of Aedes albopictus has exposed new geographical areas to the risk of dengue and chikungunya virus transmission. Several autochthonous transmission events have occurred in recent decades in Southern Europe and many indicators suggest that it will become more frequent in this region in the future. Environmental, socioeconomic and climatic factors are generally considered to trigger the emergence of these viruses. Accordingly, a greater knowledge of the determinants of this emergence in a European context is necessary to develop adapted surveillance and control strategies, and public health interventions., Methodology/principal Findings: Using French surveillance data collected from between 2010 and 2018 in areas of Southern France where Ae. albopictus is already established, we assessed factors associated with the autochthonous transmission of dengue and chikungunya. Cases leading to autochthonous transmission were compared with those without subsequent transmission using binomial regression. We identified a long reporting delay (≥ 21 days) of imported cases to local health authorities as the main driver for autochthonous transmission of dengue and chikungunya in Southern France. The presence of wooded areas around the cases' place of residence and the accumulation of heat during the season also increased the risk of autochthonous arbovirus transmission., Conclusions: Our findings could inform policy-makers when developing strategies to the emerging threats of dengue and chikungunya in Southern Europe and can be extrapolated in this area to other viruses such as Zika and yellow fever, which share the same vector. Furthermore, our results allow a more accurate characterization of the environments most at risk, and highlight the importance of implementing surveillance systems which ensure the timely reporting and of imported cases and swift interventions., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
- Full Text
- View/download PDF
30. Association between maternal prepregnancy obesity and breastfeeding duration: Data from a nationwide prospective birth cohort.
- Author
-
Boudet-Berquier J, Salanave B, Desenclos JC, and Castetbon K
- Subjects
- Adolescent, Adult, Body Mass Index, Cohort Studies, Female, France, Humans, Prospective Studies, Time Factors, Young Adult, Breast Feeding statistics & numerical data, Maternal Behavior, Obesity epidemiology
- Abstract
Association of maternal obesity with shorter breastfeeding duration may involve different factors and might be modified by parity. In a national birth cohort, we aimed to estimate the association between prepregnancy body mass index (pBMI) and breastfeeding duration after adjustment for sociodemographic, pregnancy, and other characteristics and assess the effect modification of parity in such associations. In 2012, 3,368 mother-infant dyads were randomly included at birth in the French Epifane cohort. Breastfeeding information was collected in maternity wards and by phone interview at 1, 4, 8, and 12 months postpartum. Poisson regression analyses estimated the association of pBMI with the number of days of "any breastfeeding" (ABF) and "exclusive breastfeeding" (EBF) in unadjusted and adjusted models. Interactions between parity and pBMI were tested. Obesity before pregnancy was independently associated with shorter ABF duration (incidence rate ratio [IRR] = 0.86, 95%CI [0.74, 0.99]) compared to normal-weight status. Parity showed an effect modification only with EBF duration. Among primiparae, no association was found for obesity, but overweight was significantly associated with shorter EBF duration independently of all covariates (IRR = 0.74 [0.58, 0.95]). Among multiparas, obesity was associated with shorter EBF duration after controlling for sociodemographic factors (IRR = 0.71 [0.53, 0.95]). This association was no longer statistically significant after controlling for other covariates. Obesity appears to be a strong risk factor in shorter ABF duration. Furthermore, parity is a key factor in the relationship of pBMI to shorter EBF duration. Overweight primiparous and obese multiparous women need additional support to prolong breastfeeding duration., (© 2017 John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
31. Extension of French vaccination mandates: from the recommendation of the Steering Committee of the Citizen Consultation on Vaccination to the law.
- Author
-
Lévy-Bruhl D, Desenclos JC, Quelet S, and Bourdillon F
- Subjects
- Child, Communicable Disease Control legislation & jurisprudence, France, Humans, Infant, Measles prevention & control, Mumps prevention & control, Pediatrics, Rubella prevention & control, Health Policy legislation & jurisprudence, Mandatory Programs legislation & jurisprudence, Measles-Mumps-Rubella Vaccine administration & dosage, Vaccination legislation & jurisprudence
- Abstract
On 4 December 2017, French parliamentarians passed a law extending the vaccination mandates for children up to 2 years of age from three vaccinations (against diphtheria, tetanus and poliomyelitis) to 11 by adding vaccinations against pertussis, Haemophilus influenza b (Hib), hepatitis B, pneumococcal diseases, meningococcal C diseases, measles, mumps and rubella. This vote follows a recommendation made by the Steering Committee of the Citizen Consultation on Vaccination that took place in 2016. The law applies to all children born after 1 January 2018. Parents who do not fulfil the mandate will not be fined but non-vaccinated children will not be admitted to any collective child services such as nurseries or schools. No exemption other than for medical reasons will be considered. Here we describe the historical background of this evolution and its main epidemiological, sociological and policy drivers. They mainly refer to insufficient vaccine coverage, persistence of a preventable burden for some diseases and growing vaccine hesitancy in the French population. We also discuss some of the challenges and conditions of success.
- Published
- 2018
- Full Text
- View/download PDF
32. Estimated Annual Numbers of Foodborne Pathogen-Associated Illnesses, Hospitalizations, and Deaths, France, 2008-2013.
- Author
-
Van Cauteren D, Le Strat Y, Sommen C, Bruyand M, Tourdjman M, Da Silva NJ, Couturier E, Fournet N, de Valk H, and Desenclos JC
- Subjects
- Bacterial Infections mortality, Campylobacter isolation & purification, Campylobacter pathogenicity, Food Safety, Foodborne Diseases mortality, France epidemiology, Hepatitis E virus isolation & purification, Hepatitis E virus pathogenicity, Humans, Listeria monocytogenes isolation & purification, Listeria monocytogenes pathogenicity, Norovirus isolation & purification, Norovirus pathogenicity, Public Health Surveillance, Salmonella isolation & purification, Salmonella pathogenicity, Survival Analysis, Virus Diseases mortality, Bacterial Infections epidemiology, Food Microbiology, Foodborne Diseases epidemiology, Hospitalization statistics & numerical data, Virus Diseases epidemiology
- Abstract
Estimates of the annual numbers of foodborne illnesses and associated hospitalizations and deaths are needed to set priorities for surveillance, prevention, and control strategies. The objective of this study was to determine such estimates for 2008-2013 in France. We considered 15 major foodborne pathogens (10 bacteria, 3 viruses, and 2 parasites) and estimated that each year, the pathogens accounted for 1.28-2.23 million illnesses, 16,500-20,800 hospitalizations, and 250 deaths. Campylobacter spp., nontyphoidal Salmonella spp., and norovirus accounted for >70% of all foodborne pathogen-associated illnesses and hospitalizations; nontyphoidal Salmonella spp. and Listeria monocytogenes were the main causes of foodborne pathogen-associated deaths; and hepatitis E virus appeared to be a previously unrecognized foodborne pathogen causing ≈68,000 illnesses in France every year. The substantial annual numbers of foodborne illnesses and associated hospitalizations and deaths in France highlight the need for food-safety policymakers to prioritize foodborne disease prevention and control strategies.
- Published
- 2017
- Full Text
- View/download PDF
33. Continuum of hepatitis C care in France: A 20-year cohort study.
- Author
-
Hermetet C, Dubois F, Gaudy-Graffin C, Bacq Y, Royer B, Gaborit C, D'Alteroche L, Desenclos JC, Roingeard P, and Grammatico-Guillon L
- Subjects
- Adult, Female, France, Hepatitis C, Chronic diagnosis, Humans, Longitudinal Studies, Lost to Follow-Up, Male, Mass Screening, Middle Aged, Antiviral Agents therapeutic use, Continuity of Patient Care, Hepacivirus isolation & purification, Hepatitis C, Chronic drug therapy
- Abstract
Background: Hepatitis C virus (HCV)-infected patients require a specific continuum of care (CoC) from HCV screening to treatment. We assessed CoC of HCV-infected patients in a longitudinal study., Methods: We established a cohort of subjects undergoing HCV screening (high alanine aminotransferase levels or risk factors) during preventive consultations at a French regional medical center from 1993 to 2013. Patients were considered to be HCV-infected if HCV RNA was detected in their serum. CoC was assessed as described by Viner et al. (Hepatology 2015): Stage 1, HCV screening; Stage 2, HCV RNA testing; Stage 3, continuing care; Stage 4, antiviral treatment. Cox multivariate analysis was performed to identify factors favoring CoC, defined as at least one course of antiviral treatment., Results: In total, 12,993 HCV tests were performed and 478 outpatients were found to be HCV-seropositive. We included 417 seropositive patients, after excluding false positives and patients lost to follow-up. The baseline characteristics of the patients were: sex ratio (M/F) 1.4; mean age 38.5 years; intravenous drug use (IDU) in 55%; and 28% in unstable social situations, estimated by the EPICES deprivation score. Antiviral treatment was initiated for 179 (42.9%) of the 379 (90.9%) patients attending specialist consultations. CoC was associated with screening after 1997 (HR 2.0, 95%CI 1.4-2.9), age > 45 years (HR 1.5, 95%CI 1.02-2.3), patient acceptance of care (HR 9.3, 95%CI 5.4-16.10), specialist motivation for treatment (HR 10.9, 95%CI 7.4-16.0), and absence of cancer (HR 6.7, 95%CI 1.6-27.9). Other comorbid conditions, such as depression and IDU, were not associated with CoC., Conclusions: Our 20-year cohort study reveals the real-life continuum of care for HCV-infected patients in France. The number of patients involved in HCV care after positive testing was substantial due to the organization of healthcare in France. An improved CoC along with new direct-acting antivirals should help to decrease chronic HCV infection.
- Published
- 2017
- Full Text
- View/download PDF
34. Sociodemographic factors and pregnancy outcomes associated with prepregnancy obesity: effect modification of parity in the nationwide Epifane birth-cohort.
- Author
-
Boudet-Berquier J, Salanave B, Desenclos JC, and Castetbon K
- Subjects
- Adult, Birth Weight, Body Mass Index, Cohort Studies, Educational Status, Female, France epidemiology, Humans, Infant, Newborn, Logistic Models, Maternal Age, Obesity complications, Overweight complications, Overweight epidemiology, Pregnancy, Pregnancy Complications etiology, Prenatal Care statistics & numerical data, Risk Factors, Thinness complications, Thinness epidemiology, Weight Gain, Young Adult, Obesity epidemiology, Parity, Pregnancy Complications epidemiology, Pregnancy Outcome epidemiology, Socioeconomic Factors
- Abstract
Background: In light of the adverse outcomes for mothers and offspring related to maternal obesity, identification of subgroups of women at risk of prepregnancy obesity and its related-adverse issues is crucial for optimizing antenatal care. We aimed to identify sociodemographic factors and maternal and neonatal outcomes associated with prepregnancy obesity, and we tested the effect modification of parity on these associations., Methods: In 2012, 3368 mothers who had delivered in 136 randomly selected maternity wards were included just after birth in the French birth cohort, Epifane. Maternal height and weight before and at the last month of pregnancy were self-reported. Maternal and neonatal outcomes were collected in medical records. Prepregnancy Body Mass Index (pBMI) was classified into underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9) and obesity (≥30.0). Since we found statistically significant interactions with parity, the multinomial logistic regression model estimating associations of pBMI class with sociodemographic characteristics and pregnancy outcomes was stratified on parity (1335 primiparous and 1814 multiparous)., Results: Before pregnancy, 7.6% of women were underweight, 64.2% were of normal weight, 18.0% were overweight and 10.2% were obese. Among the primiparous, maternal age of 25-29 years (OR = 2.09 [1.13-3.87]; vs. 30-34 years), high school level (OR = 2.22 [1.33-3.73]; vs. university level), gestational diabetes (OR = 2.80 [1.56-5.01]) and hypertensive complications (OR = 3.80 [1.83-7.89]) were independently associated with prepregnancy obesity. Among the multiparous, primary (OR = 6.30 [2.40-16.57]), junior high (OR = 2.89 [1.81-4.64]) and high school (OR = 1.86 [1.18-2.93]) education levels (vs. university level), no attendance at antenatal classes (OR = 1.77 [1.16-2.72]), excess gestational weight gain (OR = 1.82 [1.20-2.76]), gestational diabetes (OR =5.16 [3.15-8.46]), hypertensive complications (OR = 8.13 [3.97-16.64]), caesarean delivery (OR = 1.80 [1.18-2.77]) and infant birth weight ≥ 4 kg (OR = 1.70 [1.03-2.80]; vs. birth weight between 2.5 kg and 4 kg) were independently associated with prepregnancy obesity., Conclusion: Obesity before pregnancy is associated with a set of sociodemographic characteristics and adverse pregnancy outcomes that differ across parity groups. Such findings are useful for targeted health policies aimed at attaining healthy prepregnancy weight and organizing perinatal care.
- Published
- 2017
- Full Text
- View/download PDF
35. Economic Evaluations of Public Health Surveillance Systems: a Systematic Review.
- Author
-
Herida M, Dervaux B, and Desenclos JC
- Subjects
- Humans, Cost-Benefit Analysis, Public Health Surveillance methods
- Published
- 2016
- Full Text
- View/download PDF
36. Network for strong, national, public health institutes in west Africa.
- Author
-
Meda N, Dabis F, Desenclos JC, Crespin X, and Delfraissy JF
- Subjects
- Africa, Western epidemiology, Epidemics statistics & numerical data, Hemorrhagic Fever, Ebola epidemiology, Humans, Interprofessional Relations, Academies and Institutes organization & administration, Public Health
- Published
- 2016
- Full Text
- View/download PDF
37. [Horizon scanning in preparation for future health threats: a pilot exercise conducted by the French Institute for Public Health Surveillance in 2014].
- Author
-
Eilstein D, Xerri B, Viso AC, Therre, Gorza M, Fuchs D, Pozuelos, Ioos, Che D, Bertrand E, El Yamani M, Empereur-Bissonnet P, Duport, and Desenclos JC
- Subjects
- Academies and Institutes, France, Humans, Pilot Projects, Health Planning, Public Health Surveillance
- Abstract
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.
- Published
- 2016
38. Predicting Dengue Fever Outbreaks in French Guiana Using Climate Indicators.
- Author
-
Adde A, Roucou P, Mangeas M, Ardillon V, Desenclos JC, Rousset D, Girod R, Briolant S, Quenel P, and Flamand C
- Subjects
- Forecasting, French Guiana epidemiology, Humans, Climate, Dengue epidemiology, Disease Outbreaks, Epidemiologic Methods, Models, Statistical
- Abstract
Background: Dengue fever epidemic dynamics are driven by complex interactions between hosts, vectors and viruses. Associations between climate and dengue have been studied around the world, but the results have shown that the impact of the climate can vary widely from one study site to another. In French Guiana, climate-based models are not available to assist in developing an early warning system. This study aims to evaluate the potential of using oceanic and atmospheric conditions to help predict dengue fever outbreaks in French Guiana., Methodology/principal Findings: Lagged correlations and composite analyses were performed to identify the climatic conditions that characterized a typical epidemic year and to define the best indices for predicting dengue fever outbreaks during the period 1991-2013. A logistic regression was then performed to build a forecast model. We demonstrate that a model based on summer Equatorial Pacific Ocean sea surface temperatures and Azores High sea-level pressure had predictive value and was able to predict 80% of the outbreaks while incorrectly predicting only 15% of the non-epidemic years. Predictions for 2014-2015 were consistent with the observed non-epidemic conditions, and an outbreak in early 2016 was predicted., Conclusions/significance: These findings indicate that outbreak resurgence can be modeled using a simple combination of climate indicators. This might be useful for anticipating public health actions to mitigate the effects of major outbreaks, particularly in areas where resources are limited and medical infrastructures are generally insufficient.
- Published
- 2016
- Full Text
- View/download PDF
39. Community Incidence of Campylobacteriosis and Nontyphoidal Salmonellosis, France, 2008-2013.
- Author
-
Van Cauteren D, De Valk H, Sommen C, King LA, Jourdan-Da Silva N, Weill FX, Le Hello S, Mégraud F, Vaillant V, and Desenclos JC
- Subjects
- Campylobacter isolation & purification, Campylobacter Infections diagnosis, Feces microbiology, France epidemiology, Hospitalization, Humans, Incidence, Salmonella isolation & purification, Salmonella Food Poisoning diagnosis, Campylobacter Infections epidemiology, Salmonella Food Poisoning epidemiology
- Abstract
Community incidence estimates are necessary to assess the burden and impact of infections on health and to set priorities for surveillance, research, prevention, and control strategies. The current study was performed to estimate the community incidence of campylobacteriosis and nontyphoidal salmonellosis in France from the number of laboratory-confirmed cases reported to the national reference center (NRC). The probabilities of a case in the community visiting a doctor, having a stool sample requested, having a positive laboratory test, and having the case reported to the NRC were estimated using data of national surveillance systems, national hospitalization and health insurance databases, and specific surveys informing about these parameters. Credible intervals (CrI) were calculated using Monte Carlo simulation. In addition, we estimated the number of hospitalizations for both infections in France. The annual community incidence rate in France is estimated at 842 cases per 100,000 (90%CrI 525-1690) for campylobacteriosis and 307 cases per 100,000 (90%CrI 173-611) for salmonellosis. The annual number of hospitalizations is estimated at 5182 for campylobacteriosis and 4305 for salmonellosis. The multiplication factors between cases ascertained by the surveillance system and cases in the community were 115 for campylobacteriosis and 20 for salmonellosis. They are consistent with estimates reported in other countries, indicating a high community incidence of campylobacteriosis and salmonellosis in France.
- Published
- 2015
- Full Text
- View/download PDF
40. [Evaluation of various public health infectious diseases surveillance systems based on a generic protocol].
- Author
-
Herida M and Desenclos JC
- Subjects
- France, Humans, Communicable Diseases epidemiology, Population Surveillance methods, Public Health Surveillance
- Abstract
Background: InVS, the French Institute of Public Health, coordinates and conducts several public health surveillance systems. In 2009, an evaluation protocol aiming at evaluating different surveillance systems was developed according to the international recommendations., Methods: Between 2009 and 2013, four evaluations in the field of infectious diseases were performed by panels of independent public health experts using a generic protocol., Results-Conclusion: This article presents the protocol, the mains results of each of the four evaluations and their impact on the Institute's surveillance strategy. It also addresses the strengths and the limitations of this standardized approach., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
41. Mining local climate data to assess spatiotemporal dengue fever epidemic patterns in French Guiana.
- Author
-
Flamand C, Fabregue M, Bringay S, Ardillon V, Quénel P, Desenclos JC, and Teisseire M
- Subjects
- Data Mining, French Guiana, Humans, Incidence, Climate, Dengue epidemiology, Epidemics statistics & numerical data
- Abstract
Objective: To identify local meteorological drivers of dengue fever in French Guiana, we applied an original data mining method to the available epidemiological and climatic data. Through this work, we also assessed the contribution of the data mining method to the understanding of factors associated with the dissemination of infectious diseases and their spatiotemporal spread., Methods: We applied contextual sequential pattern extraction techniques to epidemiological and meteorological data to identify the most significant climatic factors for dengue fever, and we investigated the relevance of the extracted patterns for the early warning of dengue outbreaks in French Guiana., Results: The maximum temperature, minimum relative humidity, global brilliance, and cumulative rainfall were identified as determinants of dengue outbreaks, and the precise intervals of their values and variations were quantified according to the epidemiologic context. The strongest significant correlations were observed between dengue incidence and meteorological drivers after a 4-6-week lag., Discussion: We demonstrated the use of contextual sequential patterns to better understand the determinants of the spatiotemporal spread of dengue fever in French Guiana. Future work should integrate additional variables and explore the notion of neighborhood for extracting sequential patterns., Conclusions: Dengue fever remains a major public health issue in French Guiana. The development of new methods to identify such specific characteristics becomes crucial in order to better understand and control spatiotemporal transmission., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Published
- 2014
- Full Text
- View/download PDF
42. Complications and factors associated with severity of influenza in hospitalized children and adults during the pandemic wave of A(H1N1)pdm2009 infections--the Fluco French cohort.
- Author
-
Ploin D, Chidiac C, Carrat F, Cohen B, Javouhey E, Mayaud C, Desenclos JC, Lina B, and Leport C
- Subjects
- Adolescent, Adult, Aged, Antiviral Agents therapeutic use, Child, Child, Preschool, Female, France, Hospitalization, Humans, Infant, Infant, Newborn, Influenza, Human complications, Influenza, Human virology, Male, Middle Aged, Oseltamivir therapeutic use, Prospective Studies, Risk Factors, Young Adult, Influenza A Virus, H1N1 Subtype isolation & purification, Influenza, Human epidemiology, Influenza, Human pathology, Severity of Illness Index
- Abstract
Background: The emergence of novel A(H1N1)pdm2009 virus threatened to lead to frequent severe manifestations., Objectives: To describe the clinical, virological, and biological characteristics of the disease and identify the factors associated with severe presentations., Study Design: This prospective multicenter study recruited consecutive hospitalized patients with confirmed A(H1N1)pdm2009 disease. Clinical, virological and biological assessments were carried out at inclusion and 30 days post-inclusion. Disease manifestations were assessed by an adjudication committee using pre-identified definitions of complications and severity scores., Results: The study analyzed from November 30th, 2009 to February 8th, 2010, 40 hospitalized patients, 21 children and 19 adults. Eighteen (45%) were considered to have severe presentations. Except age, main characteristics in children and adults did not differ. The majority (18/21) of children and all adults had a respiratory presentation; extra-respiratory manifestations tended to be more frequent in children (12 vs. 6, P=0.10). Two children against 5 adults presented acute respiratory distress syndrome (ARDS, P=0.23), but more children suffered respiratory failure (7 vs. 1, P=0.046) without ARDS. At day 30, one death had occurred in each group. The main factor associated with non-severe presentation was an early (<48 h) implementation of oseltamivir treatment (P=0.038)., Conclusions: Although the study failed to achieve its main objective, due mainly to the difficulty of carrying a study of this nature in the midst of a pandemic, it allowed the description of a panel of unusual and complicated forms and confirmed the added value of early oseltamivir treatment in limiting severity in hospitalized children and adults., (Copyright © 2013 Elsevier B.V. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
43. Global HIV epidemiology: specific patterns of the epidemic in the North and South.
- Author
-
Desenclos JC, Dabis F, and Semaille C
- Abstract
Thirty years after the identification of the first cases of AIDS, it was estimated that 34 million of people were living with HIV worldwide in 2011. The incidence is declining but remains high, with 2.5 million of new HIV infections per year. Africa is the region of the world most heavily affected, accounting for three-quarters of the global burden of HIV infection and the same proportion for new infections. The incidence declines in most parts of the world while heterosexual transmission remains the dominant mode of HIV acquisition followed by homosexual transmission. Intravenous drug use continues to drive the epidemic in Eastern Europe and parts of Asia. Condom use remains the cornerstone of prevention of sexual transmission. Male medical circumcision has now been proven an effective public health intervention to prevent sexual transmission. Antiretroviral treatment may reduce sexual transmission at population level while improving the conditions of life and survival of those harbouring the virus. Harm-reduction together with blood safety prevent blood transmission. The prevention of mother-to-child transmission is now moving its global objective to elimination by the end of 2015. At least 20 years will be necessary for achieving HIV control at the worldwide level with currently available interventions.
- Published
- 2013
- Full Text
- View/download PDF
44. PLOS Currents: Outbreaks --- For findings that the world just can't wait to see.
- Author
-
Cowling B, Desenclos JC, Riley S, Simonsen L, and Viboud C
- Published
- 2013
- Full Text
- View/download PDF
45. ["Veille sanitaire": tools, functions, process of healthcare monitoring in France].
- Author
-
Eilstein D, Salines G, and Desenclos JC
- Subjects
- Algorithms, Data Collection methods, Database Management Systems organization & administration, Database Management Systems standards, Delivery of Health Care methods, France epidemiology, Humans, Information Storage and Retrieval methods, Public Health methods, Quality Assurance, Health Care methods, Quality Assurance, Health Care organization & administration, Quality of Health Care statistics & numerical data, Terminology as Topic, Delivery of Health Care standards, Epidemiological Monitoring, Population Surveillance methods, Quality of Health Care organization & administration
- Abstract
In France, the term "veille sanitaire" is widely used to designate healthcare monitoring. It contains, however, a set of concepts that are not shared equally by the entire scientific community. The same is true for activities that are part of it, even if some (surveillance for example) are already well defined. Concepts such as "observation", "vigilance", "alert" for example are not always clear. Furthermore, the use of these words in everyday language maintains this ambiguity. Thus, it seemed necessary to recall these definitions as already used in the literature or legislation texts and to make alternative suggestions. This formalization cannot be carried out without thinking about the structure of "veille sanitaire" and its components. Proposals are provided bringing out concepts of formated "veille" (monitoring) and non-formatted "veille" (monitoring). Definitions, functions, (methods and tools, processes) of these two components are outlined here as well as the cooperative relationship they sustain. The authors have attempted to provide the scientific community with a reference framework useful for exchanging information to promote research and methodological development dedicated to this public health application of epidemiology., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
46. Methadone induction in primary care (ANRS-Methaville): a phase III randomized intervention trial.
- Author
-
Roux P, Michel L, Cohen J, Mora M, Morel A, Aubertin JF, Desenclos JC, Spire B, and Carrieri PM
- Subjects
- Follow-Up Studies, France, Humans, Substance Abuse Treatment Centers, Time Factors, Treatment Outcome, Methadone therapeutic use, Opiate Substitution Treatment methods, Opioid-Related Disorders drug therapy, Primary Health Care organization & administration
- Abstract
Background: In France, the rapid scale-up of buprenorphine, an opioid maintenance treatment (OMT), in primary care for drug users has led to an impressive reduction in HIV prevalence among injecting drug users (IDU) but has had no major effect on Hepatitis C incidence. To date, patients willing to start methadone can only do so in a methadone clinic (a medical centre for drug and alcohol dependence (CSAPA) or a hospital setting) and are referred to primary care physicians after dose stabilization. This study aims to assess the effectiveness of methadone in patients who initiated treatment in primary care compared with those who initiated it in a CSAPA, by measuring abstinence from street opioid use after one year of treatment., Methods/design: The ANRS-Methaville study is a randomized multicenter non-inferiority control trial comparing methadone induction (lasting approximately 2 weeks) in primary care and in CSAPA. The model of care chosen for methadone induction in primary care was based on study-specific pre-training of all physicians, exclusion criteria and daily supervision of methadone during the initiation phase. Between January 2009 and January 2011, 10 sites each having one CSAPA and several primary care physicians, were identified to recruit patients to be randomized into two groups, one starting methadone in primary care (n = 147), the other in CSAPA (n = 48). The primary outcome of the study is the proportion of participants abstinent from street opioids after 1 year of treatment i.e. non-inferiority of primary care model in terms of the proportion of patients not using street opioids compared with the proportion observed in those starting methadone in a CSAPA., Discussion: The ANRS-Methaville study is the first in France to use an interventional trial to improve access to OMT for drug users. Once the non-inferiority results become available, the Ministry of Health and agency for the safety of health products may change the the New Drug Application (NDA) of methadone and make methadone induction by trained primary care physicians possible.The trial is registered with the French Agency of Pharmaceutical Products (AFSSAPS) under the number 2008-A0277-48, the European Union Drug Regulating Authorities Clinical Trials.Number Eudract 2008-001338-28, the ClinicalTrials.gov Identifier: NCT00657397 and the International Standard Randomised Controlled Trial Number Register ISRCTN31125511.
- Published
- 2012
- Full Text
- View/download PDF
47. Practical considerations for sensitivity analysis after multiple imputation applied to epidemiological studies with incomplete data.
- Author
-
Héraud-Bousquet V, Larsen C, Carpenter J, Desenclos JC, and Le Strat Y
- Subjects
- Alcohol Drinking, Data Interpretation, Statistical, Drug Users, Female, France epidemiology, Hepacivirus, Hepatitis C complications, Humans, Male, Risk Factors, Substance-Related Disorders complications, Epidemiologic Studies, HIV Infections complications, Hepatitis C epidemiology, Substance-Related Disorders virology
- Abstract
Background: Multiple Imputation as usually implemented assumes that data are Missing At Random (MAR), meaning that the underlying missing data mechanism, given the observed data, is independent of the unobserved data. To explore the sensitivity of the inferences to departures from the MAR assumption, we applied the method proposed by Carpenter et al. (2007).This approach aims to approximate inferences under a Missing Not At random (MNAR) mechanism by reweighting estimates obtained after multiple imputation where the weights depend on the assumed degree of departure from the MAR assumption., Methods: The method is illustrated with epidemiological data from a surveillance system of hepatitis C virus (HCV) infection in France during the 2001-2007 period. The subpopulation studied included 4343 HCV infected patients who reported drug use. Risk factors for severe liver disease were assessed. After performing complete-case and multiple imputation analyses, we applied the sensitivity analysis to 3 risk factors of severe liver disease: past excessive alcohol consumption, HIV co-infection and infection with HCV genotype 3., Results: In these data, the association between severe liver disease and HIV was underestimated, if given the observed data the chance of observing HIV status is high when this is positive. Inference for two other risk factors were robust to plausible local departures from the MAR assumption., Conclusions: We have demonstrated the practical utility of, and advocate, a pragmatic widely applicable approach to exploring plausible departures from the MAR assumption post multiple imputation. We have developed guidelines for applying this approach to epidemiological studies.
- Published
- 2012
- Full Text
- View/download PDF
48. Factors associated with hospital mortality in community-acquired legionellosis in France.
- Author
-
Chidiac C, Che D, Pires-Cronenberger S, Jarraud S, Campèse C, Bissery A, Weinbreck P, Brun-Buisson C, Sollet JP, Ecochard R, Desenclos JC, Etienne J, and Vanhems P
- Subjects
- Adolescent, Adrenal Cortex Hormones therapeutic use, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Community-Acquired Infections drug therapy, Female, France epidemiology, Humans, Kaplan-Meier Estimate, Legionnaires' Disease drug therapy, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prospective Studies, Risk Factors, Young Adult, Community-Acquired Infections mortality, Hospital Mortality trends, Legionella pneumophila, Legionnaires' Disease mortality
- Abstract
The aims of this study were to describe the clinical, biological and radiological features of community-acquired (CA) Legionnaires' disease (LD) and identify the predictors of mortality in hospitalised patients. Demographic data, risk factors, clinical and biological features, medical management, complications, and outcome from 540 hospitalised patients with confirmed CA LD were prospectively recorded. 8.1% of patients (44 out of 540) died. The predictors of survival after Kaplan-Meier analysis were male sex (p = 0.01), age <60 yrs (p = 0.02), general symptoms (p = 0.006), intensive care unit (ICU) stay (p<0.001), and class II-III Pneumonia Severity Index score (p = 0.004). Six predictors of death were identified by multivariate analysis: age (per 10-yr increment) (relative hazard (RH) 1.50, 95% CI 1.21-1.87), female sex (RH 2.00, 95% CI 1.08-3.69), ICU admission (RH 3.31, 95% CI 1.67-6.56), renal failure (RH 2.73, 95% CI 1.42-5.27), corticosteroid therapy (RH 2.54, 95% CI 1.04-6.20) and C-reactive protein (CRP) >500 mg · L(-1) (RH 2.14, 95% CI 1.02-4.48). Appropriate antibiotic therapy was prescribed for 70.8% (292 out of 412) of patients after admission and for 99.8% (537 out of 538) of patients after diagnosis confirmation. In conclusion, female sex, age, ICU stay, renal failure, corticosteroid treatment and increased level of CRP are significant risk factors for mortality in CA LD.
- Published
- 2012
- Full Text
- View/download PDF
49. Incidence of listeriosis and related mortality among groups at risk of acquiring listeriosis.
- Author
-
Goulet V, Hebert M, Hedberg C, Laurent E, Vaillant V, De Valk H, and Desenclos JC
- Subjects
- Aged, Aged, 80 and over, Female, France epidemiology, Humans, Incidence, Listeriosis complications, Listeriosis mortality, Male, Middle Aged, Pregnancy, Risk Factors, Listeriosis epidemiology
- Abstract
Background: Listeriosis is a foodborne disease of significant public health concern that primarily affects persons with recognized underlying conditions or diseases that impair cell-mediated immunity. The degree of risk posed by the different underlying conditions is crucial to prioritize prevention programs that target the highest risk populations., Methods: We reviewed cases of listeriosis reported in France from 2001 to 2008. Numbers of cases and deaths were tabulated by age and underlying condition. Measures of the impact of specific underlying conditions on the occurrence of listeriosis were calculated. For estimating the total number of persons living with specific diseases, we applied prevalence estimates of these diseases to the French population. Underlying conditions were ranked by the degree to which they increased the risk of listeriosis., Results: From 2001 to 2008, 1959 cases of listeriosis were reported in France (mean annual incidence 0.39 per 100,000 residents). Compared with persons <65 years with no underlying conditions, those with chronic lymphocytic leukemia had a >1000-fold increased risk of acquiring listeriosis, and those with liver cancer; myeoloproliferative disorder; multiple myeloma; acute leukemia; giant cell arteritis; dialysis; esophageal, stomach, pancreas, lung, and brain cancer; cirrhosis; organ transplantation; and pregnancy had a 100-1000-fold increased risk of listeriosis., Conclusions: To be effective and acceptable to physicians and patients, listeriosis prevention strategies should be targeted based on evidence of increased risk. Stringent dietary guidance, to avoid specific foods with a high risk for Listeria contamination, should be targeted to pregnant women and to others at highest risk of listeriosis.
- Published
- 2012
- Full Text
- View/download PDF
50. Impact of hepatitis C triple therapy availability upon the number of patients to be treated and associated costs in France: a model-based analysis.
- Author
-
Deuffic-Burban S, Mathurin P, Pol S, Larsen C, Roudot-Thoraval F, Desenclos JC, Dhumeaux D, and Yazdanpanah Y
- Subjects
- Adolescent, Adult, Aged, Antiviral Agents economics, Computer Simulation, Disease Progression, Drug Therapy, Combination, Drug Utilization economics, France, Hepacivirus genetics, Hepatitis C, Chronic economics, Humans, Interferon alpha-2, Interferon-alpha economics, Markov Chains, Middle Aged, Models, Economic, Polyethylene Glycols economics, Protease Inhibitors economics, Recombinant Proteins economics, Recombinant Proteins therapeutic use, Ribavirin economics, Young Adult, Antiviral Agents therapeutic use, Drug Costs, Drug Utilization statistics & numerical data, Hepatitis C, Chronic drug therapy, Interferon-alpha therapeutic use, Polyethylene Glycols therapeutic use, Protease Inhibitors therapeutic use, Ribavirin therapeutic use
- Abstract
Objective: The combination of pegylated interferon (PEG-IFN), ribavirin (RBV) and a protease inhibitor (PI) has been approved in summer 2011 for the treatment of genotype 1 (G1) hepatitis C virus (HCV)-infected patients, with a substantially improved efficacy. The aim of this study was to estimate the number of G1 patients to be treated in France in 2012 and associated costs., Methods: A published model of HCV and data on PEG-IFN sales were used to estimate patients needing treatment using three scenarios. (1) HCV screening rate unchanged versus 2010; proportion of treated F0-F1 patients unchanged, proportion of treated F2-F4 patients increased to the current proportion of treated F2-F4 G2/3 patients. (2) Scenario 1 but the proportion of treated F0-F1 patients increased to the current proportion of treated F0-F1 G2/3 patients. (3) Scenario 2 but a 5% increase in the HCV screening rate. To estimate cost, treatment duration was multiplied by drug unit cost. Probabilities corresponding to treatment duration were estimated based on liver fibrosis stage, treatment-naive or experienced status of the patient and virological response kinetics on treatment., Results: Compared with the 5100 G1 patients treated in 2010, the number of G1 patients receiving treatment in 2012 would be 15,000 in scenario 1, 18,300 in scenario 2 and 19,400 in scenario 3, among whom 2.5-3.7% may receive PEG-IFN/RBV and 96.3-97.5% PEG-IFN/RBV+PI. Costs associated with this regimen use ranged from 497 to 638 million Euros., Conclusion: These model-based estimates indicate that new anti-HCV treatments may result in a three- to fourfold increase in the number of G1 patients to be treated in France in 2012.
- Published
- 2012
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.